Anyone in here in their mid 40's and what did your surgeon advise on valve type.

[almost_hectic]

If the Ross is not considered the "standard" of care for someone such as yourself. It may be that your insurance may take issue with coverage for a much lengthier, much riskier procedure. Something to consider. I think I already stated earlier in this thread, my surgeon immediately recommended the On-x mechanical valve, as if there were no better option for me at 44. Especially since it's the most advanced available at the moment allowing the lowest dose of blood thinner, essentially removing most of the concerns of being on blood thinners long term. And the possibility in the future there may even be blood thinner alternatives, made it sound as though they are already researching what that might be using this new On-X mechanical heart valves are made with the most advanced material in the industry - pure pyrolytic carbon

 

[David W]

Hi Almost Hectic, thanks for that. I dont think the Ross treatment is available here on our NHS. Re your ON-X valve. How do you find it? Is is quiet, can you hear it? How much less warfarin are you currently taking?

 

[almost_hectic]

Well I am literally only home from the hospital a week, so I can't say I could provide much knowledge on my experience thus far as I've had very little. Yes though, I was surprised to find there are times when I can hear my valve tick, but i "think" it's growing fainter, don't know why that would be. Unless you have excellent hearing you might not hear it at all. Hearing it always makes me think I have a watch on, but I don't. As for blood thinners my levels haven't been normalized yet to even determine my base level. But I think they wait and lower it after stabilizing your INR as it relates to medication and diet. The blood thinners have no side effects though.

 

[pellicle]

Hi

...ce, for some reason my gut still tells me a tissue valve.

Go with your gut. You have to live with the choice, so if others say X but you want Y then if anything goes wrong you may feel ripped off.

Seriously there are no certainties either way and all are A class options (well except the Ross in my view, that's just fraught )

Tissue prosthesis is not a bad choice.

 

[David W]

Hi


Go with your gut. You have to live with the choice, so if others say X but you want Y then if anything goes wrong you may feel ripped off.

Seriously there are no certainties either way and all are A class options (well except the Ross in my view, that's just fraught )

Tissue prosthesis is not a bad choice.

Pellicle, thanks mate for your words.

David

 

[gregjohnsondsm]

In response to some questions from David:
Yes the Carpenter Edwards 3300 is a new design bovine valve (new in that it is using a better fixation process and should have a longer life, but not enough clinical evidence to determine that yet). I don't have any regrets, but I think that after learning more about the surgery and having been through it, I would (maybe) choose a solution that was less likely to require re-operation. I initially wanted the mechanical valve but after much research decided on the tissue valve. For all the reasons everyone lists and one other major reason: three very active heart surgeons around my age (50) said that they would choose a tissue valve (none that I could find said that they would choose a mechanical valve) and one of them actually had to have the operation and used a tissue valve.
​But now after the surgery, and having been through the surgery and used warfarin for 3 months, I would perhaps choose the On-x. I don't know, because I don't have to make that choice right now and talk is pretty cheap. But I would say for me it is as close to 50/50 as any major decision I've ever had to make. I'm just very glad that I didn't have the Ross procedure. Which my long time and now fired cardiologist suggested for me.

 

[neil]

spot on pellicle, go with you gut, remember this choice is yours nobody else, you could argue all day which people think is the best choice we all have our opinions but that's what they are ours,so go with you gut and remember any choice is a good choice

 

[cldlhd]

My valve was repaired earlier this year at the age 45 but my backup choice was mechanical. Its a personal call but I don't see how 50 makes sense as a cut off point in the decision process . Unless you expect to die by 65 you're almost guaranteed another surgery, yes TAVR is a possibility but not a certainty. If they explained it as no warfarin but most likely another ohs in your future when they recommend a tissue valve at 50 then I guess that's duly informed. I don't know about others out here similar to my age ,46, but I don't feel anywhere close to my ultimate demise. I'll take another 46 please.

 

[David W]

Thanks again everyone for their kind and honest contribution to this thread. Greg, can I ask what the reasons were from your surgeons why they wouldn't use a mech valve?

 

[dhyravy]

I got my Medtronic Hall tilting disc aortic valve at 40 years old in 1998. 17 years in and working perfectly 3 weeks ago on my echo. My cardiologist and surgeon didn't even consider a tissue valve at my age then and believe me, if you went with a tissue valve you would be kicking yourself in recovery. Valve replacement is one of those things you're really glad they can do but REALLY don't want to do again. ;-)

 

[honeybunny]

Someone (pellicle?) correct me if I am wrong, but I thought I read somewhere online (not here) that getting a tissue valve does not automatically preclude the need for warfarin. I'm going with tissue next month but because of the potential ticking of a mechanical valve. I was leaning toward mechanical originally because I thought, "what if I end up on warfarin AND need a second surgery down the road?" But I'm not certain that my rationale was correct. Just my two American cents.

 

[pellicle]

Hi

Someone (pellicle?) correct me if I am wrong, but I thought I read somewhere online (not here) that getting a tissue valve does not automatically preclude the need for warfarin.

Probably was me. There is a risk of developing atrial fibrilation post surgery and that will require warfarin iirc. Also some other surgeons have written up that under some circumstances tissue valves in their latter stages of degradation can also begin throwing clots. This aspect is usually poorly diagnosed and attributed to other things.

The risk is low but the risk is there.

The risks of complications (which are not fatal but compound difficulty in life quality) from redo operations rises greatly with successive redo operations. It used to be that the risk of death in a redo was higher, due to all the scar tissue masking stuff, but modern medical imaging has reduced the risk of death. When reading the articles please pay attention to the point that in the main they are talking about mortality (meaning death).

