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[Seaton]

Greetings Gia and welcome.

Sorry to hear your tissue valve lasted just 5 years. I had my bicuspid valve replaced August 2019 with a bovine (Inspiris), so we are almost in the same ballpark re dates and age.

I’m always gently alert to the possibility my valve could fail. I had pericarditis in 2020 and thought at first the valve was malfunctioning. But thankfully not!

Can I ask what make of valve they gave you in 2017?

I wish you all the best in the days ahead and a good recovery from the surgery.

 

[Warrick]

Hi Gia, welcome
FWIW if you go the mechanical valve route it should last your lifetime, my father had a mechanical St Jude implanted in 1984 and passed last year from unrelated cancer.
He had no issues from 30+ years of warfarin.
He had childhood rheumatic fever whereas I had a bicuspid valve so unrelated, what was the driver of your AVR?
I take a K2D3 combo daily also, a few years now, I read a few studies enough to tip the scales in its a good thing imo.

 

[vitdoc]

Hello
I’m new to this forum. I’m am currently 62 I had an AVR in May 2017 and opted for a tissue valve. I now need it replaced and am scheduled for surgery on Aug 17, 2022 and have elected to go with a mechanical valve and am looking for information about the valves and surgery outlook. Thanks

I had a sort of similar story except I was much younger (age 29) when I got a tissue aortic valve in 1977. It lasted 5 1/2 years and I got a St. Jude in 1983 and went on warfarin.
The problem you face is that if you have another tissue valve it is very likely it will behave like the first or at least somewhat similarly. Hence you will be looking at another procedure in 6-10 years. So at age 72 or less you will need maybe a TAVR or another open heart. Unless there are breakthroughs in valve design. So I think that the majority of surgeons would likely recommend a mechanical valve with anticoagulation.
Your calcification of your tissue valve should not translate into anything similar with a mechanical valve. But it would likely translate into calcification of another tissue valve.
As mentioned multiple times warfarin especially with self monitoring is not as bad as it may sound. I have been on it for 39 years without major issues so far.
Sure I would love not to be on it and be a perfectly normal healthy person. But I don't want to keep having heart surgery or procedures either with each one having it's own risks and complications and discomfort. Today my biggest decision is whether I want to go on a bicycle ride or not. (it is a bit warm)-age 73.
THERE IS NO FREE LUNCH.

 

[Timmay]

Welcome!

So sorry to hear about this failure. As questioned before, I too am curious which tissue valve you had?

The mechanical should last you for the rest of your life. It’s why “younger” people like myself (and Chuck C, and others) choose them. We’re just not willing to go through another open heart surgery if we can prevent it. More OHS’s are linked with higher morbidity.

… and a TAVR is not a guaranteed future option as many assume.

This is a great place to come and get information, ask questions, get support, opinions, etc. The forum has been invaluable during my aortic valve replacement 10 weeks ago.

 

[nobog]

"Your mechanical valve should not calcify"

It can't, its made of carbon and pencil lead (yup, the inside of a SJM valve is just like a #2 pencil)

 

[Gia]

I had a sort of similar story except I was much younger (age 29) when I got a tissue aortic valve in 1977. It lasted 5 1/2 years and I got a St. Jude in 1983 and went on warfarin.
The problem you face is that if you have another tissue valve it is very likely it will behave like the first or at least somewhat similarly. Hence you will be looking at another procedure in 6-10 years. So at age 72 or less you will need maybe a TAVR or another open heart. Unless there are breakthroughs in valve design. So I think that the majority of surgeons would likely recommend a mechanical valve with anticoagulation.
Your calcification of your tissue valve should not translate into anything similar with a mechanical valve. But it would likely translate into calcification of another tissue valve.
As mentioned multiple times warfarin especially with self monitoring is not as bad as it may sound. I have been on it for 39 years without major issues so far.
Sure I would love not to be on it and be a perfectly normal healthy person. But I don't want to keep having heart surgery or procedures either with each one have it's own risks and complications and discomfort. Today my biggest decision is whether I want to go on a bicycle ride or not. (it is a bit warm)-age 73.
THERE IS NO FREE LUNCH.

