Longevity after heart valve replacement

[David Robbins]

I am the recipient of two heart valves. I had my first on March 2008 and a redo in July 2008. I am almost 12 years from my 2nd surgery and very healthy although I have A-fin as a result. As morbid as it may seem, my research on longevity yielded the following, of which I am not afraid of but am aware of the statistical results of studies across the general population in the USA. Here is the published statistics for those of you who are interested:
Longevity after AVR Aortic Valve Replacement Longevity Statistics Pooled data from 85 studies estimated that 89.7% of people survived for two years after surgery, 78.4% at five years 57.0% at 10 years 39.7% at 15 year 25.7% at 20 years.

if this frightens you, do your own research and you will find similar statistics. My cardiologist told me I should expect to live as long as I would have without heart valve disease.
It is what it is.
David

 

[David Robbins]

I am the recipient of two heart valves. I had my first on March 2008 and a redo in July 2008. I am almost 12 years from my 2nd surgery and very healthy although I have A-fin as a result. As morbid as it may seem, my research on longevity yielded the following, of which I am not afraid of but am aware of the statistical results of studies across the general population in the USA. Here is the published statistics for those of you who are interested:
Longevity after AVR Aortic Valve Replacement Longevity Statistics Pooled data from 85 studies estimated that 89.7% of people survived for two years after surgery, 78.4% at five years 57.0% at 10 years 39.7% at 15 year 25.7% at 20 years.

if this frightens you, do your own research and you will find similar statistics. My cardiologist told me I should expect to live as long as I would have without heart valve disease.
It is what it is.
David

My Afib was managed through Tykosyn, but my sister, the Director of Cardiology told me it can cause sudden heart death after exercise. My electrophysiologist confirmed it was a side effect but rare. I told him I was stopping and he disagreed, but had me go through two unsuccessful Cardioversions thereafter. I have been in Afib for 12 years and have yet to have one incident that caused problems. I take warfarin, as well for the mechanical valve, so that drug helps minimize any blood clot issue.
Piece of advice to all. Doctors know very little about exercise and nutrition and are not Gods. Get 2nd opinions if in doubt.
David

 

[Eva]

I have 2 mechanical valves implanted in 2008.
I went March 2019 to the emergency...I was diagnosed with “unspecified atrial flutter”. They wanted to do cardio version after two days since heart beats didn’t go down. I refused and insisted they Switch me to Toprol in addition to amiodarone drip they were giving to me. Heart beats returned to normal! When discharged I was advised to see Electrophysiologist for ablation as I was in danger.
Electrophysiologist reduced My amiodarone a bit at a time and kept me on Toprol! luckily, no other incident happened since then. I hope it stays like this and I won’t jinx myself as all day today my heart beat had been jumping to 120 on and off while sitting down...stress! I hope it goes away after a goodnight sleep!
Doctors *practice* medicine!

 

[Keithl]

One concern I have with some of those stats may be the age of the patient. It is like TAVR stats, which were low because they were being put in people at 70+ years old and usually with declining health since that is the risk category. I would want more context of some of the studies again, becasue many people that have valves done are older. I had mine a year ago with On-X at 58, based on family history I gather I may make it 25ish more years. Had I had the valve done when first diagnosed in 2009 then I would have assumed 35+ years form the valve.

 

[dick0236]

............ Here is the published statistics for those of you who are interested:
Longevity after AVR Aortic Valve Replacement Longevity Statistics Pooled data from 85 studies estimated that 89.7% of people survived for two years after surgery, 78.4% at five years 57.0% at 10 years 39.7% at 15 year 25.7% at 20 years.

................ My cardiologist told me I should expect to live as long as I would have without heart valve disease.

My understanding is that the majority of valve replacements are done on folks older than 70.......and these folks probably have other conditions as well. Your stats indicate that 89.7% are still alive after 2 years......and 25.7% are still alive after 20 years+.......that seems to mean that, on average, 25.7%+ are still alive in their 90s and that ain't bad. BTW, I agree with your cardiologist that we should expect to live as long as if we didn't have heart disease.

BTW, if the C-virus leaves me alone until Aug. 2020 I'll have 53 survival years after my valve surgery.

 

[tom in MO]

**** and KeithL are correct. If an 80 yo has a valve job and is alive after 20 years, they are 100...

I was told when I had my AVR that it would keep working until I die of something else

It's kind of like the 1% failure rate for an AVR they touted before my operation. When I found out that failure was defined as death, not as no complications or a life w/o restrictions that was still better than death but not as rosy as a 99% success rate.

When quoted a success or failure rate by a medical professional, always make sure you know the definition of success and failure.