Personally I find death to be less worrying than life as a cripple or with severe limitations.

 

[neil]

in most cases and I say most you will not need to be on warfarin if you go tissue, also the stats from a re op are pretty much the same as your first op, of course its not an op you would have for fun but some of us choose that path,

 

[chickadee]

I am 43 an had my 3rd surgery in June. My last valve was tissue an I was told that was to allow me to have children (I was 21). I was told the rate of infant death if you are on warfarin- which you will be after a mechanical valve placement- is very high. I had the valve for 22 years- a very long time for a tissue valve. When it started to fail we discovered that the valve and the portion of the aorta that was also replaced had "turned to stone". That is how my surgeon described it. I had no idea they could do that. I really wasn't given a choice this time- it had to be mechanical. They last longer typically. You can't go around getting this surgery too many times. The warfarin is a pain, but I am getting used to it. Also, despite what they tell you- the mechanical valve can be noisy. I can definitely feel it beat and I can frequently hear it. Nobody else seems to though. I am still getting used to it.
Good luck with your upcoming surgery!

 

[David W]

Hey thanks Chickadee. It seems that from what ever I have read either on her or some other far flung corner of the web there are pros and cons to everything relating to this topic and I have discounted none of them for they all have the value and relevance. I am meeting my surgeon next Friday here in London and I have read that he is one of the leads here in the UK in the area of TAVI replacement. So I will offer him my questions pertaining to the future of valve replacement and better interventions for us "valvers" and post his comments in here......

 

[epstns]

To amplify/clarify pellicle's statement on warfarin for tissue valvers, many (most?) heart centers routinely prescribe warfarin for the first 60 to 90 days after implant of a tissue valve. They do this to minimize the likelihood of clot formation from the surgery and healing process. If the patient's heart remains in normal sinus rhythm, then the warfarin is discontinued after the initial term.

If, however, the patient continues to have significant atrial fibrillation (which, according to my electrophysiologist, means bouts of afib lasting longer than 5 hours or so), then the docs will prescribe ongoing warfarin treatment to minimize the chance of clots forming due to the afib. I sometimes still have short periods of afib (seconds or minutes long) and the docs aren't worried. They say that as long as the afib lasts less than 5 hours or so, then no significant clotting will take place, thus no warfarin. In my case, having a pacemaker makes it easy to know exactly what I experience, as the device will not forget, nor will it lie. When it is interrogated, it tells all. . .

 

[Paleowoman]

To amplify/clarify pellicle's statement on warfarin for tissue valvers, many (most?) heart centers routinely prescribe warfarin for the first 60 to 90 days after implant of a tissue valve. They do this to minimize the likelihood of clot formation from the surgery and healing process. If the patient's heart remains in normal sinus rhythm, then the warfarin is discontinued after the initial term..

I was only on warfarin for four days post op if that.

These were the meds I was on at discharge: pain meds dihydrodeine and Tramadol, discontinued on day 7 post op due to side effects; a PPI, omeprazole, discontinued on day 9 post op at my request; a diurectic, discontinued on day 10 post op due to low sodium and low blood pressure; a stool softener, discontinued day 10 I think; sleeping med, Zopiclone 7.5mg, kept on for about four weeks; and a beta blocker, Atenolol 25mg, kept on for approx eight weeks post op, though dose halved at four weeks post op.

 

[Zoltania]

To amplify/clarify pellicle's statement on warfarin for tissue valvers, many (most?) heart centers routinely prescribe warfarin for the first 60 to 90 days after implant of a tissue valve. They do this to minimize the likelihood of clot formation from the surgery and healing process. If the patient's heart remains in normal sinus rhythm, then the warfarin is discontinued after the initial term.

I was told that i need to take warfarin for three months after my mitral valve repair.

Claudia Z.

 

[tom in MO]

When I looked into it 3 years ago, about 30% of tissue valve recipients wind up on warfarin for another ailment not related to the valve. That's because most people who receive tissue valves in the past were older and had more problems. It does not apply to young patients.

For young patients, one thing not discussed yet, is the steady decline you will suffer with a replacement tissue valve. Just like your current valve, your replacement tissue will fail over time. It may be long, it may be short, it can have limited or severe effect on your quality of life or have un-realized effects (my case with my first valve).

My surgeon and cardiologist said to not bet on future advances in valve replacement. The current products under clinical trials, even if approved, may not be suitable in my specific case when it comes time for a replacement. In addition, it is usually a smaller valve and may not give the same amount of performance as a larger fullly replaced valve.

One thing also not mentioned, is that if you suffer from arthritis, warfarin will severely restrict the drugs that you can take for arthritis. This can have a dramatic effect on your quality of life, especially if you suffer from it already at a young age.

 

[jumpy]

Hi

I am about to have valve replacement and a 6.1cm aneurysm tinkered with in a couple of weeks. I'm 44, quite active running, cycling and have started
to lean in the direction of a tissue valve. I am so greatful to the members who have responded to my replies to other people's post offering a variety of
information relating to tissue and mechanical. So I'm just seeing who is in here of a similar age wanting to find out what valves your surgeons recommended
for you relating to your age as much of this decision in regard to valve choice seems to be defined by age. I seem to be hedging my bets on technology in the next 10 years which has been endorsed by some in this forum but not many. Irrespective of age all opinions will be greatly appreciated. Thanks in advance. David

Are there any variances to the types of Tissue valves when it comes to hemodynamic performance? As an active 44 year old as well, I am looking for something that mimics the flow of a natural valve. Are there some tissue valves that are closer than others? What would they normally recommend as far as tissue valves go? Does anyone have the St. Jude Trifecta? Does stent?stentless have an impact on the hemodynamic properties of the valve?