Luck or something else re bio valve longevity

[Justincwp]

I've been looking for an answer to my valve longevity question and have not came up with any information. Discussions are always about the surgery and recovery but I can't find any information (around the web) as to what factors may or may not influence valve longevity. I have the bio. Maybe there aren't any. Maybe valve longevity is luck. If it is I'll move on and hope for the best. Thanks for any info.
(I can find longevity charts and graphs but never any reasons for failure)

 

[dornole]

I swear I read a lot about this here. If you look in the tissue vs mechanical threads you'll find a ton.

I only remember the ones that pertain to me . . . . . ; ) so I remember reading (in a paper that linked to one of these discussions) that being young (under 60 and the younger, the worse), being female, having the replacement in the mitral position, and having rheumatic fever history all reduce the likely longevity of a tissue valve. Naturally I have all of these.

 

[Broncorod]

Hello,
If you are looking for statistical studies,
http://circ.ahajournals.org/content...FIRSTINDEX=0&minscore=5000&resourcetype=HWCIT
If you are looking for additional percentages,
http://www.ncbi.nlm.nih.gov/pubmed/12614798
Here is a study that talks about common trends of a bio valve,
http://circ.ahajournals.org/content/114/4/318.full

I really think that there are too many varying, and individual circumstances that can affect the longevity, to get a concrete answer on your question. I am 49, and had a bio valve put in 1 1/2 months ago. My surgeon (who told me in my initial meeting, that I should get a mechanical valve because of my age) told me that my decision to go bio, is the same decision he would go with if he was me. He also told me that when he went to a seminar with around 90 heart surgeons, the instructor polled the doctors and asked them if they had a patient between 40-50 years old, what valve would they recommend. He said the majority would recommend mechanical. Then the instructor polled them again, and asked if "they" were between the age of 40-50, what valve would "they" choose for themselves, the majority said they would choose a bio valve. Go figure, haha.

I hope this helps you. My decision to go bio is due to the anticoagulant pitfalls of being on them long term. I would rather go through another procedure than be on coumadin, or being worried about having a major bleeding problem, that I may succumb to. One other reason, is that technology is changing very rapidly with heart surgery procedures. There's a company that is in the process of testing a new mechanical valve, that has the possibility of not having to take anticoagulants with it. So we shall see.

Don't over whelm yourself with this, and start living.

Take care,
BroncoRod

 

[pellicle]

Hi

I've been looking for an answer to my valve longevity question and have not came up with any information. I've been looking for an answer to my valve longevity question and have not came up with any information.

to further the post broncorod put up I'll say that in general there aren't many long term studies at all. The reasons I see for this are such things as:

* the makers are not motivated (we do live in a throw away society too right?)
* the surgeons figure that if you get 10 years you've done well (perhaps because they come from a perspective of dealing with the elderly but who can be sure)
* there are many factors to consider and it seems that those of us who are younger and healther are not the norm for valve replacement.

... I can't find any information (around the web) as to what factors may or may not influence valve longevity.

there has not been much I've found that's "direct" but lots thats indirect. Stuff like "we are doing X Y and Z to our valves to increase longevity" in both maker write-ups and discussions on what caused failures (discussions in medical journals not places like here).

Maybe valve longevity is luck.

its certainly a confluence of various factors:
* your lifestyle
* your age at implantation
* your metabolism and its quirks

how long have you had so far?

Back when I got my homograft (I was 28) I spent years wondering about when it would fail and how long it would last. My surgeon always answered this with "we just don't know". I found that the significance of the question dimmed in my going about daily life and occasionaly would resurface and I'd do some research.

Back in 1992 (when I was 28) there was little on line at all, but by 2002 there was enough of an explosion of internet data availablity and access that research did not mean going into a major State or National Library and spending days pulling out stuff. Google Scholar is the one you want to be searching via

http://scholar.google.com/

this does not return "noise" like "my aunty billy had a goat"

If it is I'll move on and hope for the best.

it is indeed what all of us do. It is all that any of us really can do. That is of course slightly different for us mechanical valvers, for we need to learn about anticoagulation a bit and manage ourselves to maximise our outcomes for the positive with our dosing and measuring. To my knowledge there is nothing that a tissue valver can do to alter outcomes.

(I can find longevity charts and graphs but never any reasons for failure)

probably because the reasons are normally the same: stenosis due to calcification. Occasionally torn leaflets. But stenosis is the main reason as far as I know.

How long have you had your valve for and how old were you when you got it?

 

[pellicle]

Hi


and thanks for the links, I hadn't read (or don't recall reading) one of them.

Hello,
If you are looking for statistical studies,
http://circ.ahajournals.org/content/...urcetype=HWCIT
If you are looking for additional percentages,
http://www.ncbi.nlm.nih.gov/pubmed/12614798
Here is a study that talks about common trends of a bio valve,
http://circ.ahajournals.org/content/114/4/318.full

Perhaps like the OP I find it frustrating that there is little data which discusses valve longevity directly (meaning one has to infer it) and that medical discussions comparing tissue and mechanical valve discuss it from one stand point alone: mortality. The conclusions summarised this position.

