Aorta Valve Replacement

[Harvey Horton]

I have read many things about valves  but have not heard much about the stentless porcine valve. This is what I have been recomended to have put in. I am 44 years old and have an asending aortic anuerisym. I will be going in the hospital in 2 weeks and I dont know if this is the right decision. I have also heard about a medvac valve called mosaic, does anyone know about this one?

[CCF CARDIO MD JMF]

The key to any successful cardiac surgery is the experience of your surgeon and their preference for valves ( bioprosthetic vs. mechanical ) or repairs ( the Ross or David procedure ) in your case.

The stentless valve has far more experience in Canada and is used less extensively in the U.S.  You may want to discuss specifically with your surgeon their experience, pump times and long term efficacy with this particular valve.  It is likely that you will need a combined procedure and a homograft may be another option to consider.

If you would like additional information or want a second opinion, that can be arranged through the number listed below.

Best of luck.

[William]

Did they say why you had to have a biograft valve instead of a mechanical one??

[Gary]

There is little history in the US for the stentless porcine valve.  Tirone David in Toronto seems to have invented the valve and implants it frequently.

I have downloaded some information about the porcine stentless valve and talked with 5 surgeons, two of which use it practically exclusively when they cannot use the Ross procedure.

The other three use the bovine pericardial valve when not using the mechanical valve and only do a few Ross, mostly in children.

The Clinical trials in Canada and Europe seem very favorable over 8 years which is probably why the FDA approved it here.  But the installed base here in the US is still small and there are no long term numbers here yet. It really is up to  

If you have not already tried it, and if you want further information you can find some by using a search engine and typing in 'porcine stentless valve'.

It sure looks highly efficient but the surgery and by pass time
is longer than the bovine pericardial implant.

Your surgeon will not offer much if any choice since they choose
the valves they are most proficient with.

[DENISE]

Dear Harvey,

This is what I have learned through experience:  You must have the very best surgeon your insurance will let you go to.  If at all possible, I highly recommend the Cleveland Clinic.  They have the best surgeons.  I had my mitral valve repair there with Dr. Cosgrove.  The more skilled your surgeon, the less chance of complications.  I was never asked what kind of valve I preferred in case of a replacement, but told to trust that Dr. Cosgrove would make the very best decision for me. If you want a second opinion, please go to the Clinic.  Just my two cents worth.

[Harvey]

Thanks for the info, I would be more than happy to speak with anyone who has had a Homograph or stentless porcine valve installed. My email is ***@****. Especially Mario.
Thank you.

[E Hunter]

My father had Aortic Anuerisym surgery 5 years ago. I just received a message from my mother the other day that he has been having some problems with coughing and exhaustion. He went to the Dr. and they scheduled some test for aortic fibulation. Could someone please advise me just what this might mean. My father just had his 74th birthday. Thank-you!

[Gary]

Harvey,
Noticed you are seeking info about porcine stentless valve:

Try:

http://www.ccf.org/heartcenter/physinfo/cconsult/fall95/
valves.htm

A statement comparing this valve may be of interest to you.

[JEAN SISCO]

HI.  JUST WANTED EVERYONE,ESPECIALLY JOHN, SHANNON, MARIO AND SUSAN, TO KNOW THAT I HAD MY SURGERY THE 21ST WITH PETTERSEN AT CCF. YOYU HAVE ALL HELPED ME SO MUCH.  AND I CAN SAY AS THESE FRIENDS HAVE SAID TO ME...GET THE BEST MEDICAL TEAM, EDUCATE YOURSELF , PUT YOUR TRUST ON YOUR TEAM AND WEHATEVER HIGHER POWER THERE IS AND GO FOR IT.  I HAD THE HOMOGRAFT I SO MUCH WANTED.  EVERYTHING WENT FINE, EXCEPT I DID HAVE A TINY STROKE AND HAD NO CONTOL OF MY LEFT HAND THE FIRST DAY...NOW HAVE GOOD CONTROL PF HAND AND WRIST AND JUST STARTED GETTING MONVEMENT IN THREE FINGERS TODAY.  THIS IS SIX DAYS AFTER SURGERY AND I CAME HOME YESTERDAY WITH HUST LOPRESSOR, BABY ASPIRIN, AND ADVIL AS NEEDED.  I DO THAT ABOUT EVERY 6 HOURS SO FAR 'CAUSE YOU ALL TOLD ME TO DON'T BE BRAVE...TAKE MY DRUGS AND WALK,WALK,EALK...SO I WILL.
I'M BACK TO HELP SAVE THIS SITE IF NEED BE...LET ME KNOW ***@****

