Trending toward tissue?

[hobbysdad]

On Monday, April 6 at the Ross Heart Hospital, Ohio State University, I will have the Edwards Perimount bovine valve replaced in the aortic position. If necessary, same for the MV, but it seems like a reasonable bet for repair.
When I read the numerous posts to this section of the forum, I noted and was surprised that the majority seemed to favor mechanical valves. Usually, reason number 1 went something like this: "I don't want to have to go through being hit by a truck again!" Have I gotten that correctly?
But, reading materials from the Cleveland Clinic, possibly the top heart center in the US, the Edwards bioprosthetic device is favored in 2009. So too for OSU's heart center also, if the patient has researched the pros/cons and expressed his/her preference for this rather than a mechanical valve.
I should add here that I'm an athletic 56 y/o whose valve issues have endocarditis to blame. From all indications, the major heart centers I believe are trending toward bio-engineered valves like the Edwards Perimount for 3 reasons: 1. data now show they can go 15-20 years, 2. replacement of these replacement valves will likely be done using minimally invasive procedures, and 3. avoidance of life-long warfarin therapy
It's important I think for us to consider how quickly the technology is changing, and that for someone having had valve replacement surgery even 3years ago, the picture has changed.

 

[palmaceae]

I am a little over 3 weeks post op from an AVR. I choose the same valve you are going with, the Edwards Perimount bovine tissue valve. I am 46 so a bit younger then you, and I am sure many will wonder why I did not choose a mechanical. The main reason was I did not want to use blood thinners for the rest of my life. Now a lot of people on this forum do not have a problem with taking blood thinners and are doing quite well with it, but with my lifestyle I choose not too. I work on my '68 mustang a lot (I restored it) and I injure myself a lot working on it, and I ride motorcycles. Now will taking blood thinners endanger me, I believe so, but some people may disagree with that. My dad also took Coumadin the last 10 years of his life and always had issues with it. I know they say this valve could last 20+ years, but I believe that is for people in their 60's, younger people this valve's lifespan is a bit lower, but this is a new valve so no real actual lifespans have been reported because this valve has not been around for 20 years. I am very aware of the fact I may need to have another replacement in 20 or less years, but I am OK with that, I just know that I am blessed that the doctors found out I needed this valve because the alternative was not good! I am sure you will get more detailed answers from other people here, but since I got the same valve you want, I thought I would share my experience with it.
God Bless,
Randy

 

[escargome]

Hi, Just another tissue valver checking in. My surgery was May 2008 and so far no issues that I can report. I'm not gonna go into my reasons for choosing tissue but I'm hoping I can get at least 10 - 15 years out of this valve then see where medicine has gone. However again I must remind you both of a new found desire to stop at green meadows you might pass for a quick snack

 

[Woodbutcher]

Congratulations on being so sure of your choice of valve/valves. Thank goodness medical technology is forging ahead so quickly.
That new valve will probably see you to about 75+ and then you'll probably be able to nip into the clinic for a couple of hours for a new one ? Perfect.
Personally I wouldn't be at all sure of your points 1 and 2 or even 3 for that matter or put too much credence into the advancements and FDA approvals of these medical procedures.
Good luck with it all though.

 

[Ross]

From all indications, the major heart centers I believe are trending toward bio-engineered valves like the Edwards Perimount for 3 reasons:
1. data now show they can go 15-20 years,
2. replacement of these replacement valves will likely be done using minimally invasive procedures, and
3. avoidance of life-long warfarin therapy

1--There is not any data as of yet to determine that those valves will last that long since they haven't been in long enough to determine it.

2. While there is great talk of doing VR's by Catheterization in the future, don't bet the farm on it. As it stands, it's only being done on patients that couldn't possibly survive another major surgery.

3. The sad fact of the matter with Anticoagulation is that most Doctors and Clinics haven't got a clue as to how to dose Coumadin properly. You'd think something prescribed so often, they would have a working knowledge, but we know for a fact here that this is not true. We see it everyday and spend a considerable amount of time getting people straightened around. This is why most all of us home test and self dose. We can "Get it" but the Pro's don't seem to be able to grasp the simple concept. For this reason alone, they are trying there best not to put anyone on it anymore. A little bit of education on their part would go a long long way in resolving problems of old. To this day, they still propagate myths and continue to remain ignorant in most cases.

