Tissue Valvers. How Old is Yours?

[bobr33543]

Aortic valve replaced January 2012 with Edwards Perimount Magna Ease 3300TFX 25 mm (porcine), so over 7 years. My next echo is at the end of this month, but valve was still perfect as of last echo. I am 71 male and very active.

If I was told I needed a replacement in the near future, it would be hard decision as to going with sternotomy or TAVR. I would expect the valve used in a TAVR to have poorer hemodynamics than a standard AVR, thus adversely limiting my activities.

 

[Johan]

AVR at age 66 with an Edwards bovine Valve 3000TFX , 10 years ago. The valve still works fine. My cardiologist insists on 6 monthly check-ups. Treadmill (Bruce Protocol) for 12 minutes and an echo. All clear a month ago. I am 76 now and still very active.

 

[katm]

I have Carpentier Edwards bovine in mitral position and my valve is coming up to 4 1/2 years.
How old is yours?

I think this could be interesting.

My bovine valve is 6 1/2 yrs old. Sorry I’m not sure if it’s name. I had my surgery at Uof M. Unfortunately my cardiologist discovered about a year ago that my two of my leaflets had fused together. This happens only in 2% It’s starting to become a concern and will have another TEE Friday. My doc is thinking of putting me on Coumadin, I guess studies have shown it stops or improves the calcification. Not sure of details he briefly mentioned it last week. So I guess Im back in waiting room.

 

[arkiebelle]

I had a Carpentier Edwards bovine valve, mitral position. It lasted 11 years. I was 36 when I got it. I now have a mechanical valve.

 

[ottagal]

My Carpentier Edwards Perimount bovine valve is 9.5 years old. Appointment coming up soon and hoping things are stable and I get many more years with it.

 

[rr3972]

My Carpentier Edwards Perimount bovine is almost 11 years. It was put in when I was 50. It’s starting to get a little calcification but not on the vital parts ( leaflets). I know I’m going to have another ohs. Debating whether to get a mechanical next time.

 

[normofthenorth]

I got a Medtronics Hancock II (porcine) in Aortic position in December 2010 at 65. So far (8.5 years) so good, though this is annual checkup time so I should know more in a few weeks.
I'm a crazy active 74yo.

... I had been walking 5 miles in less than 15 minutes or riding a bike 20 miles every day. ... I too have read that valves last longer in people who are less active. ... I was also told by surgeon that bovine valves restenose and porcine valves will regurgitate as they wear out. He preferred dealing with stenosis.

1) Either your "I had been walking 5 miles in less than 15 minutes" is a typo or I'm misunderstanding, because nobody can even RUN a mile in 3 minutes.
2) I have NEVER heard that tissue valves last longer in sedentary people than in active or athletic people. Source? The evidence that they last longer in older patients is beyond reproach, but that's not the same thing. When I researched my options 8 years ago, there was no evidence of that relationship (and I hope there still isn't!).
3) I'd also love a reference for that stenosis vs. regurg relationship if anybody's got one. One interesting thing about stenosis is that it only affects fitness or athletic performance when it is your hemodynamic "bottleneck" so it decreases total blood flow. Personally, I had relatively severe measured stenosis with no noticeable impairment of my athletic performance - although a torn Achilles tendon a year pre-avr meant that I wasn't testing my stenosing valve in its last year. Until a few weeks pre-avr, when I started getting sob from walking fast.

