Mechanical Valve vs Homograft

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B

Braveheart

I'm confused about something!

Someone I met today (a girl aged 22 with congenital heart defects) is expecting heart valve replacement within 3mths. She currently has a homograft valve and they will be putting in another homograft valve.

She told me that her cardiologist, who works at the same hospital as mine, said that in young people they prefer to use homograft valves to save putting them on Warfarin/Coumadin. When I was aged 30 they told me I needed a aortic valve & root replacement. I asked about the Ross and they said no because they suspected I had a predisposition to tissue weakness in my aorta they wanted to go for mechanical implant. The other reason they said was to prevent redo surgery if possible because of all the scaring I have had from past surgeries. They said the mechanical valve should last a life time.

I hope I wasn't sold a mechanical valve, when actually I could have had a tissue one!!

or is every individual case unique and different?

Thanks friends,

Jonathan
-------------
Coarctation of Aorta Repair - Jan. 1985

CarboMedics 27mm aortic valve and root replacement - Oct. 1998

Descending Aortic Arch Aneurysm resection - Feb. 99
 
Hi Jonathan

I am 40 and have just joined the NHS waiting list for my AVR. My Surgeon explained all the various options for valve replacement and then said that the mechanical would be the best for me because it would last a lifetime and I would not require further surgery. I wanted a biological valve as I did not want to have to take Warfarin for the rest of my life. He said that a biological valve would only last around 10 to 15 years and I would need further surgery, something I should think about. I knew this and would prefer the risk of further surgery rather than take the risk of having to be on Warfarin for the rest of my life. He was happy with my decision and I will be getting a pig valve.

Peachy
 
Other possible reason

Other possible reason

Jonathan,

Another reason the young lady's cardiologist may have recommended a homograft is that childbearing and warfarin (Coumadin) do not mix!!!

If she is planning to have children some day, she cannot be on blood thinners.

Just a thought.


Kristy W
 
Christy, Peachy, Braveheart, et al

Interesting observations. I am again amazed at the advancement of valvular "science". The choices are out there, to be sure. I believe (opinion only) that each of us comes with a different mess of pathology, a unique number of options.

In 1978 I was told that mechanical was the way to go. For the same reasons stated above, that tissue valves degenerated in appx. 10 years. That has been shown to be true. Mechanical valves on the other hand, "last a lifetime". My Bjork Shiley titanium super valve with lifetime durability (or 500,000 miles) has not failed me. I however, have failed my valve. After 23 years, I had formed a panus (clumpy clotty type glob) under the valve, with string like scarring across the top. The valve was/is trying desparately to operate under these conditions. The scarring prevents the valve from opening and the panus blocks the blood flow through an already compromised valve.

Oct 6 of 1999 (2 year birthday coming up) I had a procedure to correct the problem. Due to 3 previous surgeries, nobody (but nobody) wanted to touch me. No one would enter through the sternum, and no one wanted to try and "fix" the Bjork Shiley. So i have this absurd apico aortic conduit, which slightly resembles a plumbing reroute. It works. The mechanical valve did not fail me. The valve is working beautifully.

No one can plan for every eventuality. I had a very narrow opening to the aortic valve, so small that I had a pediatric valve implant. It was the only valve that would fit within the space allowed. The Doc did not plan for this, as he didnt know it. He made do, with what he had at the time. (1978 remember!)

We all can do our research, and our reading. We can poll other valve patients, and question our Doctors and other health providers. Bottom line is, each one of us is different. At some point, a decision has to be made, and sometimes, it is (literally) at the last minute. We can take our best educated guess at what is right for us, but you best be trusting your Doctor when it comes time for the knife.

The mechanical decision, I believe, was the right one for me. I cannot have another surgery. There are many that didnt believe I would survive this one. A successful fourth surgery is rare. Each surgery carries with it successive and unavoidable problems, ie; scarring, cumulative pump problems, spider web like heart tissue that wont hold a stitch. (As described to me by my Surgeon

Do not underestimate the seriousness of repeat surgeries.
 
