Hi, I know it's not a contest. 
I've had 2 AVR OHS. Just wondering what third is like.
All input is invited.
I've had 2 AVR OHS. Just wondering what third is like.
All input is invited.
Anyone had 3 valve replacement surgeries?
- Thread starter Earthsciencerocks
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My darling wife has had 3 OHS's for valve repair and replacement:
1) 1997: ROSS procedure with MV commissurotomy (repair).
2) 2000: MVR with pericardial bovine valve (as the MV repair in 1st surgery failed).
3) 2017: AVR and MVR with St. Jude (Master series) valves, PVR with porcine valve, and repair of TV.
Her hospital stay and recovery time got shorter and shorter with less complication(s) after each OHS. This most likely is attributable to medical and technical advances in anesthesia, pain meds, and the like to reduce complications and improve recovery.
In her 3rd OHS, even though she had all 4 valves worked on (3 replaced and 1 repair), if it wasn't for her INR not being in range yet, they would have discharged her in just 2 full days after her 8 hour surgery. Amazing!
1) 1997: ROSS procedure with MV commissurotomy (repair).
2) 2000: MVR with pericardial bovine valve (as the MV repair in 1st surgery failed).
3) 2017: AVR and MVR with St. Jude (Master series) valves, PVR with porcine valve, and repair of TV.
Her hospital stay and recovery time got shorter and shorter with less complication(s) after each OHS. This most likely is attributable to medical and technical advances in anesthesia, pain meds, and the like to reduce complications and improve recovery.
In her 3rd OHS, even though she had all 4 valves worked on (3 replaced and 1 repair), if it wasn't for her INR not being in range yet, they would have discharged her in just 2 full days after her 8 hour surgery. Amazing!
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pellicle
Professional Dingbat, Guru and Merkintologist
I've had 3 OHS
I think fitness and strength leading into the surgery are important factors
Best Wishes
- repair at 12
- replace with homograft at 28
- replace with mechanical and aortic graft at 48
I think fitness and strength leading into the surgery are important factors
Best Wishes
Thanks for the info! I agree so much about fitness and strength helping with pre and post conditions.
Only 2 valve replacements, but 3 OHS. Will probably need a 3rd valve replacement in the future, but not yet. my third OHS took a lot longer to recover from, but that was due to all the fluid. I took a diuretic for 3 years. Finally got off of it at almost 2 1/2 year post op, and feel much better now
How about now? Three AVR surgeries? Any info is invited.
Sounds like my cardiologist is telling me that TAVR is my only option when my Bovine valve deteriorates.
I had Porcine (lasted 9 years), then Bovine 5 years ago, that is leaking some now.
I'm hoping I could survive one more sternotomy and get a mechanical installed maybe.
At 54 and good health, mostly, I'm thinking longer term than TAVR offers.
Sounds like my cardiologist is telling me that TAVR is my only option when my Bovine valve deteriorates.
I had Porcine (lasted 9 years), then Bovine 5 years ago, that is leaking some now.
I'm hoping I could survive one more sternotomy and get a mechanical installed maybe.
At 54 and good health, mostly, I'm thinking longer term than TAVR offers.
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Hi.
I've just had one, but was wondering:
Did he explain why this would be your only option? You might not even be a TAVR candidate, as one needs to be evaluated first.
I am not so sure getting TAVR at age 54 is a good plan. They are not expected to last as long as normal tissue valves and it is not known how long they will last for young patients like you. If you do go TAVR, what is the game plan after 5-10 years when it needs replacing due to SVD? Several top surgeons I have listened to indicate that things get very messy if you need to operate after TAVR. Not impossible, but more complicated and much higher risk operation. You would still be relatively young when your TAVR gets SVD. He may tell you that you can just do TAVR in TAVR at that point, but my cardiologist told me that the valve area is so small with TAVR in TAVR, that one should only expect about enough cardio output to walk and not much more.
