Replacement Valve Failure?

[Elgato]

It looks like the tissue valves last 7 to 10 years while the mechanical may last 15.
My understanding is that the advantages of the tissue valve are offset by the fact that you will
need to do it again. The advantage of the mechanical is longevity but offset by noise, possible anemia and
thinner.

There are many stories of multiple surgeries.

How do these valves fail? Gradually over time or catastrophic? How is it detected, by symptoms or continual
monitoring?

Thank You

 

[DavesMom]

Hi,

Well, my mechanical valve is now 15 years old and shows no sign of giving up the ghost. I got it at 42 and the surgeon said it could last the rest of my life. Of course there's no guarantee. I get a yearly echo and also a CT to check on an aneurysm. I get my warfarin checked monthly any it has given me no problems.

Good luck!

 

[Lynlw]

It looks like the tissue valves last 7 to 10 years while the mechanical may last 15.
My understanding is that the advantages of the tissue valve are offset by the fact that you will
need to do it again. The advantage of the mechanical is longevity but offset by noise, possible anemia and
thinner.

There are many stories of multiple surgeries.

How do these valves fail? Gradually over time or catastrophic? How is it detected, by symptoms or continual
monitoring?

Thank You

Tissue valve longevity, has A LOT to do with your age when you get it, it generally will not last as long in someone in some in their 30s as it will in their 60s. Most tissue valves in use to today would mos likely last 15 -20+ years in someone who is 60 when they get it.. Altho even for someone in their 30s, I'm pretty sure the majority of tissue valves last longer than 10 years. Tissue valves tend to get stenostic over time, just like a native valve.

The mech valve its self should last the rest of your life., but comes with the risks of clots so need to take Coumadin (the blood thinners you mention) and risks of bleeding..You can do the blood test at home and staying in ranges lessens the risk of clots or bleeds BUT there STILL is a risk, these days even with home testing and the newest mech valves. WHEN a mech valve needs replaced because of clots, it usually is quite quickly.

As for multiple surgery and risks, the stats for morbidity and mortality risks right now, for first time REDO are about the same for first time open heart surgery. Altho even now they are replacing tissue valves in the cath lab in higher risks patients and many doctors believe someone getting a tissue valve right now, who would need a new valve in their 70s -80s have a high chance of getting the next one by cath (percutanious valves or in the case of Aortic valves TAVI) BUt I wouldnt plan completely on the possibility of getting the next valve by cath, your should be ok w/ a possible other OHS, if you choose a tissue

 

[Mentu]

This is not a simple issue. As my surgeon pointed out, no one knows how long the current generation of tissue valves will last. I was 59 at the time my valve was replaced and he suggested a tissue valve which he expected would last the rest of my life.

There is also my Uncle Bob. My Uncle's aortic valve was replaced with a St Jude mechanical valve. At about 10 years after the replacement, tissue began growing over his valve and it had to be replaced. It had nothing to do with the valve itself but the tissue kept it from operating efficiently. He lived for the rest of his life with a porcine valve and at the time of his death, 15 years later, his valve was in very good condition. (He died from COPD after decades of smoking.)

Statistics describe the likely experience of groups of people not individuals. It is very likely that today's mechanical valves will serve one longer than tissue valves but one must consider that no one can know their own actual experience.

Larry

 

[neil]

agree with all above

 

[dick0236]

I know nothing, other than what I read on this site, about tissue valves.....but I have never read, or had a doctor tell me, that mechanical valves normally begin failing after +/- 15 years.
Even with my valve, which was one of the earliest, they told me it would last 50 years....and now they tell me it should last my lifetime. From what I read, mechanical valves are designed to last well beyond current life expectancy and explanting a mechanical valve is normally due to other issues rather than the valve wearing out....or breaking.

My valve is a "ping pong ball in a metal cage" and cannot be heard by others...or me.

After all these years, I have never been diagnosed with anemia....or had it mentioned.

Blood thinners currently are required and I had to learn to follow a simple routine of taking the pill as prescribed and testing routinely. I've had one problem, due to my ignorance, over the years.....but I've also avoided several re-ops...although I imagine that after one or two tissue valve re-ops, they would have put in a mechanical valve anyway.

Continue doing your fact finding and you will be better able to make YOUR informed choice and then go on to live your life post-op.

 

[haggis basher]

Hi All
There are a lot of unknown factors in this debate! I am still a runner (74 age), but when I had my
new 'tissue' aorta valve at 71, was told being elderly, it should last me longer than the 'younger' generation.
I think this might be right for the sedentary older age, but what about the very active guy?
I wonder if any research has been done on this.
See Ya
Brian

 

[Guyswell]

Elgato,

I received a bovine tissue valve at age 41. It lasted 8 years and failed over a one-year period. The echocardiograms showed it becoming rigid, narrow and calcified. By the time I had it replaced with a mechanical valve, the tissue valve was mostly closed. The symptoms of the failing valve were the same as someone experiencing severe and worsening stenosis (narrowing) of their native valve. Older patients are less likely to experience the early calcification seen in my valve.