 

[doclewis]

each mile in 15 minutes, not total five miles in 15 minutes, sorry that as poor wording. I have no references for either the way tissue valves wear out or whether they last longer in less active patients. I will look. Probably you are right in that it was assumed that since valve lasts longer in older patients that it is assumed that it is related to being less active. Was told by surgeon that, as you say, stenosis occurs slowly over time, but regurgitation often leads to a more urgent intervention. I was 71 when I had my valve replaced. I had been followed by cardiologist for several years with every 6 month echos. Each time I had an echo, I was told that it was getting worse. Finally I was told that I needed to stop exercising and stop travel and think about having surgery soon. I was told I had critical AS and that it was time for surgery even though I had no symptoms. Had a stress echo and was in 99 percentile for exercise in my age group, but gradient when up far too high. I did not cut way back on my exercise for fear of valve wearing out faster but because of frequent migraine auras which was concerning and bothersome. This was not a problem pre op. I am considering trying to again increase exercise but I am giving it a few months to see if this goes away. There is another thread on this web site regarding migraines and vision disturbance after valve replacement. It is apparently not that rare a phenomenon.

 

[normofthenorth]

each mile in 15 minutes, not total five miles in 15 minutes, sorry that as poor wording. I have no references for either the way tissue valves wear out or whether they last longer in less active patients. I will look. Probably you are right in that it was assumed that since valve lasts longer in older patients that it is assumed that it is related to being less active. Was told by surgeon that, as you say, stenosis occurs slowly over time, but regurgitation often leads to a more urgent intervention. I was 71 when I had my valve replaced. I had been followed by cardiologist for several years with every 6 month echos. Each time I had an echo, I was told that it was getting worse. Finally I was told that I needed to stop exercising and stop travel and think about having surgery soon. I was told I had critical AS and that it was time for surgery even though I had no symptoms. Had a stress echo and was in 99 percentile for exercise in my age group, but gradient when up far too high. I did not cut way back on my exercise for fear of valve wearing out faster but because of frequent migraine auras which was concerning and bothersome. This was not a problem pre op. I am considering trying to again increase exercise but I am giving it a few months to see if this goes away. There is another thread on this web site regarding migraines and vision disturbance after valve replacement. It is apparently not that rare a phenomenon.

Thanks. I'm a fellow migraine person, though I've outgrown the debilitating headaches of my younger days, now left with occasional auras and very rare terrible waves of dread that have been labeled "icepick headaches" though they don't seem to fit the model. I've never seen an association between my migraines and exercise, which works for me. ;-)
I delayed my AVR for several years more than my cardiologist wanted, as my numbers deteriorated. Availability of a world-class surgical team and OR was totally no problem then in Toronto under Ontario's government-insured "OHIP" system, so I kept my heart surgeon - the semi-recognized co-inventor of the "David procedure" and vice chair of the Monk Cardiac Centre under Dr. David - on speed-dial while I waited for symptoms. When they arrived they offered me a menu of potential dates for my OHS, including one that was too soon for me!
My long delay made my repair and rehab physically more complicated (my Mitral valve needed repair by the time I consented to the AVR) and very likely emotionally easier (without pre-op symptoms, it would have taken forever before I felt better post-op than before). I actually had to sign a release for a Mitral replacement a few minutes pre-op, though they judged it unnecessary while I was spread out. I frustrated my cardiologist and cost the system some time and money, but I don't think I regret the delay. (If my abused Mitral valve dies before I do, I may change my mind.)

 

[DaveEM]

My original aortic replacement tissue valve in 2008 only lasted 10 years. Suffered from severe regurgitation and early stage heart failure symptoms for about two years before getting a redo last year with another tissue valve. Thankfully the redo surgery was fine (and so much easier psychologically knowing what to expect).

 

[Brokenhip]

Currently just over 12 months with a CE bovine aortic valve & all is well. Stress test, ECHO & cardiologist once per annum.

 

[LonMel]

My 9 year anniversary with my Aorta bovine valve is coming up in July. I am an avid rollerblader and my valve is doing fine! I do get visual auras which are mostly under control with Topiramate.
When I elected to have my surgery, TAVR was being developed and I told my surgeon to be sure to make me TAVR ready! I figured that by the time I needed a new valve they'd be able to pop in a new one! I was 58 when I had my ascending Aorta and valve replaced.

