Life of a repaired aortic valve?

[Tejumurthy]

Hello friends,
Today i just had my pre-op tests for my surgery on Sept 18th at Cleveland clinic.
While talking to cardiologist, came to know that there is a chance of repair 60-70% of my aortic valve due to its regurgitation rather a stenosis.

So now, confused/wondering that if at all i get a chance to repair it, is it a reliable option? I expect the surgeons to make the right decision but just thinking to go for replacement or still go with repair?

Is there anyone who come across this situation or who really did repair and condition or the life of a repaired BAV?


Appreciate your help as always!!

-Teju

 

[pellicle]

essentially I had a repair, before I had a homograft, and then lastly the mechanical ... I'm told they do much better jobs these days. I would be guided by your Dr and also fetch a 2nd opinion from another (who perhaps doesn't just do repair surgeries). It can be hard, surgeons like what they like and don't like what they don't like. Its sometimes like asking a Merc repairer what he thinks of BMW

 

[river-wear]

I had an aortic valve repair three months ago because I found a surgeon I was very confident in, and I figured it was the best possible option for me - the chance at going back to a completely normal life. Only time will tell if it's truly permanent, but I'm going against my nature to be optimistic in my belief it will be! My surgeon was very confident in the quality of the repair he did, but even afterward he wasn't making any promises about it lasting my lifetime. You need to balance your surgeon's expertise with what you think is right, then hope for the best.

 

[river-wear]

I had an aortic valve repair three months ago because I found a surgeon I was very confident in, and I figured it was the best possible option for me - the chance at going back to a completely normal life. Only time will tell if it's truly permanent, but I'm going against my nature to be optimistic in my belief it will be! My surgeon was very confident in the quality of the repair he did, but even afterward he wasn't making any promises about it lasting my lifetime. You need to balance your surgeon's expertise with what you think is right, then hope for the best.

(This didn't post, but the site is saying it's a duplicate. I cleared cookies, so I don't know what's up.)

 

[extraordinary]

Im 25 years old female had my first surgery when i was 3 years old to repair it but they did damage instead of repair so i had my 2nd OPH for repairing ( I have nothing stenosis and regrutation ) and i had my 2nd in the cleveland clinic … and on my when i was 24 * 5 months * i had my 3rd OPH surgery for AVR at the cleveland clinic as well, if i wasn't so young i would choose to replace it from the first time i get it over with instead of having to open my chest 3 times hopping its the last …

 

[Garserin]

Hi Teju, I had my aortic valve repaired three years ago and I am very happy the surgeon was able to repair it and did not have to do a replacement. He told me he did not know if he would be able to repair or not until he get to see the valve with his own eyes. So glad we could proceed with plan A. I would do the same thing again if I had to make the decision again. My valve was in good enough shape for a repair, no stenosis, just a tremendous amount of regurgitation. Unfortunately there is still a little bit of leakage, which is not that uncommon, however I do not expect another surgery. Personally, I believe a big heart center like CC or Mayo would do a repair unless you are a good candidate. Wishing you all the best on the 18th!

 

[Tejumurthy]

Thank you All for the response.
@Garserin, YEs, even my case they would see after open my heart.

AS i have bicuspid aortic valve as well, i'm having difficult time in deciding.

However it looks like i have to leave it to them to make the right decision ..

 

[PGARG]

I can't really comment on how the repair lasts, and every case might be different. I just got mine replaces with On-X 3 weeks back. I struggled with this a lot too. I sent my case to cleveland and they gave me percentages of repair success etc etc. Stanford also told me repair is possible but told me it could be complicated. They told me they coudnt guarantee how long the repair lasts.

I definitely noticed one pattern, doctors who don't know repair, will always push for replacement. Those who can repair, offer that as an option. Replacement side folks use the same argument that repair doesn't last long. But i feel that replacement side guys are probably not in tune with advancements in the Repair side of things.

If you are getting a chance at a repair at the Cleveland Clinic, i would definitely investigate that option at least. They will give you odds, but ultimately it's your decision. Even after they open you, they have to go by what you chose, unless the situation is an extreme case, where the surgeon as to over rule you. Basically what i'm saying is that, 80% chance is they can repair you, and that repair will hold for a few years. But go into the surgery with a mindset that no matter what the odds, at some point in your life, you may need another corrective measure. Good thing is that in 10 years, you may not have to go through surgery and can get the valve using TAVR.

I still struggle with the thought that i should have gone to cleveland and explored the repair option. But as i feel better and better everyday, i am glad its over and that hopefully i got a life long solution now. So far from what i am seeing and what others have written, Coumadin is not that big of a deal. Not sure what the future holds.

Either way, Good Luck!

 

[river-wear]

I hope things went well for you today! Let us know how you're feeling when you're up to it.

