valve questions

[jx05]

Has anyone gone tissue for the first valve selection and then got mechanical for there second surgery.
I would also like to know if the mechanical valve adapts well to the heart after having used a tissue valve.

I'm 38 and i'm planning on going tissue and then at some point in my early 50's going mechanical , i'm still undecided because i could go mechanical hoping that it would last me a life time or possibly having resurgery at some point in my 70's. Any thoghts or opinions.

thx

 

[Nancy]

My husband has two mechanicals. I do think what you are planning is a very good idea, It gives you the best of both worlds, and spares you Coumadin for a little while.

From my husband's experiences, I can say that when faced with a third or fourth heart surgery, a risk to benefit ratio which is more strict will be applied to your surgery date, and that usually delays the surgery until you are very symptomatic. In spite of that Joe did well with his third valve surgery.

Even though my husband has mechanicals, it didn't spare him the need for repeat surgery, and he is probably in need of a fourth surgery but his cardiologist will not discuss it at this point. His odds for impairment or even death are high for any further surgery.

He has many other conditions as well.

So he's being managed medically and so far that is working.

But anything you can do to avoid multiple surgeries is a good thing from where we're sitting. You should have no problems with the second surgery.

Your surgeon would be the one to discuss the issue of a first tissue and then a mechanical, but I think it's doable.

 

[Karlynn]

Has anyone gone tissue for the first valve selection and then got mechanical for there second surgery.
I would also like to know if the mechanical valve adapts well to the heart after having used a tissue valve.

I'm 38 and i'm planning on going tissue and then at some point in my early 50's going mechanical , i'm still undecided because i could go mechanical hoping that it would last me a life time or possibly having resurgery at some point in my 70's. Any thoghts or opinions.

thx

I have often wondered the same thing myself. Good question!

 

[jx05]

Thanks for your reply nancy, sorry to hear your husband needs resurgery, but sounds like his doing fine with treatment, which mechanical valve needs resurgery the mitral or aortic, and is it because of the sewing.

My husband has two mechanicals. I do think what you are planning is a very good idea, It gives you the best of both worlds, and spares you Coumadin for a little while.

From my husband's experiences, I can say that when faced with a third or fourth heart surgery, a risk to benefit ratio which is more strict will be applied to your surgery date, and that usually delays the surgery until you are very symptomatic. In spite of that Joe did well with his third valve surgery.

Even though my husband has mechanicals, it didn't spare him the need for repeat surgery, and he is probably in need of a fourth surgery but his cardiologist will not discuss it at this point. His odds for impairment or even death are high for any further surgery.

He has many other conditions as well.

So he's being managed medically and so far that is working.

But anything you can do to avoid multiple surgeries is a good thing from where we're sitting. You should have no problems with the second surgery.

Your surgeon would be the one to discuss the issue of a first tissue and then a mechanical, but I think it%'s doable.

 

[geebee]

I think your plan sounds very wise. There are no guarantees with any valve and, if you are of an age that even a mechanical lasting your lifetime is questionable, you might as well avoid coumadin. Although I am one who finds coumadin no big deal, I would have been happy to avoid it for a few years.

However, even with mechanicals, I have had 3 OHS in 25 years. Obviously I would have hoped for no more than 2 in my lifetime. I just found out I might even be looking at a fourth since an echo Tuesday showed my St. Jude's might be leaking. I am just praying the tech was as dumb as he sounded and a repeat echo will prove everything is OK.

Keep in mind I am one of those exceptions to the rule. I only bring up my history to point out that no matter what you plan, crap happens. That is why you must come up with what you feel is best for you and then not second guess the decision.

 

[Chuck_S]

Please keep us posted.

Please keep us posted.

However, even with mechanicals, I have had 3 OHS in 25 years. Obviously I would have hoped for no more than 2 in my lifetime. I just found out I might even be looking at a fourth since an echo Tuesday showed my St. Jude's might be leaking. I am just praying the tech was as dumb as he sounded and a repeat echo will prove everything is OK.

Wow - I am very interested in your results. Good luck and lean back this way for support (probably not going to gain much knowledge from me ).