 

[doclewis]

Thanks. I'm a fellow migraine person, though I've outgrown the debilitating headaches of my younger days, now left with occasional auras and very rare terrible waves of dread that have been labeled "icepick headaches" though they don't seem to fit the model. I've never seen an association between my migraines and exercise, which works for me. ;-)
I delayed my AVR for several years more than my cardiologist wanted, as my numbers deteriorated. Availability of a world-class surgical team and OR was totally no problem then in Toronto under Ontario's government-insured "OHIP" system, so I kept my heart surgeon - the semi-recognized co-inventor of the "David procedure" and vice chair of the Monk Cardiac Centre under Dr. David - on speed-dial while I waited for symptoms. When they arrived they offered me a menu of potential dates for my OHS, including one that was too soon for me!
My long delay made my repair and rehab physically more complicated (my Mitral valve needed repair by the time I consented to the AVR) and very likely emotionally easier (without pre-op symptoms, it would have taken forever before I felt better post-op than before). I actually had to sign a release for a Mitral replacement a few minutes pre-op, though they judged it unnecessary while I was spread out. I frustrated my cardiologist and cost the system some time and money, but I don't think I regret the delay. (If my abused Mitral valve dies before I do, I may change my mind.)
[/QUO

Most who have posted on the migraine thread have had migraines pre op. I too had migraines starting in adolescence, but starting at about age 30 I had only the aura. They were rare only 3 or 4 a year and didn't bother me much. No relation to exercise. Post op, now 4 years they have been very frequent. Now about every week or two, but immediately post op were occurring every day. I have kept a log for a year and find that at least half are related to exercise. Either while exercising or immediately after.

 

[CatLaw]

I have Carpentier Edwards bovine in mitral position and my valve is coming up to 4 1/2 years.
How old is yours?

I think this could be interesting.

Had a Sorin Mitroflow tissue done 18 months ago at age 64 1/2(aortic position). Fuctioning beautifully so far - took me to 10,000 feet in Switzerland 1 year after surgery. Looking back, if I had more time to consider, (and hadn't been so very ill) I might have gone mechanical, but my surgeon and cardio both recommended the tissue valve, and I have no regrets. If it doesn't last past 72 or so, I may go with mechanical next time, but we made the best decision we could with the information we had, so I am not going to complain.

 

[ddwheeler]

I have an uncle who takes blood thinners, but not because of a valve replacement. But, my point is, he had a near-death experience a few years ago, from a nose bleed, almost bleeding to death due to the blood thinners. For this reason/potential threat, I would be far more inclined to want to go with a natural/bovine valve, if at all possible. I am coming up on 58. Thus far, my aortic regurgitation has been labeled as mild/moderate in the 4-5 years it has been monitored. Knock on wood, maybe I won't ever have to undergo valve replacement. But, as the years go by and I get older, if/when the time does come, the more inclined I am to go with a natural/bovine valve rather than mechanical, solely because of the requirement to take blood thinners.

 

[pellicle]

I have an uncle who takes blood thinners, but not because of a valve replacement. But, my point is, he had a near-death experience a few years ago, from a nose bleed, almost bleeding to death due to the blood thinners.

I'm sorry to hear about your uncle, I guess that you know there are more than one type of "blood thinners", was it warfarin?

I hear many bad stories about all of the anticoagulants, but the worst ones are from stuff like Dabigatran. All of the extended bleeds I've read of or known of with warfarin have also involved the INR not being managed properly (and using the so called Usual Care {perhaps best called usual neglect}). Further there are protocols for re-establishing coagulation quickly (and I'm not sure if they were followed in your uncles case).

So while what happened was disturbing and bad, my point is to get you to see that what you have seen happen may not be a totally certain outcome.

I have "near death" experiences often on my motorbike in the traffic, but I'm not dead.

Have a read of my surgical infection experience and ask yourself if second or third surgerys are as safe as you may think.

Best Wishes

 

[ddwheeler]

I'm sorry to hear about your uncle, I guess that you know there are more than one type of "blood thinners", was it warfarin?

