Tissue Valve

[Christyleedh]

I understand most people can manage warfarin, but it does have real risks. I had a uterine ablation- which my local doctor probably should never have performed while I was on blood thinners, but a few days after, I started hemorrhaging and needed 7 blood transfusions, and it wasn’t until I was transferred to cleveland clinic by ambulance that they were able to make it stop. This isn’t to scare anyone, but make sure if you choose mechanical, and you take warfarin- get a second opinion before doing an elective procedure if a doctor thinks you can have it without stopping warfarin.

 

[Duffey]

I had avr with bovine in 2013 for regurgitation, my latest echo showed I now have severe stenosis. I chose to go tissue because I did not want to be on coumadin for the rest of my life. I really thought I would get more years out of the tissue valve. Does anybody know if you can get Tavr if you already have a tissue valve?

To answer your question, yes you can undergo TAVR if you have a tissue valve. Long time member Tobagotwo, who had a porcine valve, had replacement via TAVR a year ago last June. For what it’s worth, my bovine valve was implanted 16 1/2 years ago and is still going strong.

 

[Chuck C]

Hi Chuck,

When I got my valve 2 years ago, at 67, my surgeon for some reason chose an older-type tissue valve. It was surprising since he was a lead investigator on one of the newest, most popular that seem to be used today. He felt this valve was the best for my procedure/situation. But he sized it for a TAVR replacement, and said this one should last 8-12-15 years. As you and I both know, having read these forums, some people have them replaced much sooner; some others have had them last longer.

FWIW, after I made my choice my surgeon, who was also in his 60s, said he thought tissue was the right choice.... for me. (As you know, they let YOU choose mechanical vs tissue, then THEY choose the brand/model valve.)

When mine is replaced, assuming it's via TAVR, I'll likely also need a pacemaker. I have a right-bundle-branch block, so apparently the way TAVR is done will play games with my heart rhythm. (That said, thankfully I had no aFib after my current implant.)

I had been watching my valve for 40+ years. If I had been younger, I would have likely chosen mechanical. The one constant I've read here is that living with INR testing and Coumadin is more bark than bite.... sort of like heart surgery, itself.

Like everything in life, and given the way the brain works, you adjust.

Cheers,
Herb

Good morning Herb.

Thanks for your comments, they are always thoughtful and insightful. At the time I was facing valve surgery you were one of the people who really helped me face surgery with minimal fear and I will forever be grateful.

If I was 67, I would have almost certainly made the same choice that you did, and gone with a tissue valve. As you well know, the data shows that the older one is the longer the life expectancy of the valve. Your surgeon was very realistic in setting up your expectations. I think that every patient deserves that.

As is often said, there is no wrong choice- the only wrong choice is to deny that surgery is needed and not get it done. When I was facing my surgery I connected with another forum member who was my age and faced surgery just a little bit after mine. He went with tissue. It was not the wrong choice. He weighed the pros and cons and made an informed choice. It is the choice that allows him to sleep at night, and that is what is important. He also is fully aware that it means that he faces reoperation, and is realistic about valve life expectancy.

There is no wrong choice- but the choice should be an informed choice.

What breaks my heart is when I see a young patient come on the forum and share that they now need a new valve and they believed it would last a lot longer than it did- often they were told it would last a lot longer. That is a problem and truly sad, as a decision was made with poorly guided expectations- unlreasitic guidance.

The original poster of this thread chose a tissue valve at age 44. They are now facing a reop at 52. They were told that they could expect their tissue valve to last a lot longer than that. This is troubling, because 8-12 years is what a young person would normally get from a tissue valve. No one should be telling them to expect longer.

