What Valve?

[DLH]

Ok, all indications seem to point toward surgery to repair or replace my mitral valve. So while I am waiting on my appointment with my cardiologist I am trying to gather as much info as possible and since a lot of research has been done before me by others I would like to ask what valve (exact model) would you recommend for an active 40yr old (Cycling, Softball, Soccer etc...) if the valve can not be repaired? I want to avoid having to take meds for the rest of my life, but I want a valve that should last a long time.

Thanks for sharing your knowledge and experience.

DLH

 

[901]

Ok, all indications seem to point toward surgery to repair or replace my mitral valve. So while I am waiting on my appointment with my cardiologist I am trying to gather as much info as possible and since a lot of research has been done before me by others I would like to ask what valve (exact model) would you recommend for an active 40yr old (Cycling, Softball, Soccer etc...) if the valve can not be repaired? I want to avoid having to take meds for the rest of my life, but I want a valve that should last a long time.

Thanks for sharing your knowledge and experience.

DLH

How long is a long time? My surgeon told me that my mechanical valves (St. Judes) will last longer than the rest of my body. He actually said "a lifetime" whatever that means. I'm 48 and will be continuing on rat poison forever. If you select a pig or cow or even one from a human, you can count on an eventual second OHS (something I did not and still do not want!). The consensus for tissue valves seems to be 15-20 years with the more active younger people needing them replaced toward the "sooner" portion of that window.

 

[Karlynn]

Welcome DLH! If you do some research under the Valve Selection forum, you will find lots of discussion on valves. Some of it is pretty heated. We just had a very heated debate a week ago that crazy. This is probably why there haven't been too many answers to your post yet. Many of us are gun shy now because we don't want to offend anyone and the written word sorely lacks inflection that tells of tone.

However, you will find lots of information if you read some of the Valve Selection threads. Feel free to ask any questions. We have many informed people here.

 

[Superbob]

Ok, all indications seem to point toward surgery to repair or replace my mitral valve. So while I am waiting on my appointment with my cardiologist I am trying to gather as much info as possible and since a lot of research has been done before me by others I would like to ask what valve (exact model) would you recommend for an active 40yr old (Cycling, Softball, Soccer etc...) if the valve can not be repaired? I want to avoid having to take meds for the rest of my life, but I want a valve that should last a long time.

Thanks for sharing your knowledge and experience.

DLH

The dilemma (and this is something you ultimately will have to work through for yourself) is that the mechanical is the longest-lasting (possibly for a lifetime) but the tissue offers the best hope of reduced reliance on blood thinners. Some of the newer tissue valves seem to be lasting longer than before (maybe 10-15 years or possibly even longer) but the research is ongoing.

I hope I've stated that correctly and fairly. There are indeed differences of opinion on this issue that are sometimes heated. I am 63 and ultimately decided to go tissue for a variety of personal reasons, but I came close to deciding to go mechanical because that would have been the best chance to avoid a second operation if I live to a ripe old age.

In short, there's no perfect choice that will ensure you the two priorities you indicated. You have to weigh the trade-offs, and decide what suits you best. Then don't look back and be happy with your choice.

You would make a good start by reading the past posts in this forum.

Welcome!

Rob

 

[DLH]

I guess I am wondering more about specifics. I do not want to start a debate, but would like to know what people were told by their Cardialogist, Surgeon, valve manufacturer, own research or whatever references. The things I am wondering about are valve life expectancy, materials, meds, tissue or mechanical and specific product names. I did notice other forums about this, but due to the personal aspect of the topic it became hard to follow. What I think would be helpful to me or anyone needing a valve would be to have a list of the valves with specs or links to their specific web pages. If something is out there like this already please point me to it.

