Mechanical verses repair

[allan]

I was told by my physician that there is usually about 15 percent of repairs that will fail in the first year and most repairs will need repair again within 10 years.  If this is a fact is there any reason that someone would be better off with a mechanical verses repair since from what I have heard that mechanical can last a life time, other than the comadin thing.  With the minimal procedure I was told that there could be disection of the aorta,, what is this anyway and if this occurs then what?   Do you require cardiac cath's with each surgery of people over 40 and how do you feel about the risks of this procedure?  thanks again.

[Cleveland Clinic, MD]

Dear Allan,

Thank you for your question.  Your question is a classic debate and one that we hear often in this forum. "Which is better - a tissue valve or a mechanical valve?"  There are pros and cons of each which I outline below.  The Ross procedure is a third option for patients with aortic stenosis that transplants the patients own pulmonic valve to the position of the aortic valve and places a new valve in the pulmonic position. Ultimately the decision is between you and your doctors.  Good Luck.

Tissue Valve.
Examples: CE Valve, Homograft, Porcine

Pros: Do not require anticoagulation. (unless there is another indication such as atrial fibrillation)

Cons: Have a limited life span often requiring repeat surgery.

Mechanical Valves
Examples: St. Judes, Medtronic-Hall

Pros: Long life span

Cons: Require anticoagulation to prevent blood clot complications
***********************
Here are some articles of interest that your local medical library should be able to help you find.

Starr A. Grunkemeier GL. Fessler CL. Tissue and mechanical valves: mutually advantageous interplay. [Review] [78 refs]
Journal of Cardiac Surgery. 3(3 Suppl):437-47, 1988 Sep.

Wernly JA. Crawford MH. Choosing a prosthetic heart valve. [Review]Cardiology Clinics. 16(3):491-504, 1998 Aug.

Antunes MJ. Franco CG. Advances in surgical treatment of acquired valve disease[published erratum appears in Curr Opin Cardiol 1996 Jul;11(4):454]. [Review]
[111 refs]Current Opinion in Cardiology. 11(2):139-54, 1996 Mar.

Support groups:

http:///www.inficad.com/~hanky/heart.htm

[allan]

Thanks so much for the reply.  Some of the questions I asked were not addressed so here we go,, I realize there were a bit of questions in one post so easily overlooked.  The questions were, with a minimal procedure the said there is a possibility of a discetion of the aorta but I was also told that with new equipment that this is less likely, but do they mean and what occurs if this happends. The other question was,  What do  you think of doing a cardiac cath on patients prior surgery on a patient over 40 and what do you think of it in regard to the risks verses the benefit, does your hospital require them.  Could you explain the procedure or tell me where to go to see more about it. thanks.

[ed]

Also, could you please comment on the reliability and longevity of valve repairs?  In what ways can repairs fail?

The percentages quoted here by Allan are not very encouraging.  Does the outlook vary among the valve locations?  Is the outlook influenced by age or other physical conditions?

[Stan H.]

Dissection of the aorta, in my understanding, was an unfortunate problem that occurred with the early use of the port access technique.  It has been dealt with by using softer catheter tubes and has little relevance to the typical mini-sternotomy.  As far as repair versus replacement, the majority of repairs are still going strong with statistically few early failures.  Since repairs are generally less than 15 years old, I think it's difficult to predict their actual life span.  Most surgeons and cardiologists I have spoken with feel that, when there is healthy tissue to work with, a repair should last a lifetime with no complications.  I have not yet found a doctor who felt that a mitral valve repair was not preferable to a replacement.  I had a mitral valve repair done on 5/17 with a mini-sternotomy.  I did meet a patient whose repair was being redone with a prosthetic valve, but he suffers from diabetes and CHF, and the initial repair was marginal.  In retrospect, the surgeon was quite upset that the repair didn't hold and he felt doing a replacement the first time around might have been more prudent.  If nothing else, that was a good indication of just how important the surgeons feel that a repair really is.  Please note that I am NOT a doctor, but I did recently go through a repair and have done a lot of research...both before and after surgery.  I hope this helps.

[Cleveland Clinic, MD]

Thanks for your comments Stan.

[LynRose11]

I had open heart surgery in 1996 , at 48 years old...the following year I had an echo done to see how my Mitrol valve was doing and it was still leaking.....this was just one year later....I am now at level 2 in regurtation , when I get to level 4 I will have to undergo another operation......I have severe symptoms still...and at time really wish it were at level 4 so that I can go and get in done again...Next time I do not want the repair...for I want more of a guarentee it will work with a mechanical valve...I have been to 3 drs. and they all have said within 3 to 4 years I will have to redo this again...

[Cleveland Clinic, MD]

There is the potential for failure regardless of the type of surgery but I can empathize with your not wanting to have surgery again so soon.