Will I need another valve replacement?

[Prodromos]

Hello, I am 35 years old and I had my aortic valve replaced at the age of 22. Recently I’ve heard that sometime in the future I might need a new replacement, because at the age I had the operation my aorta had not yet reached its full growth. Is this really true?

 

[pellicle]

What valve did you get? A tissue based prosthetic, a mechanical or a human valve (homograft)?

Probably the answer is yes but less certainly yes if you got a mechanical valve (which I thought uncommon at 22)

 

[Prodromos]

I have a mechanical valve, but why does it seem uncommon to get a mechanical valve at 22?

 

[pellicle]

I have no statistics on it but its just my impression. It could be related to people attempting to avoid long term effects of warfarin.

I assume you are on warfarin? Right?

First time to hear of such a thing as the valve growing after 22 years old. Certainly that was never brought up with me.

 

[Prodromos]

Yes, I am on coumadin. What they have told me actually is that the aorta keeps growing until a later age than 22 so at one point the valve will become "loose" and leaking will occur.

 

[pellicle]

wow, first time to hear that. Not saying that its not correct, just that I haven't heard that before.

 

[Mom2izzy]

Will I need another valve replacement?

I would assume it's done growing by 35. Has your cardio checked for leaks? It would seem that if it didn't grow enough to make it leak while the valve WAS growing, it shouldn't just spontaneously start leaking after you have stopped growing, but that's all conjecture on my part.

Other thoughts:
- tissue and skin are flexible and stretchy, I would imagine there is some room for growth.
- I expect that your surgeon knows about the "growing" issue and would use the largest valve possible in hopes that your valve wouldn't grow TOO much.
- In my opinion, the main reason for mechanical valve is avoiding re-ops required with tissue valves...If you were going to need a re-op either way, I would expect the surgeon might steer you toward tissue.
- I believe it is very normal for young adults to get mechanical valves, since tissue valves don't last as long in younger people. If you got tissue at 22 and stuck with it, you would probably be looking at a minimum of 3-4 more OHSs which I wouldn't want and don't think is advisable.

 

[Superman]

I had my first mechanical valve put in just before my 18th birthday. Had it replaced again when I was 36, but there was nothing wrong with the valve. I had an aneurysm in the ascending aorta - so they put in a valve / conduit graft to replace it.

I've never heard of what pellicle is referring to regarding long term complications with warfarin. I've been on it 22 years and counting. And I'm a relative rookie compared to some posters here. I've heard quite the opposite that in younger patients they tend to go mechanical to minimize the number of future re-ops. But even their toilets flush backwards in the land down under, so it could be the case where pellicle is from (only kidding, folks - I'm aware it's an urban legend).

What your Dr. is referring to is a complication that can happen - but I wouldn't think of it as a likely scenario. They did size my valve up 2 mm from the one I got at 18, but they also said that it may not be apples to apples due to the conduit vs. the valve only I had the first time.

All you can do is go in for your check ups and live your life. Oh yeah, and take your warfarin and get your INR checked regularly.

 

[tom in MO]

I agree Superman, I have not heard of these long term risks to which Pellicle refers.

The drug is widely used, highly studied and people have been on it for long time periods w/o complications.

For young men, mechanical valves are often preferred due to the number of potential reoperations with a tissue valve. However, for young women, due to warfarin complication during pregnancy, they often get tissue valves until they are done bearing children.

 

[aliceann]

I, too, received my mechanical mitral valve just before my 19th b-day. This year, I"ll have had it for 32 years!! It's gotten me thru 2 very successful and uneventful pregnancies..resulting in 2 wonderful kiddos. No complications from the coumadin either, although I was on heparin during my pregnancies...a minor,albeit necessary evil.

 

[Magnacruz]

It truly is a coin toss whether or not you will have another surgery.

 

[Ovie]

It truly is a coin toss whether or not you will have another surgery.

Yup. Mechanical Valves are made to basically out live you, the rate of which hearts grow, don't grow or stay the same is different from person to person. You can't possibly know if you'll need another surgery in your life, until of course that day comes.

 

[pellicle]

I had thought the long term effects of warfarin were well known among this forum, especially given the aversion to warfarin expressed by many here.

Primarily it revolves around increases risk of bone density in aging. This would appear to be exacerbated by people following conventional medical "wisdom" and avoiding a proper diet in the falsely based premise of making ones INR more stable.

