Tissue valve longevity: Can it last longer under certain lifestyle conditions?

[Dano64]

Still early for me, but at 58 two years and 3 months ago, I chose the Inspiris Resilia tissue valve. I have had no issues at all since then and I am currently very happy with this choice. Life seems normal to me right now, but with the Inspiris Resilia valve being relatively new, the jury is out on its longevity. Best wishes for whatever you choose going forward!

 

[d333gs]

I am a competative powerlifter. I had my valve replaced with an Edwards bovine valve in 2005. I lift HEAVY 4x per week for the last 20 years. Last echo my EF was 70 with only minimal calcification. Take from it what you wish.

Thats great , how old are you?

 

[tjay]

a thorny and vexing question. The answer is "it depends"

Too many variables to predict, you could get 2 years or 20 year ... you'll average 10 before SVD and the reasons range from as simple as "its a piece of leather and so no two bits of hide wear the same" through to the complex

get your Lp(a) tested because that's a significant determinant
https://heart.bmj.com/content/110/4/299

here's the low down on SVD
https://www.ahajournals.org/doi/10.1161/JAHA.120.018506

you won't find a better reference than that (but its quite a bone to chew).

Some simplifications are found here
by Dr Schaff of the Mayo


more current video


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306127/
I think more than mech = warfarin etc. This is the main issue of the choice of valve replacement.

also well worth your time to listen:
https://www.medscape.com/viewarticle/838221

Its up to you, but 68 would not be my desired time for a reoperation ... oh, and if anyone says "TAVI" to you just search here how many times people were promised and then found "you're not suited".

Best Wishes

I just my Lp(a) tested. It's 35 nmol/L. Am I correct in its conversion to ~16 mg/dL (= 35/2.15)?
Does it mean that I may be a good candidate for a tissue valve?

PS: My LDL, HDL etc which they test every year in the standard cholesterol panel have always been super favorable too.....

 

[pellicle]

I just my Lp(a) tested. It's 35 nmol/L. Am I correct in its conversion to ~16 mg/dL (= 35/2.15)?
Does it mean that I may be a good candidate for a tissue valve?

I'm not really fluent in this stuff (that would be @Chuck C )

So I just Googled it

https://www.heartuk.org.uk/genetic-conditions/high-lipoproteina
HEART UK's 2019 Consensus statement for Lp(a) and the recently established Lp(a) Taskforce recommend that Lp(a) should be measured in nmol/L of Lp(a) particles. Risk of CVD is determined according to the following thresholds:

• 32-90nmol/L (minor risk)
• 90-200nmol/L (moderate risk)
• 200-400nmol/L (high risk)
• More than 400nmol/L (very high risk)

HTH

 

[Chuck C]

I just my Lp(a) tested. It's 35 nmol/L. Am I correct in its conversion to ~16 mg/dL (= 35/2.15)?

Hi TJay.
Yes, that is about correct. The conversion factor that is often used is 2.4, and it does not surprise me if some use 2.15, because it is not an exact conversion- depends on an individual's particle size. Your level of Lp(a) is ideal.

Does it mean that I may be a good candidate for a tissue valve?

I don't think that this would be how I would put it. Lp(a) is not the only factor to consider. Age would be arguably the biggest factor for most people.

If you had very high levels of Lp(a), that might be a reason to consider avoiding a tissue valve, as suggested by the recent study, which found more rapid development of SVD for these folks.

But, that does not then convert to people who have normal Lp(a) are "good" candidates. It would just mean that when you do make your decision between tissue and mechanical that you should not bring Lp(a) into the discussion as you don't have a lipid condition which has been shown to cause more rapid SVD. You still are young and that is usually a big factor in how long a tissue valve is expected to last.

 

[tjay]

Thanks Chuck and Pellicle.

Yes, I wouldn't think Lp(a) was the only factor in this key valve-type determination, especially for those with good number as you said. Opposite is more applicable as you said, totally makes sense.

Hopefully this level of Lp(a) is helping with my around heart health, coronary arteries etc. And may've even helped my native valve to last this long (54 years). There's a lot more to the story there but that's for some other day. Right now, I'm getting into surgery mode

Thank you for getting me tested for Lp(a), and its importance. Just FYI, it's as good as the rest of my cholesterol panel is. It's not an outlier, rather completely consistent and corelated with standard HDL/LDL etc that doctor's order all the time.

 

[Innovativebrain]

I've been curious about the role Magnesium supplementation might play in delaying valve calcification since seeing these two studies. Interesting, No mention of this at all in the survey article at the top of the string.

