I want to join the good-old mechnical Vs bio prosthetic valve debate with some info I got couple of hours ago.
Long story short, male 34 yo, diagnosed with bicuspid aortic valve about 5 years ago. By the end of 2017 I already had severe aortic regurgitation and severely enlarged left ventricle. February 2018 had the aortic valve replacement done and choose the edwards inspiris resilia valve.
Two three months ago I realised that I've started feeling worse again: breathlessness, tiredness, etc. Several visits to the GP, tweaked medication and eventually echo.
Here starts the interesting part.. Echo showed "signs of early degeneration of prosthetic valve and and grade 4 stenosis".
No idea what is going to happen next, waiting for an appointment with cardiologist.
Anyone with similar experience?
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Zabrallo
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Sorry to hear about the situation that has caused you to post. To date tissue valves have had a maximum lifespan of 10 - 15 years because of calcification - this equates to the lifespan of the donor animal. The Resilia valve is specially treated to give it an anticipated lifespan of up to 25 years. The speed with which stenosis has occured is worrying. Has your GP checked your calcium levels. Parathyroid problems, for instance, can cause them to massively elevated which if left can cause stenosis of arteries and valves, formation of gall and kidney stones, and weakening of bones. I am just putting this in the melting pot as I cannot help but feel something is not right. Please do update the forum when you find out more or what treatment is proposed.
Potential lifespan and possibly of TAVI when the times comes to replace the valve alongside the chance to avoid blood thinners were the main reasons why I chose it.
Calcium levels were never checked as the aortic valve was never even considered as a cause. Echo was done to double check the mitral valve which was playing up before surgery because of the "escentric regurgitant flow" from aortic valve hitting it. Turns out mitral valve is fine.
On the other hand about a year ago I switched from beta blockers (bisoprolol) to calcium channel blockers (diltiazem) because of the side effects of the former. At the moment I cannot find reliable info about what it does to calcium levels..
To my knowledge CCIs do not affect calcium levels. I have had two and had bad side effects with both. For a BP I would have suggested an ACE inhibitor. I think it is very important to have calcium levels checked if only to eliminate them.
I am sorry to hear that you face this worry after such a short period of time.
I have just been discharged home having had my tissue valve replaced after 5 short years. The valve began to 'fail' after 3 years and it has taken some time to arrive at surgery - but that is another story.
My valve was monitored annually and the gradients (the mean flow across the valve) gradually increased - I understand that the valve was never really satisfactory and showed signs of difficulty fairly quickly. I was told that the replacement valve was too small for my needs. My original valve was bicuspid, the replacement was 21mm and what was needed was a 23mm valve in order to facilitate a TAVI at a later stage. Hopefully not for another 20 years (and as I am 66 years now, maybe never). This new one is an Inspiris valve. I also had my aorta enlarged to accommodate the new valve.
Like you I was shocked and worried when I first learned that the valve was failing.
In light of your age, conversations with cardiologists and surgeons about the best way to proceed are important - and you and they may need to have the conversation about tissue vs mechanical valves. I agree with Michael - all necessary checks to look at underlying risk factors become critical. However, you will need to be guided by the medics.
Please keep us posted with your progress and good luck in your consultations with the medics.
Thank you for sharing your story. Can I ask why it took so long to replace the prosthetic valve and what was the main factor - the symptoms you experienced or the test results (gradients etc)?
Brief answer: the length of time had to do with waiting lists.
The gradients were the factor precipitating action. Cardiol took to MDT and the consensus was to re do surgery. The thinking appeared to be that my prosthetic valve was too small for my needs and should be replaced with another larger valve and my aorta enlarged.
At the time I was marginally symptomatic, but became increasingly so as time wore on.
I had my first AVR op at the age of 52, having been diagnosed with a heart murmur at 16 and the regurgitation gradually getting worse. Unfortunately my valve started to leak within a couple of years but don’t know why and at 59 I had my second AVR. This time I went for a mechanical valve, after discussing it with my surgeon. I had to have my spleen removed 18months before when it went rogue and started killing my blood cells instead of cleaning them. As I now have a compromised immune system we decided a mechanical valve reduced the risk of a further heart op.
Hello, to be honest I prefer not to share this info publicly because it might look like I am blaming the hospital or surgeon - I think they did an excellent job..
Thank you very much Zabrallo for responding to my query. I fully respect your decision. As a matter of interest I had my Inspiris Resilia Aortic Valve operation at the Harley Street Clinic in May 2018 and so far so good!