Chuck S

 

[Chuck_S]

You ask questions like me!

You ask questions like me!

I just returned from the hospital last Saturday from my first OHS (AVR - Freestyle tissue). I will be 38 next month, it took little convincing for me to have the tissue valve when I heard "15-20 years, maybe more" valve life. Take a look at the attached site (medtronic freestyle valve).
http://www.medtronic.com/cardsurgery/products/free_versatil.html

The regular tissue valve - I think the surgeons sew up to create a valve using "tissues", were expecting about 10 years. If this was my option I think I would have gone mechanical.

I am not sure if I directly answered your questions,

Chuck S

 

[jx05]

question

question

Thanks for responding geebee, did you go mechanical all three times and did the valves have a problem or did the sewing come loose. thx

I think your plan sounds very wise. There are no guarantees with any valve and, if you are of an age that even a mechanical lasting your lifetime is questionable, you might as well avoid coumadin. Although I am one who finds coumadin no big deal, I would have been happy to avoid it for a few years.

However, even with mechanicals, I have had 3 OHS in 25 years. Obviously I would have hoped for no more than 2 in my lifetime. I just found out I might even be looking at a fourth since an echo Tuesday showed my St. Jude's might be leaking. I am just praying the tech was as dumb as he sounded and a repeat echo will prove everything is OK.

Keep in mind I am one of those exceptions to the rule. I only bring up my history to point out that no matter what you plan, crap happens. That is why you must come up with what you feel is best for you and then not second guess the decision.

 

[jx05]

question

question

thx chuck_s , i take that the freestyle tissue is different than regular tissue , from your knowledge what are my options for tissue valves by name & years of durability.

I just returned from the hospital last Saturday from my first OHS (AVR - Freestyle tissue). I will be 38 next month, it took little convincing for me to have the tissue valve when I heard "15-20 years, maybe more" valve life. Take a look at the attached site (medtronic freestyle valve).
http://www.medtronic.com/cardsurgery/products/free_versatil.html

The regular tissue valve - I think the surgeons sew up to create a valve using "tissues", were expecting about 10 years. If this was my option I think I would have gone mechanical.

I am not sure if I directly answered your questions,

Chuck S

 

[tobagotwo]

Some balance, as I see it, and certainly not a swipe at anyone...

In the context given, "regular" tissue valves must have meant, older, untreated tissue valves, which are seldom used anymore. Such a group would not include the top manufacturers, and especially not the new, anticalcification-treated valves, including Medtronics' other tissue valves.

There is a mention of valves sewn together from tissue by the surgeon. This is extremely rare anymore, and one of our members is one of the relatively few people to have had a valve assembled on-the-spot for her when she had OHS in Brazil.

There are valves that are premanufactured from bovine pericardium, but they are provided fully ready for implantation, and are not assembled by the surgeon. In fact, to my knowledge, they are the only xenograft (animal) tissue valves that have a track record of 80% making 20 years (Edwards Lifesciences). 90% of the bovine pericardium valves from that manufacturer go 18 years, per published studies - and that was before they got anticalcification treatments.

I'm not trying to play off or advocate one valve over another, but whoever represented alternative tissue valves to you was just blowing in the breeze, Chuck. I don't see everything, but I haven't found and don't know of any human clinical data that show that the Freestyle would last longer than a bovine pericardial valve in the same implant circumstances, or even longer than Medtronics' own stented valves.

The Freestyle is an excellent valve and a fine choice, but I only find research papers on them going back thirteen years. Longevity claims would appear to be conjecture or marketing. I'm not saying it couldn't last longer or as long, but a 20- or even 15-year study showing it actually does last that long would make the claim much more reasonable. The 25-year tissue experience they discuss in the literature link extends to other products produced before the Freestyle.

A similar stentless valve which has been on the market longer, the Toronto SPV (now marketed by St. Jude), has generally lasted 12-15 years. It is an untreated variety. The Freestyle is now treated for anticalcification.