Your at an age where you could go either way. I would love to be able to say for sure that if you went tissue, it could last you 20 years, but no one can say that as of yet. It's just guessing at this point.

Regardless of what you choose, whether Ross procedure, Mechanical or Tissue valves, there are no guarantees that you won't need surgery again. Mechanical would definately be the best thing to avoid future surgery, if possible, because most Mechanical valves outlast the patient. That being said, you have to weigh the risks and benefits of each choice for yourself. I've been through 2 OHS's now and will not make it through another, so for me, the choice was simple. I honestly think at your age, if it's your very first surgery, I might just go tissue and hope for 15 to 20 years out of it. For all we know, they could last even longer, but until the real data is available, it's only speculation.

 

[tex]

I had a AVR and had a mechanical Valve put in, this was partly because of my age i am 45.
Tissue Valve replacement was mentioned but my surgeon didnt recommend this as of the time limits this Valve lasts.I know theres no guarantee which ever Valve you choose how long they will last but there is proof that a Mechanical Valve lasts longer and that was good enough for me, i wouldnt want to go through the operation again like may of us wouldnt. Yes i do have to take Warfrin, and at first did have problems getting levels right it was up and down like a yoyo, but all seems to have settled down. It will be even better when i get my home testing kit. I think taking Warfrin is a small price to pay if this helps me not having to be re-operated on again. I was told if i did choose the tissue the Operation would be the same proceedure as a Mechanical Valve.
But its up to you which one you choose and you seem to have made your mind up and you look as though you have really looked into it.
All i doing is telling you my experience and why i picked the Mechanical Valve.
Good luck with your operation, please let us know how things go.
Take Care
Jane

 

[sue943]

Surely the reason most people go for tissue is that most people who have valve replacements are much older. I don't know what the percentages are for each age group having valve replacements, presumably that information is available somewhere.

 

[Karlynn]

At your age, 56, choosing a tissue valve isn't as cautioned as if you were below 45 or much younger. The younger you are, the less time a tissue valve lasts. Congratulations on making, and feeling comfortable with, your choice. So please don't take my following comments as trying to persuade you other wise - but information for those who are also in the decision making process. If I need another replacement at 56, a tissue valve would be a consideration for me.

Being "active" should have no true effect on valve choice....unless your activity causes you to run head-long into a brick wall intentionally, and if it is - you should still be wearing protective head gear. Or unless you have a profession that has rules that prohibits you from working while on Coumadin. (It’s my belief that many professions base these rules on myth and 30 year-old information. But it is what it is and people should be aware of their profession’s rules before making a choice.) People that take warfarin are not required to be couch potatoes because they might bleed. (The danger of bleeding is HIGHLY over-worried) Reading the sticky http://valvereplacement.com/forums/showthread.php?t=17116 can help clear this, and other myths, of the drug. Also, a look into the Active Lifestyles forum will help dispel the "active" myth.

It's no surprise that Cleveland prefers the Edwards valves. It is a good valve. Just know that it's not uncommon for large medical facilities and/or physicians, to align themselves with a company for research, development and testing of specific valves. The trend seems to be that if you go to Cleveland you have a greater chance of coming out with a tissue valve. If you go to Mayo Clinic you have a greater chance of coming out with a mechanical. I believe ONE (not all) of the reasons for this is that there are doctors at these facilities that have had a part in the development and research of these types of valves. It certainly doesn't mean that there's anything unethical going on. A good surgeon is not going to encourage a valve that he/she feels won't be good for you just for the sake of their research. But if you help develop something that’s looking like a success- you're certainly going to be very encouraging of using it and happily promote the success of it. That being said - both facilities still do other kinds of valves with great success as well.

