Longevity of repaired valves

[Blair]

Does anyone have info on the longevity of repaired valves? I had pretty much decided on mechanical, but my cardiologist thinks there is a good chance the surgeon can repair my mitral valve. At first I liked the idea. The more I think about it though, the less trust I have that a repair will last. So, are there any statistics on how long repairs can hold up?

I will meet with the surgeon in 4 days. Surgery in a week.

 

[Marc]

Hi!

There are a lot of studies out there reagrding your question e.g.

http://www.ncbi.nlm.nih.gov/pubmed/21793922

but it is all about statistics and you never know in wich group you will fall. What is widely accepted by nearly every leading surgeon is the fact that mvrepair is always the better choice than mvreplacement. So mvrepair will (under normal circumstances) be the best way to go.

 

[Tirone]

I totally agree with Marc. There's a lot of data supporting MV repair. Recently also aortic valves with regurgitation have been repaired more often and the literature suggests pretty good results, possibly lasting a lifetime. But at the end it's all statistics. Chances you might need a second operation are probably higher with repairs. But if you end up having an endocarditis or stroke with your mechanical valve, that's not a lot of fun either. Gather as much information as you can and make a choice that's right for YOU. It's like having to decide between a Ferrari and a Lamborghini. There both good choices.

 

[Midpack]

Hi!

As others have said, a good mitral repair is better than a replacement. There is a lot of evidence to support this. But the repair must be completely satisfactory, according to the surgeon experience, to be the best option. For instance, a repair that only improves your leakage from severe to moderate is unacceptable. Also keep in mind that mitral valve is more complex than aortic valve, and mitral valve replacements can pose more problems than aortic ones in the long term.

To sum it up, if a good repair is possible, it is the obvious choice. And i doubt that a surgeon will ever perform a replacement if he is skilled enough to perform a good repair, even if you ask for it.

Good luck!

 

[river-wear]

Blair, the beauty of a repair is that it's the only chance to go back to a normal life. No trade-off like you have between tissue and mechanical valves. Make sure your surgeon is experienced. Here's a recent article I found surprising - some surgeons don't try for repairs: http://medicalxpress.com/news/2014-04-greater-surgeon-likelihood-mitral-valve.html#nwlt

Personally, the only way I'd risk a second surgery is on a repair. I had decided on a mech valve (aortic) when the surgeon said he thought he could repair my valve. He didn't have a lot of experience though, so I did a lot of research and now I'm going to fly cross-country to get the best odds for a successful repair. I trust that, during surgery, if he doesn't think it's likely to be permanent, he'll replace it with a mechanical valve instead. Then I just have to hope the statistics are on my side.

Marc, thanks for posting the mitral study. 95% freedom from re-op is impressive.

 

[Mike59]

Had my aortic valve repaired in 1979

Had it replaced in 2012

33 years!!

Hope that helps

 

[Mike59]

...........

 

[bw00]

Hi, my surgeon told me it really depends on the patient. For me they first decided to repair my valve, once they did that they thought the longevity was not going to be good. They thought it was not going to last longer then a few year so they did a ross anyway. They did not decide this until I was opened up on the surgery table. But my surgeon told me that if the repair is a good option, it is better then a replacement.

 

[Marco]

Had my aortic valve repaired in 1979

Had it replaced in 2012

33 years!!

Hope that helps

33 years is impressive!! That certanly does help and I was unaware that aortic (not mitral) valve repairs were already done so many years ago. How did you (or your doctors) start noticing you needed a replacement after 33 years? What were the symptoms? Thanks!

 

[Heart Of The Sunrise]

http://www.youtube.com/watch?v=73uZzEZYogE
Here is my surgeon discussing aortic valve repair.

 

[Marco]

Recently also aortic valves with regurgitation have been repaired more often and the literature suggests pretty good results, possibly lasting a lifetime.

Do you happen to know of any such literature on the repair of aortic valves with regurgitation? Thanks for sharing!

 

[Tirone]

Hi Marco
There's a lot of literature. Here are some recently published papers. You can access the abstracts with the provided link.

de Meester at al. 2014. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: A propensity score analysis
Conclusion: AV repair significantly improves postoperative outcomes in patients with AR and whenever feasible should probably be the preferred mode of surgical correction. http://www.ncbi.nlm.nih.gov/pubmed/24656668

Saczkowsky et al. 2013. Systematic review of aortic valve preservation and repair. http://www.ncbi.nlm.nih.gov/pubmed/23977553

Svensson et al. 2014. Long-term durability of bicuspid aortic valve repair. http://www.ncbi.nlm.nih.gov/pubmed/24680032
Conclusion: BAV repair is safe and durable with low mortality, low prevalence of reoperation, and good long-term survival. Cusp prolapse from technical errors and natural progression of disease are the most common causes for reoperation, but progressive natural increase in valve gradient accounts for a substantial proportion as well.

