32 and confused re: valve type selection

[clay_from_nj]

Neither mechanical nor tissue valve is "better." Tissue may be better for you, mechanical may be better for me, either is better than staying with the inadequate original. The same reason for using tissue in an older patient, ie little risk of a reoperation, is the same reason I have a mechanical - at 46 years old, I would face a much higher risk of reoperation with a tissue valve. Not only would it be a reoperation, but a reoperation on a patient 10-20 years older than the first surgery. All in all, until someone does a life expectancy/quality of life study comparing a lifetime on warfarin compared to another heart surgery, I think the real bottom line is your personal choice. My surgery actually went very easy, quick and nearly painless, with a speedy recovery. I'd probably do just fine with another in a few years, but I'd rather not. I also did not want to face declining health as the tissue valve wears out. I'd much rather just keep ticking along at full speed. I've dealt with CHF and don't want to go through it again. (Ref: http://content.onlinejacc.org/article.aspx?articleid=1140185)

 

[Heart Of The Sunrise]

I started out solidly thinking tissue. I was afraid to be on Coumadin. Dick 0236 and others here set me straight on that. Then the fear of the necessity of another OHS or two in my lifetime was unthinkable. I am so happy I went with the ON-X mechanical. Coumadin has been no problem. I am locked in at 2.4 to 2.5 INR. I only test once a month at Quest. Life is better....my scar is rapidly fading.......:thumbup: I only hear it occasionally...usually late at night...it is not disturbing or unpleasant.
You will never be the same again...you will be much better! What is the status of your ascending aorta? Mine was 4.9 cm ready to blow. It was replaced as well.
9 hours in surgery and now almost seven months post-op...and it seems like a dream ages ago that I had my life sustaining surgery. 6 months from diaognosis to successful surgery!

 

[Luana]

Go tissueGreat durability now circa 15 to 20 years is now the norm with latest generation

Yes, that estimate is for some, though the younger one is, the less likely a tissue valve is to last a long time. I considered a tissue valve with almost 20 years older than original poster, and surgeon said a tissue valve would mean 2, possibly 3, additional surgeries.

Bottom line for me I did not want to have any more surgeries than needed. I have other surgeries before, but nothing, nothing is like heart surgery. It's a lot to go through.

There was a guy here a few years ago who had a tissue valve in his early 50s and only got a few years out of it. He almost died after his second surgery, spent something like 2 months in the hospital and had a very tough ordeal. VR is no romp in the park. Sure, some have an easy time, and even an easy time on a second surgery, but it's a crap shoot. You don't know what your fate will be until you shake the dice. I'd rather shake once and be done with it.

 

[spartangator]

Fergus,
Welcome. You've lots of information about valves above so I'll just suggest that you focus on the fact that you have multiple excellent options. There aren't wrong choices, just options that fit your medical situation and life better. As others noted, all choices are better than the current situation.

As for the sports, have no worry. You'll see loads of us on here doing all kinds of things. You'll be hiking in the Wicklow Mountains again before you know it

 

[Lisa2]

I hope you find some peace soon. It was a tough decision for me - very hard to balance emotion and intellect. I chose a homograft because I was 30 at the time, a newlywed, and didn't want to take warfarin. I lost my younger brother during his 4th OHS when I was 18 so I had some first hand knowledge of pros/cons. I must say that I don't regret my choice, it was right for me at the time; however, if I were choosing from my almost 41 year old perspective, I would choose the option that gave me the least possible chance of reoperation with the greatest life expectancy. I'll be getting a mechanical next time around!

 

[neil]

oh dear hope this wont turn into a tissue v mech thread,theres isnt a bad choice only YOUR choice, sometimes imo people put to much detail in there posts it would make a top cardio surgeon head spin, for me listen to what the experts say thats the cardio and surgeon, yes take into account what is said on forums like this but dont be to swayed by them, best advice i got was from my cardio and was short and sweet, everything being equal its a mech with a lifetime on warfarin which isnt great,or a re op which isnt great, but as he said both are gonna save your life, pick whats best for you not somebody else, and you wont go far wrong,

 

[neo]

I chose tissue over mechanical at 34yrs old for the following reasons:

1. 3rd Gen tissue valves and their anti-calcification processeses are not the same valves that came out in the 80s.
-The current durability of 5-15 years expected in young people was based on tissue valves that came out in the 80s.
-In order for tissue valves to be approved by the FDA, they must meet a durability test of 200 million cycles in a rapid accelerator. 200 million cycles represents approximately 5 years. Tissue valves, in the past, have reached up to 600 million cycles or more (representing 15 years). The newer St. Jude Trifecta reached 1.2 Billion cycles.

2. I am aware that at some point I will need a replacement. Currently, TAVR valves are being implanted all over the world and in the United States. While they are not currently the "gold standard" of valve replacement, it is widely predicted that they will be in the next 5-10 years. They are currently testing "valve-in-valve" replacements. It is thought that one would be able to have multiple "valve-in-valve" TAVR replacements in the near future.

3. Cleveland Clinic, according to my source, currently uses more St. Jude Trifecta valves than any other.

4. The risk of dieing from a bleed is comparable to the risk of having a future re-operation.

5. I don't have to worry about diet, especially leafy greens and alcohol

6. No ticking noise.

7. Risk of clots lower

8. Mechanical not "guaranteed" for life, the possibility of pannus growth or slim possibility of failure would require replacement.

Just a few reasons I decided on tissue. I am sure someone could have just as many reasons to go mechanical, but that's how I justified my decision.

