Valve choice

[johnbelloh]

I am new to this forum and will be facing aortic valve replacement sooner or later. I underwent a CABGx5 almost 10 years ago and did a total lifestyle change. I changed my diet and started exercising on a daily basis including distance running. As of late my running is down to not much over a walk due to a calcified stenotic aortic valve. I also bike and rock climb and have discounted getting a mechanical valve due to their need for anti-coagulation therapy as well as their poor hemodynamic properties. I had been following the development of the Cryolife Synergraft valve but have not seen any new news as of late. Most of them have been used in the pulmanary position for Ross Proceedures. I am only aware of a few being used as aortic replacements and have not seen any follow-up information. The tough question of course is what tissue valve to choose? If I had to pick one today I would probably go for a homograft or possibly a Medtronic Free Style. If anyone out there has any additional information please feel free to contact me.

Thanks,

John

 

[Ross]

Hi John and welcome to our humble home and family

First off, Synergraft valve:
http://www.valvereplacement.com/forums/showthread.php?s=&threadid=3214

Where are you going to have the surgery done? Not that it matters, I'm just curious. As far as a tissue valve, there are many too choose from. In your position, I'd ask the surgeon for recommendations as to what he would use. Of course, no matter what is chosen, it can be changed at the last minute due to biological incompatibility. It's pretty much a wait and see deal. Make a couple of choices and discuss each with your surgeon.

Personally, I think you'd be better with a mechanical valve at this point in your life. I guess the key question is, "How many more times do you want to go through this surgery?" Mechanical isn't as bad as you may imagine.

 

[Kevin M]

John, unless they find some other complicating factors, it is likely that your age and physical condition make you a strong candidate for any type of valve.

There is a ton of information out there. The bottom line is that most any valve replacement type these days involves only a little sacrifice to lifestyle. You will be able to do most anything that you did before the stenosis kicked in.

Basically, the chances are excellent that a mechanical valve would last you your entire lifetime with no complications aside from some small adjustments due to coumadin.

If your chemistry is typical, you should also be able to consider a biological valve because usually 60+ individuals do not calcify replacement valves nearly as quickly as we do in our youth. It's highly possible that you would require a second surgery within 25 years.

I always look at the mechanical valves as a little bit of inconvenience each day with the risk spread out over time(bleeding, clotting, accidents, etc.). I look at the biologicals as compiling all those inconveniences into one higher risk situation - an additional replacement surgery that I likely would not need if I were going with the mechanical valve.

Good luck in making your decision, but remember that your options will all allow you to continue to have the full and physical lifestyle that you are accustomed to.
Kev

 

[johnbelloh]

Ross & Kevin

Thanks for the encouragement and qiuck reply. Kevin, to answer your question as to where I am going to have the surgery, at this point I am not sure except that it won't be here in Dayton. I am going in for an echocardiogram on April 1st. to see if the stenosis has progressed to the point where I will need to replace the valve. I had a heart cath last year after the echo indicated the pressure gradient had increased significantly. The cath indicated it was no worse than the previous 2 years. The good news is that my bypasses all 5 of them are patent and show no signs of blockage.

I have been following the development of the Synergraft valve for the past 4 years and had chosen a number of surgeons based on the number of Ross Procedures they had performed. After consulting with Dr. Elkins in Oklahoma City ( he has since retired ) I came to the concluson that I was not a condidate for a Ross Procedure because of my age. ( I'll be 60 in June ). My thinking was that if a surgeon had performed over 100 Ross Procedures than he should be an expert at replacing an aortic valve. I thought I would pick out the valve I wanted and then find the best surgeon to do the job. My first and second choices have retired ( Elkins in Oklahoma City and Oury in Montana ) If I have to go this year I will probably contact Dr. Stelzer in New York or Dr. Robert Salley who is not too far away in Lexington, KY.

Strangely enough I think the reason my valve has not gotten any worse may be due to the fact that I have been on Zocor ( a statin drug ) for the last 9 years and I run 3 days a week. The last cardiologist I had told me about 7 years ago that I could not run or exert myself. Since then I have run 7 marathons.

I injured my knee rock climbing last spring and required knee surgery twice last year. My running was curtailed for about 9 months. The knee is almost back to normal and I am trying to resume my running schedule. Now I find I can just barely make it above a walk. If my fitness level does not improve it will probably be due to the valve. My ejection murmer is so loud I can hear it in my left ear. I should be able to improve my fitness level in the next month if the valve is no worse. I think my running performance is a better indicator of valve condition than the echocardiogram. I've had two false alarms with past echocardiograms.

Thanks for your support and interest. I'll keep you posted on my progress.