Thanks again,
DLH

 

[Phyllis]

Here are two links to Heart valves that I know of:
http://www.medtronic.com/cardiac/heartvalves/intro.html
http://www.edwards.com/Products/HeartValves/?WT.svl=2

 

[Phyllis]

Here's the url for St. Jude valves:
http://www.sjm.com/devices/deviceindex.aspx

 

[PapaHappyStar]

you might want to go to medline and search for durability and mitral valve bio-prosthesis
here is a link from the search i did:

full text sources:
http://www.ncbi.nlm.nih.gov/entrez/...ch&term=mitral+valve+bioprosthesis+durability

all pub-med:
http://www.ncbi.nlm.nih.gov/entrez/...ch&term=mitral+valve+bioprosthesis+durability

here is something on the Ross II procedure ( grafting your own pulmonary valve in the mitral position ):

Thanos Athanasiou, Ashok Cherian and Donald Ross, The Ross II Procedure: Pulmonary Autograft in the Mitral Position, The Annals of Thoracic Surgery, Volume 78, Issue 4, October 2004, Pages 1489-1495.
(http://www.sciencedirect.com/science/article/B6T11-4DFB63M-2X/2/3dbe8a9281306833c038872fdeb1d263)

I think the mitral valve bioprosthesis might not last as long as an aortic valve (thus the 15-20 yrs might be an overestimate given your age )-- and the surgery to replace the mitral valve is even more invasive to the heart than for the aortic valve, so repeat surgery is riskier...

read a bit and ask questions of your surgeon/cardiologist...

 

[Chuck_S]

I visited my surgeon yesterday

I visited my surgeon yesterday

First off, I just had AVR (freestyle) on July 13, 2005. My surgeon feels that it should last 20 years, but as others have mentioned this is not a sure thing. Apparenlty my tissue is not real typical, and this includes the area around my mitral valve too. They did nothing this surgery for the mitral area, besides noting that the tissue is my-ex-zomedus (sp?). I may need some help in the mitral valve area at some point. My surgeon, who is a firm believer of the fresstyle tissue valve, said he would not put a tissue valve in me in the mitral area. If I need a mitral valve replacement he recommends a mechanical (and the blood thinnner). We did not talk more about this mitral situation, I am probably 20 years from worrying about this.

FYI - it is my understanding that a mitral valve is more demanding than a aortic valve (operating pressures I believe). I do believe the blood issues are inflated. That said, I still chose a tissue valve.

Good luck with your research, and keep us posted.
CS

 

[twinmaker]

Chuck, I had my mitral valve replaced when I was 29 years old with a St. Jude mechanical. I had three small children at the time and was very active...playing tennis, bike riding, bowling, etc. The St. Jude valve was pretty new in 1981 (not yet approved by the FDA) but my surgeon said it SHOULD last the rest of my life...of course there are no promises. Anyway, I've had the same valve for going on 24 years this month. Of course, I have to take Coumadin but I'm still very active including tennis and riding my bike and just about anything else I want to do. Good luck with your decision. If you have any questions we can answer, let us know. Linda

 

[Nancy]

Chuck-

There have been others on the site with myxomatous (that the word you were looking for?) tissue. Do a search on this site for that word. Maybe you can pull up some of the posts.

Do a search on myxoid also.

 

[Chuck_S]

searching feature?

searching feature?

When I do a search for that correctly spelled word (myxomatous) in the main page, it provides all the Main topics that have that word in it. This might mean that there are 50 posts, and one has that word in it.

Can I search for myxomatous and only see the posts where that word was used?

Thanks for the help,
CS

 

[Karlynn]

When I do a search for that correctly spelled word (myxomatous) in the main page, it provides all the Main topics that have that word in it. This might mean that there are 50 posts, and one has that word in it.

Can I search for myxomatous and only see the posts where that word was used?

Thanks for the help,
CS

The word you searched for will be highlight in a different color and bold, so you can quickly scroll through the posts until your eye catches the color.

 

[ALCapshaw2]

When I do a search for that correctly spelled word (myxomatous) in the main page, it provides all the Main topics that have that word in it. This might mean that there are 50 posts, and one has that word in it.

Can I search for myxomatous and only see the posts where that word was used?

Thanks for the help,
CS

YES, you can SEARCH by POSTS (vs THREADS) by clicking on SEARCH, then click on ADVANCED SEARCH. Scroll down the Left Side and you will find a line (NOT in a box) that offers (o Threads) or (o Posts). Click on Posts. (The default is Threads).

'AL Capshaw'

 

[Chuck_S]

Thanks for the tips!

Thanks for the tips!

Thanks for the tips!

