Advances in Aortic Valve Replacenents

Posted by Eric  on May 06, 1999 at 11:57:05
I am 48 with progressive aortic stenosis (calcification)
My valve area has gone from 1.7 to 1.4 in 2 years.
I am asymptommatic as of yet and remain very active.  When the time comes for a valve replacement, I would much prefer not to be chronically anticoagulated.  I am very active and have 2 young children who like to play hard.
When is the "right" time to have a valve replaced?
Most importantly, are there any major advances in valves which would nor require chronic anticoagulation?  I have read about a newer valve from medtronic.
What valve would you most commonly use in someone like me?
Thanx,
Eric

Posted by Todd on May 07, 1999 at 08:25:57
You should also look into valve repair.  Aortic valve repair can be done at some major heart centers - I don't know about repair for stenosis.  If you are a candidate for repair - I would consider it.  I was told by two surgeons that aortic valve repairs don't last - but some surgeons have good results.  I had my valve repaired and asc. aorta aneurysm repaired last fall (I'm 33).  My choice if my valve could not be spared was a homograft for a few reasons.  I'm young and have two young children that keep me going full time, I like to play hockey (a no-no with anticoagulants, the complication risk of redo surgery 10 or 15+ years is less than the risk of anticoagulation over that time (from what I've read).   Many people do not have any problem with anticoagulation, but some have alot of problems.  I also did not like the thought of having to have my blood tested every few weeks, being very careful not to eat the wrong foods, the interaction of coumadin with virtually any over the counter medication.  After having surgery, I would make the same choice.  Its a tough decision, and there are a lot of people that would take the mechanical valve.  Hopefully, you have many years before you have to make that decision - I think that it is good to start looking at the options now and continue to be informed of recent developments.  Good Luck.

Posted by CCF CARDIO MD - MTR on May 07, 1999 at 08:50:21
Dear Todd, thank you for your input to the heart forum.  Aortic valves that are stretched and leaking due to aortic aneurysms can sometimes be repaired, but stenotic aortic valves cannot be repaired and must be replaced.  I agree with your thoughts on an aortic homograft, as my response indicates.