Thank you! You are doing great! My surgeon is recommending mechanical for many reasons one being a small aortic root that is calcified and can’t be widened and therefore a mechanical will keep it from further shrinkage. I have calcification in my mitral but the dr thinks that will not give me much trouble since it’s a low pressure system and if needed to be replaced could with TAVR since it has a larger diameter and having a good functioning new aortic value will help as well! I plan to monitor my own INR and not too worried about it.

 

[nobog]

Thank you! You are doing great! My surgeon is recommending mechanical for many reasons one being a small aortic root that is calcified and can’t be widened and therefore a mechanical will keep it from further shrinkage. I have calcification in my mitral but the dr thinks that will not give me much trouble since it’s a low pressure system and if needed to be replaced could with TAVR since it has a larger diameter and having a good functioning new aortic value will help as well! I plan to monitor my own INR and not too worried about it.

Not sure where the dr got that from, the Aortic and Mitral are the high-pressure side of your heart, the Tricuspid and Pulmonary are the low-pressure side.

 

[Gia]

Welcome!

So sorry to hear about this failure. As questioned before, I too am curious which tissue valve you had?

The mechanical should last you for the rest of your life. It’s why “younger” people like myself (and Chuck C, and others) choose them. We’re just not willing to go through another open heart surgery if we can prevent it. More OHS’s are linked with higher morbidity.

… and a TAVR is not a guaranteed future option as many assume.

This is a great place to come and get information, ask questions, get support, opinions, etc. The forum has been invaluable during my aortic valve replacement 10 weeks ago.

Yes doctors involved with TAVR keep pushing it but quickly discovered I couldn’t have one which was disappointing. I had a at Jude Trifecta GT tissue valve that lasted 5 years

 

[Gia]

Not sure where the dr got that from, the Aortic and Mitral are the high-pressure side of your heart, the Tricuspid and Pulmonary are the low-pressure side.

I will talk to him again for clarification it’s possible I missed something but my mitral valve has some calcification but no stenosis. He will only replace the aortic valve nothing else.

 

[vitdoc]

I have calcification in my mitral but the dr thinks that will not give me much trouble since it’s a low pressure system and if needed to be replaced could with TAVR since it has a larger diameter and having a good functioning new aortic value will help as well! I plan to monitor my own INR and not too worried about it.

The actual flow across the mitral valve is relatively slow from the left atrium. When the ventricle contracts the mitral should be closed and is subjected to a high pressure gradient but no flow. The aortic valve has a high gradient when open with ventricular contraction. I believe the difference is that with the high velocity when the aortic valve is open compared to the relatively low velocity of blood when the mitral is open there is more turbulence around the aortic valve which may me a contributor to calcification.
So looking just at flow across the various valves when open the velocity of flow is significantly less across the mitral than the aortic flow velocity.
From Dr. Google: Peak velocity of forward flow is about 1.0 m/s in normal aortic valve, 2.5–2.9 m/s in mild stenosis, 3.0–4.0 m/s in moderate stenosis and more than 4.0 m/s in severe stenosis.
Flow propagation velocity of mitral inflow (Vp) is evaluated as the slope of the first aliasing velocity during early ventricular filling. It is measured from the mitral valve plane to 4 cm distally into the LV cavity and > 50 cm/s is considered normal.
Notice that the aortic values are in meters/sec which the mitral velocity is in cm/sec significant difference.
Finally things get a bit more complicated when there is valve leakage. This can lead to high velocity of flow in the backwards direction with mitral insufficiency.
So I believe that the doctor was thinking about the relatively low pressure across the mitral valve when open.

 

[nobog]

The actual flow across the mitral valve is relatively slow from the left atrium. When the ventricle contracts the mitral should be closed and is subjected to a high pressure gradient but no flow. The aortic valve has a high gradient when open with ventricular contraction. I believe the difference is that with the high velocity when the aortic valve is open compared to the relatively low velocity of blood when the mitral is open there is more turbulence around the aortic valve which may me a contributor to calcification.

I don't know if that's been proven...