I hear many bad stories about all of the anticoagulants, but the worst ones are from stuff like Dabigatran. All of the extended bleeds I've read of or known of with warfarin have also involved the INR not being managed properly (and using the so called Usual Care {perhaps best called usual neglect}). Further there are protocols for re-establishing coagulation quickly (and I'm not sure if they were followed in your uncles case).

So while what happened was disturbing and bad, my point is to get you to see that what you have seen happen may not be a totally certain outcome.

I have "near death" experiences often on my motorbike in the traffic, but I'm not dead.

Have a read of my surgical infection experience and ask yourself if second or third surgerys are as safe as you may think.

Best Wishes

Thank you for your response. Actually, I do not know what medication he is taking. I just recall of the story of him nearly bleeding to death. I hear what you're saying concerning "near death" on your motorcycle. I drove one for a few years. I guess we all experience "near death" if/when we drive on the highway, even in a car. I guess bleeding to death from a nosebleed due to medication is slightly different.

I will definitely read of your surgical infection. That is scary. I will read it and come back to you.

 

[pellicle]

Thank you for your response.

you're welcome. I come here to be helpful to people who are making difficult and scary decisions. I prefer to say the things which are the truths people often think but don't say because they are too polite.

Planning for such a sugery is made difficult because it often totally upsets the persons frame of mind and their rational thinking is influenced by their emotional side (although some people are only emotional thinkers all their lives, so there's that).

Actually, I do not know what medication he is taking. I just recall of the story of him nearly bleeding to death.

well knowing the facts is critical to knowing if that is actually an important factor for you.

Its like saying "I had a friend who was horribly injured in a low speed single vehicle collision" then you find:

• he hit a muckin great tree
• he was in a 57 chev with dreadful passenger protection
• he wasn't wearing a seatbelt
• his windscreen (which he hit) was an original old tempered glass one and he went through it because of the lack of seatbelt.

We tend to think backwards in our reflection of ourselves and what we should do, I suspect because the word "reflection" comes like looking into a mirror which is not only looking back but reversed too.

We should be looking forwards and considering the likely effects of aging upon is (because there is sufficient evidence to suggest we'll all age and follow similar paths to those who have aged before us). However many people spend their lives in denial of or rejection of the notion of "I'm getting old" (yes cosmetics industry, I'm looking at you).

Let me give you an example quite similar to your uncle. A mate of mine is a pharmacist, and has a pharmacy in a place where he has a long relationship with many of his customers. One of them had a minor stroke and his doctor put him on dabigatran (a common anticoagulant now, although muckin expensive) because he didn't want him to be fussing around with warfarin and managing his INR. Dabigatran is supposedly a "dose and forget one size fits all wonder-drug".

His customer had a small fall in the garage and managed to whack his nose and it suffered a minor fracture ... but like you've seen in boxing or martial arts it bled like a *******. He went to ER where they were unable to stop the bleeding. There are no simple reversal protocols (or weren't then if there are now) for dabigatran so they had to put him on dialysis (yes, that's right, what they use for kidney failure) and just kept putting blood back into him for 3 days before the bleeding stopped.

Chances are that if he'd been on warfarin and managing his INR himself (as many of us here do) that he could have simply been given an injection of Vitamin K and the bleeding would have stopped within hours (instead of days).

There is a phrase in the surgical guidelines, which is "informed decision of the patient" ... however I've seldom seen people seeking to inform themselves, although I've seen a lot of people digging up data to support their already made decision.

I've been riding motorbikes for over 35 years (and across diverse countries too) so far I've had less accidents per 100,000km than the average (having put about 200,000 on some of my bikes). When I was younger I used to assist with a rider training program, because I believed in the notion of a trained rider is less likely to be a statistic. However I saw many things in that time which re-iterated how you just can't teach someone who doesn't want to learn (but for instance wants to learn how to go faster at an advanced rider training program).

