St Jude Trifecta failure

[TomD]

I received a St. Jude Trifecta in 2013 from Dr. Joseph Coselli in Houston. It has failed after 8 years. I am told others have recently experienced this early failure - the valve is no longer on the market. I now have Aortic Stenosis and need a new valve. My cardiologist recommended a TAVR, I just completed tests and work up for TAVR here in Fort Worth. They notified me yesterday I was a candidate, but also gave me an option/recommendation due to my age? for SAVR. They told me TAVR could last 10 years and SAVR tissue valves up to 15 yrs. I told the team leader that was my expectation when I received the tissue St Jude in 2013. I am going to visit the surgeon this after noon and discuss options. Have any VR members experienced this? Thanks for your feedback. Julie

Welcome to the forum Julie!
How long a tissue valve is expected to last has a lot to do with your age. How old are you?

I received a St. Jude Trifecta in 2013 from Dr. Joseph Coselli in Houston. It has failed after 8 years. I am told others have recently experienced this early failure - the valve is no longer on the market. I now have Aortic Stenosis and need a new valve. My cardiologist recommended a TAVR, I just completed tests and work up for TAVR here in Fort Worth. They notified me yesterday I was a candidate, but also gave me an option/recommendation due to my age? for SAVR. They told me TAVR could last 10 years and SAVR tissue valves up to 15 yrs. I told the team leader that was my expectation when I received the tissue St Jude in 2013. I am going to visit the surgeon this after noon and discuss options. Have any VR members experienced this? Thanks for your feedback. Julie

I have had my Saint Jude mechanical for 13 years and I got it at the same age you are. I am so glad that I don’t have to worry about another surgery so in my mind it’s a no-brainer. Go with mechanical because you don’t want to have another operation in your 80s.

 

[Luckyguy17]

. So ,I do have to think about do I want a SAVR tissue or a TAVR. Thanks again for your help!

Julie, in my recent experience, your surgeon armed with tests like Echo, CT Scan, chest X-ray and possibly more, will be in the best position to present the pros and cons. I went into surgery with a preference for a bio, but an understanding that I would be mech, if the surgical team thought it was a better solution and if my Mitral also needed changing.

From today’s insight in 2021, maybe in 2010 a better decision could have been made, but there is no value in rethinking the past.

like @rich01 so well elaborated above, i have very little expectation of even reaching a healthy 85. I am so very grateful for my current fix and life extension, where I became totally dependent on oxygen for survival pre-surgery

once I heal of heart, am in pursuit of an abdominal issue Re the Pancreas.

ageing sucks some, but the alternative .... well

 

[Meanjellybean]

I have had my Saint Jude mechanical for 13 years and I got it at the same age you are. I am so glad that I don’t have to worry about another surgery so in my mind it’s a no-brainer. Go with mechanical because you don’t want to have another operation in your 80s.

I agree with your statement.

I agree with the less OHS, the better. Also considering age as a factor not just for when you may need the surgery but also for the future is very important as it may not be an option.

I met a South African fellow in hospital last week who was waiting on a second tissue valve but was not able to have it due to other health issues (cancer) not being resolved.
He had been waiting in hospital over 10 weeks and was not able to go home. He was 78 years old and i am sorry to say that the likelyhood they were going to operate on him is slim due to his chances of survival. The surgeon that saw him proceeded with extreme caution on complex surgeries that carry extra risk and unfortunatley his age and other health conditions were against him.
It was a very sad moment and i really felt for him when he was told he would have to wait indefinetly.
Thankfully i believe another surgeon was discussing a TAVI as a possibility.

One must also forecast that as we age our bodies will have more complexities which does not make decisions easier for the surgeons.

Alas, it is your life and you only live it once, so live it well.

 

[Chuck C]

With the mechanical using Coumadin I can eat and drink anything I want if I’m consistent?

I eat and drink whatever I want on Coumadin and I don't worry about consistency on a day to day basis. Old school was to caution people against eating too many greens on Coumadin because the vitamin K in greens works against Coumadin. However, in truth it takes an awful lot of vitamin K to make a significant impact on how Coumadin works- which is measured by INR. I tend to eat a lot of greens, but some days I probably eat 2x to 3x the amount of greens as other days, for example if I have a spinach smoothie with 5 cups of spinach and then the wife makes salad for dinner. I have noticed virtually no impact on my INR on days when I eat tons of greens vs days when I eat my normal amount. It has never put me out of range and, as I am early in my Coumadin journey, I test a few times per week at this point.
Many will also tell you that you can only have one drink of alcohol, if any at all. As others will share with you here, this is nonsense. I drink 1-2 drinks per day and a couple days per month I like to let loose with my friends and drink beer for several hours as we watch the fights. I have noticed that on those days my INR goes up, but nothing that is alarming. After reading the doctor warnings about alcohol, I was concerned that these days might be out for me, but hearing others discuss on this board how they get smashed from time to time, or at least they did at one point in their lives , and it had little impact on their INR, I learned that this part of my lifestyle could probably remain. And, my own personal experience has been that I am fine doing this from time to time, at least as far as how it affects my reaction to Coumadin.
Perhaps you have made up your mind already, and that is totally fine. But, I would just encourage you to do a lot of research and deep thought about the choice. I was leaning heavily towards tissue valve and it took me a couple of months of research to be convinced that mechanical was the way to go for me.
It is good that you consulted with your cardiologist on the choice. But, I just hope that if he tried to steer you away from mechanical that it was not based on some of the myths and, sadly, many doctors are guilty of propagating the myths. The choice is ultimately yours.

