Staying the Course -- 11/18/2019

[Superbob]

Some time ago when I posted that I had received a bovine valve (replacing my 15-year-old porcine one that was still working well) -- all as part of my ascending aortic aneurysm surgery -- Jim asked the perfectly good question -- what brand of bovine exactly? (Paraphrasing.)
I didn't answer because I didn't know. I knew at my age (77) I was going to get a tissue valve, but never received details. Today I got online the complete record of my surgery, so now I can report I have the Edwards Magna Ease Pericardial Bioprosthetic Valve. In a quick surf, I found a research study indicating its durability is excellent.

Looks like my surgeon and his team made a good choice -- my trust in them was not misplaced -- but should we be more aggressive in seeking information bout replacement device options pre-surgery? Probably so. Be interested to know the extent to which fellow Coursers were involved. Tissue was a no-brainer in my case, and Edwards seems solid, but some pre-op discussion of specific options would have been nice.

First week of cardiac rehab indicates it will be thorough and well-planned, but not as much fun as the CR I had at a smaller hospital 15 years ago. We were the fun bunch back then. The nurses now are all very pleasant and helpful, but different patients at different stages of rehab seemingly cycle in and out. We were a cohesive group back then -- function of smaller, more tight-knit operation. This time around have some no-nonsense organization -- including taking our blood sugar at the beginning and end of each class (granted, it is interesting to see how an hour of exercise will cut 100-some points off the glucose reading.) And every Wednesday we will have a 20-minute class added, on a dozen different topics. And have a food diary to fill out -- would we fun bunchsters ever have laughed our way through one of those back in the CR of yore.

Oh well, it promises to be a rigorous and educational 36 sessions -- just with fewer laughs. Maybe that's better anyway.

Meanwhile, I have one lingering, ugly-looking suture down in tummy area that needs removal. CR nurses weren't keen on doing it. Sure hope someone in cardio's office when I visit Thursday will do it. Sure don't want to have to drive four hours back to where I had the surgery to have a 5-second snip and gentle pull. Been staring at it long enough to have a good idea how to do it myself, though that is supposed to be a big no-no.

Okay, what's happening along your courses, Coursers?

Cheers,
Superbob

 

[Paleowoman]

..should we be more aggressive in seeking information bout replacement device options pre-surgery? Probably so. Be interested to know the extent to which fellow Coursers were involved. Tissue was a no-brainer in my case, and Edwards seems solid, but some pre-op discussion of specific options would have been nice.

The extent to which I was involved was that I had followed what people wrote on forum and I knew I wanted a tissue valve and I knew I wanted a bovine valve at that. I asked the surgeon what kind of valve she was going to give me and she spat out (that was how she talked) “bovine” - so I was content with that. I never thought to ask the make…but I have an Edwards Magna Ease valve like you SB. My only regret is that I didn’t ask about the size of the valve because I had no idea that the size of valve measured during surgery can sometimes mean a smaller valve area size than pre surgery, and I didn’t realise that a surgeon could put a bigger valve in, if that situation arose, by doing a more complicated surgery - the cardiac surgeon had not investigated the size of my annulus pre-surgery - now I know that’s important too and that it can be ascertained on echocardiogram. So pre-op discussion is very important….next time I will be doing that !

 

[nobog]

The extent to which I was involved was that I had followed what people wrote on forum and I knew I wanted a tissue valve and I knew I wanted a bovine valve at that. I asked the surgeon what kind of valve she was going to give me and she spat out (that was how she talked) “bovine” - so I was content with that. I never thought to ask the make…but I have an Edwards Magna Ease valve like you SB. My only regret is that I didn’t ask about the size of the valve because I had no idea that the size of valve measured during surgery can sometimes mean a smaller valve area size than pre surgery, and I didn’t realise that a surgeon could put a bigger valve in, if that situation arose, by doing a more complicated surgery - the cardiac surgeon had not investigated the size of my annulus pre-surgery - now I know that’s important too and that it can be ascertained on echocardiogram. So pre-op discussion is very important….next time I will be doing that !

Don't be to worried about cramming the biggest valve into the smallest possible hole - especially with a tissue valve. If you are worried about the best possible flow you will get a mechanical anyway. Tissue valves have a large variability in EOA (or pressure drop - in mmHg) and the doctor can't tell which is "the best of the best" by looking at it. Over sizing a valve has its own problems and is not recommended.

 

[MartinF]

SB, tell the nurses that you need the suture out or you will do it yourself. All you need is a pair of tweezers, finger nail clippers and then pull across the opening. Of course clean with alcohol. I bet they'll take it out for you.
I did 5 1/2 miles on Sunday and ran around half of it with my dog. My quads are sore now which means I'm getting back into shape (I hope). Time will tell. BP was good most of the day. That's the goal.
This week is my first 4-day work week. I'm looking forward to the 3-day weekends.
Everyone have a great week!

 

[Paleowoman]

Don't be to worried about cramming the biggest valve into the smallest possible hole - especially with a tissue valve. If you are worried about the best possible flow you will get a mechanical anyway. Tissue valves have a large variability in EOA (or pressure drop - in mmHg) and the doctor can't tell which is "the best of the best" by looking at it. Over sizing a valve has its own problems and is not recommended.

