Surgeon consultation

[Rick W]

Hello everyone.

For all the nice fellow members I wanted to update you on things. I met with a surgeon yesterday who prefers to use tissue valve replacements or repair what you have. I was surprised to hear that the data available today does not support the claim that mechanical valves last the lifetime of the patient. He is recommending a Homograft for me and thinks I need to get the workup for surgery going sometime soon (transesophogeal echo and an angiogram). I sure like the idea of no coumadin and no physical limitations once it is done. At 55 years old it should take me to 70 or 75 before needing reoperation. I thought this would be of some interest to others out there who are struggling with these decisions. I am still a little skeptical at this point because of what I had previously learned and heard about valve choice. This guy seems well received by patients and nurses, and has a great track record for AVR surgery.

Rick

 

[epstns]

Hi Rick!

Sounds like you have things about as much under control as would be expected at this point.

As I will someday also need to make the valve choice, I am curious where the doc quotes his "durability" data from. We seem to all find the same advice that tissue valves have a limited lifespan of perhaps 10 to 20 years, while mechanicals are expected to last 30 or more. For people our age (mid 50's), that makes the difference between going in once or twice.

Was he at all specific?

 

[Dave M]

Rick,

I would like to hear specifics as well. At age 44 with a mechanical, I am thinking possible reop at around age 70. My surgeon advised me that a homograft would be much more difficult to work around for a reop. However, I also had issues with my aorta. I'm sure that makes a difference.

It does sound like you've chosen a great surgeon. I'm sure he will help you make a solid choice.

 

[plb]

Me, too

Me, too

Rick, I just met with my surgeon today and he also recommended a homograft valve for me. He asked if I would have a problem taking a baby aspirin a day! I am getting a Medtronic Mosaic porcine valve. This valve promises longer durability than traditional heart valves. It was approved for use in 2000. I don't know which valve your surgeon will recommend for you, but I wish you all the best! It is a tough decision! Good luck!

 

[pillarpaul]

Rick,

I have spent the last couple of months asking the same questions you are as I anticipate my surgery next month. I am very curious about the data on mechanical valves. Every bit of research I could find supports a near lifetime lifespan on mechanical valves. We recently had a TV anchorperson here in Denver get a tissue valve replacement only to have his body reject it. He then went right back into surgery a week later and had a mechanical valve put in.

It will be a decison you and your doc's should make jointly.Can you let us know of the stats you mentioned? I want to go into the surgery 100% sure I'm making the right choice for me. Best of luck.

Paul

 

[BillCobit]

Valve selection considerations

Valve selection considerations

Hi guys -

My surgeon has an overview article on this topic. Kind of lightweight (with a little marketing promo thrown in), but might be helpful to you. I've seen an article with some statistics behind it, but can't recall where...I'll see if I can dig it up.

http://www.clevelandclinic.org/hear...&thirdCat=247&fourthCat=&parentCat=247&docID={09C97595-6D8F-4045-97E6-D32D73215230}

 

[BillCobit]

Stats

Stats

Wasn't the article I was thinking of, but might be useful (useless?). No clear answer...so we patients aren't the only ones confused!

Session X ? Comparative Studies ? Biological vs. Mechanical

#7067


AORTIC VALVE REPLACEMENT WITH MECHANICAL (CARBOMEDIC) AND BIOLOGICAL (CARPENTIER-EDWARDS PERICARDIAL) PROSTHESES IN MIDDLE-AGED PATIENTS

Carrier Michel, Pellerin Michel, Perrault Louis P., Hébert Yves, Cartier Raymond, Pelletier L. Conrad, Montreal Heart Institute.


The choice of a prosthesis for aortic valve replacement in middle-aged patients (pts) remains controversial. The objective of the present study was to compare the 10-year results following aortic valve replacement with mechanical (Carbomedic) and biological (C-E pericardial) in middle-aged pts. Five hundred twenty-six pts, aged between 55 and 65 years old, who underwent aortic valve replacement (AVR) with mechanical (Carbomedic, n=363) and biological (C-E pericardial, n=158) between 1982 and 1999 were reviewed. Follow-up of all except 3 pts (1% lost to follow-up) was available through the Valve Clinic. There were 254 (70%) men and 109 (30%) women with a mean age of 61±3 years in the mechanical group compared with 120 (76%) men and 38 women (24%) with a mean age of 61±3 years in the biological group (p=0.2). Fifty-eight (16%) pts underwent redo AVR compared with 22 (14%) pts (p=0.6) and 101 (28%) pts underwent associated CABG compared with 41 (26%) pts (p=0.7) in mechanical and biological pts. The 10-year actuarial survival averaged 66±6% in mechanical pts compared with 75±4% in biological pts (p=0.2). The 10-year freedom rate from thromboembolism, hemorrhage and endocarditis averaged 92±7%, 97±2% and 99±1% in pts with mechanical valves compared with 91±3% (p=0.03), 99±1% (p=0.01) and 95±2% (p=0.01) in those with biological valves. The 10-year freedom rate from valve dysfunction and from valve replacement averaged 99±1% in pts with mechanical valves compared with 92±3% (p=0.04) and 93±3% (p=0.1) in those with biological valves. The 10-year freedom rate from all valve-related complications averaged 90±7% in pts with mechanical valves compared with 83±4% in those with biological valves (p=0.07).

Conclusion: Mechanical and biological aortic valve replacement offers similar 10-year survival in middle-aged pts. Because pts with biological prostheses have higher rates of valve dysfunction, the overall freedom rate from all valve-related complications was higher among pts with mechanical valves compared with biological valves 10 years following aortic valve replacement.

 

[epstns]

Bill - Thanks for finding that study (again). When I read it, though, I was disappointed because I am concerned about the situation more than 10 years down the road. Heck, I'm only 55 now, so I hope to have a long run from here. It is nice to know that for the first 10 or so years things run similarly for mech and bio valves, but I have been led to believe that after the first 10 years the differences become very marked in favor of the mech for longevity.

The wild card that hasn't shown up much in studies is the Medtronic mosaic. Does anyone have valve life expectancy data for mosaic's used as aortic valves?

 

[richie rich]

hey steve

i had the mosaic valve "installed " in me back in dec. 02. so far so great. i am better than ever. i did some research on the valve be4 the op and they are hoping that the mosaic will last for 20 to 25 years. that would put me back in for a re-op at around the 53 to 58 year range. that sounds good to me. i hope my piggy last that long.

rich

 

[Gail in Ca]

I think it is great that the porcine valves you are considering will have 20-25 yr lifespan!! I sure wish they had been invented when I had my 1st avr in '89 at age 34.
When I needed it replaced after 11 yrs, I felt from talking to my cardio and the surgeon that the mechanical was the only way to prevent having a 3rd avr down the road. My cardio says that my mech valve will last my lifetime. I really think they want to avoid a 3rd avr replacement whenever possible, which is why the mech are almost always done in 2nd surgery scenarios.
Having a tissue valve last that long and avoiding the coumadin and finger sticks for 20+ yrs sounds super to me.
Who is your surgeon?
Gail

 

[epstns]

Rich - Thanks for the update. I thought I had heard that they expect extended useful lifespan for some of the porcine valves. Let's see -- If I can wait a couple of years for replacement, then maybe get 20 or more years from one of those, then might not worry too much about a second surgery. . .

This is definitely something worth watching for progress and further studies.

Thanks!