We read a lot from people about their hopes of catheter valve replacement being available when they have their next replacement. Most of the information that has been written thus far leads people to believe that the open chest procedure is going to be the standard for quite a while. The trials that are being done now are primarily done on those who could not survive a "standard" valve replacement procedure. As far as I've learned, no trials have been started on otherwise healthy people who would expect full activity from an aortic or mitral valve replacement. There are questions as to whether the valve currently being used for catheter replacements would withstand the pressures of an active person. So my caution is just to put this in a drawer of hopes for the future, but don't count on it being available when it’s needed. While medical research seems to be getting faster and faster, the medical community is still pretty slow in it's trial process, and rightfully so. There have already been problems with some things that have been "rushed to market" (such as St. Jude’s Silzone valve). Much like I went with a mechanical in the hope that it will last my (long) life, I also knew that there was a possibility that I would need another replacement at sometime. So if someone goes tissue - go ahead and hope for a catheter style replacement for the next replacement, but also understand that there's a good possibility it will still be an open-chest procedure if you’re a healthy active person.

It’s my hope for the future that valve choice will be a thing of history because valves will be grown from our own, or a relative’s, stem cells! Seriously – I think this is the big hope for valve disease.

 

[Jkm7]

I'm in the camp of those who chose tissue valve and this was my second surgery. I was so sure of wanting tissue it was worth (FOR ME) to risk the possibility of a third but I think that very unlikely. I am a believer that in 15-20 years, many (most) valve replacement will be done by cath.

Time will tell.
The contentment with knowing you have made your choice for which valve is priceless. For me, the choice was clear and obvious but I absolutely appreciate how many struggle mightily making the decision.

Blessings for a successful surgery and uneventful recovery.

 

[ChouDoufu]

44 and had bovine implanted in january. several good reasons.

1. warfarin & dosing the diet: i have no diet. eat whatever i like, whatever
looks good and isn't moving (too fast).

2. home testing: units are not small enough for travel yet. by travel, i
mean backpacking, or taking a 6-month bicycle tour through the outback.

3. noisy valves: couldn't take a chance on being the one-in-a-million, since
a ticking alarm clock next door can keep me awake.

i realize i'll need a re-op some time in the future. i've accepted that, and
have anticipated another standard sternoctomy. catheter valves might
be available by then, but i'm not counting on it.

 

[thenewmarket]

My husband had surgery at Cleveland Clinic and I can state from experience that the valve choice was TOTALLY ours to make. My husband was 51 at the time, he had an ascending aortic aneurysm and a bicuspid aortic valve. After many, many hours of research and deliberation, WE opted for a tissue valve. However, once in surgery the surgeon deemed that my husband's native tissue on his bicuspid was good enough to do a REPAIR instead of a replacement. Aortic repair opens up a whole new discussion! There is a possibility this repair will last my husband's lifetime........there's a possibility we will face another surgery. I can tell you without hesitation, that if we faced surgery tomorrow my husband would opt for a tissue valve.

Best Wishes!

 

[neil]

it was not an easy decision for me choosing tissue,but looking at all the pros and cons i choose tissue,i think most people in our position spend a long time picking the right choice for us,for me that was a porky pig one,who knows how far heart surgery will come in 10 15 yrs time,myself am prepared for another ohs,am cool with it,having looked up and listenened to my cardio and surgeon i just didmnt fancy being on blood thinners for the rest of my life,it is a very very hard choice to choose between having another op or blood thinners,the reason being is after your op you cant turn round and say .....think i would prefer the other one lol,imo whatever you pick is good for you,

 

[bit of a chicken]

When it is time for me to decide what I am going to do regarding replacing my bav, having had OHS as a child, and having now successfully had my family, my biggest factor in the decision will be : what gives me the greatest opportunity to not be operated on again ? What option gives me the biggest freedom from the surgeon's scapel ? Warfarin will not deter me from making the decision, the greatest thing about our the internet is freedom of information, and the greatest thing about us is our freedom of choice...... we all make different decisions based on personal need, don't call me chicken for nothing!!!

