Seems like it's not an exact science

[kevin21]

I see lots of people saying that valves last 10 years and 20 years (mech.) but it seems like a lot (maybe recently) of people need theirs repaired, or fixed or redone.

I thought that once they fix it they were done for a while? Guess there's more to it than that.

I'd say just by looking that the average time is around 5-6 years before someone needs a re-op. Maybe that is just me seeing things???

 

[Ross]

It's a very small number that need reopts. Don't be discourged. Mechanicals have failed, but the majority are good for life. Tissue while given a semi short life, still have shown to outlast their expectations also. I don't know what the exact percent is, but it's miniscule I'm sure.

 

[Nancy]

I'll tell you what I believe happened in my husband's case. Shortly after his first mitral valve surgery, he started having fainting spells. He really needed a pacemaker, because his heartbeats were too slow at times and did have one implanted. However during the time when his mitral was healing he took a real nasty fall right onto his chest area and fell like a tree in the forest, not able to brake the fall. I had just come home from work and he was walking to greet me, I saw the fall, and was too far away to catch him. He also dislocated his jaw a bit. I feel that the concussion of that fall was responsible for pulling lose some of the stitches.

He had a couple of other serious falls without being able to brake the fall before the pacemaker was implanted. He has not had any more of the spells, thank God.

So it isn't just surgical things that happen. After surgery, the area is vulnerable to injury, since it is not yet healed. That is why most of the oldies here caution you newbies to take care of yourself and not push things too far when in healing mode. All kinds of things can happen.

The vast majority of patients do exceptionally well.

 

[Tom F.]

Depends on the valve. Aortic can be replaced with mech which can last you lifetime, but not always. Tissue lasts 8-20, so who can tell. Repairs last from forever to less than that. There are no exact numbers. It is an art, so much depends on the condition of the valve, and the skill of the surgeon, and the age of the person. No one here can tell you exact numbers, listen to you your doc.

 

[tobagotwo]

Five or six years could be representative of a growing child or highly active young adult, or perhaps of a pregnancy-years woman on an older-type tissue valve.

But, no. That doesn't come up as being close to the experience of most valvers. Especially older valvers (over age 45 or so).

Also, both types of valves have undergone recent upgrades that are expected to change their statistics even more.

Mechanical valves are generally projected as lifetime fixes, but I suspect that most actually wind up being replaced for one reason or another by the 25-30 year mark. The reason would not likely be failure of the mechanics of the valve itself. The newest mechanicals cause less pounding and tissue abuse in the mounting area, among other benefits, such as decreased hemolysis. They may go the distance more often.

Animal tissue valves, in those over 45 or so, had an expected life of about 13-18 years, depending on the type. Homograft tissue valves, about 20-25 years. The newer animal tissue valves should move to a more tenable 18-22 years of expected life (possibly more). This was once considered the risky alternative, but a recent, large study shows that long-term survival rates for tissue AVR recipients (including the reoperation risks), are equal to those who received mechanical valves (including the Coumadin use risks).

For a younger or atheletic person with relatively uncomplicated aortic valve problems, the Ross Procedure will probably give 30 or more years of unreoperated service, with the benefit that any reoperation would be for the less-critical pulmonary valve.

Of course, all these things can be knocked into a cocked hat by circumstance. Cancel the lifetime of no reoperations if one of the following should occur:

• If your bicuspid valve comes with a tendency toward aortic aneurisms (you would have to have OHS for the artery to be repaired)
• You have a reaction to Coumadin that is so unworkable that your valve must be replaced with tissue
• The heart tissue that your valve is mounted to weakens over time, due to inherent weakness or from other heart issues, such as enlargement
• A clot causes the requirement to replace the valve

Best wishes,

 

[Babydoll]

26 years

26 years

Hi, it would be great if medicine was an exact science. We are getting close but for now most of the time it's a guessing game. My parents were told when I was 7 that my valve would have to be replaced when I turned 18. which was around the 10 year mark but I out lasted that. Am 33 now and just found out it's time for a new one so my valve lasted 26 years and the drs say the valve itself looks and works great my heart has just outgrown it. I had the pig's valve then and will get another one in Sept. Hope this one is good to me as my last one has been!
Stacey

 

[liamty]

Steve has gone 23 years and no more surgery, thats not to say there won't be more as eventually he does need a repair. But 23 years ago (aged 21) he was the youngest to have had avr in Sydney. These days as this site shows, it is almost a common thing, and progress has been made. Imagine in another 23 years the progress again. It is my opinion that most repairs are needed on complicated or older valves and problems, surgery seems to have progressed so much that there are less ongoing issues these days. Most valve replacement patients tend to have other health issues that may lead to more complications, but from what I can gather if you have no other problems then you are obviously at a much lower risk of further surgery.
Does that make sense? I hope so.