 

[Karen7]

I guess I am wondering more about specifics. I do not want to start a debate, but would like to know what people were told by their Cardialogist, Surgeon, valve manufacturer, own research or whatever references. The things I am wondering about are valve life expectancy, materials, meds, tissue or mechanical and specific product names. I did notice other forums about this, but due to the personal aspect of the topic it became hard to follow. What I think would be helpful to me or anyone needing a valve would be to have a list of the valves with specs or links to their specific web pages. If something is out there like this already please point me to it.

Thanks again,
DLH

HI DLH,

I don't mind taking medicine every day but I balked at getting my levels checked (or checking them myself.) I dread going to the doctor or even calling him. I am the type that thinks everything will blow over if I ignore it and that thinking serves me well sometimes but has landed me in the emergency room a couple of others. I decided to "save up" my doctors' visits and have the valve repaired or replaced in 15-20 years. By then, percutaneous robotic surgery will be the norm and my surgeon said (barring unforeseen circumstances%%) I won't be looking at another open heart surgery. It's a stentless porcine valve but I can't remember the manufacturer. I guess I should find that out...

Karen

 

[tobagotwo]

Be careful when reading the posts. I note a lot of mixing of aortic (AVR) valve information with mitral valve information. The two are quite different in terms of the valves that can be used, how well they work, and how long they last. Aortic valve information is not interchangeable with mitral valve statistics on any level.

I lean toward tissue valves whenever reasonable, but you should be aware that tissue valves do not last as long in the mitral position. The appearance is about 70%-80% of what would be expected from aortic service. This is partly because the blood can move more slowly over the valve, and calcification occurs more quickly. While the anticalcification treatments might help that, there isnt a track record for it at all, and you would be truly taking your chances. At your age, you could very reasonably be looking at three surgeries at least, even with a bovine valve.

Mitral surgery goes through even more damagable parts of the heart than aortic surgery, and, especially with multiple surgeries at the mitral valve site, there is a good chance that atrial fibrillation can be a result of one of those surgeries. If you do wind up with chronic afib, you will likley wind up on Coumadin anyway.

Coumadin will not affect most of your active lifestyle. A little easy on the soccer, perhaps, or more padding. In your shoes, I would most likely be considering a mechanical valve. Interestingly, although not in use for aortic implants anymore, tilting disk valves work quite well in the mitral position. However, the choice will likely be between a St. Jude valve and one of the other top brands. I would likely take one of the others, as there have been some hemodynamic improvements in them that the St. Jude model is not yet using. Every little edge you can get, I say.

If you have myxomatous tissue issues, the Ross Procedure would likely not be a permanent fix for you, as your own tissue may well fail over time, or not even be usable right up front. I have seen one post where the surgeon is supposed to have said that Coumadin affects myxomatous tissue negatively, but the post was never verified, and I have never seen any studies or even discussion literature to that effect, and frankly don't believe it. By the same token, we do know that operating multiple times on myxomatous tissue can be very risky, as it may not heal properly.

If you want to narrow a search down to some threads that discuss myxomatous tissue, Rachel Howell and I have posted quite a bit about it.

Best wishes,

 

[Karen7]

Be careful when reading the posts. I note a lot of mixing of aortic (AVR) valve information with mitral valve information. The two are quite different in terms of the valves that can be used, how well they work, and how long they last. Aortic valve information is not interchangeable with mitral valve statistics on any level.

Best wishes,

I didn't know that. I will be more careful in the future.

Karen

 

[samiam]

My wife and I had a lengthy discussion with our Dr about tissue vs mechanical. We asked if he were in my shoes, what would he do? He said that given the advancements in heart surgery in the next 10-25 years, and given the advancements in tissue valves, he would go with tissue for me, a healthy 55 year old male with severe MVR. If I heard it right, I am now the proud owner of an Edwards-Carpentier bovine valve with an estimated expectancy of around 25 years. Even if it's 15 years, imagine how far advanced surgery will be. Even now, catheter valve repair surgery is being performed. We could have asked for mechancial, but were concerned about the coumadin routine. I don't think there's a right or wrong answer. You have to go with what you're comfortable doing. Good Luck!!

 

[Mary]

Sam,
They should have given you a temporary card in the hospital that states the valve type that was implanted.
I received my permanent one from Edwards about 3 weeks after my operation. You might want to check with the implant patient registry to see where yours is.
http://www.edwards.com