Reops with mechanical valve

[ks1490]

Hi,

I am leaning towards going with a mechanical valve (I'm in early 40s) because I do not want to have a re-operation and I've been told that the mechanical valve and Dacron graft will certainly outlive me. My question - is there any information or data out there about the rate and causes of resurgeries with mechanical valves? For example, I can understand that the valve and Dacron may live forever, but will the sutures? Even assuming the surgeon does a 100% top-notch job (which I am confident he will), are there other things related to the mech valve that can break down in over the next 40-50 years, my target age? My question is not related to the coumadin issues. Many thanks for any thoughts or any suggestions.

 

[Bina]

I'm thinking there is no solid data on mech re-ops because there are just too many variables. I do know of someone who had a mech valve for 17 yrs and then it required a suture repair, but maybe the sutures and techniques have been improved now anyway....Otherwise there can occasionally be an issue with pannus growth over the valve impeding the performance.

 

[Read]

Good question..i m looking forward to
hearing the answers ....!

 

[ALCapshaw2]

I have a vague recollection that the leading reason for replacement of mechanical valves is due to Pannus (Tissue) Growth which can impinge or block the motion of the leaflets.

This would be a good Question to ask the various Valve Manufacturers
(ATS, CarboMedics, On-X, and St. Jude).
Check their websites for contact information or search for one of the posts from member "dtread" where he listed their website addresses. (or use Google)

 

[terryj]

My husband went with the mechanical valve at the age of 51 hoping he never has to have it replaced. So far, so good. But, a man I work with has a mechaical valve and had to have it replaced because it was shearing off red blood cells. This was his third open heart surgery because he had the Ross the first time,mechanical second and mechanincal third. he came back to work after 2 months and retired the next year.

 

[ALCapshaw2]

My husband went with the mechanical valve at the age of 51 hoping he never has to have it replaced. So far, so good. But, a man I work with has a mechaical valve and had to have it replaced because it was shearing off red blood cells. This was his third open heart surgery because he had the Ross the first time,mechanical second and mechanincal third. he came back to work after 2 months and retired the next year.

The Newest mechanaical valves have greatly reduced hemolysis (damage to red blood cells), equivalent to tissue valves, and have a barrier to retard (prevent?) Pannus Tissue growth. If you've read my valve selection posts, you know the manufacturer's name.

 

[Lynlw]

I don't have the link right now, but seem to remember, from reading the last couple posted studies about tissue/mech valves, (I think it is the study Bill posted) that about 6% of the mech valves needed replaced

 

[dick0236]

Hi,

Even assuming the surgeon does a 100% top-notch job (which I am confident he will), are there other things related to the mech valve that can break down in over the next 40-50 years, .

The short answer is "yes", there are events that can cause reops in mechanical valve patients.....and I have worried about most of them, including suture failure, at one time or another. Take it from somebody that is in the middle of your 40-50 year timeline, it ain't worth worrying about all the "what ifs". As one of my docs told me a couple years ago....."you will die of something, but it probably will not be valve failure".

You will be hard pressed to find much history going back 50 years since the first successful valve surgery was done in 1960.....50 years ago, this year. The gentleman who got that valve, Mr. Philip Admundson, lived 10 years with it and died not because of the valve, but because he fell off a ladder while working on his roof......go figure.

Best to consider "what if" I couldn't have this surgery.

 

[njean]

I had to have a re-op six months after my double valve implant in 1975 due to the sutures breaking loose from the mitral mechanical valve. But, I had also been through a very difficult time during that time, i.e., divorce, heavy lifting of stuff I should never have been moving or lifting so shortly after my first surgery, & the stress & emotional upheaval of everything.

In fact, the surgeon said that if I hadn't gone through all of that mess, the re-op would probably never have happened. It was a very rare & sad thing to go through. And yet, despite of all of that, here I am, 34 years later talking to you about it!

So, if I were you, I'd focus instead on going through with the OHS & having a better & longer life ahead of you!

Wishing you the very best!

 

[mac]

One way to look at it is if you get a tissue valve you can plan on getting reopened in 10 to 15 years. And according to my surgeon at Mayo, sometimes within a year. I thought seriously about a tissue valve, but after 15 min of conversation with him my mind changed completely. He told me he did not want to reopen me in 10 years, and ya know he was right. I really do not want to go through this agin. Yes there is a chance of issues with mech. valves, but according to my surgeon far less than tissue. He was pretty serious that my valve will out live me. I was worried about taking warfrin, thats why I was considering tissue even at 56 years old. Well my surgeon told me that thousands of people are taking it with no issues. I have to agree, havn't changed my life style much, eatting pretty much the same things still having acouple beers now and agin and my blood work was stable in 2 weeks and my numbers havn't changed much since.
Anyway, just my 2 cents. There are much more knowledgeable folks around here.

Later,
Mac
AVR single by-pass 11/19/09
Carbomedics mechanical
Dr. Suri
Mayo Clinic

 

[Nancy]

I think a lot of folks (but not all) who have to have reops or repairs with mechanical valves have possible tissue problems and/or suture problems. There are some valve conditions that cause fragile tissues which can cause suture failure.

It is not a terribly common thing, but it does happen. It happened to my husband with his mitral valve.

 

[Superman]

I received a mechanical valve just before I turned 18. I had a re-op 19 years later, but not due to the valve. My aorta finally started to go, since they had to replace that, I got an updated valve at the same time. Since you're getting both at once, I don't have an answer for you. I can tell you I was happy with the mechanical valve performance and went with it again. Had I gone tissue, this likely would have been my third operation. I'm still in my 30's and too young for that. Who am I kidding? I'm too young still for my first operation. Oh well.