So I believe that the doctor was thinking about the relatively low pressure across the mitral valve when open.

True, "flow" (at normal pulse rates) has a longer time to go through the mitral valve than the aortic, thus the lower pressure drop.

 

[pellicle]

Yes doctors involved with TAVR keep pushing it but quickly discovered I couldn’t have one which was disappointing.

its probably irrelevant, but have you looked at how much those valves cost and how much more money a much smaller team bills?

Its probably not related

 

[pellicle]

"Your mechanical valve should not calcify"

It can't, its made of carbon and pencil lead (yup, the inside of a SJM valve is just like a #2 pencil)

@Gia specifically its this:
https://en.wikipedia.org/wiki/Pyrolytic_carbon
(which I'm sure nobog knows, but was trying to keep the message simpler, but as I often say the above and provide the link I'll just do it again anyway)

 

[Gia]

The actual flow across the mitral valve is relatively slow from the left atrium. When the ventricle contracts the mitral should be closed and is subjected to a high pressure gradient but no flow. The aortic valve has a high gradient when open with ventricular contraction. I believe the difference is that with the high velocity when the aortic valve is open compared to the relatively low velocity of blood when the mitral is open there is more turbulence around the aortic valve which may me a contributor to calcification.
So looking just at flow across the various valves when open the velocity of flow is significantly less across the mitral than the aortic flow velocity.
From Dr. internet: Peak velocity of forward flow is about 1.0 m/s in normal aortic valve, 2.5–2.9 m/s in mild stenosis, 3.0–4.0 m/s in moderate stenosis and more than 4.0 m/s in severe stenosis.
Flow propagation velocity of mitral inflow (Vp) is evaluated as the slope of the first aliasing velocity during early ventricular filling. It is measured from the mitral valve plane to 4 cm distally into the LV cavity and > 50 cm/s is considered normal.
Notice that the aortic values are in meters/sec which the mitral velocity is in cm/sec significant difference.
Finally things get a bit more complicated when there is valve leakage. This can lead to high velocity of flow in the backwards direction with mitral insufficiency.
So I believe that the doctor was thinking about the relatively low pressure across the mitral valve when open.

Yes! Not pressure but velocity. Thank you so much for that info. My aortic issue is stenosis severe stenosis. The surgeon believes that once the pressures of the aortic valve normalize it will be beneficial to the mitral valve so he isn’t touching the mitral valvue and no need for any bypasses. Had one with the first valve replacement so thankful don’t need anothe.

 

[Gia]

its probably irrelevant, but have you looked at how much those valves cost and how much more money a much smaller team bills?

Its probably not related

Not really I have insurance that will cover all my medical expenses since so have met deductibles!

 

[nobog]

Pressure and velocity are related. Its like this; lets say your body need to pump 5 liter per minute, so the larger the hole, the less the velocity. When your valve is stenotic, that 5 lpm needs to go through a smaller hole. So the velocity goes up as well as the pressure - remember the 5 lpm is the constant. There is no free lunch....

 

[Gia]

@Gia specifically its this:
https://en.wikipedia.org/wiki/Pyrolytic_carbon
(which I'm sure nobog knows, but was trying to keep the message simpler, but as I often say the above and provide the link I'll just do it again anyway)

It says it has some blood clotting repulsion when used for heart valve prosthesis.

 

[Gia]

Pressure and velocity are related. Its like this; lets say your body need to pump 5 liter per minute, so the larger the hole, the less the velocity. When your valve is stenotic, that 5 lpm needs to go through a smaller hole. So the velocity goes up as well as the pressure - remember the 5 lpm is the constant. There is no free lunch....

Yes fluid mechanics and if the valve is stenotic it has deformities which cause turbulence.

 

[pellicle]

Yes fluid mechanics and if the valve is stenotic it has deformities which cause turbulence.

Have you read much in that are? Can send some interesting fluid dynamics modelling papers if interested...

 

[Gia]

Have you read much in that are? Can send some interesting fluid dynamics modelling papers if interested...

I just know what I remember from high school physics! Quit boring but not as it relates to the heart. We are all just sophisticated machines!