Aortic Valve Replacement

[LaniBug]

My Dad just had open heart surgery last week. He had a bicuspid aortic valve and one bypass. The surgeon met with us a week before surgery, and told us that he should absolutely have a mechanical valve put in. He told us NOT to go with the tissue valve because those valve only last 7-8 years, and sometimes 10. My Dad has been on Coumidin for 20 years for blood clots. The surgeon sold us on the mechanical valve. Two days after surgery, the nurse hands my mom a card, to be kept Dad's wallet with the surgery info on it. It states that Dad received a tissue valve. Mom thought it was a mistake until she asked to talk to the surgeon again. He said the mechanical valve didn't fit right. So, during surgery, he changed and went with a tissue valve. He said it is a really good quality tissue valve that would last 20 years. My mom is the strongest Christian woman I know, and believes that whatever happens is God's will. She will never even question the surgeon. Can you please tell me if this makes sense. Have you heard of being able to switch valves during surgery, because one doesn't fit? Have you heard of a tissue valve that you know will last for 20 years? Wouldn't you already have all your supplies ordered already in the operating room before surgery. I don't think you'd have a different valve waiting "just in case" you need it.  I feel like the Dr. sold us on an Escalade, but delivered us a pinto. And to cover his tracks, he's telling us the Pinto will last as long! Please tell me if you've ever heard of this before. Thank you.

[Forum-M.D.-MJM]

Hello,

Sorry to hear your dad needed surgery but it sounds like he is doing well.

Have you heard of being able to switch valves during surgery, because one doesn't fit?

The sizing of valves is not something that I have experience with.  I have heard of changing valve types to make sure that it fits appropriately.

Have you heard of a tissue valve that you know will last for 20 years?

The expected life of bioprosthetic valve depends on many factors like age, sex, activity level, etc.  Valves should last longer than 7-8 years and can last as long as twenty.  You could probably call the manufacturer of hte valve for estimates on longevity.

Wouldn't you already have all your supplies ordered already in the operating room before surgery.

The hospital should have all possible equipment, expected or unexpected to deal with a change of plans.  We stock mechanical and bioprostic valves in all sizes.

I hope this helps.  Thanks for posting.

[nickppatel]

Sounds legit to me. To my knowledge, surgeons often do keep reserves in case they need to change a planned course of action, and this sounds like it qualifies. I also don't see any reason the surgeon would be lying, if he was already pushing the mechanical valve before the surgery. He MAY be trying to make you feel better about the tissue valve by saying it'll last 20 years, but I'll leave that to the Dr. to answer.

God bless †
Nick

[Momto3]

First, I hope your dad's recovery is going well : )

I have heard that it is a good idea to go into valve surgery with an open mind.  You generally have a first choice valve picked out, but you should be prepared to accept an alternative if your first choice does not work out.  

You will find a TON of information at www.valvereplacement.com.  This has happened to lots of people on that board.  

I don't find it unusual that the surgeon opted for an alternative. However, I don't understand why your family (especially your dad) was not infomed.  

I believe there are a number of excellent tissue valves out there now.  Perhaps the folks at valvereplacement.com can enlighten you as to their experiences with longevity.

Best wishes to your dad for a smooth recovery!!

[save]

I had an aortic valve replaced several months ago,and I requested a tissue valve.  I read from a Harvard Heart form that  the average life span was 5-10 years, but could last longer.  I was surprised the doctor said possible 20 years.  I have never heard of one going that long.   I did not want the mechanical valve because of the medicine one has to take - Coumidum (sp?).  I thought that if I had to have it replaced in the future that I might be able to have less invasive surgery.  They are doing new things all the time.  My surgeron explained that the tissue valve would not last like the mechanical valve.  I hope everything goes well.  I know it is a big surgery, and no one wants to do it again.

[wolfgrey]

Let me start by saying check the card and see what is said on the type of tissue valve. It may say bovine. That seems to be the primary type of tissue valve now and from what I understand they do not know how long it will last but from testing they estimate that it can last as long as 20 years. I had my valve replaced in 2002 and it was a bovine tissue valve. I have had no problems yet. The advanced in medical technology are incredible. I decided on a tissue valve due to the odds that when I do need replacement, it may very well be out patient surgery. I will say that I did a lot of research prior to making my decision and did not want to limit my activity (which happens with a mechanical valve) due to my surgery.

