Allograft in 33 year old patient

[dej72]

I will be needing surgery soon. It will be replacement of my bicuspid aortic valve and the ascending aorta.

I'm 33 years old and would strongly prefer not to have to deal with Coumadin every day, even if it means potentially another surgery later on.

Does anyone know if it is at all common for someone my age to receive a porcine or allograft? Or should I expect to be pushed toward the mechanical valve?

 

[mntbiker]

I suggest you read these two threads, they are very informative and provide views from both sides.

http://www.valvereplacement.com/forums/showthread.php?t=14330

http://www.valvereplacement.com/forums/showthread.php?t=14200

Good luck with your choice.

 

[geebee]

There are many people who have tissue valves at your age or younger. Just keep in mind that you will definitely need at least one more surgery in your lifetime (and probably 2 if you go tissue the next time also). If you are OK with that, there is no reason not to have a tissue valve. There are also people who have tissue valves at a younger age and then go mechanical with their second surgery.

Read through the threads and talk to your doctors. Ultimately it is your decision even if the doctors suggest a mechanical, they should go with your wishes.

 

[Andyrdj]

My own situation...

My own situation...

... is somewhat similar to yours. Had repair at age 17, am 31 now looking at replacement in a few years.

I'm after the Carpentier-Edwards Magna bovine valve at present, as I, too, wish to avoid anticoagulation.

This valve looks like having improved durability due to its reduced calcification rate, and I hope optimistically to have at least 15 years out of it before my 3rd and final operation. This is because of several reasons, which, note, are very individual in nature

1. Although I have seen many reassuring reports on this site from Mech valvers, I personally feel I would crack up having to watch my INR and diet daily or even weekly. I'm utterly not the sort to be a well behaved patient. I hate the idea of having to think about my condition often.

2. If I opted for a mech valve to avoid re-operation, then any new advancements would be meaningless to me. They could invent a perfect valve and I'd still be stuck with the old unless I underwent a third operation (which defeats the purpose of going for the mech valve in the first place).

I think likely that within the next 10 years we will have either
- a tissue grown valve made from our own cells which meets the durability standards of the mech valve,
- a mechanical valve which is free of anticoagulation, or
- a biological valve with the facility to last a lifetime.

I think I would be extremely jealous, watching people get the benefit of such an advancement and not me.

3. Anticoagulation therapy makes other operations difficult (the need for bridging therapy etc)

Before I woke up from my first op, I had no idea whether I was going to wake up with a mech valve or a repair. When I woke up with the repair I was so glad.
It's enabled me to have a carefree 20s in many ways, eating, drinking, (extremely) wild parties and the rough and tumble of daily life (I am one of the most accident prone people in the world!!)

Be sure, though, that you have your priorites clear to you. I am opting for a route that requires more surgery, potentially greater risks, but potentially greater benefits.

 

[Ross]

Derek just a quicky about Coumadin. It is not as bad as you've probably been lead to believe. After my first surgery, there was no way I wanted to go through another, but ended up having too to replace the valve altogether. For me, at 40, it was a no brainer to go mechanical and Coumadin. From the last experience I had, I really do not think I'd make it through a 3rd surgery.

All I ask is that you visit Al Lodwicks site and learn more about Coumadin before believing everything you hear about it. Most of what you hear is misinformation and untrue. His site will help dispell myths and provide you with solid info to base your decisions on.

www.warfarinfo.com

 

[Natanni]

Hello Dej

You will find many valvers here with tissue valves that are you age! My husband is 34 and was given only a mechanical valve option initially by the University of MN so we went to Mayo in Rochester for more options. He was really hoping for a repair but they were not doing repairs at that time on bicuspid valves. If they did, they felt it would only last about 4 years. The Mayo gave the options of a bovine or mechanical aortic valve. With Nathan's lifestyle of repetitive heavy lifting (100 lbs every day, many times a day) and activities, they predicted a bovine to last 7-12 years. It is expected that many valvers here will get 20 years on their tissue valves.

Nathan went with a CarboMedics mechanical. Coumadin is something you need to think about every day. He does lead a bit of a wild life, and I admit I do worry about him now more than before. He snowmobiles, ATVS and motorcycles. Nathan eats all the vitamin K he wants, he has a few beers on the weekends, maybe a few during the week. His lifestyle really has not changed since having his valve surgery. He monitors his INR at home, once a week. Have not had to deal with bridging therapy as of yet. I believe this would one of the things that Nathan may find to be a pain.

Nathan's chose mechanical to give himself the best chance at not ever having a re-op; Mechanical is no guarantee, but a reduced chance. His feeling is if another OHS/Valve replacement is needed in his 50s or 60s, he will think about a tissue valve at that time. Reverse order of what alot of valves feel

Welcome to VR.COM

Ann

 

[Karlynn]

Nathan's chose mechanical to give himself the best chance at not ever having a re-op; Mechanical is no guarantee, but a reduced chance. His feeling is if another OHS/Valve replacement is needed in his 50s or 60s, he will think about a tissue valve at that time. Reverse order of what alot of valves feel

This is my thinking as well. If my mechanical valve ends up needing to be replaced, I will go with a tissue if I'm at an age where it is felt it would most likely last the rest of my life. If not, I'll go mechanical again.

Having had my valve replacement at 32, with 2 young children at home, I was glad to not have to think or worry about when my next valve replacement would have come. With my children the age they were at the time of my surgery, there would have been no good time to interrupt my family's life with deterioration of another valve and it's affects on our life (it was really rough before my surgery) and another major surgery and recuperation time. Now that they are in college (and about to be out) it's a little different story.

Make the choice that "feels" the best for you. Be thorough on doing your homework to make sure the choice is made with current, correct information. At 33, you are guaranteed another valve replacement if you go with a tissue. The only reason I say this is your comment of "I'm 33 years old and would strongly prefer not to have to deal with Coumadin every day, even if it means potentially another surgery later on."

If you haven't yet, you might want to take a look through our Reference Sources forum, particularly Tobabotwo's posts. http://valvereplacement.com/forums/showthread.php?t=14330

Best wishes.

 

[mmarshall]

hey dej,
i was 31 when i had my avr done about a year ago. the plan was to have the ross procedure done and as a back up...a porcine valve. i ended up with a porcine valve with a root replacement. google or do a search on "medtronic freestyle aortic root heart valve" that is just one of the latest and greatest tissue valves being used....there are also bovine valves but i am not sure about those in detail but from what i hear, they are about the same. if you have any questions about anything let me know...or just look back to my posts from around may 31, 2005...that is when i had my surgery done.

 

[Kate]

Hi Dej72!
I'm 38 and just had my aortic valve and ascending aorta replaced in September. I decided to go with a bovine pericardial valve myself and continue to be happy with the choice I made. However, it definitely isn't right for everyone - I'm anticipating two additional surgeries and if this current valve doesn't last at least 10 years, I'll probably go mechanical the second time around.

In my opinion, it's best not to bank on future improvements in technology, since we just don't know what those will be. Read as much as you can about the options, be honest with yourself about what you think would work best for you, and then just trust that you've made the right decision. I wish you the best of luck and hope your surgery is as noneventful as mine was. Take care, kate