[Todd Williams]

I'm 34 and had my aortic aneurysm and valve repaired - the David Procedure - by Dr. Tirone David in Toronto.  My one leaflet of my valve was overstretched and had a small tear in it - he wove a teflon thread on the leading edge of the leaflet - I think he may be the only one, or certainly one of few in the world that can do this.  It's been a year and a half and so far so good.  I live in Michigan and my HMO paied for it - however I was prepared to pay for it myself if I had to (about $17,000 US).  He is certainly one of the best surgeons in the world and also has great experience with the stentless porcine valves (Toronto Valve).  Good luck - I think that bio valves or repair is the way to go (as opposed to mechanic) for what it is worth.  12 weeks after surgery I was back playing hockey and wrestling with my little ones! If you want more info e mail me at todd.***@****.

[REPLY TO JEAN]

HI THERE JEAN WELCOME TO THE OTHER SIDE OF SURGERY, I AM SURE IT WILL BE BETTER FOR YOU. THANK YOU VERY MUCH FOR THE COMMENT YOU MADE. WHEN I WAS LOOKING FOR INFO I HAD ALOT OF HELP FROM TODD, TIM, RICH STEVE ECT, ECT... THIS IS WHAT MAKES THIS SITE WONDERFUL. NOW JOIN US AND SHARE YOUR EXPERIENCE WITH US SO OTHER PEOPLE WILL LEARN ALSO WHEN YOU ARE UP AND ABOUT ON WELL ON YOUR WAY TO A NORMAL LIFE DO NOT FORGET TO VOLUNTEER AT THE CARDIAC WARD AND SHOW THE BEGINNERS THAT THERE IS LIFE AFTER SURGERY. REMEMBER THERE WILL BE THE NORMAL UPS AND DOWNS BUT BELIEVE ME IT DOES GET BETTER. DO NOT PUSH YOURSELF AND AS I ALWAYS REMEMBERED THANKS TO TODD DO NOT LIFT ANYTHING HEAVY AT ALL AND GIVE YOUR BODY TIME TO HEAL. YOU MIGHT FEEL A LITTLE LIGHT HEADED, TIRED OR MAYBE AT TIMES JUST DEPRESSED, THIS IS BECAUSE OF THE LOPRESSOR AND THE SURGERY ITSELF. FOR ME GETTING BACK TO KARATE AND NOT HAVING MY HEART BEATING OUT OF MY CHEST WAS ALL WORTH IT. DO NOT LOOK BACK AND DO NOT THINK WETHER YOU MADE THE RIGHT OR WRONG CHOICE. TAKE CARE AND DO KEEP IN TOUCH WITH ME   ***@**** HOPE TO HEAR FROM YOU SOON....MARIO

[Harvey]

Thanks to all the info received here, I have decided to have the Homograft put in. My surgery is Feb. 11, and I am ready , in fact I cant wait to get it over with. I,ll let you know hoe things went. Harvey.  PS hang in there Jean.

[Shannon to Jean]

Jean, I'm so happy to hear your surgery went well. Any help I gave you was given to me by others on this Forum before my surgery, so just keep passing it on!

Remember to take care of yourself...I know it's hard, but go ahead and be a baby for a little while.  You deserve it, and your body needs lots of time to heal.

my best wishes for your continued excellent recovery are traveling to you on the internet tonight!

shannon

[Avo Netherton]

I am not really making a statement; it is more of a question.  I had an aortic valve replacement in 1997.  I had no choice but to go with the mechanical valve becasue of various conditions.  It is working great, but could someone tell me the long term things I NEED to be looking for.  Please help.

[Shannon to Avo]

Dear Avo --

I'm not a doctor, but what I've been told is that you should have regular checks by a cardiologist, along with regular echocardiograms (annual).  I have a valve ring and a PFO patch,a and have been told by my doc to plan on coming in to see him once a year, once I pass the one-year mark for surgery (next month!).  

However, if you are having cardiac symptoms of any kind, such as shortness of breath, easily fatiguing, weird rhythms, etc., you should make an appointment to see the cardiologist relatively soon.  