I retired from the Navy after 30 years and I am 51 now and have continued to workout regular. In fact I am a certified personal trainer. I do not know what kind of physical shape your father is in but my best advice to you is to get him into exercising if at all possible. That does not mean he has to be a gym junky but should do regular exercise to keep in shape. That has helped me tremendously. The fact is that 1 year 1 month and 1 day after my surgery I was able to run and complete a marathon. I have kept in shape since and continue to workout on a regular basis.

I wish your father the very best and hope for his full recovery.

[save]

Could you please tell me if it makes any difference if I have a Porcine valve?  I read that you hve a bovine valve.  I am  very active too, and that is why I insisted on a tissue valve.  I felt in time that it would less invasive to replace.  I am glad to hear that you are running in 1 year.  I am back to exercise but not fast running yet.  They have me at rehab, but I would like to do much more that they allow.  My heart rate is too high for some reason, and the cardiologist does not feel comfortable with it high.  I had lots of calcification on the valve.  He said he had to chisel it out.  I wonder if forming so much calcium on a valve would cause it to go bad sooner.  

[EchoTech]

I've had some experience watching heart surgeons, so I'll answer the best I can.  Essentially they can plan for a certain operation, but there can be factors that they don't know about until they open up the chest that can affect the kind of vlave that they can use.  Tissue valves nowadays last a lot longer than what they used, at least in my little experiences that I've had. I've personally seen them be pretty close to fully functional 10 years after implantation. If it doesn't wear out, then they will just keep it in there until it need replaced. I can see why the surgeon wanted the mechanical valve (lasts longer and your dad is already taking coumadin and would conitnue to do so).
  There are different valve sizes of the same model, much like a shoe.  As far as having extra valve on hand, the facility that I work at literally has a cart that easily has 70+ valves just out the door when doing a valve replacement surgery, so no, it's not really that big of a deal.  
  There is a great deal of reasearch and study that goes into the valves, so you're not really getting a pinto instead of an Escallade. There are no "junk" valves on the market. Think of it instead as a really nice BMW or Mercedes SUV.

Good night and good luck.

[save]

I think you were saying that it did not make a difference if you had a bovine valve or a porcine valve.  I am glad that you mentioned the 10 year time.  I was told between 5-10 years.  That is why he suggested a mechanical valve.  I also read that the Cleveland Clinic said 5-10 years.  That is why I was surprised when they were told 20 years.  I had never heard that before.  I just had a friend's mother have to do the operation over.  Hers lasted 8 years.  Do you know anything about them having to chisel one out.  Does that indicate that one builds lots of calcium?  He said I had lots of calcium.  I am glad I picked the tissue valve even if I do have to get it done again.  

[EchoTech]

I would say if they are chiseling things, it is most likely to be calcium, and it does tend to build up in the aortic region for some folks.  As far as longevity for porcine vs. bovine, I don't know for sure, but it would seem to make sense that they would roughly last as long as each other with all other tihings being equal.  The tissue valve is nice for older folks since you don't have to constantly  keep taking coumadin and getting blood work.  The mechanical valve is nice for younger folks because it lasts longer (thus less likelyhood of having to have open heart surgery again to replace it).  I think the doctor may have been overly optimistic with 20 years, but it is certainly not out of the question for it to last that long too.  It just depends on the person's body and how they deal with it.  I've seen one replacement heart valve, the original ball and cage valve (the oldest and very first kind of heart valve {looks llike a check ball essentially},  a few years back and the guy had it put in in the late 60's.  That would make it over 30+ years for a valve that was originally supposed to be there for a maximium of 10 years.There are no guarantees in the medical field, just probabilities.

[Leon58]

I had an aortic valve replacement in 1997 with a homograft and was told it would last around 10 years. After 9 it was so calcified it had to be replaced, I optioned out for a bovine valve that is pretreated to prevent calcium deposits and history has shown it outlasts the homograft. I was told that it may last as long as 20 years or maybe 15 years but did not want to take blood thinners. Even though my doc and I discussed the valves the day before surgery and the bovine was 1st choice he did tell me that he will try to go this way and agreed with my decision but keep in mind that he may put a mechanical valve if something comes up during surgery.
Sorry this was a surprise for you but the tissue valves are getting better and better.
Both surgeries were at Cleveland Clinic and they are a first class hospital.

[junklady]

A related discussion, Heart Valve Replacement - Tissue (bovine vs porcine) was started.