A quick start in learning about this can be had at Wikipedia

http://en.wikipedia.org/wiki/Warfarin#Adverse_effects

Osteoporosis

After initial reports that warfarin could reduce bone mineral density, several studies have demonstrated a link between warfarin use and osteoporosis-related fracture. A 1999 study in 572 women taking warfarin for deep venous thrombosis, risk of vertebral fracture and rib fracture was increased; other fracture types did not occur more commonly. [24] A 2002 study looking at a randomly selected selection of 1523 patients with osteoporotic fracture found no increased exposure to anticoagulants compared to controls, and neither did stratification of the duration of anticoagulation reveal a trend towards fracture. [25]

A 2006 retrospective study of 14,564 Medicare recipients showed that warfarin use for more than one year was linked with a 60% increased risk of osteoporosis-related fracture in men; there was no association in women. The mechanism was thought to be a combination of reduced intake of vitamin K, which is necessary for bone health, and inhibition by warfarin of vitamin K-mediated carboxylation of certain bone proteins, rendering them nonfunctional. [26]

Other reading

One for the positive case
http://m.stroke.ahajournals.org/content/28/12/2390.long
One for the negative case
http://www.ncbi.nlm.nih.gov/pubmed/21456505

http://www.valvereplacement.org/forums/showthread.php?34798-Long-term-effects-of-Coumadin-warfarin

Personally I am not worried about it and only raised it as a possibility as to why someone would not recommend a young male to have a mechanical valve.

PS the abstract at least is worth reading in this one:
http://joe.endocrinology-journals.org/content/194/1/213.full.pdf

 

[njean]

I, too, received my mechanical mitral valve just before my 19th b-day. This year, I"ll have had it for 32 years!! It's gotten me thru 2 very successful and uneventful pregnancies..resulting in 2 wonderful kiddos. No complications from the coumadin either, although I was on heparin during my pregnancies...a minor,albeit necessary evil.

I've been on coumadin for 38 years or since 1975 when I had my 1st OHS. The only thing I've been told by my doctors, is that long-time use of coumadin can result in bone loss. That is why I was started on boniva and calcium supplements a few years ago. I have Osteopenia (?) in both my hips and lower spine.

 

[Ashkir]

Wow. I can outgrow my mechanical valve? I got it when I was a young 19 years old. My bones are still strained, etc because my family doctor said I'm still in puberty. I'm almost 24!

 

[tom in MO]

An "increased risk" is certainly not a "long term effect". Getting old is a direct cause of low bone density, which many people who are not on warfarin suffer from. Many younger men are encouraged to have mechanical valve due to the absolute fact the valve will need replacement if they have a normal life span.

 

[pellicle]

An "increased risk" is certainly not a "long term effect". Getting old is a direct cause of low bone densi which many people who are not on warfarin suffer from.

I assume this means you take issue with the study results. Which is fine as I do too.

It is however an effect if recipients of warfarin are suffering from lower than average bone density than the non recipients over a stastically significantly significant cohort then like it or not : agree with it or not it is an effect. if you wish to challenge it, then I encourage you to conduct research and submit this as evidence challenging their findings.

I can only read research, interpret their findings and make decisions.

Please refer to my inital post and note that I have not said "I believe there to be a significamt issue with being on warfarin".

 

[Superman]

I had thought the long term effects of warfarin were well known among this forum, especially given the aversion to warfarin expressed by many here.

Consider who the posters are who tend to have these aversions. Most of the posters who already have mechanical valves and are long-term warfarin patients tend to be pretty comfortable with the medication. It's typically those that either haven't had their replacement yet, or those that opted for a tissue valve that express the most reservations with respect to warfarin.

For the record - I broke more bones prior to being on warfarin than since. But being a kid will tend to do that.

 

[tom in MO]

Pellicle, you know very well that nobody on this board has the deep pockets or the required degrees "to conduct research and submit this as evidence challenging their findings."

However, I believe you are mistaken with your statement of "agree with it or not it is an effect."

Just because your one article says that there is a statistical correlation, does not make it an effect. A correlation does not in any way mean causality. The concept that a statistical correlation equals a true cause is the basis for a lot of bad science.

If you cut the statistics a different way, the correlation may disappear...then it certainly is not even an "effect."

Even if the correlation is real, the cause may be something else about wafarin patients, like the type of food, the amount of exercise, age, etc.

 

[hannahsmom]

Hello,

My daughter had her valve replaced at age 10. Luckily for us she had grown enough to receive an adult-sized valve. Her surgeon was very happy with being able to give her an adult-sized valve as he stated it should last her several decades, if not the rest of her life.

I would think someone your age would be given the same type of outlook as you were an adult when you received your valve. I would suggest asking the dr more questions.

Best wishes to you!

Kelly