“Why Did My Heart Valve Replacement Go Bad?” Asks Steve

As a follow-up to our recent discussion about re-operation rates, I just received an interesting question from Steve about tissue valve replacements and the potential reasons for premature failure.

Steve writes to me, “Hi Adam – It has been 16 months since my aortic valve replacement. I am being told I need another bovine valve replaced. This is not due to infection. How often does this happen? Why does this happen? Thanks for all you do! Steve”

Tissue Heart Valve Replacement
Tissue Heart Valve Replacement

To get an expert response to Steve’s question, I contacted Dr. Junaid Khan and Dr. Allan Stewart — two leading heart valve surgeons.

During our exchange, Dr. Junaid Khan, of Alta Bates Summit Medical Center in Oakland, California, shared with me, “This is an excellent question. The current guidelines quote a 10-15 year average life expectancy for all bioprosthetic valves – cow valves and pig valves. Thus, they are not as durable as our own valves or a mechanical valve option.”


Dr. Junaid Khan, Heart Valve Surgeon

Specific to Steve’s question, Dr. Khan noted, “Valve failure occurs due to mechanical stress on the leaflets — pressure gradient and motion. Early bioprosthetic valve replacement failure is uncommon before 16 months, especially in the absence of infection… Although it does occur in patients with renal failure.”

As to other, potential reasons for heart valve replacement failure, Dr. Khan stated, “A problem during implantation may occur… Or, patient-prosthesis mismatch could also lead to early failure. For example, a patient might receive a valve that is too small. However, that should have been detected during the initial (or 3-month), post-operative echocardiogram. So you know, heart valve replacements are thoroughly tested before shipping. Thus, an intrinsic problem with the valve is rare.”


Dr. Allan Stewart, Heart Valve Surgeon

I also chatted with Dr. Allan Stewart of NewYork-Presbyterian Hospital / Columbia University Medical Center in New York, about tissue valve failure. Dr. Stewart noted:

“It’s a good question. There are certain risk factors that might lead to a tissue valve failing ahead of the 10-15 year expectation. For example, younger patients, patients with high cholesterol, and patients who receive unfavorable surgical treatment might experience premature valve failure. Also, in my opinion, there are certain valve types (brands) that wear out sooner than others.”

I hope that helps Steve (and perhaps you) learn about the potential reasons why a valve replacement may need to be prematurely replaced after heart valve surgery.

Keep on tickin!

Adam Pick
Written by Adam Pick

Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.

To learn how Adam has helped millions of people with heart valve disease, watch Adam's video, subscribe to his free newsletter, or visit his Facebook, or Twitter pages.

  • Mark

    Steve,
    You’re not alone!!!! I wonder how many more are like us. I have been searching the internet for any kind of information concerning a mismatched heart valve. Outside of Adam’s Blog there is very little information that would give the laymen the ability to at least ask informed and educated questions. If anyone out there can add to this discussion it would be very helpful.

    To share my story:
    My original aortic valve was bicuspid became infected and as a result the valve failed. The valve was replaced with a bovine tissue valve in April of 2009. My recovery was considered normal.

    This spring (April 2010) I went to the emergency room complaining pain in my left chest area when I took a deep breath. After I was admitted to the hospital several test were run including x-Ray, EKG, CAT scan, Echocardiogram and Tran Esophageal Echocardiogram. The diagnosis was Pericarditis. During the explanation of the diagnosis my cardiologist mentioned that the test showed that the gradient pressures in my aortic ventricle are higher than normal. This high pressure was due to my newly installed heart valve, it very likely too small. After gathering myself, I inquired as to how this could have happened? Without answering my question my cardiologist asked that I not jump to any conclusion since it is possible that there could be other causes. He wanted to wait 6 months, complete another battery of tests to see if things improve. If improvement is not seen he would probably suggest that the valve is replaced. I agreed to wait.

