Pls if anyone has their valve replaced with the inspiris resilia comment.

[carolinemc]

This must be the third or fourth time I've seen you chime in with this type of post recently. I dont know what you have against tissue valves but you clearly do have some issue or other and believe they are flawed from the outset and that its all about revenue for doctors.

I reported the post of his. He is being very morbid.

 

[stephenismycopilot]

Does he have a mechanical himself? Does he have a tissue valve? Is he taking warfarin for something else and had a bad experience? Has he ever had to make either choice for real? Or just in the hypothetical world of patients he likely will never see again?

As far as I know, he has neither, but is excited about the new generation of tissue valves' longevity and the possibility of TAVR, which I know has been dangled like the proverbial carrot for decades. That and avoiding warfarin (and I did not ever really stabilize on it during the three months post-surgery), plus because my heart was enlarged there was the possibility of having to spend a few days on a life support, during which time he figured a mechanical valve would be more likely to clot. I'm happy with the decision, aware intervention will likely be needed in future, and academically curious to see how the technology continues to evolve. I could also be run over by a bus tomorrow. I'm of the mind that there are no "wrong" decisions in valve choice, and I say that having agonized over it before my surgery. Everyone's priorities and lifestyles are different, and views can evolve over time. The big picture point is that it's pretty fantastic that we have all these options, and I marvel at the science that keeps us alive to argue about it on the internet.

 

[pellicle]

My understanding is that biological/tissue valves used for replacement are treated with a chemical that makes them “immunologically inert" reducing or eliminating the chances of the body rejecting them.

your understanding is correct but it goes further

1. this treatment is not 'infinite' in its duration and is under constant attack
2. because the "bio" valves are not living no materials within them can be repaired or regenerated, so like a leather wallet they wear out from simple repeated mechanical bending (every beat)
3. there is almost no chance of them being "rejected" (I've never once heard or read of it but I'm reluctant to say "no chance"

IF you are genuinely interested in this topic much is written, but the usual process is that people only say they want to inform themselves, my observation is in the main they want to research that their position was the right one. The following is excellent reading if you are genuinely interested

https://www.ahajournals.org/doi/10.1161/JAHA.120.018506
The summary position is this:

• at some point in a human lifespan a leather valve works to confer advantages
• at some other points it works sufficiently for the expected duration of the person
• women in childbearing years can avoid the difficulty of managing warfarin (which we see isn't really that difficult)
• at some other point (younger) the choice to get leather will ruin you more than it will help you. (*for instance I had my 3rd OHS as a mechanical at 47, its now already 10 years old. If I get to 67 it will be 20 years old and I'd have nearly zero chance it would be still functioning)
• people are crazy about warfarin and are in the main misinformed, this drives decisions not based on substance but on emotions.
• it is very unlikely that I will ever need a reoperation driven by my valve - even if I live another 30 years. IF I even make 75 the last thing I'd want is the thread of another OHS (having had 3), for my health would surely be impacted negatively by that.
• people only think in black and white (often death or not death) but there are many other factors they ignore (and are not published)

Best Wishes

 

[pellicle]

We’ve seen upwards of 20 years for homografts (why aren’t they more common?).

in short:

1. availability of good viable tissue (is insufficient to meet demands)
2. high specialised skill levels required to implant them (successfully)

The upwards of 20 years however is confined to specific groups:

Freedom from reoperation for structural deterioration was very patient age-dependent. For all cryopreserved valves, at 15 years, the freedom was​

⦁ 47% (0-20-year-old patients at operation),​

⦁ 85% (21-40 years),​

⦁ 81% (41-60 years) and​

⦁ 94% (>60 years). Root replacement versus subcoronary implantation reduced the technical causes for reoperation and re-replacement (p = 0.0098).​

*(as you may recall I'm one of those who got theirs at "tier two") but (based on the evidence from explant due to aneurysm) it was in the "failing stages" and I may have only got another 2 or 3 years longer (making it 23).