Peachy,
MY pig valve lasted just 11 years, which I thought wasn't long enough, but the cardiologist said was longer than average of 8-10 years.
I got it at age 34, so maybe that's why I didn't get the 15 yrs I was expecting,
Gail
 
It's my impression that pig valves --- and most bioprosthetic involves -- have been significantly improved in the last 10-15 years and that valves like the Hancock Medtronics Mosaic and some others do presently offer longer average life spans across the spectrum than the 8-10 years that was previously expected.

Peter
 
:p I too am on my 3rd valve, a St. Judes Mecanical, previous valves were Porcine Hancock Valves, made by Johnson and Johnson. The first was implanted at 16, the second at 24 and the last at 40 (Gaurenteed for life) my surgeon assured me. 3 operations is enough, even though it get's easier to bear, and the techniques improve, the body tends not to rebound as quickly as the first or second. Odly enough I was told they don't put porcine valves in teenagers much any more because of the high calcium contend "Got Milk?" that calcifies the valve before its time.

Any way happily clicking away now, and coumidan is not to bad, excuse me I have to go for my blood test.

Sam
 
Jonathan... It is very unuasual to use a homograft valve in someone so young. I was told by my surgeon that even with oldsters like me (I'm 48 lol) mechanical valves were better because of their longevity and that he liked homografts for older patients.

In my opinion, going on Coumadin is a whole lot better than having heart surgery again!!!! (Boo)

Take care,
Zazzy
 
Braveheart said:
I'm confused about something!

Someone I met today (a girl aged 22 with congenital heart defects) is expecting heart valve replacement within 3mths. She currently has a homograft valve and they will be putting in another homograft valve.

She told me that her cardiologist, who works at the same hospital as mine, said that in young people they prefer to use homograft valves to save putting them on Warfarin/Coumadin. When I was aged 30 they told me I needed a aortic valve & root replacement. I asked about the Ross and they said no because they suspected I had a predisposition to tissue weakness in my aorta they wanted to go for mechanical implant. The other reason they said was to prevent redo surgery if possible because of all the scaring I have had from past surgeries. They said the mechanical valve should last a life time.

I hope I wasn't sold a mechanical valve, when actually I could have had a tissue one!!

or is every individual case unique and different?

Thanks friends,

Jonathan
-------------
Coarctation of Aorta Repair - Jan. 1985

CarboMedics 27mm aortic valve and root replacement - Oct. 1998

Descending Aortic Arch Aneurysm resection - Feb. 99
Click to expand...

This was an old thread, but there was something here that I wanted to reply to. I will be having an AVR in the next few weeks. Like everyone here, I am faced with making the difficut decision of Tissue Vs. Mechanical.

I want to go tissue at 37 years of age. I feel like I want to spare myself as many years of coumadin use as possible, get a bit older and see if my valve choices down the road will be better. Iif I can buy 10-15 years at worst, I can go mech the next time.

However, I still havent made up my mind. I still havent come accross the stats to help sway me that a re-op at 50 something is better or worse that 45+ years of coumadin use rather than 30 for example. I am still on the fence and may be there right until the last minute.

However, I wanted reply to one thing Jonathan said here. He was confused whether he made the right call about going mech this last time around.

If I were Jonathan from what I learned these last few weeks, I would have gone mech. Why? because Jonathan said he also had a root job done.

Up until my CT cleared me of having the root job I was under the impression I would need one as well. Fortunately my surgeon said it wont be necessary.


Had I needed the root job...no brainer. Like you Jonathan...I would have gone Mech. WHY??? From what I have been told by several people...an AVR re-op when there has been a root job done the first time around is EXTREMELY difficult. Its supposedly a 9 hour re-op. Apparently the root is some sort of complicated graft job that makes it much harder to get down to the valve the next time. The surgeon said the dacron they use is inflexible. Much harder surgery, much more dangerous.

Had my CT determined that the root needed to be done...I would have gone mech. If you still visit here...or if anyone else reads this I hope the feedback helps.

I think the hardest thing to live with is regret with all this. After all...it is true that there is no way to really know what will happen down the road.
 