 

[PeoriaValveUser]

On my second Mech Valve

On my second Mech Valve

My first AVR was a mech in '96. It only failed 9 years later from bacteria, (possibly from a dental infection), eating away at the sutures. It was replaced in '05 with a porcine valve and a pacemaker.In Feb of '09, they detected regurgitation due to a tear in the valve. 4 months later, they replaced it with a mech valve. I've had no problems with the valve, so far. As a result of the bacterial endocarditis that caused the first failure, I'm having problems with my short term memory and other mental 'bugs'. I may have dental work later this year and I will take precautions against another bacterial infection.

 

[Mentu]

KS, here is my penny's worth. The newest generations of valves have been reconfigured to improve performance and to reduce the possibility of problems that have been encountered in the past. Whichever valve you and your surgeon select it is likely to serve you very well. You can use statistical studies to guide you but always keep in mind that statistics apply to groups not to individuals. None of us can anticipate the problems we may encounter in the future but there is one thing that we do know. Without our new valves, there is no future.

Many of us have agonized over the issue of valve selection but in the end it comes down to selecting the valve about which you (guided by your surgeon) feel most confident. From there, you cannot control what happens to the valve itself once it is part of you. What you can control is planning and implementing your post surgery recovery plan to restore your heart and body to health. One of the results of all of the testing, analysis, surgery and all is that you are going to know more about the state of your own health than most people around you will ever know about their's. You can use that knowledge to make a difference in your life and that may well prove more significant to your future than the selection of any one valve.

Larry

 

[Gail in Ca]

I don't know the statistics, but I am living it. 3rd surgery in 20 yrs, replaced mechanical due to BE. My new valve was sewn into a graft, so the stitches are on the outside. My surgeon explained that would be better for me, if BE ever enters the picture again. I am surprisingly feeling very good. I don't feel like I've been thru 3 surgeries!

 

[Ross]

There may be data and studies out there, but in all honesty, they aren't worth the paper they're written on if something happens to you! There are no guarantees with any valve, mechanical or tissue, but mechanical gives you the best shot at no more surgeries. No one should have to go through this surgery more then once and preferably, not at all, but that's not the reality of it. Each time you go through surgery, your other organs take hits as well as your heart. I'm for anything that will keep you off the table in the future if at all possible.

 

[tobagotwo]

It's very difficult to get any good numbers about reops with mechanical valves, because frankly, most of the long-term studies were done when the main valve out there was the Bjork-Shiley, and not so many since the bileaflets came in. Charts on an On-X site that purport to show how wonderfully the On-X performs over time actually measured only four years of On-X performance against 20 years of other products. Hardly a benchmark. All of the apples-to-apples indicators were left off of the charts. I would not ask manufacturers for numbers, because they creatively post correct numbers in ways that that give very misleading information. That said, the quality of their marketing organizations fortunately does not impinge on the quality of their products.

However, even if you look at older mechanical valves after 20 years, the reoperation rate is definitely less than 10%. I would place it closer to the 6% Lyn mentions above. And only a tiny percent of that 6% is because of the valve itself.

And therein lies the rub. It doesn't matter if the valve is directly at fault. If you have to have your chest cut open, it's a reop for you.

The major reasons for reops for someone with a mechanical valve are infectious endocarditis, aortic aneurysms, loosened suture (usually caused by myxomatous - weakened - tissue from connective tissue disorders failing to hold it, rather than the suture itself breaking or loosening up), interfering pannus (scar tissue growth), a clot on or under the valve, slow growth of natural tissue over the valve leaflets ("vegetation"), a need to have another valve replaced, extreme hemolysis (damaging of blood cells by the closing action of the valve), a valve that's misplaced or that shifts due to myxomatous tissue (rubs against side of aorta, interfering with operation), loss of a leaflet or other structural fault. There is a somewhat higher risk for mechanical reoperations, due mostly to incomplete anticoagulation postoperatively.

In your early forties, I believe you would be fortunate to have a tissue valve last even ten years. However, your chances are extremely good that a mechanical valve will last at least 20 years.

There are excellent odds (94%) that you could be a 94%er. So, if your goal is to avoid reoperations, and you're not a candidate for a Ross Procedure, mechanical is certainly the best way to go.

Best wishes,

 

[Philip B]

Reops

Reops

I'll simply restate what others have said about valve replacement not coming with guarantees. I know that's not much of a reassurance when one is looking for a sure thing. Unfortunately, there are simply too many variables which are individual.

Many of us have made the choice to go with mechanical valves because we felt the odds of avoiding a reop were decent. None of us can see that future which is waiting just over the horizon.

-Philip

 

[Erika]

Hi.

I had an AVR done with an On-X mechanical valve. I also had an aortic root + arch repair done with Dacron in October 2008. In all of my research and in talking with my doctor, no concerns were ever raised about the longevity/durability of the sutures. On-X did not make a valve + sleeve already connected (like St Jude valve sleeve) at the time of my surgery. So, my team actually had to attach the sleeve to the valve all during my procedure. So far, all is well with me. Sorry I don't have any specifics but I hope that helps a little.

Erika

 

[JiminMI]

Hi.

On-X did not make a valve + sleeve already connected (like St Jude valve sleeve) at the time of my surgery. So, my team actually had to attach the sleeve to the valve all during my procedure.

Erika

Just wondering why On-X wouldn't make the sleeve with the valve (??) If it's a necessary part of a valve replacement procedure, seems to me that this is kind of a negligent omission on the part of a valve manufacturer!