I've just had one, but was wondering:
Did he explain why this would be your only option? You might not even be a TAVR candidate, as one needs to be evaluated first.
I am not so sure getting TAVR at age 54 is a good plan. They are not expected to last as long as normal tissue valves and it is not known how long they will last for young patients like you. If you do go TAVR, what is the game plan after 5-10 years when it needs replacing due to SVD? Several top surgeons I have listened to indicate that things get very messy if you need to operate after TAVR. Not impossible, but more complicated and much higher risk operation. You would still be relatively young when your TAVR gets SVD. He may tell you that you can just do TAVR in TAVR at that point, but my cardiologist told me that the valve area is so small with TAVR in TAVR, that one should only expect about enough cardio output to walk and not much more.
Hello,
I frankly think that you are too young for a TAVR for several reasons. TAVR was originally meant for inoperable 80 year olds. TAVR in TAVR pushed this down to people in their 70s. Surgical interventions after TAVR are apparently hard and have higher mortality (although there only a few cases and this could be because of the population, not the procedure - nevertheless when I asked surgeons about it, they said it is technically challenging). If your valve is only leaking and there is no calcium, TAVR may also not be possible.
I think that the smart thing to do is to visit a surgeon who specialises in reoperations. The Big US hospitals, like the Cleveland Clinic, are probably the right places to go to. I think that only such a surgeon can tell you honestly and based on their experience what the operative risk is like. Then, based on all the information you have, you can make an informed decision.
Depending on your age at the operation, a mechanical might be your only logical choice. I.e. if you are 55 and expect to live to 85 (you will know better based on family history), I would probably stay away from a tissue valve, given that this might be inviting a fourth intervention down the line. I would also emphasize that just because you choose mechanical, doesnt mean that you will not continue to benefit from technological improvements. Some of these new anticoagulants are being tested in people at the moment, which may not require warfarin monitoring. Also, just like with Diabetes, we may eventually get to a place where you can measure INR with a watch through your skin, so the risk of being out of range without you knowing would become smaller.
My two cents.
Good luck.
I frankly think that you are too young for a TAVR for several reasons. TAVR was originally meant for inoperable 80 year olds. TAVR in TAVR pushed this down to people in their 70s. Surgical interventions after TAVR are apparently hard and have higher mortality (although there only a few cases and this could be because of the population, not the procedure - nevertheless when I asked surgeons about it, they said it is technically challenging). If your valve is only leaking and there is no calcium, TAVR may also not be possible.
I think that the smart thing to do is to visit a surgeon who specialises in reoperations. The Big US hospitals, like the Cleveland Clinic, are probably the right places to go to. I think that only such a surgeon can tell you honestly and based on their experience what the operative risk is like. Then, based on all the information you have, you can make an informed decision.
Depending on your age at the operation, a mechanical might be your only logical choice. I.e. if you are 55 and expect to live to 85 (you will know better based on family history), I would probably stay away from a tissue valve, given that this might be inviting a fourth intervention down the line. I would also emphasize that just because you choose mechanical, doesnt mean that you will not continue to benefit from technological improvements. Some of these new anticoagulants are being tested in people at the moment, which may not require warfarin monitoring. Also, just like with Diabetes, we may eventually get to a place where you can measure INR with a watch through your skin, so the risk of being out of range without you knowing would become smaller.
My two cents.
Good luck.
Canton
Member
I was 53 (55 today) when I had my aortic value replaced with an Edward's tissue KONECT RESILIA aortic valve and I have no regrets. As I understand that if I take care of myself this valve should last at least 20 years and it was designed to simplify the TAVR process including the TAVR to TAVR process. So, at 53 and I get the minimum life span of the value before a TAVR I would be 73. Then at 73 I get my first TAVR and that last 10 years I would be 83. Then the 2nd TAVR would take me 93... I'm good with that.
I had several months to make a decision if I wanted a mechanical or biological valve... I did a lot of research and I myself chose the Edward's Resilia valve and my surgeon agreed and told me I made a good decision.
