Tissue longevity / endurance changing

[Savymom]

Hi everyone
I was a member about 10 plus years ago, but lost all my login info. It's been a while. I had AVR with a tissue valve 10 years ago, when I was 25. I had a bicuspid valve and ascending aortic aneurysm.

For 10 years I've run, and lifted weights. Ive felt great. I did a few half marathons but the last couple years I've been doing more weight training.

Since late may, I've been feeling like ive lost all cardiovascular ability. My runs are the slowest they have been in 10 years, and I can't seem to find any reason why. My nutrition is spot on, as is hydration. Maybe heat ? Last year I was running 7.50 and 8.15 minute miles. This year I'm running 9.45 to 10.45. Big difference. :/

I have a couple questions for those of you who have had a tissue valve replaced. How long did your tissue valve last? When it started to fail, how fast did that process go? We're the symptoms the same as they were with your native valve.

Thanks yall.

 

[tom in MO]

I have a mechanical, thus I not had a tissue valve replaced but from what I have read, the number of years before a replacement tissue valve has problems varies by individual. On this forum, the time period has been several years to 20+ years; but the younger you are the more likely it will fail earlier than later.

From what I have read, the symptoms can be the same as when your native valve failed since the failure mechanisms are similar. I'd suggest getting in touch with your cardiologist if you are concerned.

 

[Savymom]

Thanks ! I usually see cardio in January or Feb, so if it gets worse I'd call, otherwise I'll just see how my tolerance holds up the next several months.

 

[pellicle]

Hi

Thanks ! I usually see cardio in January or Feb, so if it gets worse I'd call, otherwise I'll just see how my tolerance holds up the next several months.

it should, but keep an eye on it ...

I have a couple questions for those of you who have had a tissue valve replaced. How long did your tissue valve last? When it started to fail, how fast did that process go? We're the symptoms the same as they were with your native valve.

my tissue replacement was a homograft, so that will alter things a bit. You get what you get (in my case I got 20 years). With homografts I was lucky that I got my valve fitted at about the right age to maximise a homograft lifespan.

My valve degraded at about the same rate as my native valve degraded (it was changed when I was 28yo) Fitness gradually reduced and I started putting on weight. In retrospect its almost exactly what happened between 26 and 28 ... so yes, the symptoms were similar.

As Tom says above the mode of failure (usually stenosis due to calcification) is quite like what happened to your native valve. Probably most of the measurable changes occur before you feel them, as bodies adapt to changes.

I've got a mechanical now (had a "repair" at 10yo and the replacement at 28yo) and so this made this my third surgery. Scar tissue was already a problem on the 2nd and of course more significant on the third. My surgeon simply said "you won't find good surgeons lining up to do your 4th" ... so at 48 for my 3rd OP I went mechanical.

best wishes.

 

[Savymom]

Pellicle, thanks. 20 years is great from what I've read. I originally hoped for 10, but now I'm at 10 , and hope for 10 more. I only chose a tissue valve because I wanted more children. The valve held up great through my pregnancy.

With the native valve I had zero exercise tolerance, but also didn't really try to exercise. It wasn't until the Dr said I had severe regurgitation that the light bulb went off.
I just hoped that this time I'd see it coming. Gradual change, with annual visit will show changes if they exist.

Interesting thing I noticed my last echo my gradients were very high, like 45-50 if I remember correctly. My Dr said they have always been that way. Since the surgery, so probably not a big deal. But I wonder if that will cause excessive ware on the valve.

 

[DebbyA]

My tissue valve lasted 6 years. I was seeing a cardiologist regularly, so I could track the valve decline. Symptoms were about the same until about 4 months before replacement, when I started having mild chest pain on moderate exertion. Echos showed severe regurgitation, which I didn't have the first time. Replacement surgery revealed that the tissue valve had a torn cusp. Based on my experience I would say if you noticed a decline over a few months, why wait for it to get worse? If you are having a recurrence of symptoms, Feb is a long way off. It looks like you're still mid-30's, so you can't blame it on aging.
Best wishes.

 

[pellicle]

Hi

Pellicle, thanks. 20 years is great from what I've read. ... But I wonder if that will cause excessive ware on the valve.

yes, 20 is about the max you can expect from a homograft (and even then only within certain parameters). From what I understand its not the wear and tear on the valve that causes tissue prosthetics to fail but your bodies chemistry reactions with it.

hope you get that other 10

 

[epstns]

The others have given you some very good information and advice. I would suggest that you keep a careful watch on your tissue valve, as most of the folks who manage to get 12-15-18 or more years from tissue valves are well older than mid-20's when they have their valves implanted. You may be getting closer to the re-op state than you expect, as you were so young when you got your tissue valve.

I'm not saying that your valve is failing, but all of us who have tissue valves know that as soon as we have that shiny new tissue valve implanted, they are all deteriorating toward another replacement. It is just that the older we are when the valve is implanted, the longer it will likely last. This, they say, is probably due to the fact that the immune systems of younger patients are more active, and this is what leads to more rapid calcification (and failure) of prosthetic tissue valves.

All summarized - try to live your life as best you can, but keep watching the valve for signs of advancing deterioration, then act swiftly.

 

[Savymom]

Thank you. Yes I figure I'll either feel better meaning it was a bad couple nonths.. or I'll feel the same or worse. In that case I'll call dr.

I wish there were more studies on tissue longevity in younger adults. The only info I can find is under 60. There really doesn't seem to be any study on tissue longevity in under 30 or 40.

 

[pellicle]

Hi

I wish there were more studies on tissue longevity in younger adults. The only info I can find is under 60. There really doesn't seem to be any study on tissue longevity in under 30 or 40.

There are some, but indeed youth is not the focus, as we represent a smaller market share. What studies there are focus primarily in their abstracts on "long term mortality" and not "side effects and reduced quality of life" ... only if you die or not.
For instance
http://circ.ahajournals.org/content/...ppl/I-294.full

Of these, 1512 patients contributed follow-up data beyond 20 years, of whom 567 were adults <60 years of age at first left-heart valve operation (mean survivor follow-up, 24.0±3.1 years).
...
There were 277 valve reoperations in the study cohort during the follow-up period: 198 patients underwent reoperation once, 33 twice, 3 patients had 3 reoperations, and 1 patient had 4 reoperations. As expected, frequent crossovers occurred between tissue and mechanical prostheses at reoperation, as well as occurrences of other native left-heart valve pathology requiring valve replacement.

Within AVR patients, the 20-year actuarial freedom from valve reoperation was 11.4±3.5% in those initially implanted with a tissue prosthesis, versus 73.0±4.9% in those who received a mechanical aortic valve (HR: 3.9, tissue versus mechanical; 95% CI: 2.6, 6.3; P<0.001).

There are however anecdotes from here:
http://www.valvereplacement.org/foru...fter-6-months=

http://www.valvereplacement.org/foru...746#post793746

http://www.valvereplacement.org/foru...=&p=546706

http://www.valvereplacement.org/foru...ee-years-later

there are more sadly ... to me tissue valves only stack up logically when
* you have associated co-morbidities that make mechanical more risky,
* you do not wish to risk warfarin during pregnancy (it has been and is successfully managed however) or
* when you are over 60 (in which case your duration will probably be sufficient for your life).

Best Wishes