 

[vitdoc]

Not sure where those stats came from but they seem very inaccurate.
One needs to look at the baseline group these are based on. Usually numbers like a 1% or less thrombo embolism rate per year is mentioned with mechanical valves. So a 5 yr survival rate of 57% seems way way off.
Also Tykosyn has significant risks of sudden death. In certain places they feel that the risks are manageable. Other places less so. In my local area there were a number of deaths related to the drug. So here it is not used much.
Amniodarone works great for A Fib but it too has a long list of potential side effects. Sudden death is not a significant issue but things like pulmonary fibrosis pop up. Not a great way to go. For life threatening ventricular rhythm disorders the risk of amniodarone may be worth taking. But for a.fib for the most part not. For short periods and low doses it may not be too worrisome. I personally would not take amniodarone for a.fib..

https://en.wikipedia.org/wiki/Amiodarone
I had three ablation for a.fib.. I got a few years out of the first two without a.fib.. The third not so much. I was in a.fib for around a year after the last, and somewhat miraculously I went into normal sinus rhythm and have remained in it for over a year. I did have a mitral clip several years earlier for marked mitral regurgitation which was successful. It may have the effect of that that caused the a.fib. to resolve. My primary problem Has been aortic stenosis and a 6.5 cm aneurysm with my last surgery in 2006 . (First 1977).

So there are a variety of ways to skin a cat. A.fib can be treated with drugs, ablation or not treated except for anticoagulation. Incidentally a.flutter is generally more successfully treated with ablation than a.fib..

 

[Protimenow]

I had a lot of weird things going on with my heart rhythm a month ago. The 12 lead EKG showed three different simultaneous rhythms, with pauses between beats and other good stuff.

My cardiologist started me on an amiodarone drip, followed by lower doses of Amiodarne-- with the only result being severe constipation. The rhythm problem didn't resolve.

An electrophysiologist told me that ablation was an option - but that if he tried to go through my aortic valve, I would die on the table.THe other option was surgical. He put me on a calcium channel blocker (verapamil), and it seems to have substantially evened out the rhythm.

**** has survived a long time with his valve. For me, and many others here, it's at least 28 years. I would argue that survival is longer than we would have with our faulty valves -- the prosthetics keep us stronger and healthier than we would have been with our diseased valves. It's possible that for meny of us, we're in a minority - but I doubt it.

 

[Superman]

Statistics are worthless without context, as others have already observed. What is the age of the patients studied? What did they die of? What about a control population of similar demographics without valve replacement?

As for me, (anecdotal evidence is worthless too), I’ll be going on 30 years since my first AVR this fall. I’m 47. Hoping for another 30 minimum. Still running and biking and generally healthy.

 

[Debster]

My mom has very ill when she had her mitral valve replaced in 2005. She was bad, couldn't even walk across the street. She was 65 at the time. Had a piggy valve implanted. She will be 80 in September and still going strong. So grateful!

 

[epstns]

Protime - Not sure if I mentioned this, but when I was struggling with AFIB after my valve surgery, they did put me on amiodarone. My cardio warned me about not only the risk of pulmonary fibrosis, but also some potential for vision deterioration over time. He then said that if my AFIB didn't resolve (it did), he would recommend that we change from amiodarone to multaq. Multaq is "almost as good" as amiodarone, but without the iodine, which is the main culprit in its side effects.

 

[Protimenow]

No, epstns, you didn't mention this. When I told my wife, from my hospital bed that I was prescribed Amiodarone (and had an amiodarone drip, putting that stuff directly into my system), she went online and found many of the nasty things that it does. It didn't work for me, aside from turning my intestinal contents into concrete.

Fortunately, I got a much more enlightened doctor who took me off that stuff and determined a much more effective medication. He's replaced the extended release pills (pretty expensive, even with a prescription drug plan) with a quick release form that I take twice a day. This elecrophysiologist is the one that I'm most comfortable trusting my miserable life to.

 

[epstns]

I'm on my second electrophysiologist now. That is the one specialty I travel all the way into the city for. My other docs (cardio, internist, urologist, oncologist, audiologist, ophthalmologist. . . you get it) are all out here in the suburbs. A great E-P is worth the trip.

 

[Protimenow]

Agreed. I trust my EP. I'm hoping that my HMO will authorize him to work on me (I paid out of pocket for one visit -- at about 40% of what he usually charges for a visit). He told me that if I couldn't get my HMO on board, I should consider dropping my Part C account, go back onto Medicare, and go to one of the local schools or hospitals that do this kind of thing -- UCLA, USC, or Cedars-Sinai. If any of these will take Medicare payments as payments in full, I may consider this.

For me, it's a bit of a drive to any of these hospitals - even without traffic, it's still the good part of an hour to get to any of them -- and my wife will go crazy because she won't be able to see me (but, FWIW, that would be the same issue even if the hospital was across the street).

