After 13 years in the "waiting room", surgery date is set for June. Let me know if agree with my plans...

[mecretired]

I had my first ohs at age 58—aortic root, aortic valve and ascending aorta replaced with a st Jude grafted valve. I had a short period of afib after surgery so they set my inr range to 2.5-3.5. I am now almost 70 and am very physically active. My husband and I cut our own firewood and work out at the Y 3 days a week. I just had my annual echo and everything looks great. The only problem I’ve ever had with warfarin was when I had to go off it for a procedure and had to bridge with lovenox. It took a while for my inr to come back up. I have never regretted going with the St Jude.

 

[pellicle]

Just for interest and because I notice that there is a highly partisan aspect of human nature (which quickly forms up into "teams") to denigrate the other team, even when assignment into these teams is arbitrary or even random (again I urge the reading of 12 rules for life by Jordan Peterson). I believe that its important to grasp the psychological nature of ourselves or be victims to it.

I recommend anyone considering the On-X or presently having an On-X to carefully evaluate this finding:

​

https://pubmed.ncbi.nlm.nih.gov/20598989/

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Conclusions: LOWERING-IT trial established that the proposed LOW-INR target is safe and feasible in low-risk patients after bileaflet aortic mechanical valve replacement. It results in similar thrombotic events and in a significant reduction of bleeding occurrence when compared to the conventional anticoagulation regimen.​

I highlighted critical points which anyone using an On-X should consider carefully. I encourage anyone with that valve to carefully read the full study and findings.

We are all a bit different, and so my advice is to play it safe and go based on evidence.

 

[pellicle]

Hi

It took a while for my inr to come back up.

just to ask (in order to perhaps not cause un-needed anxiety) apart from the number not returning to the number you wanted, was there any actual problem with your INR being lower for a period?

 

[pellicle]

forgot the link for a good starter intro to 12 rules for life
https://en.wikipedia.org/wiki/12_Rules_for_Life
oops

 

[BillDaThrill]

Your plan sounds very good to me. I am 53 and will be getting my first, and hopefully only, aortic valve surgery in 4 days at UCLA. I spent a lot of time trying to decide between tissue and mechanical, and came to the conclusion that mechanical is right for me, as I want to be one and done. I have a very active life, and have been convinced that I can continue to have a very active life.

I am going with a St. Jude. My surgeon prefers the St. Jude and is of the opinion that the claim that the Onyx can get by with a lower INR is not supported by the literature. That seems to be the predominant view on this board as well. I like that there is solid 30 year outcome data for the St. June. Having said that, I think that both the St. Jude and Onyx are probably good valves and many here have had each of them and are happy with theirs.

You commented on the Resilia. Initially this was my valve of choice, but like another poster, when I learned the expected life of a tissue valve for someone in our age group there was no way that I would go that route. There is hope that the Resilia will last longer than other tissue valves, but there is no data yet to support that it will. I really want this to be my last OHS.

I have heard nothing but great things about Cleveland Clinic and Lars Svensson. I believe you will be in good hands.

Best of luck!

Thanks for all the input Chuck C. Wishing you all the best with your big day coming up!!! Please keep us posted on your recovery.

 

[BillDaThrill]

I had my operation in my home city with a local team of doctors, nurses and rehab specialists. I was about the same age and chose mechanical. I have no trouble keeping my INR in the recommended range of 2-2.5. I got a St. Jude because of my surgeon's recommendation. He would have installed either, but likes the St. Jude because it's "rugged" and has a long history. My only regret is the mechanical valve does not allow me to routinely take NSAIDs (I have developed arthritis). But that's a small price to pay for avoiding future open heart surgeries.

I'd make sure you have good follow-up care at home since you've decided to have your surgery elsewhere. In my case, my team after surgery included a surgeon, surgeon's PA, a PT, a cardio and cardio's RN. When I started cardio rehab I got an additional rehab PT and RN. At home:

• You will need to be tested regularly for INR and get dosing help.
• After a few weeks you will need an Xray to check the chest and get released by your surgeon.
• Follow-up care should include cardiac rehab. Even if you know how to exercise, cardio rehab helps you start small and work up to the full monty. It's also reassuring to have an expert RN or PT to ask questions of twice a week.
• Make arrangements to assure your relevant records get transferred from the hospital to your home base doctors.

Great stuff, really helpful Tom in MO!!! Will take each of these bullets and put them into my readiness checklist. Have already called on a few of them like the INR (PT, PTT) testing and cardio rehab.