    A month ago the testing was completed and there was not any improvement. At that point my cardiologist sent all of the necessary records and test results to a Doctor at the Cleveland Clinic for a second opinion. I received word through my cardiologist assistant that the Cleveland Clinic doctors agree; the heart valve is too small and needs replaced. I have an appointment at the clinic on Dec. 2.

    To compound this matter, last week I suffered a mild stroke. After two successive days of testing it was determined that plaque was an unlikely cause of the clot since my arteries and heart are free of plaque. However the doctors are convinced that what ever the clot was made of, it probably came from within my heart. One of the tests was a TTE; the cardiologist said the bovine valve was “narrowing”. I am not sure what that means. I hope to get a good answer on my return visit Friday.

    Right now I am left wondering if the tissue valve is beginning to disintegrate due to high velocities.

    Just looking for even more answers.

    Good Luck
    Mark

  • Paul Klaassen

    Hi Adam,

    You know, despite Dr. Khan saying that this is an nearly unheard of phenomenon, Steve is the third person I have heard of this year who is going for a re-operation on a tissue valve which is fewer than two years old. The other two are members of a forum I visit. There are several others there who had their valves for fewer than 7 years before operation. I have also seen stats that show in patients under 50 some tissue valves needed replacement within ten years for up to 10% of recipients. I would guess that 10% works out to a fair number of people. Mechanical valves tend to last considerably longer.

  • Joseph

    Dear Adam,

    Now I am completely confused and undecided as to what valve to select having heard about Steve’s recent Bovine failure. I recently met a man whom had a mecahnical valve implanted recently and believe it or not, I could hear the clicking of the valve clear across the room with each heart beat. Yet, he has no problem with the noise intrusion. In my opinion, coumadin administration for life is the worst part of mechanical valve selection. When we think about how hard these God Given valves work for us each any every day; opening and closing 100,000 times perday, 700,000 times perweek, the mutiplication becomes staggering over a 50 or 60 year period. Just think about that for a moment. Nothing man could every engineer or manufacture could ever compare to what GOD has given us at birth. Nothing! But let me ask this question to all whom read this site. Does anyone out there have the ATS 3F Bioprosthetic Aortic Equine Tissue Valve? I would be interested in hearing of your experience and the surgeon who did the implantation and most importantly, why this valve was selected.

    Happy Thanksgiving to Adam & family, along with everyone in his Valve Community,

    JOseph

  • http://www.heart-valve-surgery.com/about-adam-pick-author-heart-valve.php Adam Pick

    Thanks for sharing everybody… Very helpful to all who visit this site looking for more information and patient experiences.

    Mark… I’m very sorry to hear about your stroke. If you need anything, please let me know.

    On this topic, I’ve received a few emails which suggest similar patient situations specific to tissue valve issues. Specific to general re-operation rates, you may want view this discussion by Dr. Accola and Dr. Stelzer.

    http://www.heart-valve-surgery.com/heart-surgery-blog/2010/09/14/what-percent-of-heart-valve-surgeries-are-re-operations-asks-marc/

    To Joseph,

    While you may have encountered someone with a significant “click”, this is not always the case. Several of the patients I have met over the years do not have such a noticeable click. However, this is one of the potential trade-offs for selecting for a mechanical valve replacement. Interestingly, there are some valves, like the ATS Open Pivot, which claim to be quieter than others.

    To learn more about the 3f valve, here is a link that might interest you. FYI, I understand that Dr. Allan Stewart at Columbia has a lot of experience with this valve:

    http://www.heart-valve-surgery.com/heart-surgery-blog/2010/10/21/equine-heart-valve-replacements-horse-tissue/

    Happy Thanksgiving!

