Welcome to the study of heart valve surgery. The objective of this study is to help you understand the facts about heart valve replacement, having heart valve disease and taking a manufactured valve for replacement, our life changing during the average life, the heartbeats 2 billion times, opening and closing thin valves as it pushes blood along the rest of the body. If the valves are diseased, they must be changed, and the prosthetic valve that's inserted must mimic the heart valves original functions as closely as possible. heart valve surgery is a major procedure, and the choice of replacement requires careful consideration. This study can help you understand heart valve disease, and options for replacement of a diseased valve. When a heart valve fails, repair or replacement of the disease valve is a life saving operation. The heart has four valves Two on the left side of the heart, the aortic and mitral valves, and two on the right side of the heart. The three cusps bit and pull Monique valves. The most important valve replacements and repairs occur on the left side of the heart. Let's see to dr. john Puskas of Atlanta, Georgia, and Dr. Alan gravy of Tacoma, Washington, explain heart valve disease and its causes.
The most common heart valve diseases are those related to the aortic valve and the mitral valve the two valves on the left side of the heart, and you were to gnosis and mind to regurgitation are the two most common kinds of element of disease, the valves that are inside the heart, they allow the flow of blood to go and only one direction within the heart. When they're narrowed, pressures build up inside the heart chambers are when they leak pressures and volumes build up inside the heart chambers, and that causes inefficient or poor function at the heart, the things that can cause The problem with either the valves becoming thick and stiff or thinned out include by custody or the valve. The aortic valve is three leaflets. That's the way nature designed it. And when it's two leaflets, and they open and closed perfectly normally early on in life, and yet over a period of time, we think turbulence and some other factors caused that valve to thicken and stiff and, and then to obstruct the aortic position, rheumatic heart disease or rheumatic fever sclerosis, which is simply a process of aging endocarditis, which is an infection of the heart valves. If we live long enough, in general, many of us will have problems with the aortic valve, even if it was perfectly formed at the outset, because of simply aging that goes into these tissues.
The heart valves can become static from calcium buildup, infection, aging and other causes to decrease flow, or they can leak, which is also known as regurgitation, stenosis and regurgitation can occur together. Both diseases can lead to life threatening heart failure, if not treated with repair or replacement. The good news is that the probabilities for valve replacement are many, and that surgeons worldwide are very experienced in valve replacement. Valve replacement of course means that we take out the patient's own diseased valve and replace it with another valve. We can either replace it with a man made valve what we call a mechanical valve, or a valve that is derived from an animal heart from typically cow or pig heart, and those are called biological valve replacements. Valve repair is much more commonly done for the mitral valve or tri CUSPS valve than it is for the aortic valve of the pulmonary valve.
There are several options for replacement. Mechanical valves are manufactured usually from a special form of carbon paralytic carbon. The big advantage of mechanical valves is that they are long lasting, the carbon will not wear out or break in a patient's lifetime under normal conditions because of the carbon. Patients with mechanical valves must take a drug known as anticoagulation medication to prevent clotting of the blood. So the big plus of the mechanical valve again is durability it last
forever. The minus is that it requires a blood thinner.
forever. The minus is that it requires a blood thinner.
Tissue valve replacements are manufactured from animal tissue and are more like the natural valve. The advantage of these valves is that patients may not have to take drugs to prevent clotting of the blood. Tissue valves will fail after a period of time and will need replacement. Many of our patients who did have valves put in tissue valves in their late 60s and early 70s are living to the point where they now have to come in their late 70s or 80s for re operation which is quite a big thing to go through with that age, what happens over time is the valve leaflets can tear or stiff and thicken and calcify. That seems to happen somewhere between 10 and 15 years in a Nordic position, it takes about half as long for it to happen in the metro position.
How can a patient with limited medical knowledge choose between these options of definitely having to take an anticoagulant or definitely facing a second or third procedure and the possibility of having to take an anticoagulant? A look at Valve performance can help make this critical decision. The heart valve performance is measured in two ways after implant, complication rates and blood flow. The best valves have good flow and low complication rates. Let's first review complications that may occur with both tissue and mechanical valves.
The common complications that occur for both tissue and mechanical valves at low rates are blood clotting. This can be a clot that forms on or near the valve, but moves to another part of the body, commonly known as a stroke. Small clots with temporary effects are called TIH. Or it can be a clot that stays on or near the implanted valve, which is known as thrombosis. Bleeding is sometimes caused by a medication taken to prevent the blood from clotting. Excessive blood damage caused by the implanted valve is known as endocarditis may occur. leak around the valve can be caused by calcium formations in the heart. scar tissue growth known as Panisse can occur after the valve has been implanted for a few months or years. It can restrict flow as described previously. Tissue value generation and failure require replacement of the tissue valve after a period of years.