 

[vitdoc]

One of the driving forces behind Medicare HMOs is that they frequently pay 100% of the cost other than a nominal copay. Standard Medicare allows for more flexibility in choosing what physicians or hospitals one has access to but pays 80% of the fees charged which are set by Medicare. Physicians must charge for the remaining 20% which would be paid by a secondary insurance if that is in place. If physicians don’t collect the 20% they are committing Medicare fraud. The same goes for hospitals.

 

[Protimenow]

Vitdoc - I understand where you're coming from. If I was to come to see you at your practice, I would certainly be subject to those rules (although I've seen some physicians, with appropriate documentation from the patients) waive the 20% for 'compassionate' reasons. These reasons are well documented and, if audited, could provide a reason for waiving the 20% copay.

I was lucky to have the foresight to get enrolled in an HMO. If I hadn't, and was worried about the deductible, I almost definitely would have died at home.

The facilities that I mentioned are teaching hospitals. Patients are seen by students, under the supervision of experienced, licensed physicians and specialists, but there's no guarantee to the patient that any procedure is not done by a student. I suspect that Medicare recognizes the value of having patients put their lives into the hands of students, and probably does not authorize nor require the 20% copay.

One of my acquaintances had more than one procedure done at two of the training hospitals that I've listed, and was not charged a copay.

If my electrophysiologist isn't approved by my HMO, I'll check with UCLA or another training hispital and see if, because I'm making myself available to be worked on by students, they require copay.

 

[Luckyguy17]

Am also Skeptical of the duration of replacement valves Stated at the top of Thread. I suspect that Keitl, has it right about age and other conditions causing death, not the valve.
i had open heart surgery at age 58, to replace bicuspid aortic and repair a damaged Mitral with a ring, Surgery Done on May 15th, 2010 And just had 10 year anniversary. Chose organic and had St-Jude piggy and Edwards Mitral ring. kryptonite glue of rib cage, really helped for a speedy recovery, i was 1st Kryptonite use in my local hospital in Canada.

I have had no issues to date, daily 80mg aspirin and a small dose of Atacand to maintain lowest BP, cardiologist visits every 2 years, just had Cardilogist with no regurgitation detected.

 

[David Robbins]

I was the poster on the longevity stats. I agree that these are limited by age at time of surgery and may have been done on an older demographic.
I have a question regarding heart rate variability.
My Apple Watch, which is considered accurate for this measurement consistently reports readings over 200ms. I’ve read that higher is better, but that’s a standard of 50-60ms. Higher is associated with fitness, according to the researchers. Given I have Afib, is this a relevant gauge for my heart health? My resting pulse rate is 42-46 and average in 24 hours of normal activity of 65. I have always been athletic, running intense intervals up until a week before my 1st AVR. I now hike, bike and strength train 3-5 days a week. My work is office related snd sedentary.
I take warfarin as prescribed because of my mechanical valve, so Afib’s blood clot risk is lowered. I have not had one instance of a racing heart or any other problem related to this condition of Afib.
So, can anyone provide an answer to the high heart rate variability readings?
Thanks for listening

 

[Superman]

I was the poster on the longevity stats. I agree that these are limited by age at time of surgery and may have been done on an older demographic.
I have a question regarding heart rate variability.
My Apple Watch, which is considered accurate for this measurement consistently reports readings over 200ms. I’ve read that higher is better, but that’s a standard of 50-60ms. Higher is associated with fitness, according to the researchers. Given I have Afib, is this a relevant gauge for my heart health? My resting pulse rate is 42-46 and average in 24 hours of normal activity of 65. I have always been athletic, running intense intervals up until a week before my 1st AVR. I now hike, bike and strength train 3-5 days a week. My work is office related snd sedentary.
I take warfarin as prescribed because of my mechanical valve, so Afib’s blood clot risk is lowered. I have not had one instance of a racing heart or any other problem related to this condition of Afib.
So, can anyone provide an answer to the high heart rate variability readings?
Thanks for listening

It’s taking your heart rate from your wrist. Sometimes it gets confused. I’ve had it with my Fitbit as well. It’ll show 140 plus, but I can hear and count my ticks. My best guess is it’s picking up two blood vessels and double counting sometimes.

 

[David Robbins]

It’s taking your heart rate from your wrist. Sometimes it gets confused. I’ve had it with my Fitbit as well. It’ll show 140 plus, but I can hear and count my ticks. My best guess is it’s picking up two blood vessels and double counting sometimes.

The Apple Watch is rated as the gold standard and records 24/7. Since I also have Afib, I am curious as to the correlation. Last night it dipped as low as 38. I was an elite athlete for over 35 years up until my AVR in 3008. I still am an above average athlete but not as intense. The extremely high Heart Rate Variability is also concerning. Mine is always above 200ms, occasionally 300ms.