Aortic Valve Replacement

[Jurassic Cowboy]

I am a 61 year-old male with an aortic valve that will have to be replaced pretty soon. Last echo tests showed a valve area of 0.9 cm2 and a trans-aortic pressure gradient of 49 mm Hg. These parameters are worsening with time. The classic choice is a mechanical valve and coumadin or a possibly shorter-lived tissue valve. I am currently leaning towards a tissue valve, as I have been impressed by the extended durability of the Carpentier-Edwards (CE) Parimount bovine pericardial stented bioprosthesis as reported in the recent literature (2001-2004) relative to porcine aortic valves. I see on the web in a biospace.com news story (Nov 18, 2003) that CE has recently received supplemental premarket approval from the FDA for a new tissue valve design called the CE Parimount MAGNA bioprosthesis. This appears to be a hopefully improved adaptation of the classic CE Parimount tissue valve. My questions follow. First, is the new MAGNA valve now available to anyone in the U.S. or is it still being tested for full FDA approval? Second, is the Cleveland Clinic now switching to this valve or are you planning to do so in the near future? Third, if I do require subsequent surgery to replace either a mechanical or a tissue valve in 10-15 years, what are the statistical odds of that surgery being successful, relative to a first time valve replacement at that age range? Many thanks for your time and effort on my behalf.

[CCF-M.D.-MJM]

Hello Jurassic Cowboy (great name),

1. is the new MAGNA valve now available to anyone in the U.S. or is it still being tested for full FDA approval?

We are using the valve here at the clinic.  I am not sure if it is still considered experimental or not.



2. is the Cleveland Clinic now switching to this valve or are you planning to do so in the near future? As above.


3. if I do require subsequent surgery to replace either a mechanical or a tissue valve in 10-15 years, what are the statistical odds of that surgery being successful, relative to a first time valve replacement at that age range?  

Difficult question.  It depends on other medical problems--for example diabetes, previous heart attacks and heart function, etc.  If you are a healthy 76 and need a redo valve, we quote an operative mortality of 1-5% depending on the case, but general, patients do very well.  You are much less likely to need a redo surgery with a mechanical valve though.  Coumadin is pain, but so is open heart surgery.  It is tough choice.

Good luck with your decesion.

[Carolina03]

Cowboy,

I recommend that you also post your question at ValveReplacement.com where you'll find many people who've "been there, done that," and may be able to offer some human perspective in addition to the fabulous cardio/stand-up-comedian who moderates this site.

BTW, I thought the CCF recommended AVR at 1.2? Be well.

All the best,

Carolina

[eileneee]

i have had valve repair and 5 years later had valve replacement and a ring put on another valve.  i saw your comment about the website valvereplacement.com. i have been to that site but cannot find the section where y9u can ask the dr, questions like on this site or make comments to others.  i thought maybe you could tell me what i am doing wrong, or if there is a certain link to go to.  
thanks a lot.
eilene email is ***@****

[Carolina03]

Hi, Eilene.

Click on "Forums," then "Heart ..." where you can post questions and people will answer. You'll find what you're looking for by clicking around.

Best,

C

[Jurassic Cowboy]

Many thanks for your tip about the ValveReplacement.com website to get some "been there and done that" advice. It is a treasure trove of information. Probably some is good and some bad, but talking to patients with real experiences of living with a valve replacement is an excellent counter point to talking to doctors and reading the medical literature.

Best regards,

Jurassic Cowboy

[Gem123]

Hi Eilene,
There isn't a doctor moderating valvereplacement.com in the way that there is one answering questions here - it was set up by a man who had a valve replacement himself and wanted somewhere for patients to share experiences. There is an anticoagulation pharmacist who monitors the coumadin forum though and will help if you have any questions regarding that.
To post a new question you click on "new thread" at the top of whichever topic (eg heart talk, pre surgery etc) you think your question falls into and you'll probably get lots of answers from people who've "been there, done that" :-).
Gem.