    Adam

  • debbie day

    Glad to know I’m not the only one with this problem!
    My bovine pericardial has also failed.
    Mine is only 20 months old and I started having problems about 6 months ago. Mine is on the right hand side in the Pulmonary position. After several test and a good 2nd opinion that they think valve is too small( 3000TFX– 23mm). I too have a very high pressure gradiant, thickend heart muscle and I also have a blockage of heart muscle tissue right underneath my new valve. I am 48yr.old a TOF patient and this was my 2nd OHS. I am consulting with the best surgions I can find cause I want this next surgery to last the 15 yrs.!! I will have my next OHS in a few months– I will keep you all posted. Debbie

  • Larry

    Adam,
    I am going on my 7th year with a 21mm Bovine Aortic vale and feel great. No problems so far. My main concern is I am 56 years old and hopefully will need it changed in 7-8 years. Will they change it with another bovine valve or a artifical one? I am real active and coumidine would really change my life style. I would perfer not to be on it. Please let me know what it would depened on to keep a natural valve.
    Thanks,
    Larry

  • Jim Hayden

    Adam: A great discussion on a very big issue. I had an aortic valve replaced in 2000, and a triple by-pass. In 2007 I had a re-operation and replaced the complete valve again. Both surgeries went very well and I left the hospital in 4 days and 3 days. The first valve was an Edwards 2700, 25mm, bovine. The second valve is an Edwards 3000TFX,27mm, bovine. Both valves were very good, it was very surprising when the first one failed and had to be replaced.
    After the first was removed an Edwards Life Sciences representative removed it from the hospital and took it to their California office. I visited the facility in 2008. Since that time I have been waiting for the pathology results. Until I read this discussion I had no idea why my valve failed. The statistical bell curve was the only reason given. Thank you to all of you who participated to shedding new light on what actually happens.
    I was 63 years old at my first surgery and am now 73. I play tennis two days per week for 4 hours and walk 18 holes of golf on one day. I walk and work with weights many of the other days of the week. I hope that the coumadin problem is solved so that we may all revert to mechanicals.
    Jim Hayden

  • Eva Villalobos

    Please put me on the list to receive your blogs. I don’t know how i lost receiving them.

    Do you know if there s a doctor who does only Tricuspid repairs? This is the only valve that is regurgitating and causing my lack of oxygen to be picked up and circulated and as a result I cannot breath well and must stop to rest. Thanks
    .

  • Paul Klaassen

    Larry said “I am real active and coumidine would really change my life style. I would perfer not to be on it. Please let me know what it would depened on to keep a natural valve.”

    I’d just like to say that although you may be offered another tissue valve, if you aren’t, coumadin doesn’t mean the end of an active lifestyle. I am taking coumadin. I run, cycle swim, skate, sail and ride jetskis and a motorcycle. I also camp regularly and work in a very physical job on a motor yacht. I monitor my own anticoagulation anywhere in the world that I happen to be with a portable monitor. It hasn’t slowed me down in the least to be anti-coagulated and it needn’t slow you either.

  • Joseph

    To: Jim Hayden,

    I recently read your blog on Adam’s new issue topic; Failed Valve Replacement. It’s amazing how well you’ve responded to both surgeries. If you would allow, I would love to share some information with you via the internet. It seems as though you have made a miraculuous comeback to all of your physical activities. I’m a tennis Fanatic. At 62, I have always played with great heart, chasing everything to both sides, both singles and doubles. I was boxing competively in the ring at 60 at my club, along with all of the other activities I enjoyed; weight training, cycling, swimming, jogging, and making love to my wife. Now my cardiologist has told me to back off. I have a bicuspid valve with severe AS. I need a valve replacement. This has really been a horrible experience; my heart has never failed me having been an athlete all of my life. Suddenely I’m told to restrict myself to light walking, nothing more. Having no real symptoms, it all becomes very frustrating. I’ve met with some of the very best surgeons in New York from Mt Sinai, to Columbia Presbyterian to St Francis Hospital, as well as at The Cleveland Clinic. These men are extroadinary men, men that should be honored, exhalted, TREASURED, preserved for the incredible work they do. Still, with all of the information I’ve assembled, I am undecided as to which valve to select. Thus, I continue to research and ask questions. My intellect tells me that a mechanical valve should be considered because of it’s durability and my considered life expectancy. Coumadin doesn’t sound like fun. Many Doctors say NO! Some Doctors say Yes! Who do you listen to and why? I would certain;y not want a re-op for any reason. If you’re playing 4 hours on the court, it sounds as though the pericardial valve is working pretty well. One brilliant young surgeon suggested an Equine valve. That sounds fascinating to me because I’m part horse. Other surgeons have said absolutely NOT! There isn’t enough Data on the equine valve. Get my point? My name is Joseph and I would love to hear from you: Camelot47@aol.com