Regarding bloodflow, the presentation of the differences can be deceptive. The slim-stented valves, which have nearly the bloodflow of the unstented valves, are routinely placed supraannularly now, and upsized one millimeter. To avoid regurgitation (leakage), it is suggested that the Freestyle stentless valve be undersized one size ( http://ats.ctsnetjournals.org/cgi/content/abstract/69/5/1408 ). This would eliminate bloodflow differences between the types. Stentless valve implantation also averages 30 minutes longer on the cross-clamp, due to special measuring requirements and a more complicated implanting process.

More than you ever want to know about valves is available at Cedars-Sinai:
http://www.csmc.edu/pdf/Heart_Valves.pdf

Best wishes,

 

[Chuck_S]

I would talk to your doctor about that valve in particular. I did this, and he was already a big proponent of that valve, althougth he does use mechanicals too.

I really do not have more knowledge, just a "hunch" on what is best for me. And you know what choice I made, I hope it works well for me.

CS

 

[Chuck_S]

tobagotwo

tobagotwo

I have nothing that states that my Freestyle valve should last "15-20 years or longer". Please don't use my statement as a fact, I do not think there is any concerete data on how long a valve will last in anyone. Many folks have chosen a mechanical for longivity only to have to have OHS again to rework the area near that valve.

This whole valve topic is obviously a highly talked about topic, and I am simply doing that.

My surgeon stated that there are freestyle valeves that have been in for 12 years already, and many of those are still just fine. Personally it seems odd that they cannot reproduce test that could run 30 of these valves in controlled studies in the lab to document how long they would last. They should easily be able to reproduce 20 years of human time in 1 year lab time. I know they have done this with the mechanicals.

My 2 cents,
CS

 

[Nancy]

It's Joe's own tricuspid that's leaking like a sieve, don't know about the pulmonic, could be leaking too. His mechanicals are still getting the job done.

Joe had rheumatic fever as a teen and has a great deal of destruction from it in his heart.

 

[tobagotwo]

As I said, Chuck, that absolutely wasn't a swipe at anyone. And valve life estimates are just that - estimates.

The only real data that can be accumulated is historic data. That data has problems, because it usually isn't available until the product has already been improved in some way. Using data from the actual valve, or a forerunner that is simply minus an added feature is the closest we can usually come.

The last generation of the bovine tissue valve has long-term data indicating 90% still implanted at 18 years, 80% at 20 years. The past-generation porcine valves tend to last about 12-15 years on average. One woman here claimed her porcine valve was 30 years old. It could happen, but if correct, she was a very rare exception.

The figures for the last generation of Freestyle (pre-anticalcification - approved for use in July of 1992), in a twelve-year study were that 97% of them were still implanted, and 94% had no functional problems. One notation is that 14% develop trace to mild regurgitation within four years, but that it remains constant or improves over time, rather than progressing. So if you see some insufficiency later, don't be too alarmed. Note that the anticalcification-treated version has only been available for a couple of years.

Best wishes,

 

[geebee]

Thanks for responding geebee, did you go mechanical all three times and did the valves have a problem or did the sewing come loose. thx

Here's my quick history. In 1980, when I had my first surgery, my surgeon was totally convinced he could repair the valve. We did not even discuss a replacement choice. Once he was in, he found the valve so damaged he had to replace it and chose a Bjork-Shiley mechanical thinking it would last my lifetime, thus avoiding future surgeries.

Fast foward 1 year. Started having problems with the valve sticking shut. After a few espisodes of syncope and a disasterous echo, I had another OHS because they thought I had a blood clot on the valve. Turns out I produce a lot of scar tissue and it had totally encroached on the valve causing it to stick shut. Lucky to be alive. Cleaned off the scar tissue but did not replace the valve even tho by then everyone (except me) knew the Bjork-Shiley valve had been recalled.

Fast forward again 11 years. Was having major problems with TIAs. Surgeon thought it might be a blood clot or tissue breaking off from the valve. Decided to do surgery again. Found the valve totally encroached by scar tissue. Again, lucky to still be here since the surgeon wasn't even sure why it was working at all. This time we did replace it with a St. Jude.

Not sure about the "leak" this time. Not even sure it exists since the echo tech was such a moron, so I am just in a waiting mode for a little while.