Reasons I decided against a mechanical valve:
1. Lifelong taking of blood thinners and constant blood testing.
2. Concerns about what foods you have to restrict from eating.
3. And the biggest reason... the noise. There is no noise from a biological valve
Article:
Nearly 1 in 4 people with a mechanical heart valve says the noise it makes disrupts their sleep, a new study finds.
https://www.medicaldesignandoutsourcing.com/mechanical-heart-valves-loud-insomnia/
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Those study results don't take into account how many respondents would have had sleeping problems or insomnia w/o the valve. It's easy to blame the valve when you can't get to sleep because of anxiety about life.
No surgeon will tell you that your choice was bad. I was the same age as you and chose mechanical my surgeon told me my choice was the best...one and done. Your second concern about mechanical valves is a false one. There are no dietary restrictions when taking warfarin. That's an old outdated concept. In the 21st century, we dose the diet not diet the dose
Yes, my cardiologist said about the same as you described. My surgeon said I had a hard time getting off the table after my 2nd AVR. Lung collapsing, sternum wires, lots of scar tissue, MESSY, much higher risk. Not a good prognosis. Thus my question.
Thanks!
pellicle
Professional Dingbat, Guru and Merkintologist
Good morning Canton
I see that you've already made your valve choice and so this reply is not actualy directed at you but to the others in the waiting room who are making decisions and are reading these posts. So I really wanted to address this information for them with some balance.
Due to limitations of the English language there is not third person infinitive (like in other languages), so when I write "you" I mean "you the reader" not "You Canton"
I for instance test weekly (or more often if needed for my personal learning and exploring a situation), while this may seem onerous ask a diabetic if their blood testing multiple times a day is onerous ... they'll usually say it isn't and more to the point has brought them on board with what is happening to their body.
The rest of the world has embraced the modern wave of electronic personal care systems enabling even better management of drugs. Now, being in the USA is not itself an exclusion to this, as many members here do that. Indeed if you look at this forum there are whole sections on Anti Coagulation Therapy (ACT), how to do it and how we help each other with that.
This by and large is of course a very significant misunderstanding, for which the medical system is to blame. With the exception of Grapefruit Juice and perhaps Cranberry Juice there are no real restrictions.
The core of the problem is ignorance within the medical community. This idea has become its own "lore" and is difficult to stamp out (despite efforts by the members of the medical community who actually know and are researchers in this area:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/
VKA's are Vitamin K Antagonists which is what warfarin is which is what are called blood thinners by the public (and medicos who are dumbing it down, or dumb themselves)
The above is not tin foil hat material and any reader of these forums will see again, and again ... and again attempts by those of us who are both on warfarin and self manage to dispel this notion and encourage healthy eating (including greens)
true, and while most people can adapt and even actually find some comfort in it, there are people who will tend towards being anxious about this and take this anxiety into a spiral which is unhealthy. Most of us (which would be the 3 out of 4 mentioned below)
So ultimately I come back to the postion of advice I give all newbies when deciding:
Best Wishes
I see that you've already made your valve choice and so this reply is not actualy directed at you but to the others in the waiting room who are making decisions and are reading these posts. So I really wanted to address this information for them with some balance.
Due to limitations of the English language there is not third person infinitive (like in other languages), so when I write "you" I mean "you the reader" not "You Canton"
yes, you do need to take blood thinners and you do need to test. This last aspect is primarily a problem in the USA where the medical insurance system take what is a trivial thing and inflates it into something both expensive and onerous.
I for instance test weekly (or more often if needed for my personal learning and exploring a situation), while this may seem onerous ask a diabetic if their blood testing multiple times a day is onerous ... they'll usually say it isn't and more to the point has brought them on board with what is happening to their body.
The rest of the world has embraced the modern wave of electronic personal care systems enabling even better management of drugs. Now, being in the USA is not itself an exclusion to this, as many members here do that. Indeed if you look at this forum there are whole sections on Anti Coagulation Therapy (ACT), how to do it and how we help each other with that.
