Mital and Aortic Valve Replacement

[Vanessa Naicker]

My partner is scheduled to have a double valve replacement on the 15th of March 2000.  Alex was diagnosed with having mitral stenosis and aortic incompetence in 1992 (8 years ago). He has been managing his health condition with medication for the past three years.  However, a recent visit to his cardiologist (Prof. P. Manga)confirmed that his heart had enlargened significantly, necessitating valve replacement asap.  We've met with the surgeon, Dr Martin Sussman (Milpark Clinic, Johannesburg, South
Africa), and he has recommended a mechanical valve for the mitral valve and a bioprosthetic (pig)valve in the aortic position.  We are concerned about his valve choices as Alex is only 30 years old, and we understand that the prosthetic valve will require replacement in about 5-10 years time, which we would like to avoid if possible.  We do understand that Alex will have to be on Waffarin for the rest of his life, but he has been taking this for the past 3 years with no associated problems. Furthermore, this medication will be necessary as he is to have a mechanical valve in the mitral position.  
Please answer/comment on the following:
1. The use of two mechanical valves instead of the proposed machanical + bioprosthetic valves.

2. The use of St Judes bileaflet valves for both valve replacements.  

3.We are very encouraged by the work done by the Cleveland doctors on minimal invasive surgery and would prefer this method to the standard surgery.  But is it advisable in the case of double valve replacement? NB! repair of the mitral seems remote.

4. If he opts for two mechanical valves would the dosages of Waffarin be significantly increased?


Thank you. Looking forward to your response.
Vanessa

[Julie]

My mother just had mitral and aorta valve replacement last November at the Cleveland Clinic.  Both were replaced with a mechnical valve.  It is my understanding that minimal abrasive surgery is not done when two valves are replaced.  My mom is 64 years old and she recovered wonderfully.  She just finished her rehab today.  She told me that if she would have known that she would feel so good that she would have had the surgery years ago.

[CCF CARDIO MD JMF]

In response to your questions:

The use of two mechanical valves instead of the proposed machanical + bioprosthetic valves. This is commonly done and depends on the anatomic considerations of the valve.  For example, given the profile of the left ventricular outflow tract and the mitral valve consideration, it may be more appropriate to use a lower profile bioprosthetic valve rather than mechanical.

You may wish to ask your surgeon about the rationale for the current recommendation.  

     2. The use of St Judes bileaflet valves for both valve replacements.
This may be technically impossible or provide for poor results due to anatomic considerations.  Again, this is best discussed with your surgeon.  
     3.We are very encouraged by the work done by the Cleveland doctors on minimal invasive surgery and would
     prefer this method to the standard surgery. But is it advisable in the case of double valve replacement? NB! repair
     of the mitral seems remote.
Minimally invasive surgery may not be appropriate in this case.  YOu may wish to ask your surgeon regarding on-pump options for a smaller surgical incision.  However, exposure may present a serious problem of this non-standard approach.

     4. If he opts for two mechanical valves would the dosages of Waffarin be significantly increased?  The dosage of warfarin remains virtually the same.

[banaka2010]

A related discussion, aortic and mitral valve replacement was started.

[mschoughton]

A related discussion, multiple heart valve leaks was started.

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[Hank Eyring]

Vanessa,

We have a great support group going for valve replacement surgery patients.  We have a lot to offer in the way of person to person help for your trying situation.

Go to our website (www.valvereplacement.com) and make an entry in the guestbook and I will help you become a member.

You can learn from us and we can learn from you.

Thanks and hope to see you soon.

Hank Eyring
***@****

[Donna K.]

Teresa,  My daughter had openheart surgery at 18mos. She had an atrial ventricular septal defect repaired and replacement of her mitral valve. She did very well. At 9 years she had to have her prosthetic valve replaced because she outgrew her first valve.  They were able to put in an adult size valve and we were told that unless there are problems this valve could last for life.  She continues to do well.  She is now 16 years old. I was told that when she first had surgery,at that time, there were not many success stories.  Well we are very happy to be a member of the success stories. Technology changes quickly! Hope your child continues to do well.

[Mike]

Its been about 12 months since I had my Mitral valve replaced by a St Judes. Brought on by Endocarditis. I'm on Warfarin but check my own INR with a finger ***** portable system. I didnt fancy the idea of having a needle shoved in my arm once a week or month for the rest of my life. Its also useful to take on overseas trips. Veins harden after a while. I have noticed Alcohol affects my INR so moderation is a factor here.
I would be interested to hear about other experiences of endocarditis and what their causes were.

Cheers, Mike (***@****)

[Jim]

Had an aortic valve repplacement with St. Jude (Mechanical Valve) 9+ years ago.  Noise is only a problem if one lets it be.  About the same as a watch ticking.  NO BIG DEAL!