Hi, I just noticed your reply. I had a Inspiris Resila Aortic Valve fitted on 11/19 and so far so good. Not sure of the longevity but let's hope it keeps on keeping on.
I would contact Edwards about the valve if it were me. They responded very quickly to me when my pressure gradients started rising lots after one year - not their Inspiris Resilia valve I hasten to add but their Magna Ease valve.
A cardiologist, who is a manager in Edward's Product Safety department, contacted me, phoned me a couple of times, asked how I was and the outcome of investigations. My mean pressure gradient is in the mid 30’s but the valve is not degenerating.
Hi Zabrallo. Sorry to hear this. I had an Inspiris in December and while all seems fine for me so far your post raised the hairs on the back of my neck! So hope you get to the bottom of things and things get sorted for you. Fingers crossed. Btw think you were quite right not to name hospital/surgeon. I've in previous posts named my hospital - Guy's and St Thomas's - as have nothing but praise but one of the guidelines on this site is we shouldn't name individual clinicians, for fairly obvious reasons, so good call! But keep us posted how you're doing and, as I say, we're all rooting for you. Nic x
Hi Zabrallo, just wondering how you are getting on following the early signs of valve degeneration, what were the findings/has any action been taken? Your story is very similar to mine.....bicuspid aortic valve, severe regurgitation, enlarged left ventricle....I chose to have the inspiris resilia valve fit when I had my op in February 2019 (aged 38)!
Well it looks like the test results are not that straightforward.
After the first echo Ive been told that there are the signs of early degeneration because one of the valve leaflets was "flapping" like a flag in the wind and "hemodynamics of stenosis" (basically it does not open properly anymore). Different doctor disagreed with that and ordered another echo. He thinks that condition of the valve is ok and the stenosis is caused by "patient valve mismatch" (valve is too small for me) and/or subaortic stenosis (aparently you can have some sort of mimbrane to grow after the surgery directly underneath the valve which is obstructing the flow). Basically further diagnostics is required, my next appintment is at the end of the April...
If it turnes out that valves structure is fine and it is not "early degeneration" I will pont an update here.
Hey, things got delayed quite a bit because of the covid. I had an appointment with surgeon postponed and I only had yesterday. He thinks it's "early degeneration" rather than anything else and classified it as a severe stenosis which means that it needs to be redone asap.
Aparently it quite unusual for the valve to deteriorate so quickly therefore they will have a meeting next week with other surgeons to discuss my case. My next appointment is in three weeks, he'll let me know if they want further diagnostics or I am going straight to the waiting list..
Thanks for your update Andy, look forward to hearing how you get on, all the best. I do triathlon so put my ticker through some grief, it's been just over a year now since my op and when I am exerting myself in training I am getting a sensation that was present before the op (i.e. blood regurgtitating back into the heart). This may well not be the case, however I could do with getting it checked out. My question to you therefore is how did you go about getting referred for an echo? Did you go to GP and then get referred, or go to cardiologist, or contact surgeon? Since getting discharged from surgeon after my 6-month checks I am not entirely sure who I should be dealing with!
Hello, I had my Inspiris Resilia valve implanted in Jan 2019. I think the valve may be too small for me, it is 21mm and the opening immediately after surgery was just 16mm, so basically mild stenosis right away. Before surgery it was 0.8mm so of course I do feel a lot better than I did then.
My gradients increased after surgery too, but seems to have stabilised. I was seen this Jan and my cardiologist said she will see me again in a year's time. I'm wondering if there is some sort of scarring or whether it is related to the small size of the valve. It would be good to get some answers.
My first hospital recommended the Ross Procedure but I felt very nervous about it so got a second opinion. The second surgeon I saw said that Ross Procedures can be a "disaster" (his words!) and that he deals with redos of them. He recommended the Inspiris.
Making these decisions is so hard. It is hard not to think about 'What If'. Nothing is garanteed.
When my echo came back showing that the valve is not opening well and the resulting pressure gradient is three times the norm (65max/35mean) I`ve been told that it looks like "early degeneration" of the valve.
More tests followed and the next theory was a "patient valve mismatch", however, my valve is 25mm, and according to calculations they`ve done later it suits my body complexity vell.