Welcome to our little VR family.

I find your thoughts about avoiding Coumadin with a tissue for the next 10 - 15 years and then going mechanical, interesting. My thoughts have been just the opposite.

Some of our valve type discussion revolves around whether a mechanical valve is truly "one valve for life". I had my mitral replaced with a St. Jude valve over 14 years ago. I was 32. Now, at age 47, as my body ages and I get more aches and pains, I am reminded that the idea of other types of surgery and procedures to repair an aging body becomes more of a reality. My thought has always been that, depending on my age, should my mechanical need replacing, I would consider going with a tissue valve so as to avoid the clotting/Coumadin aspect as a senior citizen when going through the time in my life that would put me in the highest age bracket for medical procedures.

I'm not saying your thoughts are wrong. It just struck me as interesting that we have the exact opposite thoughts for the same issue. Both have merit.
 
I saw two top surgeons. One recommended a homograph, the other told me that he thought that it was clearly the worst of all choices based on recent studies showing that they do not last, particularly for younger people. Ask questions about longevity before jumping in, and look at actual studies. You may want to check on what the Cornell Medical Center has on research in this area.
I chose mechanical based upon my desire to avoid further surgery, and having seen successful/ no hassle coumadin treatment within my family.
Good luck,
Tom
 
Karlynn said:
Welcome to our little VR family.

I find your thoughts about avoiding Coumadin with a tissue for the next 10 - 15 years and then going mechanical, interesting. My thoughts have been just the opposite.

Some of our valve type discussion revolves around whether a mechanical valve is truly "one valve for life". I had my mitral replaced with a St. Jude valve over 14 years ago. I was 32. Now, at age 47, as my body ages and I get more aches and pains, I am reminded that the idea of other types of surgery and procedures to repair an aging body becomes more of a reality. My thought has always been that, depending on my age, should my mechanical need replacing, I would consider going with a tissue valve so as to avoid the clotting/Coumadin aspect as a senior citizen when going through the time in my life that would put me in the highest age bracket for medical procedures.

I'm not saying your thoughts are wrong. It just struck me as interesting that we have the exact opposite thoughts for the same issue. Both have merit.
Click to expand...


Thank you for the welcome!

You know, its not that our thoughts are really so opposite perhaps its just the approach of what to do.

It sounds as if you are also concerned with the long term problems coumadin could cause. In my case I am worried about the long term health concerns from the drug itself. I recall reading that your chance of stroke increases 1% every year you are on the drug. Now, I do not know if this is true. I read it as a slide, on a surgical procedure video I watched on the Internet.

I would love for someone to have facts to dispute that.

In your case, you have raised another interesting point. Being a senior on the drug and facing OTHER surgeries. Also a great concern.

I just want to express to you, that my plan is not to take the tissue valve and then plan on mechanical+coumadin.

My HOPE is that I actually buy the years the get a BETTER option 10-15 years from now IF I do decide to go tissue valve at this time. That by the time I would face a re-op they perfect one of these 3 options:

1-An anticoagulant with a lot less short and long term concerns that we would believe is safe.
2-A mechanical valve that doesnt require anticoagulants.
3-A dead or live tissue valve that could be long lasting or perhaps even permanent.

My thought is...at worst none of these happen and then like you I have to go mechancal.

My friendly debate challenge to you is...you said IF your mech valve fails you would consider tissue. What if it doesnt fail (and hopefully that is the case), will you regret not having the chance to make that choice should something better come along, or if you do face other surgical procedures as you outlined?

Perhaps this is a good debate for people like us to have.

Anyone else have thoughts on the subject?
 
Some of this may be somewhat out of kilter. The thread we are now on was revived by Enetric from 2001 (the famous Peter Easton even made an appearance in it).

To place this thread in time...

This was before the advent of fixative and anticalcification treatments for tissue valves, On-X valves, catheter-placed valves, even before drug-eluting stents. The thread was started only a few months after Nexium came on the market. It was started before the first iPod hit the stores.

Please consider starting with fresh material. People will pick up on these older posts and think them current, and start with misconceptions.