Wafrin and Coumadin are same family, but not always same, i.e. Coumadin and generic wafrin not accepted as same by some cardiologists.  Anyway, been on Coumadin since valve replacement.  Yes, it requires monitoring, but again not a huge problem.  Blood tests sometimes monthly, sometimes as often as weekly depeding upon what has changed.  Have had other surgeries, broken arm, and CABG since valve replacement.  Management of blood thinners done well and again not a big deal.

Get a great surgeon and cardiologist, go to major cnter that does lots of valve inplants and plan for a long and good life.

Jim

[Ruth]

My son had surgery to replace his aortic valve 5 years ago.  The only options we were given were mechanical or pig and the mechanical was highly suggested.  My son is 19 and having alot of problems dealing with taking coumadin. What is the Ross procedure and why wasn't it given as a choice for my son.  He is also experiencing hair loss and I feel that this is because of the coumadin.

[Donna W]

Teresa,
     I know how you feel. My daughter was born with a Truncus
Arteriosis and had her first open heart surgery at 2 months (that
was when they reconstructed her heart). Since then, she has had a total of 5 cariac caths, stents placed, and her 2nd open heart at 6 years old. She is now almost 11 and you would never know all the problems she has had just by looking at her. We know that she still has at least 2 more open hearts and numerus caths to go through; one of them being an aortic valve replacement due
to at this point moderate regurgitation. The main reason I am responing to your comment is that I am well aware of what it is like to raise a child that has chronic cardiac problems. In case you have not already heard about it, there is a place in Great Barrington, Ma.; called The Edward J Madden Memorial, Open Hearts Camp. The only price of admission is having open heart surgery. It is for children 7-13 years old. They go for 2 weeks during the summer and get to meet other kids like them so they know they are not so "different" than other kids. Kids come there from all over the US. If your interested, all I have is there phone # [phone] and ask for Ken. Good luck.

[vanessa]

Hi Sean

My partner (30 years) has had double valve replacement (mitral and aortic) and had mechanical valves put in, because he didn't want to have the op again and his surgeon was going to put in a mechanical in the mitral position anyway.  He is almost 4 weeks post-op and on Waffarin (same as Coumadin).  Being on Waffarin can be taxing since you will need to have PI and INR counts done regularly (i.e. need to take blood samples) so that the dosage of Waffarin can be altered accordingly.  He needs to have his PI between 35-40%. Yes, the valves are noisy but you do get used to them.  In terms of lifestyle changes his cardiologist hasn't restricted his diet/alcohol intake but I guess alcohol should be taken in moderation.  While mechanical valves often seem to be the choice in younger patients it is worthwhile to note that a lot of research is being done on valves, especially to improve the life of bioprothetic valves.  Who knows in a few years time you may even be able to grow your own valve.  Also not much data on life expectencies on homografts is available, but it does look very promising.  All in all it appears that with valve replacement (provided their are no major complications) allows the heart muscle to be much stronger and while there are risks associated with re-operation it is usually quite successful.  Whichever valve you decide to go with, make an informed decision not a hasty one.

Good luck and all the very best with surgery.

Regards
Vanessa (***@****)

[Teresa]

I would like to know if you know how many children have had  mitral valve replacements.  My daughter was 14 months old when she had her 1st. mitral valve put in. She was 5 years old when she had her 2nd mitral valve put in. She will be 8 years old this year and she is doing very well.

[Harvey]

To Sean,
I had a wonderful Doctor that told me that he wouldnt do the ross procegure on anyone older than a teen ager. He said it just doesnt work as well on older people. I beleived him. I have a Homograft and I dont take any medicine other than a baby asprin a day. If you want to take rat poisan every day for the rest of your life to thin your blood, I guess the mech. is for you. It seems that even the mech. vales dont always last a lifetime like they say they do. Remember that a blood thinner will restrict you if your lifestyle is at all active, and most 36 year olds are. And also remember the noise factor. There is no guarantee no matter what valve you get but you have to decide and then come to piece with yourself about your decision .

[Harvey]

To Kerry,
I know that things have been rough for you but you WILL make it .
Dont pick the mech. valve just for monetary reasons. Look around on this site and you will see that it doesnt always last a lifetime. Your life is at stake. Money should not be what you are thinking about now. Homograft is also an option, not just a pig valve. Also, as I have said before  there is the noise factor with  the Mech. Valve. Im sure you will make the right desision, I too am 46. 8 Weeks Post Op.

