advice needed

[Barry]

Hello everyone. This is my first post to this wonderful site. I am so grateful that it exists. I am finding comfort and insight by reading the various posts and personal stories. I am 44 years old and scheduled for aortic valve replacement within the next 2 weeks. Aside from my heart valve problem I also have chronic hepatitis C which has been diagnosed since 1985. Fortunately, I have never really had any symptoms from the virus but with time I may encounter serious problems.

The hepatitis makes my valve replacement surgery more complicated. I am told that any open heart surgery is very hard on the liver. There is an extra burden on the liver when you are put on the heart machine during surgery. People with advance liver disease risk liver failure during this type of surgery. My liver specialist doesn?t think I should have a problem now but I am concerned about the future if I have to have valve replacement surgery again and my liver disease has progressed at the time.

This affects my choice of valve to use. If I go with a tissue valve I will certainly have to have another surgery again likely in 10-20 years. The state of my liver at that time is an unknown. If I go with a mechanical valve I will have to take coumadin which I am told is broken down in the liver which could be problematic if my liver deteriorates later. The benefit of course with a mechanical valve is the need for resurgery. The mechanical valve may last 20-25 years or if I am lucky the mechanical may last the rest of my life without having to have surgery again.
Personally, I am leaning towards a tissue valve. I don?t like the idea of having to take coumadin. It could potentially be harmful to my liver. I read that there are many potential drug interactions and possible complications from bleeding if I was to have some injury, accident or other illness. I think this would cause me to have a less active lifestyle. Also, I don?t like the idea of the constant ticking from a mechanical valve that I read about.

However, my wife (she?s a MD) prefers that I get a mechanical valve because of its durablity. She is concerned that I may not be able to withstand another valve surgery later if my liver disease progresses.

I am getting differing opinions from the various doctors I am seeing. Ultimately the decision is mine but I am not sure which one to choose. What would you do if you were in my shoes?

 

[Nancy]

Hi Barry-

Welcome to this fantastic site. Sounds as if you have some serious thinking about which direction to go in. I am sure you will also be getting input from all your medical specialists.

My husband is the patient here and he has had 3 valve surgeries, 2 lung surgeries, plus he has the following medical problems to deal with: severe anemia, cardiac cirrhosis, chronic CHF, pulmonary hypertension and lung fibrosis.

He has two mechanical valves and had a repair on his mitral for a small leak.

My husband is 71 years old now, and had rheumatic fever as a teenager. He had his aortic valve replaced when he was 46, and that valve is still in there.

As time went on with his heart problems, he began to get congestive heart failure which in turn caused his cardiac cirrhosis. He also suffered for quite a while with pulmonary hypertension and I believe that caused his lung fibrosis. Fortunately now he is on wonderful medications which are helping him.

Heart problems in themselves can cause liver and other organ problems. If you have Hepatitis as well, it will be very tricky as time goes on. I am sure you will be on a very tight regimen for your heart issues, so they do not further compromise your general health.

It is true that mechanical valves last the longest time, perhaps for your lifetime. My husband's additional heart surgeries became increasingly much more difficult, both from the surgical standpoint and during the recovery phase. You will probably need to seek the advice of a Coumadin expert on the issues involving Coumadin and your liver.

I can say that my husband has had little problems with Coumadin and he has been on it for 25 years. Also, he pays very little attention to his valve sounds. You do become accustomed to them with time.

Wishing you all the best with your unique issues.

 

[TIM W.]

Barry, I wouldn't want to answer what I would do in your shoes. However, I am one year younger and I chose a Bovine tissue valve. My surgeon told me these valves are beginning to last 20+ years. Because of my lifestyle, I didn't want to be on Coumadin either.
I don't know how your liver problem will play into this. All I can suggest is that you weigh all the information you get and make a decision based on that. Good luck and keep your new "family" posted. Tim

 

[Ross]

Hello Barry and welcome to our little home.

After reading your post let me say this, the Hep C is always going to be with you though it may not cause you tons of problems. I would be very comfortable with you going with a mechanical valve and Coumadin. The drug doesn't tear you up like you may think. Your lifestyle doesn't have to change, but you do have to think about the consequences of risky adventures. You don't want to place yourself in a predicament by being foolish, but life goes on. Anything can happen in life so why withdraw from things you enjoy? Life is too short anyway.

I wouldn't want to go through another surgery, if it can be helped in a case like yours. While there are no guarantees no matter what valve you do get, I would certainly opt for whatever would last the longest.

I'm 41 now and just had a mechanical St. Jude installed last July. I don't hear the ticking unless I've done something to really speed up my heart rate and then only if I listen really hard. Coumadin is like taking any other pill for me with the exception of Protime Testing. It's not a big deal. I eat what I want, when I want to.

I guess I'm saying that I'd side with your wife on this one. Besides, she's the one that would have your best interests in mind or at least I'd hope so.

If you can think of anything else, just give a yell.

 

[JimL]

Which valve to choose is your question to answer -- and then the surgeon puts in what's best for you anyway. It's very hard to be objective on this question: I have a mechanical valve, thus I recommend a mechanical valve -- that kind of advice is not much good. But a mechanical valve will last longer than you'll need it.

If you learn anything about the effects of coumadin on the liver, please post them here. I just finished reading through Al Lodwick's book on Coumadin (available at www.warfarinfo.com), and I found no mention of any effect on the liver. When the replacement for coumadin, exanta, becomes available, one question I want answered is what effect it has on the liver.

Bleeding problems from coumadin are rare, and usually not severe. I just dug out a stump, digging, chopping, etc, etc, banged up my hands pretty good. I did quit once to get a bandaid, but otherwise the coumadin was no concern.

 

[hsilvers]

Welcome to this site, and I can also fully appreciate just what you are going through.

A month and a half ago, I, too was pouring over all the posts on this site agonizing over valve choices. I am 57, in good shape and, at the time was not too afraid of possibly having to do this again. I kept going back and forth - mechanical versus tissue - and the uncertainty of this coumadin thing.

My surgeon indicated that I was in the "gray Zone" and could go either way as far as valve choice. He also indicated that his experience was that he replaced most tissue valves within 7-12 years.

I finally made the choice for a mechanical, and had a Medtronic installed on March 26. As far as the ticking - I can only hear it if I lay a certain way and cock my head at a particular angle. In other words - the ticking with these newer valves is really a non-issue. In fact, sometimes I struggle just to hear it - because it has now become most reassuring to catch the very soft ticking.

As fas as Coumadin - my experience only goes back a month. The only real hassle is that I had to go for blood tests (INR) every day for the first two weeks until they established a proper level. now I am down to once a week and simply taking a couple pills before I go to bed. Everything I read in this site about other's experience with Coumadin indicates that it really has very little impact on overall lifestyle.

I hoe this is helpful. good luck with whatever way you choose, and no matter what - stay confident and just look at this as another one of lifes's unique expereinces.

Harvey