 

[tobagotwo]

Why other issues?

Why other issues?

Will everyone need resurgery, if they live long enough? I don't believe so. Are there people who will go 40+ years on a single mechanical? I think so. I don't know if anyone has, yet. Will most? I don't know.

For that matter, until the day I read it in this thread, I would have told you that there is really no way that a pig valve (old type, no less), placed in a young child, would last 26 years.

Most of the thoughts about reoperation in my earlier post apply to all valve types, and were not aimed at mechanicals. These are uncomfortable thoughts for me, as well, but I think there is some merit to including them.

As an example, I have a tissue aortic valve that should last almost 20 years. However, my natural mitral valve is showing early signs of leaflet hardening, so it may not make it for the 20 years. As such, I may have to go through another OHS long before the twenty years is reached. The same would apply if I'd had a Ross procedure - or a mechanical.

It is not uncommon for valve problems to include other valves (especially in rheumatic or viral-type cases), and for those valves to develop symptoms at different rates and times. This is something that should be a part of the valve choice consideration process.

With bicuspid valves, a certain percentage have aortic arterial implications, such as a tendency toward aneurism. That should be a factor in determining the best valve type for that person, as the aneurism may show up years after the aortic replacement. Can you get reliable input before surgery as to the possibility of this happening? I don't know if that is available at this time. I don't have statistics for the chances of this happening either, but that may be the best input someone could use right now, if it exists.

As it relates to mechanicals, the thought might be that, if you have good reason to believe you will wind up having OHS for other reasons in the next twenty years, the overall avoidance of open-heart surgery is not really accomplished by using a mechanical valve. It doesn't necessarily mean you don't choose a mechanical. It just means you may think differently about the implications of each valve type as they relate to you.

A similar thought process might apply to a Ross procedure, as a later surgery might be for the mitral valve, which would not result in the benefits of the Ross longevity, or which would require Coumadin. Or it could be an arterial graft for the aortic artery. Again, it doesn't mean that the Ross may not be your choice anyway, it just means that these issues should be factored in, if possible.

The discussion can go many ways; these are just the more salient points for brevity, and (relative) clarity.

Best wishes,

 

[Harpoon]

I think it really dependso n the individual and their heart condition before and after surgery.


Repair jobs may not last as long as replacements, but then they might be the only surgery one needs for the rest of their life. It's really just relative to the individual.


Under "ideal" conditions, I guess artificial valves can last upwards of 30-40 years or more. However, "ideal" conditions would be opening and closing at the same rate with the same amount of force with no movement of the structure that the valve is installed in....

It's hard to mimic the conditions under which an artificial valve would operate while inside a human heart over the period of a lifetime.

I think the life expectancy of heart valves is based on known science in regards to the materials and how well they last under such conditions. It's a guess really, not something that's been tested a thousand times. That's impossible to do for technology that's only been around for maybe 20-30 years when patients might have the potential to live twice that with a "state of the art" valve.


I'm alive and healthy NOW. What comes down the road comes, there's no sense really worrying about it right now. I do the best I can to take care of myself. I eat right, I exercise, I stay away from smoking and alcohol and such and I'm doing what I can to keep my heart as healthy as I can for as long as I can.

Will my valve last 5 years? 10? 50? I don't know, ask me in another 50 years. =)



Besides, they tried DAMNED hard to kill me off before I got out of the hospital in May, 2003. If that experience didn't kill me, I don't really know what would. Before valve replacement, I was very aware of my own mortality having been born with a congenital heart defect, now, I'm not so sure I really am going to die.....


Yes, I'm being a smart ass.

I think I've earned it too.


In all seriousness though, it's just guesswork really, the valves they make these days have the POTENTIAL to last forever, whether they do or not really dpends on the person living with the valve more than anything else.