52 year old choosing between mechanical and bioprosthetic valve

[nohohamp]

I'm 52, and was recently diagnosed with Aortic Valve Regurgitation. I have no symptoms at present, and this was caught at an overdue physical. Apparently, however, it's a pretty bad leak, and my heart is significantly dilated. I'm headed for surgery the end of this month (October). There's a chance my surgeon may be able to repair the valve, but he won't know until they open me up and see the valve. In any case, I need to decide which kind of replacement valve to go with, if repair turns out not to be an option.

I'm in good health (you know, other than the leaky aortic valve), and reasonably active physically, but I don't do anything like skiing that I'd have to stop if I were on Coumadin. Still, I'm somewhat scared about the risks with Coumadin, as well as the difficulties of maintaining appropriate levels, etc. On the other hand, it seems a tissue valve might only last me 10 years, and I'm also scared about having OHS a second--and possibly even third--time. I've read some about the idea that by then there may be other procedures available, but that seems tricky to count on.

I'm still getting used to the fact that this is happening at all, of course, but mostly I want to work through to a choice about valve type I feel okay about. I've mostly gotten recommendation for mechanical from my doctors--though my surgeon recommended mechanical then said if he had needed it at my age he'd have done tissue--so he could keep being helicopter dropped places for backwoods skiing. I appreciate any and all supportive thoughts on choosing. Thanks.

 

[honeybunny]

I went with tissue at age 61 (last Wednesday in fact). My biggest concern was the ticking of a mechanical; it would freak me out. Not being on warfarin is a plus for me. But I'll likely need another surgery and don't look forward to that. If I were at risk of two more surgeries I'd probably have considered mechanical.

 

[pellicle]

Hi

Welcome aboard

They are neck and neck but depending on how you view things one can be ahead of the other.

Myself I don't see warfarin and self testing to be an issue.

Expect your decision to change over the short amount of time you have and don't be disturbed when it does, for as y say you are still adjusting to all this.

My view is that you should not apply classical consumer logic to this as its not a washing machine. Do not be swayed by "fanboyism" or emotional arguments.

The details of my views are here:

http://cjeastwd.blogspot.com/2014/01...r-choices.html

If you have any questions about anticoagulation therapy (an obvious outcome from considering a mechanical valve) then please ask. There is muchos misinformation out there, especially among those who aren't on ac therapy ;-)

I come from the perspective of having had a repair, a tissue and now a mechanical. I can't say the ac therapy or the ticking bothers me as much as the surgeries and the attending destruction of my health which took effort and time to rebuild.

Best wishes
​

 

[dick0236]

I'm 52.........

.........I'm in good health (you know, other than the leaky aortic valve), and reasonably active physically, but I don't do anything like skiing that I'd have to stop if I were on Coumadin. Still, I'm somewhat scared about the risks with Coumadin, as well as the difficulties of maintaining appropriate levels, etc. On the other hand, it seems a tissue valve might only last me 10 years, and I'm also scared about having OHS a second--and possibly even third--time. I've read some about the idea that by then there may be other procedures available, but that seems tricky to count on.

.

The "risks with Coumadin" are few IF you take it as prescribed and routinely test.....and with home self-testing, it is a ten minute test that is done about once per week or so, much like what diabetics do several times a day. I've been on it for 48+ years and the ONLY problem I've had was due to my ignorance back in the "olden days"(1970's) when knowledge of managing the drug was very limited. If my choice was between Coumadin(warfarin) or future surgery(ies), I choose mechanical hands down.

BTW, I got mine when I was young and back then they never told me what I couldn't do.......so I've, pretty much, lived a very normal life and accepted the bumps, bruises and occasional stitches along the way with no undue concern. While I've never snow skied(little snow in Kentucky) I have done a lot of water skiing and water is "liquid snow".....and just as hard when you crash. If I hit a tree or stump, in or out of the water, I'm probably gonna have serious problems that have nothing to do with warfarin.

Read the arguments for each valve and make the choice that seems right to you...and then go on with your life.

 

[almost_hectic]

Forgive me if I'm wrong but reading your post it almost sound like you've already decided against having repeat surgeries in the future. That just leaves resolving the unknowns you have about Coumadin and eliminating the fear factor. I'm new to it myself but I only see it as a minor nuisance, nothing major to dwell on. And I'm still learning the ins and outs of dosing, diet and testing. All just a minor inconvenience, but a BIG comfort to know my new mechanical valve should last forever.

