Replacement valve failing, why?

[anne casey]

My mother's pig valve isn't even 2 years old and is failing! she is already in the serious stage. how often does this happen? and why? She's in her early 80's and the thought of going through surgery again is overwhelming. She was told it would last much longer than this. Wish she could have minimally invasive surgery, but they (Mayo) tell her regular surgery is best. has anyone else had a similar situation?

 

[kfay]

At your mother's age, I'd have to suspect that there is something wrong with the valve itself. The younger a person is when they get a tissue valve, the quicker they will need a replacement, however, even 2 years in a very young person is very unusual. What brand valve does she have? Which valve is it that needs to be replaced? What did the Mayo say about the early failure?

I'm so sorry for this news and I'm sure it is shocking. They do valve surgery on patients this age more and more frequently with good results. You have a very good medical team behind her.

Kim

 

[Duffey]

I can only imagine how heartsick your mother and your family is over this development. When she had her original replacement, she would have received a card stating the particulars of the valve and a way to communicate with the company. I would start with the company to find an answer. As Kim stated, it probably is a valve failure, and the manufacturer wants to know about it too.
It is a replacement for the aortic valve? Was the original replacement done at Mayo? I think you still have time to investigate options if the valve is still in the serious stage. If it were me, I would try to get a second opinion for what type of surgery can be done, and I would definitely want to know why this valve failed before I had another one put in.
Please keep us informed and let us help in any way we can.
Mary

 

[anne casey]

Thanks Kim and Mary for the posts. Helps to hear from others.

The cardiologist said there was "conflicting" information on her last report and he was going to consult with others and get back to us. But he did say it's possible they gave her a valve that was too small. I feel really sick about this now, because I think we threw the paper work that came with the kind of valve she got or what company it was from. Do you think her medical records would have this info.? We are thinking of going to Allina in Mlps. for another opinion.

On top of this, my son who is only 15 also has the condition. We just found out about 1 year ago about him. (I was tested and don't have it.) So now I'm thinking how many surgeries will he have to go through in his lifetime? They tell us he'll need surgery within 10 years or sooner. life is tough enough as a teenager without this on his mind too. We aren't telling him about his grandma until we have to.

 

[kfay]

Anne, I'm assuming that since your son has it too, it is her aortic valve? How is her health otherwise? If it is her aortic valve, one option to consider is percutaneous replacement of that valve, unless the one she has now is too small which may make that not possible. The type of valve she received would most certainly be in her surgical notes. Did she have her original surgery at the Mayo, if so, they typically send out copies of all those notes after each visit/hospital stay. Others on here are more knowledgeable than me on this, but I didn't realize that a valve being too small could cause it to fail early, I just thought it could cause other issues.


As for your son, there really is no telling when he will need surgery, and depending on his age at the time, it may be best to consider a mechanical valve for him so he doesn't have to go through numerous surgeries in his lifetime.

Kim

 

[Duffey]

Anne,
I have a bicuspid aortic valve, bav, one son has it, and a grandson (age 2) also has it. Is this the condition you are referring to? If so, your mother actually made it many years without needing replacement, so it's possible that your son will too.
Is it possible the paperwork you threw away was in regards to something else other than her valve? The valve company sends a card with the information on it and mentions that the card should be carried with the valve recipient at all times. Usually it's not something that one would think was unimportant and pitch. Her cardiologist should also have the valve information. Usually when they run an echocardiogram post-replacement, they want the valve information because the echo's software program needs the information to calculate results.

 

[anne casey]

Anne, I'm assuming that since your son has it too, it is her aortic valve? How is her health otherwise? If it is her aortic valve, one option to consider is percutaneous replacement of that valve, unless the one she has now is too small which may make that not possible. The type of valve she received would most certainly be in her surgical notes. Did she have her original surgery at the Mayo, if so, they typically send out copies of all those notes after each visit/hospital stay. Others on here are more knowledgeable than me on this, but I didn't realize that a valve being too small could cause it to fail early, I just thought it could cause other issues.


As for your son, there really is no telling when he will need surgery, and depending on his age at the time, it may be best to consider a mechanical valve for him so he doesn't have to go through numerous surgeries in his lifetime.

Kim

Yes, they both have BAV stenosis. it was her aortic valve that they replaced. Dr. said it's best to wait until she has symptoms again. she takes BP, chloresteral and thryroid meds. Drs. gave her a 98% successful surgery rate last time and luckily, surgery went as it should have & no complications. What is "percutaneous replacement?"

 

[Duffey]

Yes, they both have BAV stenosis. it was her aortic valve that they replaced. Dr. said it's best to wait until she has symptoms again. she takes BP, chloresteral and thryroid meds. Drs. gave her a 98% successful surgery rate last time and luckily, surgery went as it should have & no complications. What is "percutaneous replacement?"

