Craig's Journal

Deb Yednak  Craig Ostfeld, my bi-cuspid aortic valve was watched  until the stenosis was at the point of open heart surgery at 71 years old. ( was not a candidate for TAVR)  I was told that the porcine valve would last between 10-15 years. Then if needed a TAVR could be done to give me another 10-15 ...or more.  They say the older we are the longer the valve lasts.....however my new valve is a year and 2  months old and is being watched because its tight.    Soooo I am just waiting now to see what can be done and when.  I am alive and glad of it, but this has been a bumpy ride for me.  

Craig Ostfeld  Hi DEb,  Yes, I've always heard that 10-15 years.  I hadn't heard that they last longer as we get older.  That's interesting (and positive!)  I don't know what a "tight" valve means.  Obviously you're worried.  So I hope it goes well.  TAVR sounds so easy,  If you had open heart surgery that must have worried you a lot.  But you cane through.it.  The 25 years I gave myself with one replacing the first assumes neither fails early. But, if one fails early, then one lasts longer.  Do what's needed to make it last longer.  That's what I'm hoping doctors are working on.  Best of success for you!  Let me know.

Alexander Casler  Hi Craig,

You touch on a couple of interesting points that I've given a lot of thought and done some research into myself. 

While I'm on the younger side of valve problems (32), the issue with any bio replacement is still present.  Going purely off of the  statistics that are available, bio prosthetic valves would possibly lead me into 4+ operations.  While a Ross may very well have me needing another procedure in my 50s, then again in my 70s, or more depending on the second valve that's involved (similar to Schwarzenegger having a Ross at 50 then two additional surgeries in his 70s).

As for diet, vitamin k2 is interesting.  There are some studies on it, mostly with results that aren't particularly helpful, but it is being looked at.  I believe there's an article on this website that discusses it.  Hawthorne is also worth looking at.

I believe that the idea of decalcifying heart valves through diet is largely discounted by the medical world, but I've been seeing interesting results from my imaging after 2 years of commiting to a supplement, diet and exercise routine.  The Cardiologists I've spoken with don't have anything to say about it other than the imaging must be wrong, which I believed for a while.  But if they're correct all three echos and a cardiac MRI I've had over the last two years are all wrong.

Just to elucidate on what I mean in regards to my imaging...  From the age of 30 to 32 my Aortic valve area has increased by 37%, from severe to moderate.  My Left ventricle has decreased in size from dilated to normal, and my gradients have fallen by 14% across the board, still in the severe range but coming very close to moderate after 2 years of being severe.

So either there is something to diet and heart valves or 2 years of my imaging is completely wrong and continues to be wrong (last echo was a month ago and it showed the trend of my valve and ventricle improving is continuing).

Rose Madura  Craig, interesting set of questions..so first off, my aunt has had a  traditional surgery with a tissue valve and in her 70s, had a TAVR. Just last year she had a 2nd TAVR at age 82.  So you can have 2 TAVRs but who knows how long it will last, they told her not as long.  Regarding diet, you'd think if they can put a man on the moon, they would know how to prevent or dare I say reverse calcification.  

Robert Miller  Valves seem to last longer the older you are. I was told that this has to do with the immune system. Supposedly, the immune system doesn't outright reject the valve but it reduces the longevity. I haven't researched this so don't quote me on this.

I was debating about a mechanical valve and a tissue valve since I was at the younger age range. I was very reluctant to risk requiring a 3rd OHS. Having said that, many patients get their first heart surgery in their 60s and 70s and they are doing just fine. If you are doing fine then after 2 months you are back to normal. Compare that to being on blood thinner the rest of your life (I don't quite care that much but I just mention it for something to take into consideration). 


As for tissue valve replacement, I was told by Dr. Woo (from Stanford), that FDA might possibly not allow a valve over valve procedure (which avoid OHS). On the other hand, I was told that in the future it might be possible to put two valves over an existing valve replacement. So that would put you at some 30 years after the initial OHS (assuming each valve lasts about 10 years in average). 

Craig Ostfeld  Hi Alexander.  Well, whatever you have, bottle it.  Should be worth a fortune.  If you keep it up we'll have to keep you out of the group as unqualified.  Maybe the first echos were in error.  Originally I was told I had a bicuspid valve.  Now it's tricuspid.  I asked Adam about Vit K.  He pointed me to a doctor who Pooh-Poohed it. Still....  I've been taking Vit K supplements.  It's better than leaving the money to my heirs.
Hi Rose, So what did they tell your aunt was going to happen when her current valve wore out?  I always loved that argument, "If they can put a man on thr moon............"  If they can put a man on the moon I could understand my wife.
And Hi Robert, It makes some sense what you said about the immune system weakening as we age.  Is that the good news or bad news?  Only 10 years valve lifetime sure seems pessimistic.  So what's the down side of taking coumadin?  Do you become like a hemophaeliac?

Rose Madura  Well, they pretty much told her there's no room for a 4th valve and the 3rd one makes the opening even smaller so they said it would last about 5 years or so, but they really don't know since it's so new.  She's been like a pioneer in all this. She was the first TAVR in Butler County, Ohio for someone as "young" as 75.  And she was also the first TAVR in a TAVR as well.  In five years, she'll be 87.  That's how old my mom (her sister) was when she died. That side of the family has all kinds of heart issues.  So we'll take another 5 years.  

Craig Ostfeld  5 years is not very long. It seems like those valves aren't lasting very long.  Did they say why?I'm wondering if the early ones should be OHS instead of TAVR.  TAVR sounds so easy.  But maybe there's a price down the road.  And, of course, I don't know your aunts health. 

Marie Myers  Yes, I had AVR and 2 aneurysms fixed on Plain Old Medicare plus my Medicare Supplement. The supplement pays the 20% not covered by Medicare. I live in Florida, land of “Many People On Medicare. “ I also work in the operating room, and docs here do not complain about Medicare . All the insurance companies do not pay well, and I don’t believe docs dislike Medicare any more than any other insurance. This was not always true, since decades ago, private insurance paid better than Medicare, but I don’t believe it is true now. No one pays well!  I would not think Medicare patients are treated any differently than any other patient. It will be very hard to get exact figures on what you will pay for the 20% that Medicare does not cover, since possible complications and longer hospital stays will increase the cost. Hope that helps.

Craig Ostfeld  Hi Marie, When you say you have "the supplement" that indicates you have a different type of insurance than straight Medicare.  Also, not an eact quote but a "ballpark estimate". an AVERAGE or minimum without unusual complications  I'm interested in hearing from patients who ONLY had Medicare because that's all I have.  Or maybe some doctors here have insight.  

Ana Brusso  Marie explained very clearly she had Medicare. The supplement is the insurance that you pay out of pocket on a monthly basis so that supplement insurance can cover the 20% out of pocket you have to pay after Medicare pays for their 80%. There is not such thing as average. Each hospital charges differently. Maybe you can call Medicare and ask them if they know. I have had my surgeries with Medicare and felt very well taken care of. 

Marie Myers  Got it. Hopefully someone without a supplement can give you an idea of what their out of pocket expenses are . I believe the total Medicare was billed was around $388, 000.00 for my surgery.

Craig Ostfeld  Hi Marie, Thanks for that.  If I'm responsible for 20% I want to be prepared for what that might be.