 

[epstns]

The "traditional" wisdom of the past decade or so has been that, barring other unique issues that would dictate valve choice, unless a patient is a female within their childbearing years, or is over 60-ish years old, they recommended mechanical valves. This is because their (valve manufacturers) research has shown that tissue valves do not last as long in younger patients as they do in older patients. The (once-again) traditional wisdom is that this is because the valve deterioration is caused by the immune system of the patient, and the immune systems of younger patients are more active/aggressive, thus affecting the tissue valves sooner. That is what we hear as traditional wisdom.

Fast-forward to the present time, and for the last few years, facilities like The Cleveland Clinic have been lowering the age line at which they have been implanting tissue valves. Their logic, I believe, is that the newest generation of tissue valves is projected to last longer in all patients, including the younger patients. You would have to contact Cleveland Clinic for specifics, but that is how I understand their logic and their valve recommendations.

So, at your age, it all boils down to a personal judgment. If nobody has told you yet, there are no bad valve choices. They all lead to longer, usually improved lives for the patients. The only choice known to have a less-than-favorable outcome is the choice to do nothing. I can tell you my own opinion, which I am sure is worth double what I charge for it. I have a tissue valve. I was 63 at time of implant. I am happy with my choice. Had I experienced surgery at your age, I would have chosen a mechanical valve. I am OK with taking small, managed risks, but I personally feel that at your "young" age, the mechanical valve will more likely keep you out of the OR for a second replacement.

BTW - nohohamp. . . Northampton, MA?

 

[ELFD56]

I was 55 when I had my OHS (BAV with Ascending Aorta Aneurysm), My surgeon wouldn't consider anything but a mechanical valve. He stated he didn't want to open me up 10 to 12 years down the road and neither did I. I didn't have any decision in what valve he was going to use either. He wanted an On-X because I wouldn't have to monitor my INR as close. I get checked once a month. I leave the decision making
up to the surgeon, doctors and God. I'm just along for the ride. So far I'm very happy with my valve. You get use to the ticking and after a while you don't even notice it any more.

 

[Vincent63]

i am 52 and had an AVR done in July .. choose mechanical .. was right for me .... I wasn't worried about Warfarin (Coumadin) but preferred not to have another op in future unless something goes badly wrong ... I don't think there is a good or bad choice ... only what you are comfortable with ... I had no idea i had a problem ... but 3 months post op I have never felt so good in last 10 to 15 years .. good luck ..

 

[neil]

hi and welcome, its tissue for me, didn't fancy being on warfarin and the possible problems with it also the ticking, I know I will need another op in the future but that's my choice, bottom line is its your choice and everybody has different views as you can see, whichever you pick is a good choice

 

[Paleowoman]

I was 60 when I had my replacement. Chose tissue, but I'm sure that at 52 I wiould have chosen tissue too. Didn't want a life on warfarin - look at the threads posted in the anti-coagulation monitoring forum - plus I would hate the ticking. I was a patient in a doctors' exam yesterday and one of the doctors just held his head a couple of feet from my chest to listen for ticking which would have told him I had a mechanical valve….they don't need a stethoscope to hear ticking. Some people don't mind having the ticking as it reassures them their valve is still working, but I know that wouldn't be the case with me so very glad I have a bioprosthetic valve even though I"ll need a re-do one day.

 

[maisiejane]

I was 52 when I had my valve replacement due to my leaking Aorta, I chose Tissue for the same reason as others, it was personal to me, I couldn't stand the thought of hearing the ticking, any repetitive noise drives me mad. I know I may have to face a re-do at some point, but I will face that when it happens. Good luck with your decision

 

[McCbon]

Hi, and welcome! I am female, 62 and in the waiting room although I am pretty close to the door. I hadn't given valve choice any thought because I assumed I would only be a candidate for tissue due to my age. At my check-up last May at Mayo, both the surgeon and cardio recommended mechanical. I was stunned. They said, because I am very active I would wear out tissue faster. I wasn't convinced so I did some looking-into-it and have come to some conclusions pertaining to no one but myself, but just incase you are interested:
I loathe the idea of another surgery, let alone possibly two.
TAVR, or the predicted valve in valve is a long shot and still has hemodynamic issues.
Looks like about 30% of folks in my age group and up, end up on warfarin anyway.
I am hoping to continue, and possibly increase, a robust physical activity level. have heard, and hope folks will correct me if I am wrong, that the hemodynamics of mechanical are better suited for exertion.
I can hear my heart beating now, so I am maybe naively thinking the ticking won't bother me.
The risk of re-ops go up with age and number of ops.
I hate the slow deterioration of my physical stamina as the valve gets worse, but not bad enough for surgery. I hear it is similar with tissue valves before a re-op.
On the down side,
I am a gardener and I love kale and sundry hi K greens. And I love a glass of wine with dinner which sometimes translates into half a bottle!
And of course I fear an embolic or hemorrhagic stroke.
I can be clumsy and a small bruise can turn into a big one.
I may need a spinal surgery down the road and having been a nurse, I know not all medical professionals pay enough attention to things like bridging a pts anti coag regime.
So, there's my calculation and I decided, in my case, the upside of mechanical beats the downside of tissue. Even at my advanced age.
Good luck with your choice. You wil thrive in any case. Bonbet