 

[haggis basher]

Elgato,

I received a bovine tissue valve at age 41. It lasted 8 years and failed over a one-year period. The echocardiograms showed it becoming rigid, narrow and calcified. By the time I had it replaced with a mechanical valve, the tissue valve was mostly closed. The symptoms of the failing valve were the same as someone experiencing severe and worsening stenosis (narrowing) of their native valve. Older patients are less likely to experience the early calcification seen in my valve.

I hear what you say Elgato, but why wouldn't a new valve in an older person 'calcify' just
as quick as a young fella! I mentioned that I am deeply into running, I think it might be the reverse!
See Ya
Brian

 

[pellicle]

Hi

I hear what you say Elgato, but why wouldn't a new valve in an older person 'calcify' just as quick as a young fella!

its a good question and as far as I know there are some researches done on it and it is well enough understood that it is something which valve makers attempt to work on mitigating.

I guess the simplest answer is their metabolisms are different. You may as well ask why 70 year olds don't typically run as much / lift weights as much / swim as far / train as hard as twenty or 40 year olds

http://circ.ahajournals.org/content/66/5/1100.abstract

Age at the time of valve implantation also had a strong effect (p less than 0.001) on the amount of valvular calcium

http://www.med.upenn.edu/cstr/documents/SchoenandLevyAnnThorSurg2005.pdf

Calcification is accelerated by young recipient age, valve factors such as glutaraldehyde fixation, and increased mechanical stress.

Anyway If you want the answer to "why" - you'll need to bone up on your biochemistry, but this is a good start

http://www.ncbi.nlm.nih.gov/pubmed/20420613

 

[pellicle]

Hi

It looks like the tissue valves last 7 to 10 years while the mechanical may last 15.

yes and no ... Tissue valves can last between six months to 20 years (based even on the experiences of members here). Much depends on your age and your activity levels.

Mechanical valves are more or less rated to something like "well beyond you lifespan" and their actual failure is exceedingly uncomon (especially with modern pyrolytic carbon valves). "Failure" of a mechanical valve is most often related to obstruction

My understanding is that the advantages of the tissue valve are offset by the fact that you will
need to do it again.

that and that you will be far less likely to require ongoing anticoagulation treatment.

The advantage of the mechanical is longevity but offset by noise, possible anemia and
thinner.

near enough

There are many stories of multiple surgeries.

If you get a tissue valve (depending on your age) its more or less a certainty you'll be up for another operation.

How do these valves fail? Gradually over time or catastrophic? How is it detected, by symptoms or continual monitoring?

yes, gradually over time. There are issues of 'stenosis' in the tissue valves (becoming stiffer and not opening properly) as well as in their late stages a possibility of thrombosis. Yearly checks are advised for good reasons. Symptoms are also something which you would bring up at a monitoring meeting with your Dr / Cardiologist.

There are also other reasons to go for these checkups. They can detect new threats, such as aneurysm. I had an aortic aneurysm appear ... it was lucky that I'd gone for a checkup (missed a about a decade worth due to complacency and belief that I could 'tell', perhaps I could because I went because I felt "something") for at that checkup they found an aneurysm. So I had an OHS to replace that with a tissue aortic graft (and a new valve too).

 

[pellicle]

also http://www.cardiothoracicsurgery.org/content/8/1/11

We report a case of early bioprosthetic valve calcification in a 76 year-old woman who had received supplementation with alfacalcidol, an analogue of vitamin D, for 3 years after her initial valve replacement. She underwent aortic valve replacement at the age of 71 and subsequently complained of shortness of breath. Ultrasonic cardiography revealed severe aortic stenosis and we performed a second aortic valve replacement with a bioprosthesis. Histopathologic and x-ray examination showed calcification on the explanted valve. She had not presented with any known risk for early bioprosthetic calcification, suggesting that vitamin D supplementation may accelerate calcification of bioprosthetic valves.

may be of interest...

 

[Paleowoman]

I've gone for tissue valve at age 60 but I am concerned re calcification (though I wouldn't want a mech valve for various reasons) as I am on an osteoporosis medication which stimulates the osteoblasts to form new bone (Protelos/Strontium Ranelate). Most people over a certain age don't make much new bone, as the mechanism just stops with age, unless they continue giving the body the kind of stress which stimulates bone formation, ie mechanical stress. There are other osteoporosis medications which stop the osteoblasts, such as Fosimax and other bisphosphonates, and they've been shown in some studies (not all studies) to protect heart valves from calcification. So…what I'm leading to is the point that maybe younger people and people giving continued mechnical stress get quicker calcification of their tissue valve because their osteoblasts are working forming new bone in their bones, which is healthy, but also in their tissue valve…which would also apply to me since I'm on an osteoblast stimulatng med (and do a lot of mechanical stress/weight lifting…or will resume soon). I should add here that somewhere I read that osteoblastic cells have been found in the calcification in heart valves. Maybe taking vitamin K2 will help prevent calcification to some expent since K2 puts calcium in the bones rather than in the vascular system. Who knows ? I feel that I am a kind of experiment, especially since Protelos is a new med for osteoporosis…..but then again, it seems that the medical profession are still quite in the dark as to what leads to calcification of tissue valves.