 

[AZ Don]

This was discussed not too long ago and what I took away from the discussion is that a repair done somewhere other than a top level heart hospital is generally not advised, however, Cleveland Clinic is THE top heart hospital and there is a very good chance they can make a durable repair. There is some chance that the repair will not last but a replacement tissue valve is virtually guaranteed to fail after 20 years or so and that is still a good option for many, even with the likelihood of follow-up surgery. I had my BAV spared during an aneurysm repair, taking a roughly 50% chance that my valve will need to be replaced (or repaired) someday. No regrets.

Best wishes on your surgery and recovery.

 

[OldManEmu]

The surgeon discussed a David procedure for my self at the time of my first surgery, (cleaning up the valve and reimplanting) however the valve was in such bad condition from endocarditis this wasn't and option in the end. My first surgery was only ever going to be a stop gap measure.
If the surgeon thinks an aortic valve repair will last as long as a tissue valve then the choice becomes that of a tissue valve(repair) and a mechanical valve.

 

[river-wear]

If the surgeon thinks an aortic valve repair will last as long as a tissue valve then the choice becomes that of a tissue valve(repair) and a mechanical valve.

Except, as Don pointed out, the "tissue valve" (in this case a repaired native valve) could last the rest of your life, rather than the near-certainty (for anyone under 65 or so) of wearing out a prosthetic tissue valve.

 

[cldlhd]

Except, as Don pointed out, the "tissue valve" (in this case a repaired native valve) could last the rest of your life, rather than the near-certainty (for anyone under 65 or so) of wearing out a prosthetic tissue valve.

I was given the same impression but being the curious type I wonder why a pig or cow valve doesn't last as long as a native tissue . Is it because pigs and cows have a shorter lifespan or is that too simple an explanation?

 

[Fundy]

The pig or cow valve you get, usually isn't an actual heart valve from a pig or cow, although it sometimes is an actual pig valve such as with the Mosaic. In either case its not tissue that's still living.

For instance my "cow valve" has the valve material crafted from a cow pericardium which is placed on a metal stent which itself is covered with pig pericardium.
Here's a link to it from the St. Jude site itself.
http://professional-intl.sjm.com/professional/products/sh/tissue-valves/aortic-mitral/trifecta

 

[OldManEmu]

river-wear
I probable didn't phrase my response correctly, the point I was making is as you said, if the surgeon thinks the valve repair will last as long as a tissue valve then there is only upside to a repair due to the potential to last a lifetime.

cldlhd
It isn't just animal derived valves that do not last as long as the native tissue valve, human donor valves also do not last as long as the native valve.

 

[cldlhd]

river-wear
I probable didn't phrase my response correctly, the point I was making is as you said, if the surgeon thinks the valve repair will last as long as a tissue valve then there is only upside to a repair due to the potential to last a lifetime.

cldlhd
It isn't just animal derived valves that do not last as long as the native tissue valve, human donor valves also do not last as long as the native valve.

Thanks to all who helped shed some light on my question. As for a donor human valve not lasting as long that does seem strange but I'm sure there's a logical explanation. It does seem odd that if a 50 yr old received a donor aortic valve that is trileaflet and perfectly healthy that came from a 20 yr old donor why wouldn't it be likely to last as long as their native repaired BAV?

 

[pellicle]

Hi

I was given the same impression but being the curious type I wonder why a pig or cow valve doesn't last as long as a native tissue . Is it because pigs and cows have a shorter lifespan or is that too simple an explanation?

kinda a cute explaination, but nope. Its more for the same reason that my pig skin wallet doesn't last as long as the skin a living pig does.

The stuff the tissue valves is made of eventually gets calcified by the metabolic activity in the body. The makers go to great lengths to reduce this, but as you can read here its not as good as the makers claims (which are of course best case situations) and frequently these valves are degraded, particularly in the younger recipients. Curiously they are also the ones most likely to opt for them citing the very aspects which degrade them - active lifestyle.

hope all is well your end, and the waiting not preying upon your mind.

Best Wishes

 

[cldlhd]

thanks buddy, all is well I've been keeping occupied working on the house,exercising and spending a lot of time with the family. The fall is my favorite season,spring down there eh, hope all is good with you also

 

[Tirone]

I'm 30 and had a David procedure last year. I life a normal life and still do lots of sports. The only difference from me to buddies that have a mechanical valve is that I don't have to take oral anticoagulation. However, most people will tell that warfarin and home monitoring is no problem at all for them.
Nobody can tell how long a repaired valve will last. Most likely it will not be more than 10-15 years. Of course there are outliers where it will last a lifetime, but early failures after 1 year are also described, even at top centers. If you decide to have a repair, you also decide to have a second open heart surgery. I don't feel like I ever left the waiting room, I just postponed the mechanical valve for a couple of years.