Metal v Prosthetic valve replacement

[andrew4322]

Hello,

This is my first post here. I've done a search of this and read around, and here's my question. I'm looking to gauge the views of others in a similar situation.

I'm 28. I was born with Fallots, full correction at 11 months old, nothing since then till last few years. Put on Bisoprolol, spironolactone, furosemide, and had an ICD put in last year.

I've been told I'll need a pulmonary valve replacement. My question is, if I get the option, metal or prosthetic at this stage?

Metal = one surgery, but drugs for rest of life.

Prosthetic = potentially 5 or 6 more surgeries, but lack of drugs.

What's the 'better' option? What has anyone else experienced?

[Midgeymoo17]

I have Fallots and having a PVR in two weeks. I was not given an option and told outright a prosthetic was better for the following reasons:

1) they are less likely to develop infection (endocarditis) which is an extremely lethal condition

2) if you are considering kids pregnancy is far safer with no anticoagulation (I am a 20 year old female).

3) If one was involved in a car crash or needed surgical intervention (particularly emergency operations) for any other reason the risk of death or not being offered the treatment due to bleeding on the table caused by warfarin is non-existent. So you are later more likely to receive quality of life operations and care with out anti-coagulation and if the need for emergency surgery occurred your chances of survival are much increased.

The disadvantage you have correctly identified as the need for repeat operations with a prosthetic valve. However during initial Open Heart Pulmonary Valve replacement a solid structure will be placed in the pulmonary artery to support the valve. Once the solid structure is in place future valve replacements can occur by a small catheter up an artery in your leg. This method will mean my first PVR will be my last open heart procedure (provided my Tricuspid does not fail which we think it might be). And recovery from catheter PVR is I was led to believe about a week- so nothing like the three months I am looking at with my upcoming first valve replacement.

[andrew4322 in reply to Midgeymoo17]

Hi, Thanks for your reply. Some very good points to consider, which I'm sure the doctors will have thought about but I hadn't. I don't think I'll get the chance to choose, but if I do, I want all the info so I can ask the right questions with the doctors.

And the replacement of a prosthetic valve sounds a lot easier!

Good luck with your valve, hope it all goes smoothly and the recovery isn't too long!

[Midgeymoo17 in reply to andrew4322]

I think it is very likely your doctor will choose and I suspect predominately based on my third point is likely to suggest a prosthetic regarding your age but it is obviously important to ask and ask the questions relevant to your life. My second reason may not hold true if you are male.

What I did not say before- my surgeon said outright he thought prosthetic was best for the pulmonary valve as they do tend to last minimum of 10-15 years (some unto 30). Which makes it worthwhile.

The two main reasons given for using metal to me were:

1) In other positions (Aortic valve?) prosthetic valves seem to wear out much quicker around 5 years so the reoperation rate is very high.

2) The other scenario (not relevant to you)where he considers a metal valve would be if the patients remaining life expectancy was close to the lifetime of a prosthetic valve. This is because it is the last valve replacement and he would not want the end of a patients life to be plagued with the symptoms of a disintergrating prosthetic or to do an unnecessary procedure on an older person.

[Joscott71]

Hi Andrew I was born with fallots, in 1971 I am waiting for my third valve replacementhe. My first replacement valve was a bioprosthetic made from pig tissue and my second was a donor valve from a cadaver.

Being given an optionif you do is a very big decision one I haven't had yet but I would always follow the advice of my cardiologist. For each sugerery in which a valve must be replaced careful consideration should be given to durability and medication options and risks. Sit down with your cardiologist and talk about it as many time as you like until you're both satisfied which is the best option and the best quality of life for you.

[andrew4322 in reply to Joscott71]

Thanks for your reply! As I said to MidgeyMoo above, it doesn't look like I'll get the chance to choose, but if I do, I want the info to ask the right questions.

Hope your third valve replacement goes well when it comes round to it.

[Liam47]

Hi,

I'm waiting to have an aortic root replacement, but I've also got a leaky aortic valve.

My surgeon has already said, that he's going to try and repair the aortic valve, but if he can't he has also already said that he'll replace it with a metal mechanical valve. The reason why he's choosing that valve is because of my age (which is a young tender age of 47), and also because of other health problems I've got. I even might have to have more open heart surgery in the future to replace another part of my aorta, because of this other health problem I have. So he's trying to keep the op's down to a minimum.

Your heart surgeon will base his decision on what valve to use, with you age and any other health problems you may have in mind.! I'm no doctor, but I personally think he will choose the animal tissue valve because of your age and 10-15 years in the future when the valve will need to be replaced , you'll still be a good age. 10-15 years down the road, he might then choose the metal mechanical valve.

Hope this helps Andrew!

Liam.