Good luck.

 

[Agian]

Being in the waiting room and all, I find these discussions interesting. 1.2 Billion cycles, you say? Did they address potential calcification in their research.

Exciting times on the horizon. I hope for the sake of those that follow that this will be a walk in the park one day.

 

[pellicle]

Did they address potential calcification in their research.

I guess that he will find out and I hope report back here and tell us. I still read of recent failues here and in the current medical experience, which seem to be most pronounced in Younger (sub 60yo) active people.

I have a 2x3 meter print on my staircase wall at home that cost me a bundle. Was printed (from my 4x5 film) using Fuji Crystal Archive paper. Its supposed to be guaranteed for decades against fade. Well in less than 10 years the colours are significantly faded (and its not in direct light either). Each year the sales people peddle "sure we had an issue with the older stuff but this *new stuff* thats just solved it all. So many new developments since then..." . No valve maker that I know of will take responsibility for your reoperation in case of early failure. But I would love to hear otherwise...

Its always hard to predict the future.

 

[neo]

In regard to the 1.2 billion (30 years) cycles, the newer St Jude Trifecta design with the leaflets opening in a more "flexible" way has led to increased durability in a rapid accelerator. To address calcification, each of the newer 3rd gen valves I studied, Trifecta and Edwards Magna, use newer anti-calcification treatments/processes. Whether the newer treatments and accelerator based studies prove themselves over the next 30 years, I guess we'll have to wait 30 years for that long term data. The Trifecta was only approved in 2010.

In the meantime, I just read this article published last week about future TAVI replacements for failed bio-valves. Very exciting news...

http://www.newswise.com/articles/mi...ortic-valves-successful-in-high-risk-patients

 

[dick0236]

In regard to the 1.2 billion (30 years) cycles, the newer St Jude Trifecta design with the leaflets opening in a more "flexible" way has led to increased durability in a rapid accelerator. ............... Whether the newer treatments and accelerator based studies prove themselves over the next 30 years, I guess we'll have to wait 30 years for that long term data. The Trifecta was only approved in 2010.
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1.2 billion cycles in 30 years is an average of 80 beats per minute(if my longhand multiplying is correct.....ran out of digits on my little calculator)......kinda rapid average heart beat over such a long time.

FWIW, here is my REAL TIME(not accelerator) long term data with an old 2nd generation mechanical valve. 1.5 billion cycles at 60bpm for 46 years.......using my current heart rate of about 60bpm. My actual "cycles" are probably quite a bit higher, since I was very active as a younger man.

 

[neo]

That's a good point. I am sure they wanted to be conservative with their estimates. Makes you wonder if we keep our blood pressure and heart rate down, maybe we can extend the life of these valves even longer.

1.2 billion cycles in 30 years is an average of 80 beats per minute(if my longhand multiplying is correct.....ran out of digits on my little calculator)......kinda rapid average heart beat over such a long time.

FWIW, here is my REAL TIME(not accelerator) long term data with an old 2nd generation mechanical valve. 1.5 billion cycles at 60bpm for 46 years.......using my current heart rate of about 60bpm. My actual "cycles" are probably quite a bit higher, since I was very active as a younger man.

 

[pellicle]

..kinda rapid average heart beat over such a long time.

not if you're an active go getter, always on the go and training every day ...

alternatively after I've had a few drinks my heart rate goes up to about 80 ;-)

 

[pellicle]

Makes you wonder if we keep our blood pressure and heart rate down, maybe we can extend the life of these valves even longer.

a bit hard to do that while being a "active lifestyle" sporting person ... seems to preclude the low heart rate to me.

 

[neo]

Probably why a lot of docs prescribe beta-blockers after AVR

a bit hard to do that while being a "active lifestyle" sporting person ... seems to preclude the low heart rate to me.

 

[pellicle]

Probably why a lot of docs prescribe beta-blockers after AVR

??

betablockers or not, if you hike and ski your heart rate will go up because that's what transports oxygen around your system.

 

[neo]

That's why they looked at an 80 average. That's pretty typical with me. 60s to 70s during the day, higher with exercise, and lower when sleeping. I think that's been the standard testing measurement for years.

??

betablockers or not, if you hike and ski your heart rate will go up because that's what transports oxygen around your system.

 

[Rachel]

Exciting times on the horizon. I hope for the sake of those that follow that this will be a walk in the park one day.

Oh - I REALLY agree with you! Just like we have it easier than people before us......I also hope that future generations of new people will have it SO MUCH easier than we do!

 

[Rebecca]

My tissue aortic heart valve will be two years old soon. I know that it will one day need to be replaced. I took a group of people to tour this lab (CorMatrix). They are now working on heart valves. Two infants now have their heart valve in them and they are doing great. We had two different people show and tell us about their labs. David Camp spent 45 minutes speaking to us. Dr. Matheny did a half hour slide presentation for us. This is the future of what is in the making.

July 15, 2013: http://www.cormatrix.com/sites/cormatrixcom/files/991-Press_release_-_New_patents_-_7-15-13_-_V2.pdf

Patient information: http://www.cormatrix.com/PatientInformation-26

Article in the Newspaper: http://www.northfulton.com/Articles...sub-Group-fighting-to-help-womens-hearts.html

 

[dick0236]

That's why they looked at an 80 average. That's pretty typical with me. 60s to 70s during the day, higher with exercise, and lower when sleeping. I think that's been the standard testing measurement for years.

WOW!!! Using your 80bpm standard, I am nudging 2 billion "cycles" on mine......without even an oil change (LOL).