  • Joseph

    Question: What are the real inherent dangers of life time coumadin therapy? Especially for someone whom is active. And when I say active, I mean active normally with sports, no sky diving out of planes, no leaps off tall buildings, no knife fighting in the jungles. Some patients have sad it isn’t that bad. What must be done to maintain constant monitoring of this medication? How do patients feel whom are taking it. What are the dangers?

    Thank you,

    Joseph

  • G A Johnson

    I have a question please if anyone is out there who can help. My daughter-in-law had lung cancer at 22, double mesectomy at 42 just a few months ago; now she has been diagnosed with a sever mitral valve regurgatation and aorta leak as well. Because of being a cancer survivor 20 years prior and receiving radiation treatments she was not a candidate for implants and they had to use her stomach muscle to rebuild breasts. At this time Cleveland Clinic has determined due to 65 percent regurgatation that it would be to high risk to do robotic surgery and must due open heart. IF the opening is to long it can destroy the vein that feeds the new breasts which of coarse is devastating the plastic surgeon was just preparing to do the lazer and nipple procedure to complete the breast. Thank God this was discovered no question in that she can live without breast if need but not without a heart. She has been looking on line for anyone who may have been through this in this order who could give her some information concerning the outcome of their surgery and help her know some of her options and what to expect during recovery. Most have had heart surgery first but her problem was not discovered until after the double mesectomy when her blood pressure started going off the chart only a heart murmur was noticed and her appointment had been schelduled after surgery to find out what was causing it. Is anyone out there who can correspond with me that she may contact via email. This is Dec. 13, 2010 and she is scheduled for surgery on January 5, 2010 and is starting to have some panic attacks, feeling alone, fearful of what is ahead with so much that has happened already and praying that somehow she will come out of surgery with a healed heart and be able to keep her breasts as well.

  • Steve falor

    Thank you all for your responses to my recent entry. It is dec 14 and I am home and “on the mend”. Sorry I didn’t respond earlier but prior to surgery I was repeatedly warned, by Dr Landolfo, that this second surgery was much more risky. Therefore, I put everything on the back burner.
    Thankfully, The earliest dangers are behind me. The next several months are important and I intend to follow directions.
    The valve that was installed is the St Judes mechanical. I will take coumadin or it’s equivalent for the rest of my life. I am 63 and have led an active life… Golf, fishing, hunting,scuba, spelunking , etc. My future activities will be more thoughtful.
    I cannot say enough positive about The Mayo Clinic! I am convinced they saved my life. From an early diagnosis by Dr. Yameni to a “long distance” diagnosis by Dr. Brinker. I am here today thanks to their diagnostic talents and the surgical skill of Dr. Landolfo.
    The reasons for my trouble are still being processed.

  • Paul Klaassen

    Congratulations Steve, and welcome to the mechanical valve/coumadin club. You said “I am 63 and have led an active life… Golf, fishing, hunting,scuba, spelunking , etc. My future activities will be more thoughtful.” You have your recovery to take care of first, but you shouldn’t think that any of those things are out of reach just because of coumadin. I live life quite actively on coumadin. I test and dose myself with a relatively inexpensive machine, and I really just try not to hit my head too hard. That’s the only restriction I impose on myself.
    If you would like I could direct you to a forum discussing anti-coagulation, home monitoring and active lifestyles.
    Good luck with your recovery.

    Paul

  • kathy

    Any problem or precautions working in a hospital environment IE: (Bacteria) post valve surgery?