Hi @nobog - the surgeon put in too small a valve for my body size so that I have patient prosthesis mismatch and have high pressure gradients and not recovered to fitness I had prior to surgery. True, she could not have put a bigger valve in the space where the aortic valve goes, she measured the space properly with a sizer, but she could have put a bigger valve in the suprannular position or used a sutureless valve for example. If I'd have known this kind of problem could have arisen I could have discussed the options prior to surgery.

 

[nobog]

not recovered to fitness I had prior to surgery...
Keep in mind that might not be the only issue. Pressure gradients go all over the place - especially for tissue valves, a one size up does not guarantee a lower pressure drop. PPM is somewhat of a "grey area" - there is no absolute this is right and this is wrong.

 

[epstns]

When I had my final consultation with my surgeon, we discussed valve choice. He convinced me the Edwards was the "only" choice, as he had been a member of the development team for that valve and had already implanted loads of them with great results.

I've probably got "90,000 miles" on this one over the past 9 years, so I'd say it was a wise decision to trust him.

 

[Paleowoman]

PPM is somewhat of a "grey area" - there is no absolute this is right and this is wrong.

I've had a formal diagnosis of moderate patient prosthesis mismatch - not gray at all. Even TEE cardiologist noted physically small size of valve.

I think it would have been good to discuss with surgeon prior to surgery what options to take in the event of the valve size going to be too small. The cardiac surgeon who I was referred to three years post surgery told me that when he considers that a bioprosthetic valve might be too small for a particular patient he discusses this beforehand with the patient and tells them that if that scenario becomes apparent during surgery he will put in a mechanical valve instead as that gives a larger valve area than a bioprosthetic one. Not that I, for one, would have liked that option - there are other options such as a sutureless valve or valve in supraannular position. Anyway, it's one of those things that patients could "be more aggressive in seeking information bout replacement device options pre-surgery" as SB asks in his original post !

 

[Duffey]

I have an Edwards Magna Perimount, older generation of what you have, SB. It’s almost 15 years old and seems to be doing well. We leave tonight for your old stomping grounds, Richmond. Our son is in Air Force training at the Fort Lee Army base. It’s an 848 mile drive, complete with a lovely daughter-in-law, one rambunctious five year old, one really rambunctious two year old, and grandparents (Hubby and I) acting as chauffeur and babysitter. We will miss our traditional Thanksgiving celebration, but that’s life! I hope everyone has a great week and stays the course!

 

[FredW]

Hi, my Valve Replacement friends.

It's been a while since I stopped by. It's nice to get caught up with everyone.

I find the discussion of which valve we have interesting, not so much as to the specific valves, but rather the knowledge we have before surgery versus after surgery.

For example, before surgery, I had done my research on valve type: tissue and mechanical, but I had not done any research on the manufactures of valves. I figured and trusted the surgeon would know best. Just after surgery, when I received the warranty card specifying the model and serial number (St. Jude TFGT-25A). I did my research on this specific valve and learned more about the size and other details.

Of course, some of the information on St Jude's website was useless - like "don't use the valve if dropped" - well Duh! But other information was interesting like why the surgeon should not oversize a replacement valve and that there is an expiration date on Trifecta valves.

However, being the questions kind of guy I am, had I known all this information I learned from St. Jude's website before surgery and asked my standard set of questions, I probably would have pissed off the surgeon. You do not want a pissed off surgeon working on you. So, if I ever have another valve replacement done, I'm not going to ask "What's the expiration date of the valve your putting in?"

As for an update on me, life is good three years after my surgery. At 76, I feel better health-wise than I have since age 70. I attribute this to my new valve, treatment of sleep apnea and getting off my beta-blocker medication. I play pickleball three times a week, hike better, do my chores easier, think better, and love better.

I hope you all also find your life better after surgery.

Wishing you all happy holidays, whatever you celebrate.

 

[Superbob]

Don't want a "pissed-off surgeon," lol Fred! Great piece of folk wisdom right there, and probably explains why I didn't press for more specific info --other than knowing he would go for tissue for this septuagenarian (now pushing octo status). Especially given his experience and expertise dealing with aortic aneurysms, and even "cutting-edge" national research. So glad you are doing well, Fred. Same goes for me, except I did have a worrisome episode this morning when bolted out of bed quickly and immediately felt very dizzy. Think I've learned over the years that can happen when bp goes awry from swift positional changes. Seem to be better now 'cept that DW wants to drag me out for shopping, so...ugh.

Duffey, say hello to the Holy City for me. Safe travels -- and hope your sanity remains intact with 800-plus miles of "are we there yet" -- : )

 

[nobog]

FYI, all tissue valves have an expiration date. The manufactures have to do a "shelf life" test, this is typically done at 1 yr thru 5 yrs. Mechanical valves also have a shelf life but that's for sterility issues - nothing wrong with the valve of course. It take A LOT more than dropping a SJM to damage it, that's in there for legal reasons.