• There are two studies I am aware of that seem to indicate magnesium supplementation may delay vascular calcification in general, but nothing about preventing calcification of the Bioprosthetic valve material (Bovine Pericardium) I've been supplementing with Magnesium Citrate 200Mg 2x daily since seeing these studies. https://www.ahajournals.org/doi/full/10.1161/atvbaha.117.309182 and https://openheart.bmj.com/content/5/1/e000668

 

[Elcarim]

I had a porcine aortic valve put in in 2000. I was 22yo. They told me 15-20 years. It barely lasted 5. Admittedly I had two pregnancies in that time, which are very hard on bioprosthetic valves. Presumably you won't be doing that. But it was very hard going in for the second surgery knowing what was coming. I had complications after that second surgery that had a serious impact on my quality of life and now 20 years on I'm looking at surgery #3 in the near future, with even bigger risks.

If I had my time again I'd have got a mechanical valve from the get go. Managing warfarin is a lot more palatable than multiple surgeries.

 

[newarrior]

There is a lot of uncertainty in the above statement. Why not get the mechanical valve and remove the future uncertainties?

Dick with respect to your 57 years with the mechanical valve they're still uncertainties related to a mechanical valve and blood thinners as well. However the science backs up of course especially if you're under 71 getting a mechanical valve. And there is more certainty you're probably right related to a mechanical valve as opposed to a tissue valve. Some of us just may not be able to handle the ticking or have various things that may not make us a good candidate for blood thinners or INR management.

 

[newarrior]

I've been curious about the role Magnesium supplementation might play in delaying valve calcification since seeing these two studies. Interesting, No mention of this at all in the survey article at the top of the string.

• There are two studies I am aware of that seem to indicate magnesium supplementation may delay vascular calcification in general, but nothing about preventing calcification of the Bioprosthetic valve material (Bovine Pericardium) I've been supplementing with Magnesium Citrate 200Mg 2x daily since seeing these studies. https://www.ahajournals.org/doi/full/10.1161/atvbaha.117.309182 and https://openheart.bmj.com/content/5/1/e000668

Thanks I've been a strong proponent of magnesium supplementation for my hearing loss ringing of the ears cardiac issues keeping regular digestive wise it kind of keeps my constipation at Bay also seems to have a lot of cognitive and anxiety related positive affects as well

 

[carolinemc]

I had a porcine aortic valve put in in 2000. I was 22yo. They told me 15-20 years. It barely lasted 5. Admittedly I had two pregnancies in that time, which are very hard on bioprosthetic valves. Presumably you won't be doing that. But it was very hard going in for the second surgery knowing what was coming. I had complications after that second surgery that had a serious impact on my quality of life and now 20 years on I'm looking at surgery #3 in the near future, with even bigger risks.

If I had my time again I'd have got a mechanical valve from the get go. Managing warfarin is a lot more palatable than multiple surgeries.

So true. I can do many things with the mechanical valve. Active lifestyle.

 

[hevishot]

Thats great , how old are you?

69

 

[Lisa from LJ]

I had a porcine aortic valve put in in 2000. I was 22yo. They told me 15-20 years. It barely lasted 5. Admittedly I had two pregnancies in that time, which are very hard on bioprosthetic valves. Presumably you won't be doing that. But it was very hard going in for the second surgery knowing what was coming. I had complications after that second surgery that had a serious impact on my quality of life and now 20 years on I'm looking at surgery #3 in the near future, with even bigger risks.

If I had my time again I'd have got a mechanical valve from the get go. Managing warfarin is a lot more palatable than multiple surgeries.

But then you wouldn't have babies! I had two pregnancies before my valve replacement. The first was against my cardiologist's advice and the second I didn't ask because the first had gone so well. Because of the damage from rheumatic fever and my age (36), they told me no CV surgeon would have put a tissue valve in unless I still wanted to get pregnant, and even then, it wouldn't have been a guarantee. I had also read the story of one of my favorite funny guys - Lewis Grizzard - and knew that multiple surgeries wasn't something I wanted. From what I've heard, no one who is young gets even 10 years from a tissue valve so not sure why you were told 15-20, although I do understand them giving you the chance to have babies at your young age.

 

[Chuck C]

From what I've heard, no one who is young gets even 10 years from a tissue valve so not sure why you were told 15-20,

It is unfortunate how often this type of false hope is given to young patients. Any cardiologist who tells a 22 year old to expect 15 to 20 years from a tissue valve has no business practicing medicine.

 

[David W]

Hi Tjay, I went for a tissue valve in 2015 and since then have had no issue at all. I'm sure you might have already had your procedure and everything went well. The topic of trying to mitigate negative future experiences is certainly a good foot forward. Any behaviours that lead to positive feelings on a personal level isn't a bad philosophy for life, as post my own operation, I've continued to be active and healthy, i run as often as i can, walk the dogs over 50 K each week, still partake in low load bearing exercises and have cycled many thousands of miles far and wide, nothing has held me back. But a more philosophical frame of reference guided my choice of valve, in that despite all of our best intentions to live healthily and to cultivate as much advice as possible to make the right choice for a valve, we've all got a diagnosis of death irrespective of the choice we make, we just don't know when we will check out. So no matter how you engage with the information, try and live the life you want (but check with your doc first)...