This by and large is of course a very significant misunderstanding, for which the medical system is to blame. With the exception of Grapefruit Juice and perhaps Cranberry Juice there are no real restrictions.
The core of the problem is ignorance within the medical community. This idea has become its own "lore" and is difficult to stamp out (despite efforts by the members of the medical community who actually know and are researchers in this area:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/
In conclusion, the available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, thus avoiding wide changes in the intake of vitamin K. Based on this, until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.
VKA's are Vitamin K Antagonists which is what warfarin is which is what are called blood thinners by the public (and medicos who are dumbing it down, or dumb themselves)
The above is not tin foil hat material and any reader of these forums will see again, and again ... and again attempts by those of us who are both on warfarin and self manage to dispel this notion and encourage healthy eating (including greens)
true, and while most people can adapt and even actually find some comfort in it, there are people who will tend towards being anxious about this and take this anxiety into a spiral which is unhealthy. Most of us (which would be the 3 out of 4 mentioned below)
find no problem and actually adapt to this (and other) changes which life brings.
So ultimately I come back to the postion of advice I give all newbies when deciding:
- get the actual facts (not the folklore)
- spend time learning (not only listening to your doctor who may not actually know)
- set aside the Fear and work with gaining knowledge
Best Wishes
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I’ve been on the table x3 - age 11 for sub aortic stenosis, age 46 for AVR porcine valve, age 54 for mechanical replacement of failed pig valve.
Wish I was better informed in 2014 when I got the pig valve. When the pig valve failed, I’m fortunate that TAVR was not an option - I should have gone mechanical from the start but did not understand options or consequences.
The benefit of 3rd OHS? They did remove bony projections on my sternum that were left over from the second surgery. It was the weirdest thing when I could wash my chest and not feel the nodules…
But I would rather avoid another go around.
Wish I was better informed in 2014 when I got the pig valve. When the pig valve failed, I’m fortunate that TAVR was not an option - I should have gone mechanical from the start but did not understand options or consequences.
The benefit of 3rd OHS? They did remove bony projections on my sternum that were left over from the second surgery. It was the weirdest thing when I could wash my chest and not feel the nodules…
But I would rather avoid another go around.
I have had the privilege of three open heart surgeries with 3 aortic valves. 1977 porcine-51/2 years fell apart 1983 St.Jude started warfarin.
2006 aortic aneurysm new valve also St.Jude again. Surgeon said “you don’t want to be opened up again “ (age 58).
So warfarin for 39 years. Annoying but not a life stopper. Did anything I wanted and still do.
Given that I totally detested the surgical experience I agreed with the surgeon. TAVR was not available in 2006.
To me at least the clicking of the valve is inconsequential. I can measure my heart rate without feeling my pulse. I don’t hear it unless I listen for it. Only once did someone mention it. I was in surgery (doing it) when another surgeon asked if I had gotten a new watch.
Really no big deal.
Every procedure has its own risk including TAVR.
So in general the fewer procedures the better.
The trade off is warfarin. Which is annoying as I mentioned but at least to me much better than potentially several more procedures.
There is no perfect solution. But we all should be happy there are solutions.
Good luck.
2006 aortic aneurysm new valve also St.Jude again. Surgeon said “you don’t want to be opened up again “ (age 58).
So warfarin for 39 years. Annoying but not a life stopper. Did anything I wanted and still do.
Given that I totally detested the surgical experience I agreed with the surgeon. TAVR was not available in 2006.
To me at least the clicking of the valve is inconsequential. I can measure my heart rate without feeling my pulse. I don’t hear it unless I listen for it. Only once did someone mention it. I was in surgery (doing it) when another surgeon asked if I had gotten a new watch.
Really no big deal.
Every procedure has its own risk including TAVR.
So in general the fewer procedures the better.