I will definitely read of your surgical infection. That is scary. I will read it and come back to you.

It was a rough ride in those couple of years ... don't expect me to have written anything up beat. Ohh, and btw 7 years later I'm still on antibiotics and have spent an amount of my own personal cash to understand if I still need to be.

When reading that thread sus out the X-Ray pictures and observe the junk left around from multiple surgeries (which privide fantastic hard to get to places for an infection to colonise, making it a real war to defeat.

Right now I suffer no difficulties from my possible "share mates" but I am cautious to not want them to take over and make a mess with another "home party".

Best Wishes

 

[ddwheeler]

Thank you for your very informative reply. Yes, there is a lot left to question, concerning my uncle and his situation, his medication, etc. This is definitely an area which I must keep in the back of my mind, if/when the time should come that I have to make a decision as to what direction to take. And, as you've shown through the details of the experiences you have seen, a lot of thought and prayer must go into it.

I full agree that we, as patients, must be informed patients, and we should want to be informed patients. I do think far too many people remain ignorant of situations regarding their own health, and they blindly put all of their trust into their doctors and just go along with their program, and truly have no idea of what is taking place with themselves. Doctors see loads of patients and we can't expect that they have intimate knowledge and full understanding of our personal situations. Yes, they have a file, or files, on us, and they typically know what they are doing. But, they rely on patients to inform them of what is going on, how they are feeling, to know if any issues have arisen. A patient has to try to understand their situation as best as possible. Honestly, I would think that a patient would want to be as well-informed as possible, and have an understanding of what is going on. But, sadly, there are far more people than we'd like to think, who don't want to be bothered. They figure it is the doctor's responsibility.

 

[pellicle]

Hi

Thank you for your very informative reply.

Yes, there is a lot left to question, concerning my uncle and his situation, his medication, etc. This is definitely an area which I must keep in the back of my mind, if/when the time should come that I have to make a decision as to what direction to take.

well myself I'd look also at family history of bleeds and indeed more importantly your own. Are you one to get nosebleeds (for no aparent reason) or not? If not and if no history of ulcers then I'd suggest that (should you need it) AC Therapy is not a bad compromise for you

have seen, a lot of thought and prayer must go into it.

thought yes, pray no. I was raised a Catholic and since then I've come to the firm conclusion that should there be a god (I'm not denying there is) such a god bears probably utterly zero resemblence to the fictions proposed by the various political movments called Religions.

God has always been silent (suggesting God is not there) in my life and I've watched as "God" stood by and did nothing at all to prevent horrible situations (over and over again).

If God exits my observation is that God does nothing (and why give in to that whinging kid screaming for a chocolate in the supermarket unless you want the screaming and bad behaviour to be entrenched)? So my view is that if there is a God then that thing wants us to grow up and stand on our own two feet.

I instead turn to the Stoic views developed by the ancient Greeks, Epictetus, Marcus Aurelius, Seneca just to start with the greats.

Strength comes from within ... not holding mums hand (even if she has a crook and a staff). Would not any good parent want the same?

I full agree that we, as patients, must be informed patients, and we should want to be informed patients. I do think far too many people remain ignorant of situations regarding their own health, and they blindly put all of their trust into their doctors and just go along with their program,

agreed ... and my experience (and that of many and various medical professionals I've spoken to) is that far far too many (a majority perhaps) recoil from understanding and "just want it fixed" by the magic doctor so that they can "go back to normal".

Myself I've viewed my situations as a wake up call out of the march towards being homologated into normal think.

But, sadly, there are far more people than we'd like to think, who don't want to be bothered. They figure it is the doctor's responsibility.

worse, you'll find many (again more than you'd like to believe) actively push their personal choices upon everyone as being what they should do. Its not unlike the mentality of sports teams, their team (Football, Hockey, Soccer ...) is the best team and the others are opposition.

This adversarial view is unhelpful to say the least.

Anyway, its been a pleasure talking with you ...

Best Wishes