 

[Mike59]

I was 52 and chose tissue 3.5 years ago
very happy with outcome and choice

both options offer excellent outcomes, BOTH are good choices

 

[nohohamp]

...BTW - nohohamp. . . Northampton, MA?

Right you are, epstns. What's your connection to Northampton?

 

[pellicle]

I just wanted to say that its nice to see we can all express our opinions of what we chose (and why) in a peaceable manner.

Diversity = Strength

 

[MethodAir]

Hi

If you have any questions about anticoagulation therapy (an obvious outcome from considering a mechanical valve) then please ask. There is muchos misinformation out there, especially among those who aren't on ac therapy ;-)

I come from the perspective of having had a repair, a tissue and now a mechanical. I can't say the ac therapy or the ticking bothers me as much as the surgeries and the attending destruction of my health which took effort and time to rebuild.
​

I think that sums it up pretty nicely right there. When the tissue valve starts to fail, the left ventricle also suffers, and that can quickly lead to heart failure. Then the cardiologist will more than likely jump in and try and add some (debilitating) medications to the mix.

With a mechanical aortic valve, the tick only happens on diastole as the valve closes. Most of the time, I find it is not even perceptible.

 

[AZ Don]

I'm still getting used to the fact that this is happening at all

I can relate. I was 51 when I found out I had a Bicuspid Aortic Valve and an Aortic Aneurysm. I had surgery a little over a month later for the aneurysm but didn't replace the valve because it was working well. Whichever you choose, your problem can be fixed. OHS was not as bad as I thought it would be. Good luck.

 

[Paleowoman]

both the surgeon and cardio recommended mechanical. I was stunned. They said, because I am very active I would wear out tissue faster.

I'm extremely active Bonbet, doing serious weight lifiting three times a week and usually walk a few miles every day. Both my cardiologist and surgeon knew this and neither ever suggested mechanical when I said I wanted tissue, they were both happy with me having a tissue valve. I was 60 when AVR was done.

 

[LondonAndy]

I was 48 years old (about 13 months ago) when I had a mechanical valve for aortic stenosis in something of an urgent situation. I work full time but am not especially sporty, so the prospect of being on Warfarin/Coumadin was not especially concerning and, for me, was a much more attractive option than repeat surgery with a tissue valve. I am diabetic too, and so used to finger-prick blood tests to monitor blood glucose levels, and made a point of getting an INR meter almost immediately so that I can self-test at home/when travelling.

I don't like ticking things, and deliberately don't have any ticking clocks or watches, and I hardly notice the ticking of the valve.

 

[David W]

Hi Nonohamp.

As you can see the advice in her is extensive and varied and all spot on. I was in your position as recently as 3 weeks ago. I'm 44 and had quite a large aneurysm 6.1cm on the root of my aorta, regurgitation in the valve and I needed part of the aorta changed. Prior to this I'm a cyclist, runner and generally quite fit. In the space of 2 weeks I went from deciding on a tissue valve, to mechanical valve and back to tissue valve as they all have their strengths. For me my final choice of a tissue valve had a few reasons. Warfarin being the the major one, however most people in here don't have a problem with that but I felt I didn't want surgery to correct one problem whilst creating another that needed ongoing attention. Also I guess I'm ever the optimist and much of the reading and discussions that I have had with my surgeon and other professionals here In London feel that in the (nearish) future, further procedures will be less invasive and require less major surgery. Also the development in tissue valves is developing very quickly and it seems that research and tests have and are being carried out on tissue valves that actually grow with the patient.

So in spite of me being aware that I will need another op I truly believe from my own research and discussions within the health system here in the UK, my next op will be less of a worry and that definitely seems to be the trend in opinion. This might not help but the reports on the ONX mech valve are really good with less warfarin required. When it came down to it, I just wanted to retain as much of a normal life as I could and plan to return to cycling up mountains and running through the streets of south London. My mantra is “it's not how long you live, but how you live that counts”. Whatever valve you choose, it will put you in a much better position than where you are right now……..