Mechanical vs biological for mitral

[Juan P. Negret]

On June 25 I will undergo surgery because of a mitral prolapse. In case the valve cannot be repaired, very soon I need to tell the surgeon the type of replacement valve that I want.

What criteria can I use to help me in this decision? I have no symptoms, but the valve has severe regurgitation, my right atrium is severely enlarged, and my left ventricle is enlarged. In two months I will be 60 years old. I am in good health, a bit overweight. I do not practice sports, besides walking about a total of 3 hours a week. I am disciplined with my medicines.

My first decision has to be between mechanical or biological.

I appreciate any suggestions. Thank you in advance,

Juan

 

[catwoman]

Juan:
You could go either way.
I was a month shy of 52 when I had MVR and I had chosen a mechanical years before that -- if I ever needed MVR. My father-in-law had his first MVR around 1979 and got a porcine valve. Ten years later -- the week that Noriega was ousted as Panama's leader -- he had to have that valve replaced a 2nd time (plus AVR plus quad bypass + other things done). Several months later I was diagnosed with mitral valve prolapse and told I'd "probably never" have a problem requiring surgery. At that point, I decided that if I did need surgery, I'd go with a mechanical.

I'm not sure what type of porcine valve my FIL got either time. He was put on warfarin the 2nd time. He lived 65 miles from Fort Worth, Texas, where he had surgery, and was widowed. So his doctor sent him to a nursing center for about 6-8 weeks to convalesce and his protime tests (not sure if INR was the standard then).

There are a number of tissue valves that seem to be very good. Among other factors, I would consider the longevity of my closest relatives and otherwise how good my health is in choosing whether to go tissue or mechanical.
For example, my grandfathers died at about 57. However, my grandmothers lived to be 95 and 99+ years of age. My parents are still alive at 80 and 82. My dad's only brother is still alive, and my mom still has 2 of her 3 siblings.

The anticoagulation therapy is easy, or has been for me. My family doctor is very knowledgeable about it, and I've been testing my INR at home since November 2003. I'm able to adjust my dosage as well as my doctor's clinic (I'd say better than other doctors there can), so I do that too.

Valve choice is a very personal matter. There is no one perfect choice for everyone.

 

[Ross]

Welcome Juan. At 60, I'd go with tissue, but as for what particular valve, I'll leave that to the tissue folks to answer. I'm a mechanical man myself. As you get older, you really don't want to be on anticoagulants, though sometimes, even with a tissue valve, it's unavoidable due to the possibility of Atrial Fibrillation.

 

[Karlynn]

And you say now that you have no symptoms. My guess is that after the surgery and recovery of several months, you will realize that you had a lot of symptoms but that your body had just slowly adjusted to the changes. I'm making an educated guess that you are going to feel so much better a year from now. Best wishes!

 

[john79t]

I am 61 and having AVR on June 30th. I am going with a tissue bovine valve. it should be good for 20 plus years. The tisuue vale tends to last longe in older folks. (I know we don't like to think of ourselves as older) It is a personal decision but like Ross said dealing with Cumodin as you get older is not something I want to deal with.

 

[kfay]

As Ross said, at 60, I too would go with tissue. At 45, I went with tissue even though I didn't have much choice.

Kim

 

[Juan P. Negret]

Thank you for your inputs. I am still researching this mechanical vs biological issue.

In the meantime, I would like to receive opinions about which are the top (best) two mitral valves in each set, that is, the top two mechanical and the top two biological.

Thanks in advance,

Juan

 

[ALCapshaw2]

The Bovine Pericardial Tissue Valves have the longest PROVEN durability (90% at 20 years when implanted in patients over 60 years of age). The "new and improved" Porcine Valves are 'Hoped to" last longer than 'ordinary' Porcine Valves taken straight from the pig which have a much shorter durability.

In my (non-professional) opinion, the Best Mechanical Valve, especially for the Mitral Position which is more prone to form clots, is the On-X Valve. Due to several technological advances, these valves have the lowest propensity for clotting of the mechanical valves. See www.heartvalvechoice.com and www.onxvalves.com for considerable information on these valves.

My Second Choice in Mechanical Valves would be the St. Jude Master's Series Valves which have been around for 30 years. They are reliable but have a higher incidence of clotting and higher susceptibility to interference from Pannus Tissue Growth from what I read.

 

[Juan P. Negret]

Thank you ALCapshaw2 for your reply and the the www.heartvalvechoice.com link. I found very useful data and charts. Nevertheless, this is the site of the On-X valve manufacturer and cannot be entirely unbiased in helping decide on mechanical vs tissue, or the best model in each.