Aicher D et al. 2011. Quality of life after aortic valve surgery: replacement versus reconstruction. http://www.ncbi.nlm.nih.gov/pubmed/21450311

The current literature influenced my decision a lot. With repairs I think it's very important to be at a center that has extensive experience. Hope this helps.

 

[Mike59]

Regular 2 yearly checkups

During the 33 years I was very fortunate to be symptom free

 

[cldlhd]

Thanks for the posts. I don't know if my valve is repairable or not and even if they say it is I'm not sure if I want to go that route or a mech valve but I say the more info the better.

Hi Marco
There's a lot of literature. Here are some recently published papers. You can access the abstracts with the provided link.

de Meester at al. 2014. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: A propensity score analysis
Conclusion: AV repair significantly improves postoperative outcomes in patients with AR and whenever feasible should probably be the preferred mode of surgical correction. http://www.ncbi.nlm.nih.gov/pubmed/24656668

Saczkowsky et al. 2013. Systematic review of aortic valve preservation and repair. http://www.ncbi.nlm.nih.gov/pubmed/23977553

Svensson et al. 2014. Long-term durability of bicuspid aortic valve repair. http://www.ncbi.nlm.nih.gov/pubmed/24680032
Conclusion: BAV repair is safe and durable with low mortality, low prevalence of reoperation, and good long-term survival. Cusp prolapse from technical errors and natural progression of disease are the most common causes for reoperation, but progressive natural increase in valve gradient accounts for a substantial proportion as well.

Aicher D et al. 2011. Quality of life after aortic valve surgery: replacement versus reconstruction. http://www.ncbi.nlm.nih.gov/pubmed/21450311

The current literature influenced my decision a lot. With repairs I think it's very important to be at a center that has extensive experience. Hope this helps.

 

[river-wear]

Thank you, Tirone. I had been looking for studies like that and was having a hard time finding them. The third study (728 patients at CC) concludes there is a low re-op rate, but 22% at 10 years doesn't sound all that great to me. I wish we could see if there was a pattern in the re-ops over time - that is, are they clumped with the early cases. Of course, the more time that has passed, the more likely a re-op but I'm trying to get a sense of whether all they have learned has significantly improved on that. The first link, with a much smaller sample of 44 patients, concludes there is a small (statistically insignificant) increase in risk for re-op. Their time window was 1995-2012, versus 1985-2011 for the CC study. It looks like both studies reviewed about 9-10 years post-op (yes, with a larger range for CC).

 

[pellicle]

Hi

The third study (728 patients at CC) concludes there is a low re-op rate, but 22% at 10 years doesn't sound all that great to me.

I noted the same thing but wasn't going to mention it because enough people claim I'm somehow biased as it is.

I have observed in my readings that very few (almost no) studies extend past 10 or 15 years. I assume that is because most of the AVR recipients (statistically) are over 50. As a younger person I would be interested in how things stack up over longer periods (I was given my first AVR at 28), and somehow research suggests that 10 years is "long term".

 

[cldlhd]

Hi



I noted the same thing but wasn't going to mention it because enough people claim I'm somehow biased as it is.

I have observed in my readings that very few (almost no) studies extend past 10 or 15 years. I assume that is because most of the AVR recipients (statistically) are over 50. As a younger person I would be interested in how things stack up over longer periods (I was given my first AVR at 28), and somehow research suggests that 10 years is "long term".

As for being biased I imagine anyone who had a life saving operation with a good outcome would be passionate about their choice and some situations kind of make the choice for you.
As someone who just turned 45 I don't consider 10 yrs to be long term either. I have to imagine repairs done today have better techniques than 20 yrs ago and that the ability of the surgeon factors in to the equation also. So I imagine it's difficult to compare a repair done 20 yrs ago with one done today but if the technique has changed and is relatively new how do they predict longevity with any accuracy?

 

[Marco]

Hi


As a younger person I would be interested in how things stack up over longer periods (I was given my first AVR at 28), and somehow research suggests that 10 years is "long term".

I couldn't agree more. Now I'm wondering if wouldn't be brilliant if we would start to put together a database based on this sample to start with - just the people on this forum to start with - and see where that takes us?

 

[river-wear]

I emailed the CC study to my friendly surgeon and he said techniques changed significantly in 2004, so ten years is all we have for the latest - plus now we benefit from a decade of practice. He pointed out how far back that sample goes (1985).

 

[Tirone]

Hi Pellicle, you're totally right. 10-15 years doesn't sound like longterm to me either. For me, longterm would be 50 years or so.

Not only operative technique changed in the past decade, but also anesthesiology, heart-lung-machines, intensive care, diagnostics and indication for surgery. Then it's difficult to follow up a representative number of patients after 10 years, as they might have moved, died of other reasons, changed hospital, etc. "Longterm" studies will always have one of these flaws. But in my opinion techniques and procedures improved in the last decade. So I think we can interpret most results (for all types of AVR or repairs) rather optimistically.

At the end, no one can tell, whether exactly you will be the one that needs a re-do after 1 year or suffer from endocarditis or stroke. Biological, mechanical or repair all have their pros and cons. There's no bad choice.