There is no perfect valve choice. The important thing is to do your due diligence and really weigh all the pros and cons with accurate information. Whichever valve you choose, I wish you the very best of luck with your procedure and please keep us posted.

 

[user 15848]

Chuck, thank you for your very helpful reply. This is good information and I’m going to consider it today when I talk with the doctor

Good idea consult with your Cardiologist/Surgeon, "for me" the concern about the TAVI promise is that it means they will place a Valve inside the older Valve, and the new one will not last as much as previous one; it is a hard decision, inform yourself about the options, and what makes YOU feel ok with it

 

[user 15848]

With the mechanical using Coumadin I can eat and drink anything I want if I’m consistent?

"Anything".... not Everything with out knowing what is done; SOME things like for example TUMMERIC Supplements will take the INR out of control, but most of "anything" is a matter of apply proper dose for the diet, the less changes the eassier; and DO get a HOME testing little machine and test yourself, that way if concerned, the INR Value is just one tick away.

 

[hevishot]

Unicups, Thanks for your response. It appears the comoumdin is manageable for you? BC of course that why I chose a tissue valve and know that has been the subject of numerous posts on VR.

The older one gets, the longer a tissue valve is expected to last. If they told you to expect 15 years when you were age 60/61, that seems a little optimistic to me. I am 53 and was told to expect 10 years, give or take 2 years, if I choose a tissue valve. Now that you are 68, I think you are getting into the age range where 15 years might be a reasonable expectation, though certainly not a guaranty. And, it is probably correct to expect to get a few less years from TAVR, as they just don't have the long term data yet to predict otherwise.
That is a tough call. Face likely reoperation at about age 78 if you go TAVR or likely reoperation at about 83 if you choose SAVR. Is consideration for a mechanical valve even on the table? This would likely mean not ever needing a reoperation. When one is between 60 and 70, that is the range in which either tissue valve or mechanical valve are generally considered reasonable.

 

[hevishot]

Please don't take anything you read here seriously about the longevity of tissue valves. I was only 49 when I received my Edwards valve and 16 years later it's still not showing any signs of deterioration. My cardio feels I could get 30 years out of it. Mechanical valves fail too. The reason you don't hear about it here is because when a Mechanical valve fails it's usually lights out. Your dead. With a tissue valve you usually have ample warning. Keep that in mind.

 

[dick0236]

........I was only 49 when I received my Edwards valve and 16 years later it's still not showing any signs of deterioration. My cardio feels I could get 30 years out of it.

Congrats on the life of your valve..... 'ya can't beat an Edwards valve. Mine is also an Edwards.......a Starr-Edwards mechanical valve that "started" Edwards Lifesciences Co. back in the 1960s. I was 31 when I got it and 55 years later, at 85, it is still going strong.....and my docs tell me it probably will never fail and is unlikely to be the cause of my death.

Edwards Lifesciences produced my valve until 2007 when they left the mechanical valve market in favor of the more lucrative tissue and TAVR market. It is my understanding (not confirmed) that Edwards has a major financial interest in one of the mechanical valve companies......so they have "hedged" their bet regardless of the outcome of the "mechanical vs tissue" valve war.

 

[Unicusp]

Please don't take anything you read here seriously about the longevity of tissue valves. I was only 49 when I received my Edwards valve and 16 years later it's still not showing any signs of deterioration. My cardio feels I could get 30 years out of it. Mechanical valves fail too. The reason you don't hear about it here is because when a Mechanical valve fails it's usually lights out. Your dead. With a tissue valve you usually have ample warning. Keep that in mind.

Theoretically you may be correct, but again it is all theory. Would love to see some data, but since autopsies are not performed unless suspicious cause of death, one can't know if "Heart attack" really meant catastrophic valve failure.
Yes, any mechanical device can fail just like airplanes can fall out of the sky, but the probabilities are infinitesimally low as proven in the FDA testing submissions from the valve manufacturers.
Your same theory could apply to tissue valves as well. The ones that have total sudden failure instead of slow deterioration could also result in sudden death. But, one will never know. Luck of the draw I guess. Make a decision and move forward.
Now, if you really do get 30 years out of a tissue valve mfg 16 years ago, I would say you will probably set records.

 

[nobog]

Please don't take anything you read here seriously about the longevity of tissue valves. I was only 49 when I received my Edwards valve and 16 years later it's still not showing any signs of deterioration. My cardio feels I could get 30 years out of it. Mechanical valves fail too. The reason you don't hear about it here is because when a Mechanical valve fails it's usually lights out. Your dead. With a tissue valve you usually have ample warning. Keep that in mind.