 

[epstns]

I was told that once we have a propensity toward aortic stenosis, we never "lose" it. We do, however, cause valve stenosis at a slower rate as we age. They think it may be an immune system reaction, and the immune systems of younger patients are more active than those of older patients. So, while we do not know how long my bovine valve will last for me, we do believe that it will last longer having been implanted at age 63 than it would had it been implanted at a younger age. I guess it is all relative, and there are few absolutes.

They also "believe" that the newest generation of tissue valves will last longer than the previous generation. The previous generation ("second generation") was found to have typical lifespans of 7 to 15 years, and they believe that the newer ("third generation") valves will last longer than that. That's where the comments of "up to 20 years" come from.

 

[DebbyA]

About age and tissue valve: I'm probably an outlier, but my tissue valve, implanted at age 60, lasted 6 years. Maybe age is not merely defined by the calendar. Since I have a family history on longevity on both sides, perhaps my cells' true age is less than my years? Statistics are a compilation of numerous experiences, and no guarantee for what will happen to you individually. I think it still boils down to deciding which set of inconveniences you can live with.

About failure of tissue valve: it is gradual when caused by calcification, but a calcified valve can tear along the cusp, and could become more catastrophic.

I'm interested to see several people stating that activity level influences tissue valve longevity, because I thought there was no relationship?

 

[ChicagoMammy]

I had my mitral replaced with a bovine tissue valve 6.5 years ago. Calcification was noticed after 3 years. It has not progressed passed the mild stenosis stage yet. I am having my aortic replaced with a mechanical next week. If recommended I'll have the mitral replaced with mechanical then too.

 

[Marty]

I had Mitral replaced with a St Jude mechanical in 1998 at age 72. No problems. I am happy that my surgeon went with mechanical even though some cardiologists thought he should have installed a tissue valve so that I would not have had to take warfarin.

 

[Lynlw]

About age and tissue valve: I'm probably an outlier, but my tissue valve, implanted at age 60, lasted 6 years. Maybe age is not merely defined by the calendar. Since I have a family history on longevity on both sides, perhaps my cells' true age is less than my years? Statistics are a compilation of numerous experiences, and no guarantee for what will happen to you individually. I think it still boils down to deciding which set of inconveniences you can live with.

About failure of tissue valve: it is gradual when caused by calcification, but a calcified valve can tear along the cusp, and could become more catastrophic.

I'm interested to see several people stating that activity level influences tissue valve longevity, because I thought there was no relationship?

"About failure of tissue valve: it is gradual when caused by calcification, but a calcified valve can tear along the cusp, and could become more catastrophic."

I actually was going to mention that, altho from what I know USUALLY pericardial valves calcify "only" and porcine valves tend to be the ones that calcify and then can tear, (just a guess here, butmaybe because it is an actual pigs valve that hinges (for lack of a better word) open and closed at the same place and bovine valves are made of cows pericardial sac)

As far as longevity being effected by activity, we have discussed that with many CHD doctors and they said physical activity does not play a role in tissue valve longevity.

I believe it at least partly related to the body's chemical activity related bones and teeth (apatite) and tissue valves last shorter in young people who are still growing and making teeth or are in the younger age groups , whose bones tend to heal quicker if they break, and last longest in people in the age groups, who have lower bone density or broken bones take longer to heal. or post menopause IMO and off the cuff talks w/ various doctors while Justin was in the hospital and I couldnt sleep)

I was wondering from what I remember, shortly after your surgery your gradient was already high or the valve area smaller than expected? I dont remember exactly. When they removed your Mosaic did they say anything about the size or how the valve looked? Do you know if they sent it out to see, if it had any of the "bumps" or other issues reported a few years ago when reports were first coming out out some mosaics failing very early?

 

[Paleowoman]

I believe it at least partly related to the body's chemical activity related bones and teeth (apatite) and tissue valves last shorter in young people who are still growing and making teeth or are in the younger age groups , whose bones tend to heal quicker if they break, and last longest in people in the age groups, who have lower bone density or broken bones take longer to heal. or post menopause IMO

That's why I think I'm going to be an experiment because the osteoporosis med I take, Protelos (not available in the US), actively increases bone density in post menopausal women by stimulating osteoblasts, plus it has also been shown to increase speed of bone healing when bones are broken ! But I cetainly hope I'm wrong and my tissue valve does not fail too soon and lasts many, many years.

 

[DebbyA]

Lyn--what a memory you have! My porcine valve started off with a mean gradient=22. I thought it was high, but current surgeon says normal. The operative report stated " significant calcification...with a torn leaflet", but no mention of abnormality. I should probably get the pathology report too.
My new ATS valve (first echo report) has a mean gradient of 19, which the report describes as "high-normal". Also has "mild/moderate regurgitation". I see the cardiologist Friday but am not hopeful of much enlightenment--she always says brightly "I'm not worried!".