The trade off is warfarin. Which is annoying as I mentioned but at least to me much better than potentially several more procedures.
There is no perfect solution. But we all should be happy there are solutions.
Good luck.
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pellicle
Professional Dingbat, Guru and Merkintologist
I've recently bought a set of Bose ear bud (squish in) type headphones for my phone (well mainly hands free phone calls via bluetooth but listening to music is a bonus). For me when I push these things in my internal noises become more prominent in my hearing (same things happen with those little hearing protection foam plugs).
Its a bit annoying, but there just aren't many other options these days in the ANC (Active Noise Cancelling) world ... its either cans or squish-in. Given the fines (for even touching your screen to answer a call) these days I've pretty much got them for free and then some. (a link to my appraisal if curious)
Not that I'd pick having a tissue valve and another surgery instead for this point.
as well (as what you identified with the pulse) I was able to pick up ectopic beats and mention this to a doctor (who had the good sense not to ask me "how did you hear those") ;-)
Canton
Member
Actually, that was my point to begin with! Just like maybe things have changed with better medicines for taking blood-thinners, noise etc for mechanical valves... but the technology and development of tissue valves have also greatly improved as well in the last couple of years. It cut both ways. I did say in my original comment that I spent MONTHS researching my condition and every option available to me at that time. Including watching MANY youtube videos of those who had heart valve surgery (including viewing the actual full surgery itself... which I regret doing so before my surgery) and that included both mechanical and tissue valves. With regards to mechanical, I've seen/heard some who felt comfort from their mechanical valves ticking to those who are not happy with it... which included trouble sleeping and having to explain to people why they hear a ticking sound coming from them. That's why I was surprised by a story on a lawsuit by the actor Bill Paxton's family when they sued Mount Sinai for the death of Bill after heart surgery, claiming (among other things) the hospital didn't warn them of the potential risks he faced by using such and such procedure; who goes through open heart surgery without learning about what's about to happen to them and all their available options? But that's another issue.
So ultimately, I come back to the original comment that suggested it was not recommended to have a tissue valve at 55 because it's not believed to be a good viable option today at that age that I disagree... which is why I say to you and others... "get the actual facts"... research all the options. I'm not sporting by "fathers tissue heart valve"... but I agree 100% with vitdoc's comment above.... there is no perfect solution and when it comes to replacing a heart valve ... either biological or mechanical valves, there are pro's and con's and only the person who requires a new valve can make this decision for themselves. There are definitely pro's for the mechanical valve worth considering... I certainly wouldn't dispute that.
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Canton
Member
'Misunderstanding as there are no restrictions except' ... this and that... ok
Mayo Clinc: Warfarin diet: What foods should I avoid?
https://www.mayoclinic.org/diseases-conditions/thrombophlebitis/expert-answers/warfarin/faq-20058443
Canton
Member
Those study results don't take into account how many respondents would have had sleeping problems or insomnia w/o the valve. It's easy to blame the valve when you can't get to sleep because of anxiety about life.
No surgeon will tell you that your choice was bad. I was the same age as you and chose mechanical my surgeon told me my choice was the best...one and done. Your second concern about mechanical valves is a false one. There are no dietary restrictions when taking warfarin. That's an old outdated concept. In the 21st century, we dose the diet not diet the dose
From the report...
On average, the patients were 60 years old and 76% men. Nearly a fourth reported the valve sound being disruptive during sleep, and 9% reported daytime disruptions. Over half of the patients reported the sound being too often and could be heard by others, but only 16% said it created an uneasy feeling. Additionally, 28% said they would replace their valve with a soundless prosthetic valve if given the opportunity.
This speaks for itself.
BTW, when I also told my surgeon I wanted to use a breast plate instead of wire to hold the split breast bones back together... he made very clear to me that decision was BAD... just saying. Maybe New York City doctors are different from your doctors. They clearly will tell you if you chose something they don't agree with. It's a New York thing I suppose.
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