Repair vs replacement for mitral valve

[Praline]

Not really a valve selection question but I was not sure where it belonged on the forums. Is a repair better than a replacement? I can see all the advantages but how about the length of time it lasts?

 

[geebee]

Praline,

I believe a repair could last as long as some tissue valves. It will eventually require a replacement because it will continue to suffer from whatever caused the problem in the first place.

I have seen repairs last years and some last only a few months. I do not know why that is but I am sure you will hear from others.

My valve was unable to be repaired although a repair is what the surgeon was hoping for during my first OHS.

 

[bvdr]

Praline,

I believe a repair could last as long as some tissue valves. It will eventually require a replacement because it will continue to suffer from whatever caused the problem in the first place.

I have seen repairs last years and some last only a few months. I do not know why that is but I am sure you will hear from others.

My valve was unable to be repaired although a repair is what the surgeon was hoping for during my first OHS.

Geebee, I don't know why but I never really questioned but that a good repair was a permament fix. It isn't the case of course with valvoplasty that basically only temporarily enlarges the mitral and then it is expected to slowly stenose again but I just assumed that it was a final fix. I was told that "rheumatic valves aren't worth repairing" so I would expect that repairs done to them might not last but you really have me thinking about other repairs. Now I have to research a whole new area. For our repaired folks I sure hope it was a one stop deal. What would be the advantage over a bio if both lead to a re-do later on? I know of ones that didn't last very long too but I thought that to be the exception. Anyway, you've got me curious.

 

[Geo]

Praline,

my wife had her mitral valve repair last 17 years. She then had a replacement 9 years ago with a St. Judes valve. She has been doing great. There are the coumadin issues to deal with but so far so good. Best of luck.

George

 

[bvdr]

Praline,

This is a rather lengthy article but it has a good section on the durability of mitral valve repairs. It might have some helpful information for you.

http://www.dcmsonline.org/jax-medicine/2001journals/Oct2001/valvular.htm

 

[geebee]

Betty,

I am not sure how things work with aortic valves, only mitral and I am most familar with rheumatic mitrals. I am not sure about prolapsed mitrals because I am not sure what causes them to begin with. I do know any repair to a calcified mitral will fail eventually because it will simply re-calcify. I am sure it all depends on what caused the mitral valve failure to begin with. My surgeon told me if he could have done a repair it would not have lasted. However, he always preferred his patients to have their own valves as long as possible even if it required additional surgery.

 

[bvdr]

Betty,

I am not sure how things work with aortic valves, only mitral and I am most familar with rheumatic mitrals. I am not sure about prolapsed mitrals because I am not sure what causes them to begin with. I do know any repair to a calcified mitral will fail eventually because it will simply re-calcify. I am sure it all depends on what caused the mitral valve failure to begin with. My surgeon told me if he could have done a repair it would not have lasted. However, he always preferred his patients to have their own valves as long as possible even if it required additional surgery.

Geebee, I think since both you and I have RHD we tend to reference from that viewpoint. It sounds like your surgeon and mine thought alike. By the way, was your surgeon able to preserve any of your chordae? I agree on the calcification issue. If a valve calcifies once it will do it again.

 

[Christina L]

Thank you Betty

Thank you Betty

for finding this article. I breathed a sigh of relief while reading it. My cardiologist told me he thinks my mitral valve repair for congenital mitral valve prolapse will last my lifetime and I am banking on that. However, as we know the heart is complex and there are MANY other things that can go wrong also, BUT I will try to be positive and trust God for His/Her will for my life.

Thanks again, Betty. As I have said before on VR.com, it seems by reading the posts on this site, that mitral repairs end up in replacements 98% of the time - we have to realize that most of the people who come onto this board are seeking help and encouragement. Most people go on to live healthy, happy lives after a replacement OR a repair, and search out sites such as VR.com only if they have a problem. SO, we have kind of a skewed view of mitral valve repairs on this site, I believe. Most repairs DO last a long, long time, if NOT for the person's lifetime.

Christina L

 

[geebee]

Geebee, I think since both you and I have RHD we tend to reference from that viewpoint. It sounds like your surgeon and mine thought alike. By the way, was your surgeon able to preserve any of your chordae? I agree on the calcification issue. If a valve calcifies once it will do it again.

Betty,

You know, I am not sure about the chordae. I will have to go back and read the surgical notes because I don't think it was ever discussed. I was so very naive about all this back in 1980 that I asked very few questions. Once I woke up and realized I was still alive, nothing else seemed to come to mind.

 

[Praline]

Here are more articles.

Here are more articles.

One oF these articles is from Cleveland.

http://www-cme.erep.uab.edu/onlineCourses/uab_insight/winter05/mitral_valve/ID0227.htm#valve

http://jtcs.ctsnetjournals.org/cgi/content/abstract/115/2/389

http://www.umm.edu/heart/mitral_adv.html

http://www.ccjm.org/pdffiles/Thamilarasan902.pdf

http://www.surgery.wisc.edu/cardio/mitral/repairreplacement.shtml

http://www.uwhealth.org/servlet/Sat...A_UWH_HOME/AArticles/AArticleLink&c=AArticles

 

[MelissaM]

"A major concern of valve repair is that it will fail over time, i.e. experience structural deterioration. Fortunately, with an experienced surgeon, the repairs are remarkably durable. A recent study of valve repair for mitral regurgitation secondary to degenerative diseases found that the freedom from reoperation was 85% at 15 years.12 Repairs of mitral regurgitation due to rheumatic disease do not appear to be as durable, and valve replacement is more common. The quality and durability of mitral valve repairs are significantly related to the experience and skill of the surgeon."

Thanks for posting the link to the above article.

Melissa

 

[RCB]

This researcher is no mathematician or editor

This researcher is no mathematician or editor

Praline,

This is a rather lengthy article but it has a good section on the durability of mitral valve repairs. It might have some helpful information for you.

http://www.dcmsonline.org/jax-medicine/2001journals/Oct2001/valvular.htm

Surgery For Valvular Heart Disease
Harry J. D'Agostino, Jr., M.D., Assistant Professor of Surgery, Division of Cardiothoracic Surgery, University of Florida / Jacksonville


"This past year marked the golden anniversary of cardiac valve replacement surgery. In 1960, Harken1 and Starr2 implanted the first man-made valve prostheses in the aortic and mitral positions, respectively, ushering in a new age of treatment for a difficult medical problem. The last forty years have seen major advances in the devices, the procedures and the results. Heart valve surgery is now routine with low perioperative morbidity and mortality, as well as long-term improvement in survival and quality of life"

It is funny, but I read this article a few years back and the first thing I noticed was the author's error in stating it was the "golden anniversary" of HVR surgery, which we all know will happen in 2010. Even funnier, is the statement in the third sentence(correctly stated) of "forty years" of advances, which directly contradicts the first statement. I kind of dismissed
this paper because of some other problems, but other research seem to be in agreement with his basic thesis on repairs.

 

[Christian]

Everything that I've read indicates that repairs for degenerative (myxomatous) mitral valves (rather than rheumatic) require reoperation at the same rate as mechanical valves. Each person is, of course, different -- both a repair and a mechanical valve could quickly require reoperation for numerous reasons. Or they could last for sixty years. It really all depends on the underlying cause of the dysfunction. If the mitral valve is severely myxomatous, a repair would likely be less durable. If it's only mildly myxomatous, you might be able to bank on a longer-erm fix.