Ross could pick this up from the first Enetric post, if Enetric is amenable, and place it as a new thread.

Thank you,

Bob Hendricks
 
WOW before the IPOD? lol

WOW before the IPOD? lol

Justin still has a hard time believing, that we really did survive w/ out computers and mac machines, and looks at me like I'm nuts when I talk about being so excited when we got a color tv.Lyn
 
I was 32 years young when I had my mech installed. Had it been tissue, I would have been lucky to get 10 years out of it. Young hearts chew up tissue valves (to quote our Valve Comparison Guru-Tobagotwo). I had 2 young children at the time, who had been through a lot with Mommy not feeling good. I wanted (and still want to) stay out of the OR as long as possible after my replacement. It worked out well for me. Right around the time I would have been getting another valve my kids were graduating from high school, we took a trip to Europe and I was a very busy Mom of 2 busy teenagers. My doctor didn't really give me the choice of tissue or mech. 14 years ago, tissue valves didn't have nearly as good a track record as they do now. He knew my family circumstances and knew that a young mom just couldn't keep going in and out of surgery.

If my mech valve doesn't fail (or more likely, my heart have issues), I will not regret not having the chance to go with the latest that science has to offer. I think most of us here would tell you that, whether we have tissue or mechanical valves. I sincerely hope that I go to my grave at 100 knowing that what had been clicking in me for 68 years had been surpassed many many times over. My valve has already been surpassed by other mech valves. I think Nancy's Joe has a ball and cage valve that's been in for 26 years or so and it's still doing it's job.

I think future hopes of technology are good, but my personal opinion is that your mains reasons for your choice should be based on the science of today. Many good things will occur in the future. But many things will also look promising and then won't pan out for whatever reason. What's the saying... "Life is what happens when you've made other plans."
 
I have been on coumadin for over 25 years. I have had no problems of any significance. Unfortunately I am one of the few in which the "one valve for life" theory didn't pan out.

Had I known, in 1980, that I would have had more surgeries, I most certainly would have gone tissue (with a mechanical down the road). However, I did not know the future. The reason the surgeon chose mechanical was because he believed it would be my last OHS. I do not regret his decision as it was made in my best interest.

I almost died during my second OHS due to a lacerated pulmonary artery that happened during the path clearance to my heart. I was given really bad odds on surviving my third.

It is impossible to guess the future; we can only look at what is here today. Make the best choice based on what is fact today and don't ever look back.
 
Sorry Enteric

Sorry Enteric

You have made two misstatements:

"I am worried about the long term health concerns from the drug itself. I recall reading that your chance of stroke increases 1% every year you are on the drug. Now, I do not know if this is true. I read it as a slide, on a surgical procedure video I watched on the Internet."

1. Your chance of stroke doesn't increase 1% a year! It is 1% per year.
If that were true I would have a 45% chance of a stroke this year!:eek:

"I would love for someone to have facts to dispute that."

2. The burden of proof is on you to prove your statement, not on "someone"
to prove you wrong!

I'm am the only one here who is reading another "Nightmare of Warfarin"
thread here?:eek: :confused: :( :mad:
 
Second Guessing-Are you sure?

Second Guessing-Are you sure?

geebee said:
Had I known, in 1980, that I would have had more surgeries, I most certainly would have gone tissue (with a mechanical down the road). However, I did not know the future. The reason the surgeon chose mechanical was because he believed it would be my last OHS. I do not regret his decision as it was made in my best interest.

It is impossible to guess the future; we can only look at what is here today. Make the best choice based on what is fact today and don't ever look back.
Click to expand...

Well let's see........ MV. young active women(good looking, being chased by all those guys) you might very well be on your fourth tissue valve by now,
given that you survived all your surgeries and had one of the better tissue
valves implanted. Remember, there were not only failures in early mech. valves, but early tissue valves also. How long do you think that fourth valve
would last at your at your age? Do I hear number 5!:eek:

Your second statement is the one that rings true!:)
 
Gina, back in 1980, I'm not so sure that a tissue valve would have bought you anything special.
 
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