4 Days to decide between bio and mechanical aortic valve

[pellicle]

Hi

One thing no one mentioned that could effect your choice is how many surgeries are you likely to have unrelated to your valve. I've never gotten a very clear picture of what a hassle it might be to come off of warfarin so you can have surgery but it must make things more complicated.

No, actually its no big deal. I've had two surgeries since I've been on warfarin and its simply a matter of stopping warfarin prior to the surgery and then resuming it after.

It is not the case that you turn into a big blood clot as soon as you cease warfarin and indeed if you are a higher risk person (such as say, stroke prone AND Mitral valve (vs aortic) AND other risks for clotting then they may put you onto heparin (some Americans know it as the product name Lovenox although it is not known as that in Australia) in the period that it takes for your INR to re-establish.

In my case I was on heparin once, but not the other time.

I just resumed warfarin after I returned to the ward.

Simple really

 

[Paleowoman]

I think a lot depends on what the re-do surgery involves as to what type of valve to go with. I'll be facing a re-do - not sure of the timeline yet. I was 60 at my first surgery and got a tissue valve. IF everything had gone according to plan that tissue one would have lasted until my mid 70's and then I would have had a re-do with another tissue valve which could last until the end of my natural life. However, tests now show that my re-do will involve a root replacement to enable the surgeon to put in a bigger valve. Root replacement is much risker surgery especialy the older one gets. Plus I have a slightly depressed sternum, and from the looks of the CT scan, my heart/pericadium is touching my sternum due to adhesions which makes resternotomy difficult/risky. So, when I have a re-do I will doubltess be going with mechanical because I would need to avoid a third re-do which might be a risk if I had tissue valve.

 

[tigerlily]

Yeah, there is a lot still unknown to me that might change the course of things considerably. More testing should give better answers to what is going to be best. I have read that warfarin can become a problem as people get older. Not exactly sure what those risks are but I'd like to know more about that. On the other hand, my Dad is in his 80's and is on it. He hasn't complained but he does have a younger wife who helps him stay on top of things a lot.

 

[pellicle]

Yeah, there is a lot still unknown to me that might change the course of things considerably. More testing should give better answers to what is going to be best. I have read that warfarin can become a problem as people get older. Not exactly sure what those risks are but I'd like to know more about that.

that is the good thing about being on here ... there are quite a few of us who are on warfarin and have been for some time. You can read much of what we have written and decide for yourself

 

[Zoltania]

My stepfather is now 90 and has had a mechanical mitral valve for 14 years. He did very well on warfarin without complications until the last year or so. He had issues from a TURP (prostate procedure) a number of years ago which required him to self-catheterize on a regular basis. That was OK for a while, but in the last year he developed recurrent bleeding from the self-catheterization process. He now has to use a permanent catheter, which makes him very unhappy. So that's an example of a problem that can develop due to warfarin and aging.

 

[dick0236]

I have read that warfarin can become a problem as people get older. Not exactly sure what those risks are but I'd like to know more about that.

I am approaching 82 and have no more problem dealing with warfarin as a senior than I did when I was young.......thanks to my seven day pillbox

 

[erik]

Hi there all!
For those people who want to go for a biological valve; there is a new type of biological valve on the market from Edwards Lifesciences, especially for young active people. Edwards Lifesciences claims: "The special coating prevents calcification and the valve can potentially last a lifetime"
http://www.dutchnews.nl/news/archive...f-heart-valve/

Ofcourse, we still have to see prove of this claim in a random trial with humans, but if you want to take the risk and you embrace 'new technology', you could opt for this valve and maybe it will last a lifetime, that would be great (without warfarin). On the other hand, if you want proven technology, go for a 'normal' 'proven' bio valve or a mechanical one.
I have a mechanical one (age 42). I am a very active kitesurfer, self control my INR (I even love it ;-) and no problems with bruising or warfarin so far. My INR range is 2 - 2.5.
My reasons for opting a mechanical one:
1. It was going to be my second surgery; that was enough for me; I wanted the best proven solution to solve the problem...
2. I am very active/sporty; biological valves tend to deteriorate faster...
3. I don't know in which fysical condition I will be in after 10 or 15 years.
4. I am afraid of possible complications of a re-op (e.g. my friend woke up with a pacemaker after surgery and i had many complications after my first operation)
5. Being in the waiting room again with a bio is, for me, not very pleasant state of mind
6. I underestimated the psychological stress of a OHS


The problem with possible re-ops is not the re-op itself, but the possible complications you can get such as pericarditis, PVCs, atrial filbrillation, fluid in longs, stroke and others. My first operation was a hell, my second one was heaven. Why? really don't know... was it the surgeon? was I lucky? Only God knows...
Maybe TAVI will change the future, but even for mid-aged adults, you might need another operation after the TAVI. (valve in valve in valve has never been done as far as i know...)

Hope that this info might help somebody to make a thoughtful decision...

 

[LondonAndy]

Thanks Erik - very interesting post.

 

[Paleowoman]

Most interesting. I just did a bit of searching and found the name and details about the new valve: http://www.edwards.com/gb/devices/heart-valves/resilia You have to click OK to view !

 

[Warrick]

A bit more reading , very cool
http://www.edwards.com/ns20160929

"Plans are underway for a full U.S. launch of the INSPIRIS valve in early 2018. The valve became commercially available in Europe earlier this year."

 

[Paleowoman]

I'm quite excited about this new valve as when I have to have this too small valve I was given three years ago replaced I was thinking I would have to go mechanical as I will need aortic root replacement and I know there's lots of adhesions already, I've seen them on CT scan - pericardium and sternum with adhesions between - so I wouldn't want a third surgery if I had a regular tissue valve, BUT with this new tissue valve that would mean perhaps it would last till the end of my life, just like a mech valve would. I'm in the UK so the Inspiris Resilia valve is here already, I've printed off stuff about it.

 

[ottagal]

Re: Inspiris valve...thanks for sharing this news! I , too will tuck away this info! Looks promising.

 

[Dodger Fan]

Hi



No, actually its no big deal. I've had two surgeries since I've been on warfarin and its simply a matter of stopping warfarin prior to the surgery and then resuming it after.

It is not the case that you turn into a big blood clot as soon as you cease warfarin and indeed if you are a higher risk person (such as say, stroke prone AND Mitral valve (vs aortic) AND other risks for clotting then they may put you onto heparin (some Americans know it as the product name Lovenox although it is not known as that in Australia) in the period that it takes for your INR to re-establish.

In my case I was on heparin once, but not the other time.

I just resumed warfarin after I returned to the ward.

Simple really

Agreed, when I had my TIA, they initially thought I had a brain bleed, so they took me off warfarin and put me on a heparin drip. When they were confident that my brain wasn't bleeding, they put me back on warfarin and released me from the hospital when my INR was back in range.

 

[Nocturne]

This may be good news for me as well. I generally agree with Pellicle that warfarin is not the end of the world, but for me in particular with my gonzo coronary calcium score Inmay not want to mess with the stuff.

 

[mikeccolella]

http://www.acc.org/latest-in-cardiol...-young-patient

I found this article helpful when I recently had to make a decision. Anecdotal evidence can be emotion based. We like to hear good things and avoid bad things so when someone says how well they are doing with such and such it draws us in; unfortunately it is very misleading. Best to go with well researched scientific evidence. The decision is very dicey as this article shows, but you know yourself and I think it outlines the risks and benefits of valve choices in such a manner that it may prove helpful