Tuesday, October 14, 2014

Life Savers - Heart Valves Made by Man

Starr-Edwards ball and cage valves                                                    
I took this picture on a tour of the valve                                                    
 museum at Edwards Lifesciences                                                      

Thirty years before my husband's crisis, surgeons began implanting artificial valves in place of damaged, failing valves like his. Pictured here are some of those early ball and cage valves. We did not know very much about mechanical heart valves. We did know that there were newer versions with movable leaflets. 

Now that we were meeting the surgeon, we had one very important question to ask him.

Frightening Headlines in the Local Paper about  Bjork-Shiley Valves

While we were waiting for my husband's surgery, some very alarming stories appeared in our local newspaper. Mechanical valves had been breaking inside people's hearts! People were dying. Others were having surgery to replace these valves before they could break.

Imagine having a valve like this in your heart!

Having seen these articles, we wanted to be sure that the surgeon was well aware of any problems with mechanical valves. He was. I realize now that every heart surgeon in the world would be well aware of these problems. I remember him telling us that certain sizes of the Bjork-Shiley valves had the problem. While these valves were no longer allowed to be used, we did not want anything even remotely like this to happen to  my husband!

I also remember being told, perhaps by the cardiologist, that the valve my husband would receive had been tested in the laboratory and proven reliable. It would last far beyond a human life span.

We had no choice. Tissue valves wouldn't last very long. My husband would die, like untold numbers before him who needed help prior to 1960 had done, if his valve was not replaced. And so we placed our trust in the surgeon's judgment regarding the valve he would implant in my husband's heart.

Ultimately, that is what you do when you sign the papers.
 You trust the surgeon with your heart, your life.

Encouragement from Others

I have always been grateful to one of my sisters. She told me about friends of her family who had gone through this. This man had recently had aortic valve surgery and was doing well. He had been offered a tissue valve locally, and had gone elsewhere, to another state, to a surgeon who would implant a mechanical valve instead.

Not long ago I asked her about this man. For him, the mechanical valve implanted about 25 years ago now has worked out very well. He still has it. Perhaps it will be a lifetime solution for him. I believe his heart valve had been damaged by rheumatic fever. We know another man who had his aortic valve replaced also, around the same time. I saw him perhaps a year ago. He too still has his valve. So far, it has served him well. I am so glad when it works out this way. This is the dream we all have.

Yes, this is the dream.
A valve solution that lasts a lifetime.
But too often it remains an elusive one. 

On the eve of his surgery, talking to the surgeon, no one knew that the same valve that would save my husband's life now, would later become the source of a terrible injury to him.

Today, the number of mechanical versus tissue valves being used is an interesting comparison. Tissue valves now far exceed the number of mechanical valves being implanted. In 2011, 16,780 mechanical valves were sold in the United States, compared to 75,734 for tissue valves. There are a number of reasons for this, a topic for another time. (See reference 1 below)

I am remembering the first time, years later, that I heard a surgeon tell someone that there are no perfect valve solutions, and then go on to discuss options in detail. It is a more realistic, much better informed experience than what we experienced so long ago. Today the patient is much more a part of the valve decision making process.

Perhaps it is fair to say there are no perfect solutions,
 but there are certainly good, life-saving ones!

There is a great deal of work going on as I write this,
aimed at new solutions already being made available to high risk individuals.

Saying Goodnight

At 10 pm, the hospital told me that I had to leave. Worse than that, I could not call him later. The hospital switchboard would not accept calls to patient rooms this late. And so I drove the few miles home. Neither of us could sleep! My husband was not to be defeated! I remember the phone ringing, around midnight or was it 1 am? I could not call in, but my husband could call out! After that call, we both slept. The next thing I knew, in the wee hours of the morning I was up and back at the hospital. The nurse was helping him prepare for surgery when I arrived.

Waiting for this day, I remembered how I thought we would be old before he would need anything done to his heart. That had been wrong. Our wedding anniversary would be in the summer. Now, I wanted so much just to have that 10th anniversary together. This was the surgery that would make that possible!

With all best wishes,
- Arlys Velebir

Reference 1 - Aortic Valve and Ascending Aorta Guidelines for Management and Quality Measures


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