Well, tell that to the guy who's tissue valve lasted 6 months - I've personally seen the valve.

 

[Chuck C]

Please don't take anything you read here seriously about the longevity of tissue valves.

In doing one's due diligence, the intelligent approach is to listen to others who are experienced on such matters, but also to do your own research and review the published literature.

Tissue vs Mechanical Valve data:

There is significantly higher early mortality for those age 40 to 49 who chose tissue valve. Not opinion- see the linked publication below and the graphs for age range of surgery comparing mortality for tissue vs mechanical. I am very glad that you are one of the exceptions and that your tissue valve is still going strong after 16 years. Perhaps you will break the world record on the longest surviving tissue valve. But, one ought not make their decision based on the anecdote of your good fortune, which is a statistical outlier.

https://www.heartvalvechoice.com/ti...l valves are likely to,in patients ≤ 65 years.

 

[pellicle]

Mechanical valves fail too.

Care to share the data on that?

 

[hevishot]

Care to share the data on that?

Yes. My cardio (who happens to be the head of the department) said he had 2 mechanical valves come back this year and both died. He's not recommending them any more unless absolutely necessary. As far as "studies" go it's all about money. If they hold stock in mechanical valves then mechanical valves are better. If they hold stock in tissue valves than tissue valves are better. It's a lot of "Blue Sky." Just because they are physicians doesn't exempt them from being greedy. I apologize in advance if I don't answer any more of your questions, I am training for a powerlifting tournament and won't be visiting this site for several months. Good luck all.

 

[nobog]

What does that even mean "come back" ? SJM alone has sold nearly 4 million mechanical valves, add everyone else and lets just say 10 million over the last 40 years. How many of those "came back" - almost none - of course there has been documented cases of breakage but these are super rare events.

How many tissue valves "come back" - a large percentage of 'em, and it will be more now that the doctors are recommending them for younger and younger patients.

 

[Chuck C]

Yes. My cardio (who happens to be the head of the department) said he had 2 mechanical valves come back this year and both died

So, you are asked to support your wild claims about mechanical valve failure and you provide no published literature, but two alleged anecdotal cases. You imply that your cardiologist, who ostensibly is the head of the department, now does not recommend mechanical valves anymore, not based on the published literature and statistics for such valves, but based on two cases.

But, then you go on to shed further light on your position, claiming that we can't really trust science; can't trust the peer reviewed published studies on the valves because:

If they hold stock in mechanical valves then mechanical valves are better. If they hold stock in tissue valves than tissue valves are better. It's a lot of "Blue Sky."

Are you aware that this would be a conflict of interest that would be required to be disclosed?

Such is the tactic of conspiracy theorists. When they don't understand the science or if the science does not support their position, they attack the science and instead gain their information and make their decisions based on dubious, unverifiable anecdotes from the internet.

To be clear, I am not saying that bias does not exist. We need to review the scientific literature with a careful eye and always ask who is funding the study. The key is not not rely on any one study and to follow the preponderance of the evidence.
But, to suggest that we discard them all and that they are all worthless, well, then we might as well be back in the dark ages when doctors drilled holes in people's heads to let out the evil spirits.

 

[pellicle]

But, to suggest that we discard them all and that they are all worthless

I wonder if Hevishlt is preferentially a reader of "the only book you ever need to read"

that science stuff is confusing and inconsistent.

 

[MdaPA]

My cardio (who happens to be the head of the department) said he had 2 mechanical valves come back this year and both died.

Why did they fail? And if "he had 2 mechanical valves come back" to him this year alone then perhaps they failed due to surgeon error during implantation?

He's not recommending them any more unless absolutely necessary.

So......when would he consider mechanical valves "absolutely necessary" then?

As far as "studies" go it's all about money. If they hold stock in mechanical valves then mechanical valves are better. If they hold stock in tissue valves than tissue valves are better.

If you truly believe this then you are going to the wrong surgeon/hospital.

 

[pellicle]

If you truly believe this

I truly believe you're arguing with the wrong guy ... I gave up expecting logic from this fellow years back. He's been gone a while, his recent posts suggest he hasn't changed. People often don't

 

[tom in MO]

Yes. My cardio (who happens to be the head of the department) said he had 2 mechanical valves come back this year and both died. He's not recommending them any more unless absolutely necessary. As far as "studies" go it's all about money. If they hold stock in mechanical valves then mechanical valves are better. If they hold stock in tissue valves than tissue valves are better. It's a lot of "Blue Sky." Just because they are physicians doesn't exempt them from being greedy. I apologize in advance if I don't answer any more of your questions, I am training for a powerlifting tournament and won't be visiting this site for several months. Good luck all.

I checked up on my St. Jude mechanical valve on the FDA website. Only 1 failure in many years and that one was a long long time ago. We've had forum members who have got only 2-5 years out of their tissue valve.

Seems to me you are just fear-mongering and that's cruel.