Next, it was thought that it might be a clot or subaortic stenosis (scarring or a membrane) underneath the valve which is obstructing the flow. I`ve been put on strong anticoagulation in case of a clot and have had the CT angiogram to investigate further. Test results didn't show anything - no clot, no other suspicious tissue.
Basically, on my last appointment, my cardiologist said that the reason for the narrowing of the valve and resulting high-pressure gradient remains uncler. He said they will write a letter to the valve manufacturer to ask if it could be an issue with the valve not related to the degeneration.
I am wondering if there more people out there who have similar issues with Inspiris Resilia - i.e. it not opening well.
Can I ask what were the symptoms you experienced before the surgery - did you get any chest pain/discomfort and have the symptoms improved after surgery?
I just wondered if you had any further update on your situation. I have an Inspiris which is potentially slowing after 4 years - although for those 4 years I have been the fittest in my life, living life to the full. If anyone would like to start a conversation, let me know.
Hi, I have same valve, already stenotic only after 1 year, still waiting on plan, can I ask what your gradient is, mine went from 11 (which is normal) to (23-25) in just one year. Thanks
Mine went from 14 to 30 but it has stabilised and hasn't changed in a year. The performance of it with exercise hasn't changed. I did speak to edwards who were interested in the results but haven't commented any further. I go back nect year to see the status. I'd be happy if I can get 10 years out of it..
Thanks for the info, do you remember how fast it moved up? Mine started at 11 one month after surgery and is now 23 ish, which is a huge jump. Are you saying yours started at 14 but was fine for the first 2 years and is now 30?
Edwards is very interested as well, I like their response. The guy I talked to has a son who has one of their valves, so makes me feel a bit more relaxed they really mean to help.
Did they do a CT scan or a TEE (where you swallow a echo camera) to get a closer look? Edwards said it could be over growth due to my body scarring too much or a thrombosis that will need warfarin to try and clear up, but the Echo report just says stenosis. Waiting to hear from Cardiologist and speaking to my surgeon this week.
Hey not to bother you but did you see my further questions from 9 days ago? I've got a TEE coming up in 2 weeks, so they can get a closer look at the valve.
Sorry for not getting back to you. I had an Echoe both times, after initially getting an all clear with an MRI 2 years ago. The one that raised an alarm was repeated 8 months later with apparently no change - My surgeon took the decision to wait another 8-10 months before the next one. Tbh, I feel absolutley fine, I'm really active. I know that one day I'll have to have another operation but try not to dwell on the situation unless I start to get any symptoms.
The weirdest thing was for months I kept feeling that I was getting worse, especially whilst I was waiting for the results which took a long time. As soon as I was told there was not any immediate issue the symptoms disappeared.
I'll be getting a private echoe at some point before my next one to I have a comparison. Edwards backed off as soon as I sent my latest results.
Please do keep me informed of your results, and please try not to worry too much. What will be, will be and you have little control at the moment. Try seeking out a book called Happy, by Derren Brown, its on Audio and Paper. It really helped me through a lot of worries over my heart.
Thanks and thanks for the book recommendation. I have faith in Christ, but admittedly I'm a natural doubter, its just tough thinking that I might already be needing something, but your case and a few others I've seen give me hope that even if my gradients are up, they might stabilize and I can get several years instead of just a couple...they do a TEE where I swallow the echo camera in a little over a week, so its pretty good at getting pictures. Appreciate it!
Hi, just been reading posts about the inspiris valve, sorry to hear about you failing valve, have you got any update on your condition and have you had a re op done. Regards Presely.
I had my Aortic valve changed, I had requested a mechanical valve because I’m so active I was informed the tissue valve would wear out faster. I woke up from surgery with a tissue valve they said the mechanical one would have blown my heart in two, so they went with the tissue valve, I’m assuming they didn’t have the right size of mechanical valve available. However my cardiologist said at 6 months post op my valve was already failing I’m about 1 year and 9 days post op now and it’s at moderate stenosis. So we will do another echo in July and go from there. I’m wondering if they can’t just put in a mechanical valve now if they order the correct one . But O wanted to say yes there are others who are dealing with a short lived, very short lived tissue valve. My surgeon said these valves were supposed to last about 15 years so failure at 6 months is not OK. I’m thinking I have a refund coming at this rate.
Hey Jallen0347 do you have any updates, my one year gradients are 25 and 40 peak, and they started at 11 and 19, which is where they should be. I had a tough go in the first surgery as well, I had a lung issue after that thankfully cleared up, but I thought I had at least 10 years before I'd have to worry again.. thanks for any input
Quick update on the condition of the Inspiris Resilia valve. Despite the poor performance of the valve right from the start the decision had been made to wait and montior.
