Valve repair?

[Traveler]

I'm a little confused on the benefits of valve repair. I see that several people here were hoping for a valve repair or happy to get one rather than a valve replacement. My surgeon says that valve repairs have a 10-20% chance of needing further work (OHS) within 5 years. Alternately he says that valve replacement with a bio valve has very low replacement rates in the first 10-15 years.

So if I'm in the lucky 80% on valve repair am I good for life or will a eventually need a valve replacement. If I eventually need a replacement (following repair) is there any advantage over a valve replacement since in either case I'd need a second surgery and the valve repair might come much earlier. Just confused on this point.

Thanks

Mark

 

[Tom F.]

First, you need to tell us which valve and your condition. Mitral vale repair has a great track record. Aortic valve repair in the presence of an aneurysn and an otherwise normal valve also seems to have a good record. Others maybe not.

I have had an aortic valve rapair and sofar its good. Email me if you have questions.

 

[Traveler]

First, you need to tell us which valve and your condition. Mitral vale repair has a great track record. Aortic valve repair in the presence of an aneurysn and an otherwise normal valve also seems to have a good record. Others maybe not.

I have had an aortic valve rapair and sofar its good. Email me if you have questions.

Ah yes -- details they always help

Biscupid aortic valve, regurgitation 4, ascending aortic aneurysm 5.0 cm. I'm 52 and in good health, no complicating factors.

Thanks

Mark

 

[Marty]

Mitral valve repair?

Mitral valve repair?

Attempts to repair the aortic valve are not recommended. However repair of mitral valves as devised by the great surgeon Alain Carpentier, the "French correction", work quite well if the valve is not too damaged.
I went into surgery expecting a repair but got a
St.Jude mechanical valve instead. This is where surgical judgement comes in. My surgeon said he could have attempted repair but it would have lasted less than two years. We had one patient post here on vr.com whose repair lasted six weeks! I trust the surgeons at my own hospital because they trained with Carpentier,but nationally Cleveland Clinic or Mayo have the reputation as the best place to get a mitral repair.

 

[weekycat]

I guess I'd listen to what you surgeon recommends

I guess I'd listen to what you surgeon recommends

Since you clarified that it is indeed your aortic valve that's in need of repair/replacement. I just thought I would clarify for others that if they are looking at a mitral repair, I don't believe there is that much chance of needing work done on it within 5 years. At least I hope not, since my "warranty" would then be up in about 4 months

For the benefit of others that will read this thread in the future and are looking at mitral repair, after mine was done my surgeon said, "That repair should last you for the rest of your life". He did extensive repair to both leaflets and used an annuloplasty ring.

The benefit of repair vs replacement in my case was that I only had to be on Coumadin for 8 weeks-just long enough for my own tissue to grow around the plastic ring...and long enough to know that I'm very thankful I don't have to deal with taking it for the rest of my life like many others here.

It usually comes down to what's right for you and what you and your surgeon are comfortable with. Good Luck Mark, nice to meet you.

 

[Tom F.]

Marty - I have to disagree. Where the aortic valve is normal or near normal they can be repaired when that surgery is done in connection with an ascending aortic aneurysm. The procedure was developed by Dr. Tyronne David in Canada, and it is referred to as a "David type" repair. That is the procedure I had performed, and according to published reports they seem to hold up well.

Where the valve is bicuspid, and therefore not normal, that is another matter completely. Dr. David has tried to repair these, but its very iffy. Generally bicuspid values will be replaced.

 

[Christina L]

I don't think they would be

I don't think they would be

doing so many repairs these days if they didn't believe in them. Over 90% of repairs are viable at 10 years (at least mitral from what I have read). My recent echo shows I now have 1+ regurgitation from my mitral valve whereas I was never told that before - always told I had NO regurg at all from my repaired mitral valve - three years postop.

However, I lived ALL my life with 2+ to 3+ regurgitation - even as a child I had a very, very loud murmur. So, I need to look at it that way. The 1+ regurgitation is something that people with healthy hearts may have - and it may never get worse or it may.

Repairs are like rolling the dice but so is getting a replacement - and so is living with a heart murmur from birth! Come to think of it, life is just basically a crap shoot!

