Tricuspid mechanical valve replacement - lot´s of questions, few answers....

[ValveViking]

Hi,

My name is Martin, I had an aortic valve replacement(mechanical) in 2003, but I am writing due to a concern of a newly made friend of mine. So same as me, my friends (tricuspid)valve was destroyed by endocarditis. It´s was a quick turn of events and she had to have an emergency surgery. The surgeon choose a mechanical tricuspid valve for her(she´s 35 years old) and due to the speed of events, this choice was never discussed prior to the surgery. We both do not know where the endocarditis came from, no records of drug-abuse or anything like that.

Now in Sweden, where we both live, a mechanical tricuspid valve replacement is a v e r y rare thing. The doctor´s told her, there´s only 2-3 done in the whole country thus far and the longterm use of this valve is not known (here) at all in terms of mortality over the years. They did not paint a very pretty picture though and needless to say, my friend is devastated and kind of lost for guidance in life pretty much at large.

I feel so sorry for her and like to reach out here and see if there are any kind souls that could shed some more light on this - any feedback, experience or information would be received with the highest of gratitude.

Many thanks in advance,

Martin

 

[Richie Rich]

As you say tricuspid mechanical valve is very new, there was recently a link to it on here posted by another member, possibly Pellicle. I can't find it right now, but I seem to recall it may have advantages over other mechanical valves in that it is closer to a native valve in function and may not require warfarin. It's not proven like other valves but I'm sure the surgeon would not use it if he was not confident. Was there any specific reason to use this valve?

 

[pellicle]

Richie, thanks for the "honourable mention"

As you say tricuspid mechanical valve is very new, there was recently a link to it on here posted by another member, possibly Pellicle. I can't find it right now, but I seem to recall it may have advantages over other mechanical valves... Was there any specific reason to use this valve?

I looked at the post and then when I read it I think it was intended to be: replacement of the tricuspid valve with a mechanical valve. Curiously one of the valves is named the tricuspid (although indeed anatomically both it and the Aortic are tricuspid in morphology. [IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/e\/e5\/Diagram_of_the_human_heart_%28cropped%29.svg"}[/IMG2]



look to the LHS of the figure under pulmonary
I think that actually only the Mitral valve is intended to be a bicuspid as the pulmonary is also a tricuspid valve too. I have no idea why the tricuspid valve is not named something more intelligent.

To ValveViking I haven't got any information because as you say the operation is one of the less common ones. However if your friend now has a mechanical valve implanted there in that position, to the best of my knowledge (which is restricted to how such a valve performs in other locations) that she will be fine and just need to manage her INR. Initially of course that will be done in conjunction with the hospital and then later on perhaps with her GP (doctor). There is no reason why she could not manage her INR herself, as some of us here indeed do. In that case I recommend my blog post here for tips and pointers on doing just that.

https://cjeastwd.blogspot.com/2014/0...ng-my-inr.html

I regularly trapse between Australia and Finland (and travel some around Europe) and being able to self test and self dose gives me confidence and certainty in my life with my new mechanical valve. Virtual hugs from Finland

Best Wishes

 

[ValveViking]

Thanks Pellice and Richie. I also selftest with Coaguchek since -03 and knows all the advantages that comes with it. I´ve visited some 50 countries since that traveling both professionally and in leisure and I totally agree putting yourself in control and understanding the metabolism and how you work, enhances life and put you further away from harms way. I guess getting her on self-testing, but not necc. self-dosing to start with will make her more at ease. Virtual hugs back!

 

[ClickityClack]

So I used a tool that pellicle put me on to... Google Scholar. It basically lets you search just in academic literature.

I used the term "tricuspid valve replacement long-term"

This is my layman's take on what I found, so I urge you to look for yourself:
- It seems that surviving the operation is a significant hurdle in and of itself.
- Mechanical vs bio-prosthesis seem to have similar long-term survival.
- The damage from the endocarditis may not have been limited to the tricuspid valve and many seem to succumb to other cardiac events.
- Well managed anti-coagulation seems fairly important.
- 10 and 15 year survival rates aren't terribly high.

She survived a surgery that about 1 in 4 don't. If she didn't get that surgery, she'd be dead. All things considered, I think she's doing alright. Facing your own mortality is tough but, with the right attitude, you can use it to make the best use of however much time the universe deems that you have left. Shoot, she might well outlive both of us - despite all the studies and numbers nobody really knows.

 

[ValveViking]

Thanks ClickityClack, I think the bottom line is you have to accept your destiny a bit and try to live, as nobody knows what´ll happen anyhow. The issue here is it´s a rather rare occurrence and not much to relate too I guess.