I had two surgical consults before making my choice. One at Cedar Sinai and one at UCLA. Going into each consult I was 95% sure that I was going to go with a tissue valve, as I feared warfarin, and wanted my life to be as normal as possible after surgery. I had seen the infomercials sponsored by the leading tissue valve company about the new and improved tissue valve, meant to delay calcification and felt that was the right one for me. I was optimistic that it would last a long time. The surgeons I consulted with each had completed over 6,000 valve surgeries and, as one would hope all surgeons would be, were up to date on the published literature for expected valve life. They both told me about the same thing. At age 53, the data and their experience would indicate that I would probably get about 10 years before needing valve replacement as young patients usually go through tissue valves quickly. Yes, I could get a little longer, but I could also get a little less. I was also told that I might get very lucky and have it last several years longer than that, but the flip side of that is that I could be very unlucky and need replacement much sooner, like after 2-5 years. We have seen both of these situations many times from members on the forum. When I brought up the new and improved tissue valve being marketed I was told that the data is not there to make any predictions yet, but that it probably would last as long as the previous generation valves and I could get lucky and have it last longer, but just don't base my decision based on believing that it will.

I feel very fortunate the surgeons whom I consulted with were realistic. It is the only way to really allow the patient to make an informed choice.

Take care,

Chuck

 

[Chuck C]

I had avr with bovine in 2013 for regurgitation, my latest echo showed I now have severe stenosis. I chose to go tissue because I did not want to be on coumadin for the rest of my life. I really thought I would get more years out of the tissue valve. Does anybody know if you can get Tavr if you already have a tissue valve?

Hi again Bigchzz.

Per your question if TAVR can be used with an existing tissue prosthesis, I just checked my notes from my consult with Dr. Curtiss Stinis of Scripps. Stinis is an interventional cardiologist who does a lot of TAVRs.

My consult was to determine 1) If I was eligible for TAVR, so that I would know that this choice was on the table for me and 2) If I go with a tissue valve in surgery #1, have a discussion for the prospect of going TAVR for operation #2.

Regarding going tissue and then TAVR, he cautioned me that there are two valves that I should avoid for surgery #1 if I want to have a TAVR for #2, as they don’t expand properly:

Hancock II by Medtronic

Trifecta made by Abbott

I found this publisehd review, which looked at several studies testing various tissue valves for their ability to be expanded, which is needed to put a TAVR inside an existing tissue prosthetic. It seems to confirm the information from Dr. Stinis regarding the Hancock II an Trifecta.

You can take a look at Table 1 to see how your valve did when tested for expansion:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872348/
There is also additional good information in the review which should be considered, such as: "Importantly, patient–prosthesis mismatch and high residual transvalvular gradients are associated with reduced survival following VIV TAVR"

Ultimately, you will want to consult with a surgeon or interventional cardiologist who has a lot of experience with TAVRs to be property evaluated as to whether you are a candidate and whether it is the best choice for you.

 

[hevishot]

I'm also curious as to what risks you see ... the primary risks are all on you really:

• you fail your compliance and didn't take it
• you don't bother testing and therefore don't know your INR and if its out of range there are real risks

the risks of having a tissue are that it will fail (note, not might) and require reoperation unless you die earlier. There is the possibility that you can (at your age) get 15 years before the onset of Structural Valve Degradation (SVD) and then have a TAVR which may last as long as 10 (not so much data around) 15 + 10 + 52 = 77 : which is a real bad time to be needing an OHS. However you may be dead by then anyway. Not that TAVR is without risks ...

View attachment 888252

52 is an age were I think that if you aren't active and sporting then a tissue isn't a bad choice.

If you are not the type that wants to take the helm and look after your own health then tissue is the best choice IMO

The real kicker would be that you pick tissue for the sole reason of avoiding warfarin and then become one of the lucky 10% or so who are stuck on warfarin with a tissue valve anyway (of course your surgeon will tell you "that won't happen to you".