 

[Lynlw]

On Monday, April 6 at the Ross Heart Hospital, Ohio State University, I will have the Edwards Perimount bovine valve replaced in the aortic position. If necessary, same for the MV, but it seems like a reasonable bet for repair.
When I read the numerous posts to this section of the forum, I noted and was surprised that the majority seemed to favor mechanical valves. Usually, reason number 1 went something like this: "I don't want to have to go through being hit by a truck again!" Have I gotten that correctly?
But, reading materials from the Cleveland Clinic, possibly the top heart center in the US, the Edwards bioprosthetic device is favored in 2009. So too for OSU's heart center also, if the patient has researched the pros/cons and expressed his/her preference for this rather than a mechanical valve.
I should add here that I'm an athletic 56 y/o whose valve issues have endocarditis to blame. From all indications, the major heart centers I believe are trending toward bio-engineered valves like the Edwards Perimount for 3 reasons: 1. data now show they can go 15-20 years, 2. replacement of these replacement valves will likely be done using minimally invasive procedures, and 3. avoidance of life-long warfarin therapy
It's important I think for us to consider how quickly the technology is changing, and that for someone having had valve replacement surgery even 3years ago, the picture has changed.

I believe the reason most larger that started doing more tissue valves did so, was because as time went on they started getting MUCH better at repeat surgeries. Alot goes back to the children born with CHDs that had to have 2 or 3 surgeries in their first few years of life to survive. So the CHD surgeons got much better at knowing the issues that come up with MULTIPLE REDOS and HOW to avoid/treat those issues. AS the Mortality/morbidity rates improved greatly over the past decade or 2 and more surgeons had experience Operating on patients that had 3 or more surgeries AND the CICUs and rest of the staff also got alot of experience taking care of multiple REDO patients, Many of the doctors started looking at the risk/benifit ratios a little different. That played a large part in leaning toward tissue valves for younger people. The future things that MAY come to be are nice to think about, but the major change came when the stats for multiple surgeries got so much better.

 

[Karlynn]

My husband had surgery at Cleveland Clinic and I can state from experience that the valve choice was TOTALLY ours to make.

I just wanted to be clear that I wasn't implying that surgeons or hospitals twist people's arms as far as valve type. My point was that because many of the larger hospitals are involved in research, development and trials of different valves that they are enthusiastic about them and would naturally be recommending them highly and probably using them more than other types. This is how valves get studied and tried and how large data is collected. It would be harder to collect data if you had to count on hundreds of hospitals to report their data and oversee just how the data is reported. Relying on large hospitals gives companies access to larger demographic groups of people and centralizes the data collection area. Without sounding like too much of a cynic - this is a money making enterprise for the companies and the hospitals. They aren't doing it just out of the goodness of their hearts (slight pun intended).

 

[sheridan07]

I chose a Mechanical valve for a couple of reasons. My age(35) was a big factor along with the fact I don't want another surgery. That being said, You should do what is best for you.

 

[Lynlw]

#1 4 Hours Ago
hobbysdad

When I read the numerous posts to this section of the forum, I noted and was surprised that the majority seemed to favor mechanical valves. Usually, reason number 1 went something like this: "I don't want to have to go through being hit by a truck again!" Have I gotten that correctly?


I also wanted to add, altho this is NOT scientific, it seems to me at least that many of the people who chose Tissue valves, don't stick around as often as those with Mechanical, it MAY have to do with they aren't taking any coumadin and don't have questions ect. or it can just be a coinicidence. So that is why it MAY seem that more people chose mechanical.

 

[Woodbutcher]

I think Lyn makes a good point there !
It's true, of the few members I know of that have had Tissue valves implanted recently they do seem to disapear ... I think their new tissue valves, once settled in are "out of sight and out of mind" and they go about their lives without much thought on the subject ? Where as us with Mech valves have a day in day out chore of thinking about them and tending to them, like an unwanted old inlaw living in the spare bedroom !? We know we can go out for the day and leave them in the dark watching daytime telly but they're always there niggling in the back of our minds !?

 

[tex]

Woodbutcher thats very true what you wrote.
JANE

 

[Jkm7]

I agree. Far fewer folks who have tissue valves seem to continue to post here at VR.com after their surgery and early recovery.

If it is true our tissue valves might last 15-20 years (or more), we probably will not hear from many of them again.