Hope this helps.  My option, if the docs were unable to fix my valve, was a mechanical, and I was told to expect it to last a long time -- like 15 to 20 years, or even my lifetime (I'm 45).

take care.

shannon

[steve]

Jean (and others),

Thanks for posting your experiences for the rest of us. Have you completely recovered from the mini stroke?

After considerable reading,investigation and consideration I have  asked for the homograft also. I am scheduled for surgery at the CCF on 2/29. Can you tell what a "HUST LOPRESSOR"

Thanks,
Steve

[Comment to Steve]

Steve, that was a typo. It was meant to read "just Lopressor."

[Mario]

HI THERE, LOPRESSOR IS A DRUG FROM THE BETA BLOCKER FAMILY. IT IS A DRUG THAT IS GIVEN TO MANY HEART PATIENTS. ITS MAIN ROLE IS TO KEEP THE BLOOD PRESSURE DOWN AS WELL AS TO SLOW DOWN THE HEART. IT IS VERY WELL TOLERATED BY MOST AND THE MAIN SIDE EFFECTS CAN BE LIGHT HEADEDNESS FATIGUE AND IN SOME MEN IT CAN SLOW DOWN THE SEXUAL FUNCTION. YOU MIGHT ALSO FEEL COLD IN THE EXTREMITIES LIKE FEET AND HANDS. THIS IS BECAUSE OF THE REDUCED BLOOD FLOW TO THEM. WHEN TAKING THIS DRUG FOR THE FIRST TIMES GIVE YOUR BODY SOME TIME TO ADJUST. DO NOT GO FROM A LYING POSITION TO A FULL UPRIGHT POSITION IN ONE SHOT BECAUSE YOU COULD BE STRUCK WITH A FAINTING SPELL. NOT EVERYONE IS THE SAME AND THE DRUG MAY HAVE NO SIDE EFFECTS ON SOME PEOPLE. HOPE I HELPED A LITTLE.....MARIO

[Mike]

to havrey i had my aortic valve repair by Dr Bill Williams at  
toronto general. He did the David procedure using a porcine valve  he also replace my replace my pulmonary valve with a pig valve it's been my third opertion. I have tetralogy of fallot with absent pulmonary which i was born with. good luck with your surgery

[Shirlene]

I just found out this past summer that I would be needing an aortic valve replacement sometime soon, due to aortic stenosis. Since that time have felt increasingly worse, and finally my cardiologist scheduled another angiogram this past Thursday.  When he came into the room after the procedure, he told me now is the time, but my heart is beating too hard.  He did a TSH blood test to check the level, had thyroid removed in 1993 due to carcinoma. So as soon as the test gets back, we will go from there.  May need a bit of time to calm heart down, then on to the surgeon and the OR.  What questions should I ask the surgeon when I have my appointment with him?  I am a 50 year old female and in fairly reasonable health other than the heart thing.
It's nice to know we have a place to go for questions.  I applaud all of you who have been there.  May God Bless You All. I can be reached at ***@**** or this site. Thanks

[Harvey]

Just a couple of comments, after a 4 day stint in the hospital I am feeling great. I did have the Homograft and 2 dacron tubes to deal with the anurysm. The anurysm was so large it extended into an Artery at the top of the Aortic Arch. I of course will be recouping for a few weeks but am truly feeling great. One of my pieces of advice would be to go on a high fibre low fat diet long before your surgury. You will not only bring down your weight but also bring down your cholestoral levels as well. After a while it becomes a way of life.
And to Shirlene, ask your Dr. what options you have? Ask him what his specialties are. Some Dr. dont even do some procedures, and some have had bad results with some procedures that others do all of the time with great results. I just want you to keep your mind open and dont feel like you have to do what 1 Dr. tells you. If you dont feel right, get a second opinion. Remember this is a matter of life and death to you. YOURS. You can contact me at ***@****

[JEAN SISCO]

Steve,  Hi and thanks for inquiring about my hand.  Sorry for the long delay, but I hadn't checked back in quite a while.  My hand is about all normal...I even can put in my stud earrings now.  Just a few fine motor moves I'm still working on...and more typos than usual, but I can make my left fingers do the proper keys now.  I'm still feeling great, although I am looking forward to nicer weather so I can walk.  And yes, my hust Lopressor was a typo...just Lopressor.  I'm still having flutters...is that what they call PVCS?  Sometimes my heart throws in a really strong beat, but my doctor says I'm doing great and that is all normal...and blood pressure is good.