[kerry wright]

i am 46 yrs old .i have had quad bypass surgery at 29 yrs old and again at 35 years old. i now haveaorta valve that is .07 according to cc,i need new valve and 2 more bypass. dr tells me mechanical is the way to go,cant afford to go back again and replace pig valve. how much is a mechanical valve going to change my life  hoping of course i can live thru the operation ,,this being no.3 time

[james]

Dear Sean.  I have had a mechanical valve put in to replace my leaking bicuspid aortic valve.  First Warfarin is the same as Coumadin and you do have to limit your consumption of alcohol.  Lucky for me I didn't drink anyway so it didn't affect me.  But I know of others who can only have a couple of beers before it starts getting to them.  When before they just drank all they wanted.  To answer your question about the valve and how noisy it is.  Let me tell you it can be noisy.  When I'm alone in a room I can hear it quite loud and others can as well if they are near me.  It sounds a lot like the ticking of a clock as the valve opens and closes.  But it's also something you get use to quickly.  Sometimes I won't notice it at all and will have to think about it and listen hard just to hear it myself.  It does grow on you.  But overall you have to be the one to decide whether or not you want a homograft or a mechanical valve.  Both have their pros and cons and it's up to you to decide.  I hope I've helped you a little.  Later.

[Sean Smith, London, England]

I am a 36 year old male about to have aortic valve replacement surgery at the Royal Brompton Hospital in London. My surgeon advises me that a mechanical valve is probably the best, though he admits that others might advise a 'Ross Procedure' - he thinks that this is somewhat risky and that the advantages are only potential ones, or 'conceptual' as he puts it.
I haven't got much time to make my decision but I'm really unsure.
What are the disadvantages of warfarin? (is this the same as Coumadin?) Do you have to moderate alchohol intake with it? And, in particular, is a mechanical valve noisy? - How noisy, I'm a very light sleeper!! This might sound trivial but it's really troubling me.
Some of your correspondents say; don't worry about re-operation and choose a homograft, and that they might last 20 years. Is this sensible advice, can someone evaluate it?

[bob]

Julius, Only your cardiologist can help tell you how badly you need surgery and how soon it must be done.
  Sixteen years is a pretty good run for a porcine valve from what I've read, so it wouldn't be unusual for you to need repeat surgery around this time.  Especially if you're active.  Also note that once they start to leak and fail, the valve failure process seems to go fairly rapidly.  
  As far as your age, most sources don't seem to feel it to be as much of a risk factor as you might think, assuming there are not other health problems that would be factors.  The concensus appears to be that the benefits greatly outweigh the risks. Granted, surgeons may have a different slant on what is an acceptable risk than patients do.  
  If you're starting to have symptoms and limitations, a new valve is probably the only realistic answer in the long run.  The real question is when would be the best time to do it.  That is between you and your doctor.      

[[email protected]]

My 77 year-old mother-in-law was informed several months ago that her mitral valve is severely clogged. She had rheumatic fever as a child. She is very frightened about valve replacement and doesn't know what to do. What exactly is involved with mitral valve replacement, how long is recovery time, and how long will she need to be on blood thinners after surgery. Mind you, my mother-in-law would just like to let things be and she hopes nothing bad happens to her in the meantime. Can anyone help by letting me know what I should tell her?
Thanks so much!

Patty
***@****

[Julius Herzog]

I am a 78 year old male & had an aortic valve replaced with a pigs valve in March 1984. I am told by my cardiologist there is now a considerable amount of leaking. What are my chances and how urgent is surgery at this time?  Thank you.

[Julius Herzog]

I had an aortic Valve replaced with a pigs valve 16 years ago. Now I am told,there is considerable leakage and I am in need for replacement surgery. What are my chances and how soon should this be done. I am a 78 years old male and have been playing tennis until now. Thank you.

[bob]

Thank you for responding, Jean and Harvey.  I very much appreciate it.  It doesn't seem possible to post questions any longer - the site always seems to say it can't take any more questions.  I guess they just can't have time for everything.  

I've been to many places on the Web for information, and a lot of it is contradictory.  However, I think I'm looking at a homograft or other biological, regardless of the reoperation.  I don't think I'd thrive on the warfarin, although I can see why many people might choose the mechanical.  I guess it's the lack of connection to expert help and advice (cardiologist/clinic) and the unknown of the rate of progression that keep me off-balance.  

I'm not thrilled that the Dr. and (apparently) the cardiologist are looking at this as *ho-hum*, no big deal.  It IS a big deal.  I need to be as prepared as possible to make those decisions that I will need to make.  I don't want to wind up taking a certain path just because that's what that particular doctor is used to doing, and just assumes will be best for you.  Some doctors seem to feel that if you are under 50, you should automatically go for the mechanical, and just adjust your life to the coumadin.  All fixed.  Go home.  

Interestingly, apart from those who found out at a very early age, or who have age-related heart problems, there seems to be a common thread of people who are very active, perhaps used to carrying heavy weights, etc.  This would seem to be a factor in abusing the valve, particularly if it were bicuspid.  I wonder what the percentage is of bicuspid vs. tricuspid valves found in initial surgery.

[Harvey]

To Bob,
Bob, Jean gave you good advice. I too had a homograft put in 5 weeks ago, I didnt have a waiting period at all. The new stentless porcine valve is the only other valve that I would have picked if I didnt get the Homograft. The mechanicals I hear are noisey. And you have to take blood thinner for the rest of your life. I am 45 and I am back to work already. It is not as bad as you think. Harvey, ***@****.