Conclusions— In our experience, selecting a tissue prosthesis at initial operation in younger adults does not negatively impact survival into the third decade of follow-up, despite the risk of reoperation.

There is little discussion on what is the reoperation rates (including the outliers of how many required more than 2 reoperations) only discussions on death.

Death is a negative outcome for sure, but so too are many other factors (such as ongoing need for a pacemaker), which are often ignored completely in the discussions on reoperations. Instead its just "dead or alive".

This study examines a cohort of adult patients who were 60 years or less of age at the time of first time aortic valve replacement (AVR), mitral valve replacement (MVR), or combined aortic and mitral (“double”) valve replacement (DVR), who survived the operation, who were prospectively followed in a dedicated valve clinic, and who contributed 20-year follow-up information.

Which for a 28 year old like me (or like I was) is not long ... sure to someone in their 70's with heart issues if you say "you're not likely to live another 20 years" they may already be thinking that. But 20 years to a 28 year old (or to a 24 year old who posted here recently) 20 more years only gets you to 48 and still much younger than many who are having their first operation.

In this regard, data with sufficient follow-up duration to adequately capture tissue prosthesis reoperations and long-term mortality in younger patients have been lacking and, in our opinion, are necessary to compare the presumably more evenly distributed hazard of having a mechanical prosthesis against the later phase hazard of surgically replacing a tissue prosthesis.

again its all about death not about what happens to you on your third or fourth (or ...) operations ... as long as you're not dead.

But anyway, that's my issue with the direction or research, nothing about what you've said.

Best Wishes

 

[Fundy]

I had come across studies that suggest someone with Type 2 diabetes would maybe expect earlier valve deterioration than usual, and those with diabetes treated with insulin would especially so.
http://www.medscape.com/viewarticle/791117

 

[Fundy]

The study I linked to in previous post mentions cholesterol levels as well.

Total-cholesterol levels and total-cholesterol/HDL ratios were also a strong independent predictor of valve degeneration in the study, which confirms previous research showing that hyperglycemia and hypercholesterolemia accelerate the atherosclerotic process, which appears to play an important role in valve degeneration, according to the authors.

If that held true in many other studies as well, you'd think it would get mentioned more that keeping cholesterol levels in line would maybe help valve longetivity. But it was never mentioned to me, nor do I remember anyone else mentioning cardiologists or surgeons discussing cholosterol levels.

 

[Justincwp]

Follow up. Thanks for the replies. I guess I'll be working on lowering my blood sugar. (mildly high has been to 111) Here's my thing. I'm not really unhappy being alive and I'd like to keep it that way as long as possible. The post above in my summary are saying (unless I'm wrong) is pay attention to the general heart healthy guidlines. Stress, cholesterol and blood pressure. (add in blood sugar) Stress is my down fall. I got into animal rescue and animals I rescued that were not really adoptable I still have. Most are in their teens with expensive health problems and they aren't easy on furniture. They've had the best care and even my old beagle with enlarged heart gets meds and keeps going. But they do create stress. I could put them down but that would be even worse stresswise. (also have several animals with paralysis)
(some of this is a reply to pellicle's questions) I'm 69 with an Edwards Valve I've read about their Thermafix Calcium Treatment. Hope it works. So far I was out shopping for exercise 5 days after surgery. I did a stress test for cardiac rehab and was close to the top tier. I graduated from Cardiac Rehab with a diploma in 13 weeks out of a possible 32 weeks. Cholesterol is 145 I'm on the lowest dose

 

[Justincwp]

My reply got chopped. I probably need to review how to work this board
.................................................................................................

. Cholesterol is 145 I'm on the lowest dose of Metoprolol or in summary I'm doing quite well and "happy" about that. The surgeon gave me 20 years and Edwards claims up to 20 years. Age is a downside with stats from 10-15 years. For the most part I'm trying to ekk out what I control with a curiosity about what goes on. I read Edwards was originally a valve guy in the industrial fuels area. The artical went on to mention how similar blood was as far as being a caustic material.

Thanks for the replies. (the last message I sent was around so long I didn't know it went and sent it twice. Hope this is better

 

[pellicle]

Justin

At 69 (not sure when you got it) I would guess that you are likely to get 20 years from the valve.

All the other points you took out seem to sit with whatI know too

Actually at 69I don't thiink age is a downside for the valve at least. If y said 29I'd seriously doudbtthat you would get 20 years.


Best wishes.

 

[ottagal]

Great reminders and information!
Just wanted to add that smoking is a risk factor. I recall reading studies stating that it contributed to both valve deterioration in those with bicuspid valves as well as those with bioprosthetic valves. Sorry...just don't have the time to research them right now.