Find a discussion of percutaneous replacement here:http://www.valvereplacement.org/forums/showthread.php?38925-Percutaneous-Info

 

[Johan]

I had my surgery just over 2 years ago and must say I would be devastated if I should now learn that, for whatever reason, the valve is up to no good. Tissue valves, both porcine and bovine, are supposed to last much, much longer in us older people, so the 2 years is just so upsetting. You should really try to obtain the particulars of the valve, make, model and serial number. If I were your mother I would definitely alert the manufacturers of the valve. In fact I would strongly insist that my cardiologist and surgeon also involve themselves. Johan

 

[ElectLive]

Anne - So sorry to hear this is happening. Pig valve failure in 2 years at the age of your mother is not impossible, but extremely rare, as the others posted. Based on your follow-up comments, I'm wondering if maybe it may be more directly related to the valve size issue, possibly something called "patient prosthetic mismatch". All prosthetic valves reduce the effective opening area of a patient's native valve to a degree, depending on the type of valve used. In most circumstances, this is not an issue, but for patients with an already small native valve, it can lead to problems. Let me just say I'm only guessing here, I could be completely off track. But a common factor for this "mismatch" issue are patients who have small aortic roots, seen most frequently in the elderly, particularly women. The surgery to avoid this potential problem and allow a larger size valve to be implanted involves enlarging the aortic root , which is more complicated and higher risk, not often the first choice procedure. Again, please forgive me for speculating, but just wanted to mention one possible scenario that could explain valve "failure" as it relates to size.

The percutaneous replacement method mentioned, done through a catheter and not open-heart, was FDA approved only in the last month or so. It's an amazing breakthrough, but unfortunately is only for patients who meet certain criteria. Most critically, it is only for those who are deemed otherwise inoperable.

Best wishes to you and your mother in trying to learn more about this situation, and finding the best possible plan moving forward.

 

[anne casey]

Thanks again for everyone's well wishes and comments. I appreciate the support! The doctor left us that day, last Thurs., telling us he would look at echo himself and consult with collegues. Now today is late Tues....no call back yet, as he said he would. I will call him tomorrow. She says she won't go through another OHS, feels she wouldn't survive it at her age. I think we will try to go to another Dr. before Christmas, regardless of what this cardiologist says when he calls (if he calls.)

 

[anne casey]

An update...Card. told her Nov 23 that he and his collegues could not figure out the conflicting info. on her echo and that he is sending it to a specialist at Mayo, Rochester and he would call us when they know more. That's been 2 weeks ago! No news is good news?? Part of me thinks, good, can't be too bad then....but I know I better call and find out what's going on. In the meantime, she will see another Dr. next week to get a referral to get another opinion.

 

[ottagal]

Hi Anne,
I like the premise of no news being good news. To put my mind at ease, I would be putting in a call to the office to confirm this. Glad you are getting another referral.
Other than an echo, has she had a TEE or angiogram to confirm the diagnosis? I would want another type of test to confirm the echo (which isn't always reliable).
All the best,

 

[Lily]

Ditto to ottagal. I'd get that call placed as soon as possible; this can be a difficult time of year to get things done. And more expert opinions probably can't hurt. Occasionally a member here reports a frightening echo report which later gets clarified as a harmless "shadow" or something. I hope you and your mother get much better news. Best wishes

 

[Kathy McCain]

Ann, I am truly sorry your mother has to go through this! My first thought would be that there was something wrong with the valve itself, or maybe a mis-match?? Tissue valves ordinarily last much long, especially in the elderly.

 

[sarahsunshine]

Sorry to hear your mother's predicament. I hope the consult with another doctor will help clarify the situation.

Just to echo what others have said, me stepson had an echo that came back with rather frightening results about 3 years ago. Then he had a catheter procedure done and the results came back in the "normal" range. Getting a more specific and predictable test done is definitely an option. I'm surprised that the doctors haven't discussed that with you and her.

 

[normofthenorth]

Good luck, keep us posted, and ditto to what everybody else has said.

 

[markp66]

Did she have a mosaic valve by any chance? Lots of early failures (incluing 4 years for me) from what people have said on this site. My surgeon said it was something to do with what it was coated in. However, there are many people with this valve who have no problems.

Other issues for early failure are kidney problems and potentially high blood pressure.

I didn't think they could do catheter ops with porcine valves but I could be wrong. It could be done minimal invasive if there isn't too much scar tissue.

If she does have the op again it may be worth getting a mechanical valve. Although rare at an older age it would be a risk to get another tissue valve if it were to fail again (unless there is an obvious cause)

Just go let you know that reops are not generally more risky than first ops although I know your mums age is also a risk factor for a 2nd reop. This is definitely something that should be sorted out ASAP. The fitter a person is that goes into surgery the better the outcome, no matter what age.

Good luck.

 

[tobagotwo]

It sounds like they're concerned that there's a patient-prosthesis mismatch, which is when they put in the wrong size valve (usually too small, although too large can cause just as much trouble). Other than that, it would have to be an actual failure of the valve structure. She didn't calcify it in two years. Too small, it causes instant stenosis. Too large, the leaflets of the valve rub and get caught and damaged by the surrounding structure.

The thing I'm wondering about is why they haven't redone the echocardiogram with a different tech and different machine (unless they have and I missed it). Conflicting results and no symptoms should be waving red flags.

Percutaneous replacement is so much less demanding than the full surgery. If I were her, I would want to go with that. As far as I'm aware, all of the percutaneously-replaced valves are xenografts (biological valves). In this situation (depending on what that turns out to be), the only good thing about the current valve being biological is that it allows replacement with a percutaneous valve. If it were a mechanical valve, it would require the reoperation.

Best wishes,

 

[marie]

I have a mosaic porcine heart valve. My surgery will be 4 years old in January. After 6 mts my valve was failing. I saw another surgeon in Houston and he agreed that it was failing but thought I would get another 3 years out of it and would be replaced with a mechanical valve. I had an echo done two weeks ago and there is no further change in the valve. It's the same today as it was six months after I had surgery. No one could tell me why, just one of those things however when it's you it's not just one of those things. I am 70 now and certainly am not looking forward to another surgery but maybe I'll continue to beat the odds and I do hope your Mother does as well. As everyone else said follow up, get another opinion.