Question Title: Valve Replacment and Renal Failure

Obviously she and my family are disheartened by this new set-back. Doctors refuse to transplant until she has the heart valve replacement. She was informed today that they would like to schedule surgery as soon as next week. She is fearful to ask many questions, yet I am more afraid of not asking.

My major questions and concerns are how risky is this procedure, and what type of valve will most likey used? The little research I have done shows that mechanical valves generally last the lifetime of the individual but the person has to be on anticoagulants. If she does recieve a mechanical valve, could there be conflicting problems either now or later after she recieves the kidney transplant?

She has already had to go through so much that I would hate for her to get a stentless or stented valve, and need it replaced in the future.

A reply as soon as possible is greatly appreciated due to the surgery being called for so quickly. Replys from others in similar circumstances is apprecated as well. Thank you for providing this service. The news I recieve will certainly help to releive my anxiety!

Dear Kristie, thank you for your question. This is a difficult question to answer, but I recently reviewed some published material on valve replacement in patients with renal failure so I'll share that information with you. Chronic anticoagulation for a mechanical valve can complicate dialysis since there are frequent bleeding complications at the dialysis access site (arm fistula for example) after the dialysis needles are removed. Additionally, dialysis patients are at risk for bloodstream infections which could infect an artificial valve (mechanical or porcine/stentless). However, once you mother gets a second kidney transplant, then she would no longer need dialysis so these complications would not be as much of a worry to her physicians. If your mother's mitral or tricuspid valves are leaking, they may be able to be repaired without needing a valve replacement nor long-term anticoagulation. If, however, the aortic valve is leaking, then valve replacement would be necessary. You are correct in stating that porcine valves are not as durable as mechanical valves but do not require anticoagulation other than aspirin. The typical duration of a porcine valve is 10-15 years, but is less in someone with renal failure that is not relieved with transplantation. I would need specific information from her echocardiograms and her clinical symptoms to comment on the type of valve that is best suited for her, so I recommend that you speak to her cardiologist and cardiac surgeon about this issue. The other alternative is for your mother to come to Cleveland Clinic for an evaluation since our cardiac surgeons are among the best valve surgeons in the world. If you would like to arrange an appointment, please write back and I'll try to expedite arrangements. Overall, the goal is to prepare your mother for the kidney transplant so that she will have the best expected long-term outcome from a transplant.

I hope this information is useful. Information provided in the heart forum is for general purposes only. Only your physician can provided specific diagnoses and therapies. Feel free to write back with further questions. Good luck!

If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.