Do you know of a web site where a good set of CRITERIA (perhaps with some sort of questionnaire and points system) are developed for this mechanical vs tissue decision in an entirely non biased fashion?

Thank you in advance,

Juan

 

[Marcia58]

Juan,
Do you have any other health issues? If so, they need to be considered as well. For example, I'm 50 and had grandparents who lived into their 80s and 90s. When I needed to choose a type of valve, on the chance that my mitral repair wasn't feasible, first consideration would indicate a mechanical valve. However, I also have Parkinson's disease and a blood disorder that already increases my risk of developing clots. So with an increased risk of falls as the years pass, and the blood issues I already have, I opted for the tissue valve, if necessary. Thank God, the repair was successful!

I said all that to say, be sure that you and your doctors consider all aspects of your health in this decision.

Best wishes,

Marcia

 

[Juan P. Negret]

Thank you Marcia. Besides my mitral valve problem, I am in very good health. No symptoms. The only other medications that I take is one (tamsulosine) to avoid symptoms from an enlarged prostate gland, and another (simvastatin) to help in the control of cholesterol levels.

Juan

 

[ALCapshaw2]

Thank you ALCapshaw2 for your reply and the the www.heartvalvechoice.com link. I found very useful data and charts. Nevertheless, this is the site of the On-X valve manufacturer and cannot be entirely unbiased in helping decide on mechanical vs tissue, or the best model in each.

Do you know of a web site where a good set of CRITERIA (perhaps with some sort of questionnaire and points system) are developed for this mechanical vs tissue decision in an entirely non biased fashion?

Thank you in advance,

Juan

You're not the first to ask for an Independent Comparison of Valves. So far, Consumer's Reports has not undertaken such a study and whenever I ask for someone to perform an independent study and publish their results for FREE, there are Never any volunteers.

On-X reports that their data came from FDA Submissions and other 'official' reports.

FYI, ALL the main 4 Mechanical Valves were designed in part of whole by Jack Bokros, Ph.D., whose group created the Pyrolytic Carbon used in the leaflets. The St. Jude Valve was his First Project, about 30 years ago. He then formed Carbomedics to produce Pyrolytic Carbon products. He holds patents on Carbomedics and ATS Valves. He developed the On-X valves to minimize the deficiencies in the Older Mechanical Valve Designs.

Which would you prefer, his FIRST Design (with a 30 year track record for reliability) or his Latest Design based on 30 years of experience designing Heart Valves (with 70,000 valves sold in 64 countries over the last 12 years)?

Do a Search on VR.com for keyword "Bokros" to find posts detailing his background and history.

IF and when you discover any independent studies, please let us all know where to find them.

Two Highly rated Surgeons, Dr. Pettersson at Cleveland Clinic, and Dr. Puskas at Emory University in Atlanta have stated that the On-X Valves offer the best Mechanical Valve performance available in their opinions based on posts by some of their patients here on VR.com. Dr. Puskas is heading the NO/Low Anti-Coagulation Study of the On-X valve.

Whatever you choose, it will be better than NOT replacing your diseased valve. It's your choice.

 

[Marty]

On June 25 I will undergo surgery because of a mitral prolapse. In case the valve cannot be repaired, very soon I need to tell the surgeon the type of replacement valve that I want.

What criteria can I use to help me in this decision? I have no symptoms, but the valve has severe regurgitation, my right atrium is severely enlarged, and my left ventricle is enlarged. In two months I will be 60 years old. I am in good health, a bit overweight. I do not practice sports, besides walking about a total of 3 hours a week. I am disciplined with my medicines.

My first decision has to be between mechanical or biological.

I appreciate any suggestions. Thank you in advance,

Juan

My advice, go mechanical, go On-X. I was 72 when my surgeon made the decision. Now 10 years later I'm happy not to be facing another valve surgery.
Anticoagulant therapy has been easy for me and my wife is now on it also. We self monitor and self dose. If you elect the ON-X you may be able to go on aspirin alone after the results of the PROACT study are in.

 

[Lynlw]

My advice, go mechanical, go On-X. I was 72 when my surgeon made the decision. Now 10 years later I'm happy not to be facing another valve surgery.
Anticoagulant therapy has been easy for me and my wife is now on it also. We self monitor and self dose. If you elect the ON-X you may be able to go on aspirin alone after the results of the PROACT study are in.

I don't believe any of the current studies /trials will allow patients to just go on aspirin.

 

[Juan P. Negret]

For independent comparison of valves, I found several academic articles. Their abstracs (summaries) are found thru PUBMED (http://www.ncbi.nlm.nih.gov/pubmed/). For some, the full article is also available there. All articles are available at libraries.