John

 

[johnbelloh]

Update

Update

Hi Ross & Kevin

I had my annual echocardiogram last week and reviewed the results with my cardiologist today. He indicated that the stenosis had not progressed since last year and that both the instantaneous and mean pressure gradients had decreased across my aortic valve. I must be doing something right.

I have had echocardiograms once or twice a year for the past 5 years and 3 angiograms in the same period. The valve looks like a piece of stone but seems to have stabilized. All the literature I have read on aortic stenosis generally indicates that at my age the stenosis progresses rapidly. I will be 60 in June. The Zocor ( statin drug ) I have been taking and my vigorous exercise schedule along with a special diet and supplements appear to be holding further calcification of the valve at bay.

I am beginning to wonder how long I can go without replacing the valve. My regimen may be of value to those of you with new tissue valves.

John

 

[Ross]

John I certainly think your regimen and what your taking has a lot to do with keeping things on an even keel. Unfortunately, I don't think any of us are capable of predicting when the valve will sound off and want to be replaced. I'm glad you and they are keeping a close eye on it. Let us know how things go as time progresses.

 

[JimL]

John you write that certain things "appear to be holding further calcification of the valve at bay."

I asked my surgeon and cardiologist after surgery what had caused my valve to calcify so much, and they both answered that no one knows. If that is so, then your special regimen could be making a difference, there just isn't any scientific evidence for it.

Otherwise, I understand that the valve just goes bad over the course of time. In the meantime, we can watch it closely, until it comes time for surgery.

For someone post-surgery like me, this is a question of curiosity only; but for someone pre-surgery, this question has much greater interest. Am I understanding correctly?

 

[johnbelloh]

Jim L

Your question is a good one. Do the same processes of calcification apply to damaged original valves and replacement tissue valves? I think you are right that no one really knows for sure. I did see a recent study that indicated that statin drugs seem to prevent further calcification of aortic valves for patients with aortic stenosis. This may explain why my valve is holding up.

I'm no expert, but I don't see why this side effect of the statin drugs should not also apply to a replacement tissue valve.

John

 

[ccrawford]

Zocor

Zocor

John and Jim - I saw somewhere that based on clinical trials, some docs were indeed prescribing Zocor for valve preventative maintenance even when the patient did not have a bad lipid profile. If I find it, i'll let you know. I wouldn't know why Zocor wouldn't prevent any type of calcification, but I'm not qualified to say. I've been using it for several months, along with diet and exercise, until recently when stamina seems to be an issue. The only side effect I've had is pain in the calves. Chris

 

[johnbelloh]

Chris

I have been on 20MG of Zocor for the past 9 1/2 years. I had a CABG x5 in August of 93 and my doctor started me on the Zocor then. The discomfort in your calf muscles is probably from exercise and not the Zocor. In the almost 10 years I have been on Zocor I have never had a problem with muscle pain other than overuse soreness. I exercise every day and run 3 days a week.

John

 

[ccrawford]

Different folks

Different folks

John - I wish what you said was true. I think it affects everyone differently. I haven't excercised for over a week and the calves are still sore. I used to be a serious athlete, so I understand how far I can push without problems. It takes awhile to get Zocor out of your system too. All these drugs are different and it can get confusing. Chris

 

[Granbonny]

Zocar

Zocar

Dan Reeves, the Atlanta Falcon's Coach had open-heart surgery..maybe 2 years ago. He advertises for Zocor on the Atlanta T.V. stations.. Like. I take Zocar everyday..I have learned to stop and smell the Roses. Next scene..chewing out his football players. ( I know nothing about Zocar) but his ad runs several times a day on T.V. Bonnie

 

[ALCapshaw2]

Hello John,

If I lived in Ohio, I would go to the Cleveland Clinic which is the #1 rated Heart Hospital in the world.

Since you are interested in Tissue Valves, ask about the Bovine Pericardial Valve which is made from the pericardium of a Cow's heart and shaped similar to a human valve. It has been around for close to 20 years and has a durability of 90% at 15 years and counting. I believe Dr. Cosgrove at the Cleveland Clinic is a BIG proponent of the Bovine Pericardial Valve.

'AL'

 

[Jennie]

Hi John,

You mentioned CryoLife's aortic SynerGraft homografts. They only just became available in the US early last year, only at Mayo Clinic and possibly U of Oklahoma, so maybe this is why there is so little news about them. There are a few of us (five that I know of, oldest being 55) on this site that have these valves. John Cochran is a great guy to talk to about this; I'm not sure if you've run into him here yet or not. You also mentioned the Ross Procedure using the pulmonary SynerGrafts: I would agree with you that the procedure is intended for younger folks, but I think another valid reason to avoid it is that you'd then have two valves to maintain instead of just the one.

JEnnie