TO HARVEY:  Keep us posted about how you are doing also...good luck.  I can tell you it just keeps getting better...I am still having trouble believing how great I am doing.  As somebody said to me, just keep checking back and help out the new people who are just starting their journey.  I can so plainly remember how terrified I was and how much it helped to talk to all the great people who nurse maided me through  the  fall.

Jean

[CCF CARDIO MD JMF]

To all,

Thank you for  all your comments and the support you provide each other. Unfortunately, as you know, physician support on this forum has been cut back so it is important that you all provide whatever additional support you may to each other.

thanks again for utilizing this forum!

[steve]

TO MARIO: Thanks for the info on lopressor, I appreciate it.

TO JEAN: Glad to hear your hand is getting the motor skills back.  Do you have any idea what caused the mini-stroke you had?

I never made it for my scheduled surgery at the CCF on 3/1 because my body decided to unload a kidney stone on me and that derailed me for about 1.5 weeks because it wouldn't pass and required surgery. I'm now shooting for 4/5 and, at this point, I just want to get on with it.

Regards

[JEAN SISCO]

Hi, Steve,

The word on my stroke is that they aren't sure if it was a stroke.  They (neurology at the Cleveland Clinic) did an MRI the third day and found a spot that could have been the site of a stroke (apparently blood clot as opposed to calcification from the old valve) but it was healing already and they could not say for sure THIS IS IT.  I had been warned before surgery and had read that with the calcified valve and the change of clots during surgery a stroke was always a variable.

Anyway I would say I am 90% recovered now...just need to work on strengthening my hand and a little more fine motor control.

Went to my cardiologist Friday and he added Finestril (spelling) to my Lopressor for the blood pressure.  It is still higher than either of us like.  First day on the med. it dropped to the 120 to 135 range.  I am eager to get this settled and off meds and back to better than normal...my dad at 77 takes no meds at all --just a vitamin pill a day.  I feel great though.  Am walking 50 minutes a day three or four times a week, doing chores, even horsing grain bags and hay bales around again and not hurting from it at all. Only take Advil (one pill) every so often -- some days not at all, others one or two times.

I would like to hear from any of you who had to work on your pb after surgery...my never used to be a problem.

Jean

[Harvey]

Just an update. Its almost 5 weeks since my Aorta replacement with a Homograft. . 1 baby asprin and a betablocker every day. My strenght is coming back every day. Although I dont lift anything over 10 pounds yet I can do many things. I do about 1 day of work a week now, and am planning to go back next week about 3 hours per day. My sternum is still sore but Im told to heal properly it will take 3 months.
Jean,  Im glad that your feeling better and Im praying for your complete recovery. Sometimes it seems so tough, but I think if we didnt go through with all this we may be gone.

[Dawn Morey]

I just found this site and would love to ask a few things. I am 30 years old now and had my arotic vale replaced with a bjork-shiley in 1981. This was done in Vancouver BC Canada. I have had four children of my own (we have six in the house) and the docotos are now recomending that I have this valve replaced as it is 'waring out'. I have been told to chose between a St Jude or a tissue valve. I also have troubles with coumadin. We have a very hard time keeping my blood thinned to the right range. How long do St Judes last? If I choose a tissue valve they say I would be back in for a third surgery in about 20 years. The idea of no coumadin is tempting but I don't like the idea of another surgy. Any ideas? It is recomended I do the surgery before summer within a few months. I am tired all of the time and short of breath and cough like a smoker every morning. Thanks to those who have written.

[Terry J.]

My 16 year old son has a defective aortic valve and has been on medication (Vasotec) for 1 year.  We have one cardiologist telling us to consider operating soon and another telling us to wait and monitor him.  We have an appointment at the Cleveland Clinic next month for an expert opinion.  I have been reading a lot about all the valve repair and replacement surgeries that are done at the Clinic.  My question is how often are they done on young patients like my son?