Christina L

 

[ruth]

I just had mitral valve repair 3 weeks ago so no long term results here to report. I really expected a replacement since I had rheumatic fever and often rheumatic damage isn't repairable. The surgeon had given it a 99.5% chance of replacement going in.

That said, from what I remember of the CICU drug-fog-induced conversation with the surgeon she was pleased to have been able to do the repair and considered it a longer term solution that the biological valve I had chosen. She said she wouldn't have done the repair if she didn't think she could get longer out of it than the replacement valve. Her statement was "this is a 20+ year repair or more". I just hope she's right!

I think the moral is, we can choose what we prefer but at the end of the operation the surgeon will do what is required for the optimal outcome in their best medical judgement.

Regards,
Ruth

 

[WayneGM]

My mitral valve repair is only 11 months old so I cannot say from actual experience, but my surgeon told me the repair should last me for the rest of my life.

 

[Adrienne]

The following is from a site I found on the Internet:

WHAT ARE THE RESULTS OF MITRAL VALVE REPAIR
The first thing to remember is that a surgeon can predict the likelihood of repair before surgery, but cannot guarantee it. If repair is possible, the likelihood of long-term success is good, particularly for degenerative valve disease. Depending upon the underlying abnormality there may be an 85 to 95% chance of needing nothing further done to the valve over the next 10 years. If a more complex repair was required for degenerative disease, the chances of long-term freedom from reintervention (further surgery) may be less. If a valve was damaged by rheumatic fever, the disease may progress even after the repair, making the chances of the repair holding up in the long run less. Some surgeons are, therefore, reluctant to repair rheumatic valves. The results of repair of mitral regurgitation associated with coronary artery disease are the most difficult of all to predict.

WHAT WILL MY CONDITION BE LIKE AFTER MITRAL VALVE REPLACEMENT?
After successful mitral valve replacement you can expect to return to your
preoperative condition or better. Anticoagulation (blood thinners) with Coumadin is often prescribed for 6 weeks to 3 months postoperatively.
Generally this prescription is not required in the long term unless other indications for anticoagulation such as atrial fibrillation are present. Once wounds have healed there should be few if any restrictions on a patient's activity.

Since my repair was a very complicated one, I do worry about the long-term outcome, I must admit, but I still feel it is the best decision.

 

[Marty]

Marty - I have to disagree. Where the aortic valve is normal or near normal they can be repaired when that surgery is done in connection with an ascending aortic aneurysm. The procedure was developed by Dr. Tyronne David in Canada, and it is referred to as a "David type" repair. That is the procedure I had performed, and according to published reports they seem to hold up well.

Where the valve is bicuspid, and therefore not normal, that is another matter completely. Dr. David has tried to repair these, but its very iffy. Generally bicuspid values will be replaced.

Thanks, Tom, I didn't know about the David repair. I only knew they tried years ago to repair bicuspid valves anf that didn't work.

 

[Marty]

My mitral valve repair is only 11 months old so I cannot say from actual experience, but my surgeon told me the repair should last me for the rest of my life.

Wayne, I think the surgeons got to your valve in time.If they did ,a repair is much preferred to a replacement and should last for the duration. I was 72 when I finally relented to have the surgery with 4+ regurg that I may have had for quite a while. I wasn't very good about physical checkups and all that.You can feel pretty good with mitral regurg until you crash which is what I did. My surgeon said he would try to repair if he could. However he found the valve leaflets mostly shredded and flail and the chordae tendininae ruptured. The replacement restored my health.
The moral of this story is to find a surgeon who has good judgement and will repair if possible but not try to be a hero and repair the impossible.

 

[tobagotwo]

The two most common replacements for valve-and-aneurysm combinations are the Medtronic Freestyle porcine tissue valve and the St. Jude Medical Masters carbon (mechanical) valve, each of which includes replacement material for the aneurystic aorta (porcine aortic tissue and polyester, respectively). Further repair usually require polyester fabric tubing, which allows the patient's own tissue to grow through it over the first six months.

I agree that aortic repairs are generally quite iffy, and I believe that 20% requiring resurgeries in five years is a very optimistic estimate, unless the statement was qualified in some way. It's not that it can't be done successfully, but it takes a very experienced surgeon to determine whether it's worth doing. The reason for the regurgitation is very important in this determination.