 

[tom in MO]

your understanding is correct but it goes further

1. this treatment is not 'infinite' in its duration and is under constant attack
2. because the "bio" valves are not living no materials within them can be repaired or regenerated, so like a leather wallet they wear out from simple repeated mechanical bending (every beat)
3. there is almost no chance of them being "rejected" (I've never once heard or read of it but I'm reluctant to say "no chance"

IF you are genuinely interested in this topic much is written, but the usual process is that people only say they want to inform themselves, my observation is in the main they want to research that their position was the right one. The following is excellent reading if you are genuinely interested

https://www.ahajournals.org/doi/10.1161/JAHA.120.018506
The summary position is this:

• at some point in a human lifespan a leather valve works to confer advantages
• at some other points it works sufficiently for the expected duration of the person
• women in childbearing years can avoid the difficulty of managing warfarin (which we see isn't really that difficult)
• at some other point (younger) the choice to get leather will ruin you more than it will help you. (*for instance I had my 3rd OHS as a mechanical at 47, its now already 10 years old. If I get to 67 it will be 20 years old and I'd have nearly zero chance it would be still functioning)
• people are crazy about warfarin and are in the main misinformed, this drives decisions not based on substance but on emotions.
• it is very unlikely that I will ever need a reoperation driven by my valve - even if I live another 30 years. IF I even make 75 the last thing I'd want is the thread of another OHS (having had 3), for my health would surely be impacted negatively by that.
• people only think in black and white (often death or not death) but there are many other factors they ignore (and are not published)

Best Wishes

Your summary does not reflect the article. For example, not sure where you got "leather" valves; the word isn't used once in the article. They also don't use the word "warfarin", "misinformed", etc. Where do you get this stuff from? For example, many of the anticoagulation remarks concern Biologhical Heart Valve (BHV) not Mechanical Heart Valves (MHV). Per anticoagulation therapy for mechanical valves:

MHVs are durable yet highly thrombogenic, which necessitates life‐long use of anticoagulants. In contrast, BHVs do not require anticoagulant therapy and demonstrate excellent hemodynamic properties similar to those of native valves; nonetheless, their durability is limited because of inevitable structural valve degeneration (SVD), a dangerous condition eventually requiring redo valve replacement, a major surgical intervention.​

​

What I found interesting is this "As of today, there is no Food and Drug Administration–approved therapy to control SVD [structural valve deterioration of bio-valves]. Conflicting evidence on the effectiveness of statins to treat SVD may be explained by multifactorial nature of this condition."

And this:

Another point that may be important in evaluating the treatment outcomes is that SVD is a process rather than an event and ideally should be measured repeatedly over time, albeit in certain cases even serial echocardiography fails to provide a reliable snapshot of SVD. Hence, temporal patterns of SVD development, including the rate of its progression, might be taken into account when assessing the clinical efficacy of the respective therapy. In addition, consideration of the redo surgery as the only clinical definition of SVD results in a bias because some patients with SVD are not eligible for the reintervention. Therefore, a need to perform a repeated heart valve replacement surgery (which may also depend on the comorbid conditions of the patient), but not reintervention itself, should be more frequently used as an SVD definition in clinical studies. ​

 

[hevishot]

I will follow your results with interest (academic of course because I personally would rather die than have a 4th OHS).

Be careful what you wish for.

 

[Warrick]

Pretty sure the words ‘wish’ and ‘rather’ have two very different definitions.

 

[hevishot]

Pretty sure the words ‘wish’ and ‘rather’ have two very different definitions.

OK. "Be careful what you "rather" for." Better?

 

[Warrick]

Scodey

 

[Daniel758]

I had my IR tissue valve surgery in April 2018 at age 54 and it's still going strong with absolutely no issues whatsoever (other than an afib episode a month or two after surgery).

It's been nice not having to worry about my heart every day and being able to do things without restrictions again.

Ex. I retired in 2001 from an office job to fulfill a lifelong dream of building my wife and I our dream home (by ourselves, contractors limited to foundation and HVAC).

I never expected to be able to do something like this again with my heart problems but now, after my surgery, I'm wrapping up a cabin rehab that I'm doing by myself. It's been crazy fun and I can't wait to get to work every day.

It's truly a second chance at life that I will always be grateful to my doctors, etc. for being given.