One valve for life?

[rcatalano]

Jim,

First, let me say that in your shoes (and I have been there), I would go for some type of tissue valve for the first go around.

Now I must admit the surgeon said a couple of things that are bothering me. One being that Coumadin requires a lifestyle change. The second being a mechanical valve would last 30 years.

I'll let you know when I get my medical degree and complete 150 Ross procedures before I try and refute him.

It's a moot point, however, since I feel strongly that the surgeon is more important than the valve type. I have no doubt that whatever you do, you will come thru this with flying colors.

Be warned, I am calling the hospital in advance to remove any stationary bikes from the premises - can't have you pulling an Arnold!

 

[Mara]

Jim-

This is, I think, the hardest part of the whole surgery: deciding which valve to get.

I had the Ross Procedure with the Cryolife SynerGraft. I am extremely happy. It has been a little over 2 years since my surgery and I am doing something I would never have done before the RP--- playing soccer in a women's league!

I feel great. And the cardio says that i am now "normal." (except for being a little nutty.) No murmurs, no drugs, just the scar.

But, only you and the surgeon can make the call.
The rest of us can only give our personal endorsements on what worked for us.
Good luck. You can't pick the wrong valve, you just have to pick the one that's right for you.
-Mara

 

[chilihead]

OK Rob,

But I do have a spinner bike in the bedroom at our home, so look out. Mara, thanks for the advice. Like I said, I'm trying to decide between a tisse valve and the Ross. The doc said I could also have a Ross with a new tissue valve for the Pulmonary side. Did your surgeon suggest such a thing?

 

[DANIEL]

Everyone's choice and results are different. I had the Edwards-Carpentier Bovine Percardial sew-in on 07/02/03. Went to my first echo-cardio on 9/02/03 and all was looking fine. Went to the gym for the first time last Saturday and did 30 minutes of cardio.
It is amazing, but my life is pretty much back to "normal". Also, I am a single parent with a 14 yr old.......now that is stress !
Today my chest is not sore, but I did lose some chest/arm muscle mass and am very careful - will only use light-wt/free wts for the next few months. I thought that I was asymtomatic prior to the surgery, but can breathe so easily now so I wonder just how asymtomatic I actually was.......I am very active outdoors and had to make a decision re mechanical or not. There are no guarantees no matter which valve you choose. I agree 100% the most important decision is to pick the surgeon you feel is the best for you. The surgeon is one member of an entire team so ask about the cardio-staff. Personally, I agree with Ross about the Ross Procedure. Whatever you chose you need to totally embrace, have complete confidence and you will do fine.

 

[DANIEL]

Dang fool AHHNULD

Dang fool AHHNULD

Just a note:

Arnold blew the new AV out and they had to replace the AV with a homograft as the pulmonary they put in place for the AV was ruined. Not the smartest move for the next Guv.

Not back to riding but have an '73 Raleigh Pro - all Campy -
531 double butted - sew-ups.....must seem liike a Model T to you.

 

[Mara]

Jim

I had a choice of a regular tissue valve for the pulmonic, but got the SynerGraft instead. It was what my surgeon thought was best.

-Mara

 

[MarkU]

I chose a mechanical valve and was willing to accept the consequences being on Coumadin in order to avoid additional surgeries down the road ( I was 47 at the time 2-1/2 years ago).
I am fortunate in that the Coumadin hasn't affected my lifetstyle at all, and I feel better than I have for years. I had to give up heavy weight-lifting, but I having started training with the goal of doing a sprint triathlon next summer.
I feel very lucky and blessed. Every day is a good day.
Mark

 

[chilihead]

Daniel,

You can't go wrong with Campy! Glad to hear you're doing well. I'm looking at the Carpentier-Edwards PERIMOUNT aortic Pericardial Biologic valve. Is that what you got? How long did they say it should last?

Regards,

Jim

 

[Kevin M]

Jim, I don't understand why your doctor would consider two different Ross procedures, but ignore the bovine, homograft (non-Ross) and stentless porcine valves?

They are far more common procedures than the Ross. Not that the Ross isn't solid, but it just seems odd that he would not bring these up as alternatives given your age and the fact that it sounds like your health is very good aside from your heart problem.
Kev

 

[chilihead]

Kevin,

He did give me that option. He said I should either go with a stenless pig, a regular Ross with cadever valve for the pulmanary side, or a Ross with the pig valve used in the pulmonary position.

I'm just trying to find out the difference in estimated longevity is between the standard Ross and going with a single valve replacement of my bad aortic with one of these new pig valves.

The idea of using the pig vlave in the pulmonic position is too new to get any data on. It's just a thought by the doctors in this heart group I'm seeing.

How long did they tell you your valve was good for?

Regards,

Jim

 

[HFK]

It's so great to read everyone's experience, one area I believe that is making head way is tissue valves and homograft valves,cyrolife and Medtronics and other companies are working hard to preserve the life time of these valves.The Mosiac v. and a few others are out with anew coting on them to help prevent deterioration I have homograft valve and love it its been 3 yrs. Have other problems not related to aortic v. You really have to look at your own lifestyle and feeling toward coumadin,sometimes its not longevity of life but the qualitiy. I know people with pig valves in for 20 years= and some only 12. Like I've said before and someone else made coment "their are no 100% guarantee with any valve ." Its a hard choice, I was a competive racqetball player so I decided and my Dr that coumadin was for me. hfk

 

[Granbonny]

Jim

Jim

Have you a date set for your operation? How's the new baby? Know you love to bike. Did I hear Lance Armstrong is getting a divorce from his wife? think I read it.. Let us know your surgery date. We put them on calendar. Whatever your choice for a valve will be a good one. You will feel so much better....down the road. Bonnie

 

[DANIEL]

Cannot find the warrantee !!