[Christine]

My 18 year old nephew has Congenital Aortic Stenosis which he was treated for at the age of 7 with open heart surgery to open the valve and again 3 months ago for a valve replacement (sow). He is now having vision problems: blurred, double, spots and some chest pain and dizziness. He was checked a month ago for similar vision problems and his doctors at Mass General in Boston Mass said he was ok. He now is refusing to see the doctors. I believe he is a bit frightened and also in denial. The doctors want to see him. Does anyone know about these symptoms or how to deal with a teenager with this sort of problem. We are at wit's end and quite frightened that it is related to his heart.

[JEAN SISCO]

Dawn,

I do not try to pressure people to choose a bio or a mechanical valve.  I'll just tell you the thought process I went through when I decided on a homograft.

I did not want to mess with coumadin.  I farm and I know that coumadin is Wayfarin and that is a rat poison...that freaked me out.  I have had cancer and done the blood testing every week routine and didn't want to do that.  I also love and could not be without fresh or cooked green veggies, and I like wine with dinner.  In my opinion what I read about the whole coumadin thing, I did not want to go that route.  Also I am very physically active and did not like the restrictions and risks of the mechanical.  And besides I heard from so many people who had a mechanical "because it lasts forever" and like you found that it did not.  In fact I know a gentleman who is on the third mechanical in 18 years.  Also I figured that in 20 years who knows what research will bring us...do you know the homografts may last longer (or shorter, I know) its just that now we know they will last 20 years if all goes well.  To me the risks of the coumadin and the mechanical valve were greater than those of the homograft and resurgery in 20 years more or less.

But I will restate , that I think each individual needs to do their own research and settle in their own mind.  You get to live with it.

[Ted]

Does anyone know how long after aortic valve replacement you must stay on lopresser..  I have taken alpha blockers before and it was not a good experience for me..  I am scheduled next month for this surgery..

[Bonnie Bridges]

Is there anyone who had his aortic valve replaced with a St.Jude's Silzone Valve? We are looking for doctors that have had experience replacing this mechanical valve in less than six months after it was implanted. My husband got one of the recalled valves and his is leaking badly. He is facing surgery in two to three weeks again. We are scared. Please let me know if you know of an experienced surgeon. My husband's doctor has an excellent reputation, but he freely admits that St. Jude's valves have not had problems until they made the change to Silzone, and he has never had to replace one so soon after surgery. Thanks.

[Harvey]

To Dawn,
If you have problems with blood thinners I would recomend a tissue valve. This is what I have and I dont have to take any. Also you have proven that there is no guarantee how long a mech. valve will last.You only got 20 years out of it. So no matter which one you choose, you, in all likely will have to have another surgury at some time anyway. Why not go tissue and releive some of your ongoing problems.

[Alan McFarlane]

My doctor advises me to have a heart catherization. Is this procedure safe in a hospital with no heart surgery facilities or should I go to a distant city that has such facilities ?

[bob]

I had aortic valve replacement two years ago, and since then have had a lot of pain where my sternum was cut.  The xrays show a broken wire, so my sternum has always moved when I cough, and is very painful.  Has anyone had any experience with this problem?

[james]

This is a reply to Bob.  I have had two open heart surgeries one last October and my first one was in November 1992.  I had problems with my sternum for 7 years.  I went to the doctor and when they took x-rays it always showed that the bone seemed to be connected properly.  I went repeatedly to the doctor for the first couple of years after the operation and they made me feel like an idiot and tried to get me to believe that it was some kind of Post Traumatic Stress Disorder.  They tried to get me to go on medications for depression.  I learned last October that the upper third of my Sternum was not connected properly from the first operation.  So I wasn't depressed all that time I was just feeling the effects of a surgeons negligence.  So Bob if you are experiencing any problems and I mean anything go to the doctor and make sure they hear your problems and do something to correct it.  I lived seven years with that pain and was made to feel like it was all in my head.  So I hope you go to your doctor and make sure he/she hears you out properly.  Good Luck Bob.

[Karen Bull]

My daughter has to have surgery to replace her aorta valve, due to moderately leakage. My daughter is 28 and has 2 children. She is very worried about the survival rate, so could you tell me the percentage of making it through the surgery? She had Tretology of the Fallot at 22 mos. old and came through it fine, in fact the Dr who performed the surgery was amazed at her recovery rate.  Of course the credit goes to GOD but GOD gave the Dr the knowledge and was with them all the way. If you could tell me anything I would appreciate it, She doesn't need the excess worry. Thank you for any information you can give. Karen