I would make efforts to educate yourself on facts. Because after surgery is too late to go "oh, nobody tol

 

[hevishot]

I'm also curious as to what risks you see ... the primary risks are all on you really:

• you fail your compliance and didn't take it
• you don't bother testing and therefore don't know your INR and if its out of range there are real risks

the risks of having a tissue are that it will fail (note, not might) and require reoperation unless you die earlier. There is the possibility that you can (at your age) get 15 years before the onset of Structural Valve Degradation (SVD) and then have a TAVR which may last as long as 10 (not so much data around) 15 + 10 + 52 = 77 : which is a real bad time to be needing an OHS. However you may be dead by then anyway. Not that TAVR is without risks ...

View attachment 888252

52 is an age were I think that if you aren't active and sporting then a tissue isn't a bad choice.

If you are not the type that wants to take the helm and look after your own health then tissue is the best choice IMO

The real kicker would be that you pick tissue for the sole reason of avoiding warfarin and then become one of the lucky 10% or so who are stuck on warfarin with a tissue valve anyway (of course your surgeon will tell you "that won't happen to you".

I would make efforts to educate yourself on facts. Because after surgery is too late to go "oh, nobody told me that"

"52 is an age were I think that if you aren't active and sporting then a tissue isn't a bad choice."
The insinuation is here that if you are active and sporting your heart rate increases and your valve will wear out faster. Actually the opposite is true. Exercise strengthens the heart and cardiovascular system which in turn lowers your resting heart rate. I am a powerlifter and my resting heart rate is 52 BPM. So your tissue valve will last longer if your are active not shorter. I wish people on this site would stop spreading biased and disinformation.

 

[pellicle]

I wish people on this site would stop spreading biased and disinformation.

yes, I often wish they would

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706839/
Table 1, I've taken the opportunity to just highlight why I say what I do ... last I looked 52 was < 60

I hope you weren't also Biscuspid aortic valve ...

This stat isn't helpful to your views of misinformation either

The long-term durability of conventional, surgically implantable biological valve protheses is by far the best documented: the reported 5-year reoperation rates range from 13.4% to 36.6%, and the pacemaker implantation rate is ca. 4%. ​

oops

The crucial advantage of using biological valves—compared with valve replacements using mechanical prostheses—is the fact that continuous anticoagulation is not required. ​

which sort of backs up exactly what I said ... if you manage anticoagulation then that crucial advantage vanishes.

I look forward to your counterarguments

 

[bizinsider]

I just checked my notes from my consult with Dr. Curtiss Stinis of Scripps. Stinis is an interventional cardiologist who does a lot of TAVRs.

By all accounts, Chuck, he is considered world class. Or so says my cardiologist, who runs integrated medicine at Scripps, and speaks highly of him. Scripps was a pioneer in TAVR (notably, Dr. Teirstein)... a friend had his TAVR done by Stinis and coundn't speak more highly of him. It's kind of off topic, but thought I'd toss it out there!

 

[Chuck C]

Scripps was a pioneer in TAVR (notably, Dr. Teirstein

Indeed- yes I understand that Dr. Teirstein and Stinis are the TAVR team and have heard nothing but good things about them as well.

In my consult with Stinis, I can say that he was one of the brightest that I have ever consulted with- up on the literature and happy to engage in discussion and answer all questions completely.

 

[haggis basher]

I had avr with bovine in 2013 for regurgitation, my latest echo showed I now have severe stenosis. I chose to go tissue because I did not want to be on coumadin for the rest of my life. I really thought I would get more years out of the tissue valve. Does anybody know if you can get Tavr if you already have a tissue valve?

I

 

[haggis basher]

I had avr with bovine in 2013 for regurgitation, my latest echo showed I now have severe stenosis. I chose to go tissue because I did not want to be on coumadin for the rest of my life. I really thought I would get more years out of the tissue valve. Does anybody know if you can get Tavr if you already have a tissue valve?

 

[haggis basher]

I had Aorta tissue valve in 2011, at 71 age. Had cardiologist check recently October 2021 - told it's as good as new! I run 3-5 km most days] Told if another valve needed - would be by TAVR!!