These complications occur at low rates, but they may lead to a re operation or death. Bleeding after valve replacement is considered related to taking a medicine that lessens the chance of clotting an anticoagulant medication. The most common name of this medication is warfarin, with the brand name Coumadin in the United States. The blood clotting process is complicated and warfarin interrupts this process. The effect of warfarin is measured with a test called INR or international normalized ratio. For mechanical valve patients after valve implant and INR of two to three is necessary for aortic replacement in patients without risk factors and 2.5 to 3.5. For patients with mitral replacement both my Chemical and tissue valve patients are prescribed anticoagulation after surgery for at least three months.
All mechanical valve patients and some tissue valve patients with risk factors take it permanently. Tissue valve patients without risk factors may be able to stop after three months. How monitoring of INR for valve recipients has been shown to reduce complications as much as 50%. Visit the website to find out how they can help you obtain home monitoring after surgery. In order to receive approval for implant in the USA. Clinical results are submitted to the Food and Drug Administration for evaluation and approval of the device. Clinical Trials must be carried out and data must be collected for patients for several years after implant. studies for all heart valves are conducted under similar protocols with similar patient populations. So a good equal comparison is the data submitted by Valve manufacturers to the FDA for approval. Here are the clinical results from the FDA approval trials for the for mechanical heart valves on the market in the USA, you can see a definite trend for some valves to be better than others. If we look at mechanical valves compared with tissue valves, the rates for tissue valves are greater because of increased risk of re operation. several recent studies have shown that when similar patients are matched for age and other characteristics, mechanical valve patients lives significantly longer than those with tissue valves. At five to six years, a greater percentage of onyx patients survived in these trials.
Another way to measure valve performance is to look at the valve gradients from the FDA studies. pressure gradient is the difference in pressure from one side of the valve to the other The lower the value, the better. Again, you can see that some valves are better than others. mechanical valve brands generally have lower gradients than those for tissue valves, especially in the small sizes. The ideal heart valve does not exist, one that lasts for a lifetime, with the best flow and complication rates, as well as not requiring anticoagulation medication. But there are good choices with most of these benefits realized. Let's take a closer look at these choices. The onyx valve alone stands out as having complication rates about half as often as other mechanical valves, and as low as those of tissue valves even lower in many instances. For flow, the Onyx valve is again the pacesetter, the first valve approved by the FDA with desired gradients less than 10 millimeters of mercury in every size, other valve manufacture have had to try to emulate this. The unique design of the annex valve contributes to these low complication rates and paste setting flow. A natural length, inlet flare and greater pivot space create a setting for reduced blood damage, which lowers complication rates. The natural length and inlet flare protect against scar tissue in growth, a common complication for other valves. This design would not be possible without the properties of an improved Pyro medic carbon, onyx carbon that has a smoother surface more compatible with blood cells made an orifice that was long and tapered. And we found with the optimum length of the orifice that eliminated the kind of turbulence that you would get if you'd use the straight cylinder for the orifice.
This chart shows the same level of blood destruction for the annex valve as that of tissue valves. Mechanical valves will make a noise when the Let's have the valve close. Sometimes patients cannot hear this noise. more often. This noise can be heard by the patient and sometimes is quite loud. Valve noise studies do not consistently identify one valve is being quieter than another. Tissue valve patients rarely hear their implanted valves. The onyx valve was designed to be quieter, and onyx patients often confirm this.
I very rarely hear this thing. Very pleased. Because I was, you know, thinking when I go into a place and people be listening, what's that noise, but there were Ray ever notices. It is no noise at all clinical results with the Onyx valve or sufficient for the FDA to approve a lower anticoagulation trial that is currently ongoing in the US and Canada. It is the only study of its kind, examining the possibility of lowered INR and the possibility of aspirin clopidogrel brand name Plavix. As an alternate to warfarin, the results of this unique trial will be available in the near future, meaning the possibility of a lower level of warfarin, or even a non warfarin therapy for a valve that can last a lifetime.
This is an important trial, because it'll be the first FDA trial to explore lower anticoagulation with mechanical heart valves.
If the Onyx valve is able to sustain the patient on a low level of anticoagulation, then this valve might be the valve that would allow a patient to have a mechanical valve without the complications of bleeding, and only have a valve for their entire life essentially, about the life. Low complication rates, better flow, less noise and the possibility of lowered medication or no anticoagulation medication, make the onyx valve an ideal choice for younger patients.
My friend and I went to the beach and I was battling the big storm with some diving under the waves and that was less than four weeks later. I definitely knew that I wanted to not have surgery for two one so I chose the Onyx valve says recover from surgery I presume the dirt sports. I've competed in numerous traffic on the highlight being a half Ironman in New Orleans in April 2009 distances on that were at 1.2 mile swim 56 mile bike and a 13.1 mile run the Onyx Valve has restored my quality of life and I'm really looking forward to the future for my for myself and for my family.