Leakage from an aortic valve can be caused by an aneurysm, as the root enlarges, but the valve cannot. This is one of the more repairable causations. The valve-sparing David procedure is mostly a stabilizing and realigning of the valve and its base in situ, when it has been misaligned by an aeurysm which has warped its shape and base by its expansion. The aneuristic tissue is removed, starting just above the valve.

Reassuring statistics from the CCF website: "Cleveland Clinic Surgeons have performed over 120 Modified David Reimplantation procedures with no deaths and 97% freedom from reoperation at 10 years."

Best wishes,

 

[WayneGM]

Originally posted my Marty
Wayne, I think the surgeons got to your valve in time.If they did ,a repair is much preferred to a replacement and should last for the duration. I was 72 when I finally relented to have the surgery with 4+ regurg that I may have had for quite a while. I wasn't very good about physical checkups and all that.You can feel pretty good with mitral regurg until you crash which is what I did. My surgeon said he would try to repair if he could. However he found the valve leaflets mostly shredded and flail and the chordae tendininae ruptured. The replacement restored my health.

Yes, I think I was diagnosed quite early before too much damage was done. I was feeling perfectly fine, but always go for an annual medical check-up (my wife insists...and I'll never hear the end of it now!). My GP noticed a strong heart murmur that wasn't there the year before. Two visits to the Cardiologist, one with the Cardiac Surgeon and the next thing I know I was scheduled for a mitral valve repair. The regurg was severe enough that my heart was starting to become enlarged, but it was reversable as since the OHS its already returned to normal. Coincidently for this thread, my cardiac surgeon was the Dr Tirone David that Tom F mentioned. We never discussed replacement, other than when I signed all the legal release forms "just in case", as he was pretty confident from the outset it could be repaired.

 

[Bradley White]

Dr. David is one of the better known valve surgeons in the world. I think he has a reputation for being very innovative and successful. You had the best man for the job Wayne.

 

[Christina L]

This article is a pretty

This article is a pretty

detailed reading of the success rate of mitral valve repairs.

http://jtcs.ctsnetjournals.org/cgi/content/full/107/1/143


Christina L

 

[xbxb]

Tissue Saving Valve Repair

Tissue Saving Valve Repair

Aortic valves can be repaired.
Here is a little bit of my experience and information I learned along the way.
I had an Aortic root replacement and Valve sparing repair to a bicusid valve at age 42(18 months ago).
Problem is there is very little data. Cases such as mine are relatively rare- most of the time the valve is replaced- patient is older, or depends on the experience of the institution where you are having your surgery.
A bicuspid valve is a disease of the Aorta and 50% of bicuspids will have an enlarged Aorta that needs work.
The 4 institutuions I found that do repairs w/some level of experience:
Cleveland Clinic
Mass General
Brigham & Woman
Texas Heart Institute
I chose Mass Gen. The surgeon needs to be an experienced valve man AND Aorta specialist.
It is true that no one can tell you how long the repair can last. I was given a 50% - 80% chance of repair from all the opinions I had from the above hospitals. After my TEE test-gives best look at valve- my surgeon was 80% confident- which proved to be correct.
The thinking is this - that a repair is your own body. Being free of a mechanical valve was my choice. How long an animal valve would last was an issue.
My surgeon was quite conservative - he told me that the length that animal valves last are still variable.
It is expected that I will need another surgery some day- but the hope is that I will be much, much, older. Because my root was replaced with an artificial piece, the sense is my bicuspid will last longer. The odds are that my next valve will be made from my own body.
My surgeon told me in his whole career he had only performed approximately 15 of the exact same type of surgeries that I had done- he is senior surgeon. He also told me he had not yet had one fail.
All the Dr's agree there really is very little data on how long a repair will last. But the Dr.s that are expeienced in this exact procedure believe it makes sense, especially in a younger person. What is critical is that you are a good candidate, and that the surgeons are experienced in this delicate procedure.
By the way - I am playing basketball 4-5 times a week now!
Please email me if you have any further questions.