  • Fred Benton

    Just returned today from my 3rd yearly checkup at WakeMed. My cardiologist has always had a concern about the Edwards Model 2700 25mm aortic valve implanted in 2009 (he says that it is too small-I’m 6′ tall, 170 pounds, 66 years old, and jog and work out almost daily). Now he’s very concerned. The gradient is high, and today he detected regurgitation. I’ll have a follow-up echo in 6 months, but it looks like another operation for me. This is devastating news to me. If you’re in line for aortic valve replacement, talk specifically with your surgeon about valve size. The surgeon should be more aware of this problem, but obviously this is not the case!

  • Carman Dodd Davis

    i lost my mother recently, Jan. 17th 2014 at St Lukes Hospital in Houston Tx. after undergoing 4 open heart surgeries in 5 days. She was 69yrs of age, and was having a valve replaced, which was reassured to her and my family, that with todays technology, was a typical low risk procedure. She went in on the 8th for a scopic test thru the groin, and it was determined that she would be admitted and go into surgery on the 9th. This was the 2nd scopic test done within 2 weeks…the first one was thru the throat to check top valves, and 2nd one was to determine how bad the bottom valves were. This was an expected surgery for several years, nearly 10 due to her heart being damaged the older she got, from having rhumatic fever as a child and being misdiagnosed due the times she lived in.However, during surgery a mechanical valve was put in and since the surgeon wasn’t happy with it’s performance, he decided to put in a pig valve, which worked better even tho it was the old school way and probably an option for her condition…bacterial blood disease from the fever when she was young. That next day when she regained conciousness from being under, she hallucinated terribly for nearly 2 days straight and her heart rate and blood pressure was thru the roof we were told it was normal till the surgeon was called back inand we were told something went wrong and she was back in surgery…then we were told the pig valve decenigrated in his hands…so after trying another kind of valve, while she was still opened up they detected 1.5 cups of blood clots that had formed behind her heart and they removed them and even showed them to us:( then assured us everything should be back to normal and even better than she was for the last 15 or so years…so we waited for her to rest and come to. We were allowed to visit her and check on her every hour in ICU as we all did so…we noticed within hrs of the last surgery as they were draining the fluid from her body…that her fingertips, toetips and ankels and wrists and her mouth and nose were turning purple…we were told this was normal for she had been thru heavy sadation and surgeries back to back that the body would return to normal within a day. It only got worse from there, her organs began 1 by 1 shutting down and there was barely any brain activity detected after brain and cat scans…she was gone within hours. My question is…”What do you think we weren’t being told”? ups and downs were happening quick yet we were so reassured by the surgeon that it was all normal, yet nothing we have researched ever mentioned any of this being normal, and she was in the best hands and hospital in Texas. The only thing we have found thru research of being normal or common was that kidney failure was possible but would be rejuvinated after a week or so??? No we are not angry or bitter because we are all firm believers in God thru Jesus Christ and we are slowly learning to accept her death, but at the same time we are all so confused…Can someone please shed some light on what could have possibly gone this wrong or how, it would be greatly appreciated and Thank You for your speedy reply.

  • Carman Dodd Davis

    …oh and i forgot to mention also….we spoke to the dr’s and surgeons in charge of her case frequently they would provide us with updates and explain things to us as they were performing procedures and tests and the tests were also showing good, the blood dr said her blood circulation was slow due to the trama her body had endured in only a few days but her blood looked great, yet her purple limbs continued to look worse and worse in fact we had to have a closed casket funeral because of no blood circulation, and also, the brain elctrode test we were told hrs before her passing looked fine except it showed evidence of a mild stroke from more recent years, which she had had one in 2000. We are just trying to figure out the shock of it because we had been given such good reports with each day and each surgery???? No one there could provide and answer as to what happened is all.

New Patient Posts

The Patient's Guide (7th Revised Edition)

Did you know that over 50,000 patients relied on this 204-page book before heart valve surgery?

» Learn more

Heart Valve Hospitals (Click a logo)

Have A Question? Call Us at (888) 725-4311

HeartValveSurgery.com
2117 Huntington Lane, Unit A
Redondo Beach, CA 90278
Phone: (888) 725-4311