Hope this helps some.

 

[RCB]

Some thoughts

Some thoughts

The last generation of the bovine tissue valve has long-term data indicating 90% still implanted at 18 years, 80% at 20 years. The past-generation porcine valves tend to last about 12-15 years on average. One woman here claimed her porcine valve was 30 years old. It could happen, but if correct, she was a very rare exception.



Best wishes,[/QUOTE]

You might want to PM MOO, he went from tissue to Mech.

Bob H.
Funny how things get repeated here. There was somebody who made a
claim of from 30-35 years on a tissue value, of course that same person has been caught in several lies on this forum and has been banned. Just in case I did a MedLine search(You know how much I like to search for Valve Life studies) for a study that show tissue valve lasting over 25 years- couldn't find it- maybe you could find the case study she was talking about. Also it is very important to make clear that, unlike mech. valve, what valve and the age that it is implanted make a considerable difference on the USEABLE life of the valve. It is misleading to state that a tissue valve has a certain life, unless you know the valve and the age of the recipient. Someone who is 65 right now and gets the newest MAGNA........ valve in the aortic position might get 35 years out of it if he lives to 95, but someone who is in his twenties, a runner and has his mitral valve replaced might not get 6 years out of it. Just my perspective.

 

[Mary]

Bob,

I wonder if you've mixed the "woman with the 30 year old porcine valve up" with LA Cruiser. I read all those old threads, and sure enough, when LA Cruiser joined he stated that he had a pig valve implanted back in the 60's after suffering a gun shot wound as a child.
Of course he was questioned about it, and in subsequent posts, it turned out to be something entirely different (but still pretty amazing!)

That's the only member I've found that's claimed a tissue valve with 25+ years longevity.
Mary

 

[Chuck_S]

I learn more everyday, thank you!

I learn more everyday, thank you!

I learn more everyday, thank you!

 

[tobagotwo]

One woman here claimed her porcine valve was 30 years old. It could happen, but if correct, she was a very rare exception.

I'm not holding this up as a banner of anything that someone could expect. In fact, the statement was plainly made to exemplify exactly that point.

Because their is no "Physical proof" doesn't mean they aren't out there!

Best wishes,

 

[Debrinha GT]

dura-mater

dura-mater

There is a mention of valves sewn together from tissue by the surgeon. This is extremely rare anymore, and one of our members is one of the relatively few people to have had a valve assembled on-the-spot for her when she had OHS in Brazil.

I am the member from Brazil that Bob was talking about. I've already had three mitral valve replacements, all with tissue. I had rheumatic fever at seven and had my first suregery when I was ten, performed by the late Dr. Euriclydes de Jesus Zerbini at the Beneficiência Portuguesa Hospital in São Paulo, Brazil. I was a very extreme case at the time and I remember that even such an experienced surgeon like himself didn't think I would make it. Well, despite all the setbacks I did, but five years later(1980) I had to replace the valve again. He put another dura-mater in me which then lasted for nearly sixteen years before a rupture was detected in 1995. By then, this type of surgery was common practice in Curitiba, where I live. I was offered the choice between another tissue or mechanical, and I chose tissue, this time bovine, since I was trying to get pregnant. My new surgeon was Dr. Francisco Diniz Afonso da Costa. In those days I didn't have all the information I do now, but even after hearing about all the pros and cons of either type, I still want to go tissue again for my fourth surgery within a couple of years. I've been a member of VR for well over a year now, and I feel much more confident and at ease with my present situation. Again, valve choice has been discussed a lot here and we've all come to the conclusion that it's a very personal choice. I wish you luck with whatever you decide.

Gina, I didn't know you might need a fourth surgery and I hope you don't. But if by any chance you do, I want you to know that I'm here for you and I'm sure the two of us will help each other through it. However, there is a good chance your echo result may be wrong. By the way, I had never really heard much about scar tissue until I found VR, and the only time my cardio ever mentioned it to me was back in 1994 when I asked him about the risks of a third surgery. His words were that it's something like getting the same clothes fixed several times, they'll never be as good as before. I guess he meant the scar tissue here!???

Débora