Cannot find the warrantee !!

Jim,

Still rides great and has been everywhere !

Yes the CE Bovine Pericardial Biologic valve 27mm is the one that I chose and got. Sorry, no one is giving me any estimates regarding how long it should last. However, recent studies have shown that this valve is still functioning after 15 years in patients who received it with an average age of 60 years. The average age is an important number as the older the recipient the slower the valve will calciify and this is the major determining factor re how long the valve will function properly. I have two friends who received mechanical valves in the 80's and both are doing fine - though they are not very active do to their choosing/lifestyles. My surgeon knew of a patient with a porcine valve going on 22 years. I spoke with a mechanical valve recipient who needed a replacement after 5 years due to leakage.....If I get 12 years or so from my Bovine I will consider it a fair deal !!! I am hoping that in 12-15 years medical science will evolve to the point where my next valve could be a 3rd generation tissue or a clot-free mechanical. When talking to my friends with the mechanical valves it is amazing how different our hospital experiences were, giant leaps in technology. They were amazed when they visited me the day after my OH surgery.

Find the best surgeon - the one who you have the most confidence in. You will do fine. Keep up the positive attitude.

 

[DANIEL]

PS

PS

Yikes.

Meant to say that the CE Percardial valve is still functioning AFTER 15 YEARS in 90% of the recepients that received it.....!!!


Daniel

 

[Kevin M]

For Jim

For Jim

Jim, as per your question, my doc said this stentless porcine valve would last probably 20+ years. The previous doc said my homograft would last 25+ years (it lasted 10). I don't believe a word they say unless there is research to back it up. Ultimately, we are all guinea pigs to some of these guys.

I will be happy if my stentless pig valve lasts 15 years. In fact, I would be delighted if it lasted that long.
Kev

 

[Gail in Ca]

I just got the regular pig valve in '89, and got 11 yrs out of it.
My surgeon said he had seen upwards of 15 or more with this valve, but this is very rare. I exercised regularly and considered myself in great shape, but still only got 11 yrs. I read that the new tissue valves last longer and I am glad for those that have one of those.
I would get the tissue valve for the first surgery again, if I had it to do over.
But, remember, the second surgery comes as a surprise that you think you are ready for, but when they say 'you must have that pig valve replaced', you are not ready at all for another go round with open heart surgery.
I have not been told by my cardiologist or surgeon that my mechanical valve would only last 30 yrs or whatever. I was told it would be the last valve I would need (in the aortic position, that is), and that if I ever need my leaky mitral replaced, I would have surgery thru my rib, not sternum, to replace it.
As far as sports go, I would say that if you don't fall much, mountain biking would probably be okay. Only you can make the decision on which activities to discontinue or to keep going.
You basically feel the same with a mechanical, it's just the coumadin and the problems if you were to get a major contusion from a bad fall.
However, after a tissue valve, you feel like yourself again with only the scar as a reminder that you ever had someone touch your heart!
Gail

 

[KathyH]

Jim,
Good luck with your surgery. You certainly have gotten alot of responses with alot of good information. Sounds like liking your surgeon is the biggest factor and going with what he/she is most comfortable with. It seems that everyone has different opinions on how long the valve lasts.
Kathy H

 

[chilihead]

Kathy,

That is an understatement! I think it's not so much how ;long the valve will last, in the case of the mechanical, but rather how long the sutures will last holding it in place.

The surgeon I am seeing now also said he could do a minimally invasive, through the rib, operation to put in a mechanical in the aortic position if I wanted.

I'm still leaning toward the Ross, since I am fortunate to have a Ross expert here in Dallas.

Take care,

Jim

 

[Andrea]

I was under the impression from my doc that my mechanical would last my lifetime, but I'm only 32. Now I'm worried.

I have had my mechanical for about 5 months now and the coumadin is no bother. My doc said I can do anything I normally would but to be mindfull of potential for a cut. I have had no bruising or anything. To be honest I cant even tell anything is different except I need to recondition which has nothing to do with the coumadin.

I heard the average lifespan of a tissue valve is 8-12 from my docs... but who knows maybe the pigs are healthier where you live

 

[rcatalano]

Andrea,

I know what you're thinking, but don't go there!
If so many brilliantly talented people (heart surgeons) could disagree so completely on this issue, its not worth getting yourself all worked up about it.

Bottom line is, if you're trying to minimize your chances of another surgery, right now I believe a mechanical valve is the way to go.

If your goal is the most perfect replacement to your current aortic valve, there is nothing like the Ross procedure.

Since you had a MVR, a Ross procedure wasn't even an option for you.

I just don't think there is enough data to GUARANTEE anything, just statistics based on the moving target of heart surgery and constantly changing (improving?) techniques.

We all need to monitored closely for the rest of our lives - just take it one check up at a time!