The following are interesting articles:

Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial.
http://www.ncbi.nlm.nih.gov/pubmed/11028464?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

Long-term outcomes with mechanical and tissue valves.
http://www.ncbi.nlm.nih.gov/pubmed/11843524?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

Choice of prosthetic heart valve for adult patients.
http://www.ncbi.nlm.nih.gov/pubmed/12651032?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedreviews&logdbfrom=pubmed

Selecting the best heart valve for your patient: mechanical or tissue.
http://www.ncbi.nlm.nih.gov/pubmed/15805765?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

Mechanical versus bioprosthetic valve replacement in middle-aged patients.
http://www.ncbi.nlm.nih.gov/pubmed/16857373?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed

Selection of prosthetic heart valves for adult patients by age
http://www.ncbi.nlm.nih.gov/pubmed/17405540?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

Juan

 

[dtread]

Juan, there is some bad information about the On-X Clinical Trial in this thread.

READ MY LIPS: Nobody will be on Aspirin alone after the On-X Clinical Trial, unless they do so by choice. I posted the following just two weeks ago in response to the same bad information that was put in thread about "Wiggletts MVR or Replace":

The Clinical Trial with the On-X will not result in anyone just being able to take aspirin. Low risk AVR would have to take Clopidogrel (i.e., Plavix) and aspirin (or have the option of remaining on Warfarin [aka Coumadin]).

There are three arms to the Trial: low risk aortic valve replacement - aspirin/Plavix, high risk aortic valve replacement - Coumadin at INR of 1.5 to 2.0 plus aspirin, and mitral valve replacement - Coumadin at an INR of 2.0 to 2.5 plus aspirin.

Recommend you read the Clinical Trial: http://www.clinicaltrials.gov/ct2/show/NCT00291525

I had roughly the same quandry you had two years ago only my decision was for aortic versus mitral. I was 58 at that time. It is a tough choice. However, I made my choice to go mechanical because I am very active physically and did not want the prospect of having to go through another open heart surgery to replace a biological 15 - 20 years later. By then I figured I'd be near 80 and the surgery could likely kill me, plus just the idea of having to go through the surgery is enough to spoil your whole attitude. And, I figured a biological would degrade over time so the last few years of its life might impact my health.

Good luck on whatever decision you make.

 

[Ross]

Look at the price of Plavix vs Coumadin. You'll have a heart attack just doing that. In my opinion, Plavix is far more dangerous then Coumadin. I've been on both and Plavix seems, at least to me, a very real beast that I cannot live with.

Plavix - 75mg Tablets 30 tablets $151.94 - save 16% ($28.09)
Coumadin - 5mg Tablets 30 tablets $45.81
Warfarin Sodium - 5mg Tablets 30 tablets $13.99 - save 30% ($6.00) Or go to Walmart or similiar and get it for $4 for a 30 day supply or $10 for more.

http://www.drugstore.com/templates/...0663&trx=GFI-0-ROTABS&trxp1=10663&trxp4=10785

 

[ALCapshaw2]

To my mind, the MAIN Benefit of the On-X Valves is that they appear to have the Lowest Risk of Clot Formation among the Mechanical Valve Choices. In addition, On-X is the ONLY manufacturer that provides a Barrier to retard / prevent Pannus Tissue Growth which can impinge the leaflets or at least limit their range of motion.

The Low / NO AntiCoagulation benefit is a Direct Result of the Above, which to my mind is a potential secondary benefit. (Personally, since I am already on Coumadin, this potential benefit is of little interest to me. Minimizing the risk of clot formation / stroke is of GREAT interest to me.)

Patients who choose to use the On-X Valve receive the Primary Benefit from DAY 1 and it is there regardless of the outcome of the PROACT Low/NO Anti-Coagulation Studies.

 

[Lisa in Katy]

It kind of depends on how long you think you're going to live. If you are in good health at 60, you've probably got many more years ahead of you. I plan on my mechanical St. Jude's lasting forever, but have begun to think about "what if". Here's where I am right now. At 60, I would still go for mechanical. My grandmother just passed away at 100, so if I went with tissue at 60, there's a good possibility I would need it replaced at least once and possibly twice. However, at 70+, I would strongly consider tissue. The newer ones seem to be predicted to last 20 years. As I am getting older, my skin is getting more fragile and I am prone to bruising. Prior to her death, my grandmother barely had to touch something to cause major bleeding and bruising, so I think Coumadin could be an issue for me as I age.

As far as the best valve, I would find a surgeon that I trust with my life (literally), and defer to him.

 

[Lynlw]

I'm not sure if this is helpful to what you are looking for it is pretty recent (2007) from the AHA http://www.circ.ahajournals.org/cgi/content/full/116/11_suppl/I-294