David

 

[xbxb]

Valve Repair

Valve Repair

Susan
I was told I was the ideal candidate by Dr's that do the repair.
(I was also told to put in a mechanical and be done with it, before I did a lot of research).
42 - in very good physical shape, non smoker.
This was an open procedure - though my incision is only about 4.5" long.
My valve was not stenotic - calcified. I think this is the biggest consideration, and most likely the reason a repair was possible.
The TEE test was the confirmation that my valve was most likely repairable- gives a good look at the valve.
Still even though I was given an 80% chance of repair, I was told that the decision would be determined in surgery. In surgery, after the repair they test the valve and if they felt it would not function correctly a replacement would be made.
The biggest complication and what made the surgery complex was the aortic root replacement. There are many, many valve surgeries, but less w/root replacements and much less with repairs of bicuspid valves.
I spoke w/many people before my surgery- my opinion is that many of the Dr.s that are out there are not familiar with repairs- I think due to the number of patients they see that would be concsidered a good candidate. Most people that have valve surgery are close to 70, and an animal valve that could last 10+ years is an option. Also as you get older bicuspids tend to get stenotic - and thus become unrepairable. As you know in your 40's - a valve type decision is a little more difficult. Also the little data that was available in the medical literature had many redo's - that is why many people hear a repair is not possible.
My experience was to find the people that did have experience with cases such as mine - and these people all believed a repair was most likely the best option. I actually was searching for Aorta specialists.
I asked my surgeon "if my valve was repaired, and someday needed to be repaired again, would he replace it or rerepair it?" he said he never thought about it but that he would probabably try to repair it again if possible.
My repair does leak, but minimally, and due to the artificial root, the conduit does not expand and thus helps maintain the valve composure.
With my repair I have virtually no lifestyle restrictions. On the down side more than likely I will face another surgey - but hopefully when I am old and grey.
The risk increases on the second (95-5)surgery due to scar tissue- but hopefully this surgery will be far, far, far in the future where there will be new advancements!
How long has it been since your repair?
Stay healthy!

 

[Traveler]

Thanks for the thoughts.

My situation is that my surgeon at Mayo has said that he needs to understand my risk tolerance for repair. The scale is "absolutely I don't want to have a repair even if a repair seems like it will be successful" to "save my valve at any cost." That said I told him that I'm not eager for a repair, but if it seems like the best choice when looking at it to go ahead -- but I'm having second thoughts.

He noted that I am not an ideal candidate for repair because I'm a little older than he would normally recommend, but I'm very active -- so maybe. We discussed the risks I mentioned above and I asked what he would do if he were me. He said that's unfair question since he is not me. (fair enough) He also noted that he was "hot to perform a valve repair right now" using a new procedure that he has done 10 times before, some change in how the leaflets are repaired with the thread. But noted that the long term outcomes are not known. I trust he'll follow my instructions, but I'm still confused a bit. I've read several journal articles on aortic valve repair but they really don't address the risk issue.

Mark

 

[Marguerite53]

I'm sorry if this furthers to muddle your thinking, but for last April 's surgery I was 52. My cardio advised me to go mechanical. I never wanted that, for lots of silly reasons....mostly just my personal gut reaction to the choices. The surgeon was happy to discuss tissue with me. I think he was barely a year younger than me so it was nice to have someone of similar age listening to all my questions. When we'd decided on the CE bovine he volunteered to me that he was happy with our choice, that most certainly it would be the one he would choose for himself or anyone in his family!

I know that I would be very uncomfortable with the inconsistency of someone saying I was not a strong candidate for a repair but that a surgeon was itching to perform a repair on someone...anyone....

I guess you could consider the result more deeply. Where does the downside really lie on each option. If the repair may need tweaking over time (or be more likely to need tweaking right away) and the replacement is pretty much guaranteed (my surgeon said numbers were coming in great on the tissue for 20+ years.......with someone for whom everything went right.....and continued to go right.....in other words......still a crap shoot, but at least with better numbers!! )

Like any "purchase" it is often most important to really work hard to get at the necessary info up front. You are really thinking hard, and doing your homework. You have time to. Many here did not. You owe it to yourself to be comfortable with your decision. It sounds like a few more phone conversations are in order for you. USE THIS TIME. It will give you the confidence you need going into this major surgery. Not a good time to be shrugging your shoulders and acquiescing (okay...I cannot spell that word!).

Good luck. Get back to us.

Marguerite