Over the last couple of years forward flow and pressure gradient numbers been have been slowly but steadily creeping up. The most recent echo showed that it moved well into the "severe stenosis" range and reintervation is required sooner rather than later.
The result: it has been stenosic from the start and lasted less than six years.
Hey Zabrallo, I just had my one year with Inspiris and what started out as normal gradients, have doubled in a year. I plan on contacting Edwards, let them know, maybe they will want to even review my Echo, and also my surgeon, still waiting on my actual Cardiologist to respond, but I haven't been happy with him. I noticed what I thought was a murmur from the start, but they said it was the normal valve sound, then recently its got a lot louder and my worst fears came true at my Echo.
Looking back you had very high gradients 4 years ago, so while the valve still failed, I'd be thrilled at this point to think I could make it several more years before a re-do. I'm only 55, feel like I will have to bite the bullet and go mechanical next.
Have they mentioned a TAVR? My valve is 25 mm and designed to have one in it, I thought maybe if mine is failing, if I could get a few more years, maybe go TAVR and then if it only last a few years, get the re-do surgery then, but I don't know enough about it. Sorry to hear of your situation, sounds like we're in the 2-3% club, as many seem to be doing great with this valve.
Hey, I see you liked my comment, not to push, but do you have any information at all as to where you are now, what you're going to do (for example, mechanical or what), I'm pretty anxious and we're all in the 2-3% group, so not a lot of us to question. Appreciate any info you can give me. One question, you mentioned your valve was stenotic from the start, mine is already at 23 gradient, in one year, did yours do that as well, before finally slowing down for a few years? At this point, a few more years is a lifetime, as I don't want to face surgery so soon. Thanks
The valve wasn’t performing well from the start and deteriorated quite quickly within the first year or two after the surgery. However, the decline has since slowed down and remains slow but steady. At the moment, the mean gradient is 35mm Hg, peak velocity is 3.7 m/sec, and the AOV is 1.0 cm. It’s a 25mm valve.
I had a meeting with the cardiac surgery team this week. They don’t think a reintervention is necessary just yet, as my symptoms are being managed with medication and other measurements, like ejection fraction, ventricle wall thickness, and aorta size, are relatively stable. However, they want to monitor things closely with an echo every six months from now on.
I asked about the valve-in-valve procedure (TAVR), but I’m not a suitable candidate for it. It’s typically reserved for frail patients where the risks of open-heart surgery outweigh the benefits. While TAVR is less invasive, it has a shorter lifespan and tends to come with more side effects like fibrillation.
So, we’ll keep a close eye on the numbers, but I’m pretty sure I’ll opt for a mechanical valve next time—I've had enough of Edwards' tech.
Apologies for the late reply; my mental health has been a bit up and down lately.
Thanks, that helps a lot, this is certainly stressful, I'm waiting to see what they think on my situation. I'll try to remember to give an update, please stay in touch, and I get the stress and mental stuff, hang in there.
Just reading back through the comments it sounds like you've been at 35 mean gradient for 4 years or longer, so while it sucks, man, be thankful, I talked to a lady who had to have surgery again in just 2 years. I hope my deal is more like yours for sure, though it sucks we even have to be thinking on this right after surgery. Thanks again for getting back with me.
I am truly sorry to read about your ordeal. I truly hope that the intervention fully resolves matters. Honestly doesn’t give give a lot of confidence to someone like me who has been referred for similar surgery. Wishing you all the best. Please keep us updated on your progress.
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To date tissue valves have had a maximum lifespan of 10 - 15 years because of calcification - this equates to the lifespan of the donor animal. The Resilia valve is specially treated to give it an anticipated lifespan of up to 25 years. The speed with which stenosis has occured is worrying. Has your GP checked your calcium levels. Parathyroid problems, for instance, can cause them to massively elevated which if left can cause stenosis of arteries and valves, formation of gall and kidney stones, and weakening of bones. I am just putting this in the melting pot as I cannot help but feel something is not right. Please do update the forum when you find out more or what treatment is proposed.
Any recent ops using inspiris Resilia aortic valve?
Edwards Inspiris Resilia valve
Aortic valve mild regurg
Aortic valve replacement. 
Valve Sparring Aortic Root Replacement.
