Time for 2nd surgery 10 years after the first.

coryp · Sep 10, 2015

After a long hiatus from the board i find myself back where i first started. I had my valve replaced 10 years and 3 months ago with an Edwards 29mm bovine valve, i was 34 at the time. I decided with the help of my surgeon that technology would be on my side regarding TAVR as long as i hope to get 10 years out of my new tissue valve. 10 years has gone by very quickly and Ive lived just as I had for the prior 34. I went to see my surgeon for my annual check up (echo and 64 slice ct) and he has just given me the bad news that the valve will have to be replaced just as it had to 10 years earlier. TAvr is not an option for me he says at this time and will most definitely be an option when i have to do my third (again 10-15, hoping for 20 years). He said it really is done for high risk patients that cannot stand an open heart procedure so i do not fit that mold. While i am unhappy with that as I recall the toll it took on my body and mind, im still optimistic that this 2nd surgery will be easier and then my third will be a piece of cake done through the groin. I do have thoughts today of maybe going ON-X but would that be a wasted 1st surgery? I have so many unanswered questions running through my mind since i got this news.... i have read through several posts of second surgery and valve selection. I have not forgotten all that happens after my 1st but much has been put out of my mind. Looking for a refresher from recent 2nd surgery patients.

I was quite certain that my 2nd AVR would be TAVR and i was NOT going to go through the sternum being broken and mended a 2nd time. I am pretty bummed at this point. Curious what all of you think about this as well as any other options I may have..

Thank you

Cory

ottagal · Sep 10, 2015

Hi Cory,
Welcome back, but sorry to hear of your circumstances.
I am still one tissue valve #1 and am about 6 years out, so unfortunately don't have any input for you. Times does fly, doesn't it.

It's unfortunate that your surgeon promised you TAVR by the time your next surgery would come around as this has resulted in a huge disappointment for you.. I hope this doesn't sound harsh, but you can't change the past or predict the future and all you can deal with is the present knowledge at hand. Know that others have gone through a second surgery (and some third!) and have come out of it leading full lives. Good luck with your decision. I know others who have been through this journey more than once will be able to help you with the process.
I can think of a number of members on the board who have had 2 surgeries. Off the top of my head, I can think of jScott Eitman and Pellicle, You may want to use the search engine, too.

All the very best. We will be here for you to help you get over this hump. Thinking of you.

ChrisF · Sep 23, 2015

Hi Cory,

I was pretty bummed too.

I had my second AVR in 2011, was 44 at the time, my tissue valve failed after 10 years - so similar boat. In my case, the valve broke one day, and then my chest had a very very pronounced vibration - like a blown bearing - the rest of me was behaving a little bit strange too. Calcification hardened the leaflets and then one of them cracked. So, for me, 2nd time, no research - surgeon said on-x I said ok. Afterwards, he said he hopes to never see me again. It was a bit of work getting the tissue valve out - well over 2 hours - an awfully long time to have your heart and lungs stopped for.

For me the tissue valve didn't really work out, and it wasn't working 100% after about year 7, even though the ultrasounds were ok.

So, I've got 4 years into this on-x valve, and so far so good - actually it is a noticeable improvement over the last few years of the tissue valve. The warfarin is not a big deal, but it did mean an extra day in the hospital to sort out that out.

I don't restrict my activities, I just have to tell a new message therapist that the ticking is me. And it doesn't affect my sleeping which was my worry back then.

Chris

AZ Don · Sep 23, 2015

2 years ago I had a valve sparing surgery to repair my ascending aortic aneurysm. My BAV was well functioning so I took the chance that I might never need another surgery again, or warfarin. After the surgery my valve started leaking so it's no longer a question of if I need another surgery to replace it, but when. Like you after your first surgery, I'm hoping that with time I'll have a better choice in the future. I'm not so much hoping for TAVR as much as a valve that can last a lifetime and not require warfarin (no such thing yet but they are in the works). The problem is we can't know what the future will bring. Even the experts can't, though they might have better guesses. When it comes time to make a choice I will look at my options. While I would like to avoid warfarin my current thinking is that I want to minimize the possibility of requiring a 3rd OHS and if that means a lifetime of warfarin, so be it. I'm not trying to say what you should do, just sharing how I'm looking at my own situation. The choice between tissue and mechanical is a personal choice. We should all be thankful we have these options, it's not so long ago that such issues were beyond repair. I wouldn't look at your 1st surgery as wasted. Without it I imagine you would have missed out on a lot of things over the past 10 years.

Duffey · Sep 23, 2015

Hey Cory! Glad to see you but wish it was under different circumstances. Just sent you a PM.

dornole · Sep 23, 2015

You still seem super young to expect a tissue valve to last 15-20 years, the younger you are the faster they degrade. And you have already had one poop out after 10 years. I'm wondering if assuming that 10 more years out of tissue max is more realistic in your case. Maybe that changes the equation for you, maybe not. I'm about the same age as you and assuming that I would be lucky to get 10 years out of a tissue valve. Unless the repair I have now lasts way longer than anticipated, it'll for sure be mechanical for me.