 

[Chuck C]

" I had Aorta tissue valve in 2011, at 71 age. Had cardiologist check recently October 2021 - told it's as good as new! I run 3-5 km most days] Told if another valve needed - would be by TAVR!! "

Thanks for sharing that Haggis. In my opinion, if you are a candidate, going TAVR in your 70s is a no-brainer. If younger than 70, I would be concerned with the lack of data on the durability of the TAVR valves. If it turns out that they last as long as normal tissue valves and the patient has decided to go the tissue route, then it makes perfect sense.

 

[haggis basher]

Mean t to mention - did 31mins for tough 5km x- country race a few months ago - 81age!

 

[Chuck C]

Mean t to mention - did 31mins for tough 5km x- country race a few months ago - 81age!

Fantastic!! Great job!!

 

[Lynn]

Below is a link to and the title of an article I found interesting in when making my decision between mechanical and tissue.
The article discusses some of the many complex reasons bio valve degenerate, often faster than native valves. One of the lines that stuck with me is the following

“Recent studies implicate the host immune response as a major modality of SVD pathogenesis” …essentially acting on the same principles as transplant rejection.

It’s an interesting piece for anyone wants to did a bit deeper.

https://www.ahajournals.org/doi/10.1161/JAHA.120.018506 This is a link to a article in JAHA entitled Degeneration of Bioprosthetic Heart Valves: Update 2020.

 

[pellicle]

OMG Lynn

It’s an interesting piece for anyone wants to did a bit deeper.

https://www.ahajournals.org/doi/10.1161/JAHA.120.018506 This is a link to a article in JAHA entitled Degeneration of Bioprosthetic Heart Valves: Update 2020.

best article I've read in years ... (not that I'm in the market or anything) (and I might be a communist)

;-)

Thanks for posting that

 

[Lynn]

best article I've read in years ... (not that I'm in the market or anything) (and I might be a communist)

;-)

Thanks for posting that
[/QUOTE]
In Aussie land (like Canada) I understand there is no “free market” for valves so you should be fine lol.

I found it very interesting and informative article. My take away was that this is a complicated subject with many moving parts and there is still much to be learned.

 

[Croooser]

best article I've read in years ... (not that I'm in the market or anything) (and I might be a communist)

;-)

Thanks for posting that

In Aussie land (like Canada) I understand there is no “free market” for valves so you should be fine lol.

I found it very interesting and informative article. My take away was that this is a complicated subject with many moving parts and there is still much to be learned.
[/QUOTE]

Thanks for posting. I won't pretend that I understood all of it. But I think I got the gist of it.

As a recent BHV (look at me using the lingo)recipient, I have a vested interest in the durability issue.

 

[tom in MO]

I never used the term fraud. It is actually brilliant marketing and educating; optimistic human nature does the rest. The hope is not made up. They have reason to hope they will last longer and, therefore, educating about why they believe this is not fraud. They educate physicians and the public and the optimistic nature of those who wish to believe hope, rather than data will lead many patients, and yes, many physicians, to speculate on expected valve life when the actual data is not yet there. Because with only 5 years of human data, you can't realistically predict that a new valve will last 15 to 25 years for a young patient, despite a new anti-calcification treatment that they hope will extend the life of the valve.

But, just in case I change my mind and do decide that it is fraud, perhaps you can help me out. Perhaps you can send me the form that you used to file the complaint with the FDA when you told us all about the fraud that the vaccine manufacturers were committing.

You did file a complaint with the FDA after you said the below, right?

"If you want proof of fraud in vaccine production, just look to the contractual scandals surrounding Emergent and the fact that vaccine developers don't need a few billion more in profits. They have already recouped costs with most of them were paid by your tax dollars and not Pfizer et.al. They have reaped insane profits from a pandemic."

The fraud I mentioned in vaccine production is already investigated by the FDA that's why it is reported. That's why it's real.

I contacted FDA about to see if a prescription is required for an INR monitor by FDA. It is not. Their website is easy to follow, I am sure you can figure out who to call.