warfarinfo

Warfarin Institute of America

Dedicated To Your Health

AN INTERVIEW WITH THE WORLD'S LONGEST SURVIVING AORTIC VALVE REPLACEMENT PATIENT

48 YEARS EXPERIENCE WITH WARFARIN THERAPY

This person is truly a miracle. Prior to September 1960, no person who had a mechanical valve had survived more than three months. One month later, this person had a valve inserted and is still alive after 48 years. There was so little known about warfarin and mechanical valves back then that they did not know if a person had to take warfarin for just a few months or forever. One surgeon from that era has been quoted as saying – we were not allowed to put in an artificial valve in those days unless the only other option was death. They had to be dying before we could work on them.

These are his memories of the early days of warfarin therapy

"…I was only 11 years old then, so everything is through the eyes of a child. About three times a day, the floor nurse would come in and stick my finger and then draw the blood up in a 5 inch long capillary tube. Then she kept rotating it 180 degrees to keep the blood moving back and forth in the tube, timing it till it stopped moving (clotted) – the original pro time. I was in the hospital for six weeks so you can imagine what my fingers looked like. My mother used to say that they looked like pin cushions. Now here is the real shocker. The protocol for post-op was to go home and monitor it by checking your urine. If it was red or brown, cut back a little. After a few months you were taken off the Coumadin. (Nobody knew at that time whether or not warfarin was safe for long-term use or if it was still needed because it was thought that the body may have adapted somehow to the artificial valve.)

How would you like to monitor your warfarin today by checking for blood in your urine and then "cut back a little"?

It was a time of many strokes. I had a TIA in 1967, then they put me (back) on the drug (warfarin). In 1977, I misunderstood my cardiologist and went off Coumadin and just on aspirin. In 1981, I had a stroke that left me a right hemiplegic. When they took a CAT scan, they said that I had been having several mini-strokes before I had the big one. In 1982, I had (another) aortic valve replacement and a Starr-Edwards ball to replace the one that was put in in 1964 that was cracked and throwing off clots."

Later he wrote this, "With my first valve in 1960( the no-name leaflet type) the drs. kept me in the hospital for two months, even though I felt okay. Then they wanted no real physical activity for almost 9 months. During that time I broke my ankle. When they finally eased up on my restrictions, I started in regular phys.ed. and did fine, till I had yet another bout of Rheumatic Fever. While in the hospital in Cleveland, they notice that the valve was beginning to fail. So between one thing and another, I really wasn't "well" for any time period. After my surgery in Feb. of 1964, I was on restriction till October of that year. In January of 1965, I enrolled in a military school for academic reasons. That Spring I learned to play tennis and when I graduated in 1967, I won letters in football, wrestling and tennis. (editor's emphasis) I don't remember the exact time, but I think my drs. took me coumadin after about six months after my AVR."

Think about this the next time the doctor wants you to stop warfarin for some ridiculous amount of time for a minor procedure, this guy lettered in football and wrestling.

This is a PS sent to me later:

A number of my friends who have seen your website and read my story have ask why I didn't mention my drs. name? I can't tell them why other than it never really came up. Without them I would not be here today. With that in mind I wonder if you wouldn't mind crediting my surgeon, Dr. E. B. Kay, my cardiologist, Dr. H. A. Zimmerman and St. Vincent hospital of Cleveland, Ohio. I feel very bad about not mentioning them to you- they were cutting edge drs. of the early valve years.

THESE ARE PICTURES OF THE FAILED STARR-EDWARDS VALVE

This valve was an early Starr/Edwards installed Feb. 1964, replacing a plastic leaflet valve installed in Oct. of 1960 of which there was nothing left. The leaflet valve had no name. The S/E valve was replace in 1982, because I had a stroke. Dr. Earl B. Kay did all three surgeries.

When the heart pumped, the force of the blood caused the ball to jump up to the bars in the cage. Then as the blood tried to rush back into the heart the ball would settle back and prevent back flow.

This is the bottom of the valve. The blood being pumped from the heart pushed against the ball from this side causing the ball to jump up in the cage shown in the previous picture. Note the sutures still attached to the sewing cuff. These are how the valve was attached to the heart.

The point of this story is not that the Starr-Edwards valve failed, after all it lasted 18 years, but that this person has survived 43 years when his life expectancy back then was probably 3 months.

For more information on the development of the Starr-Edwards valve see http://www.texasheartinstitute.org/starr.html

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Last reviewed January 28, 2008