Anyone wish they had chose the other option?

[Heart Of The Sunrise]

I am still in the pre-surgery waiting and research phase. I have yet to meet the surgeon my cardio wants to do the surgery.
Anybody choose tissue and then wonder if they should have gone mechanical?
Anybody choose mechanical and then wonder if they should have gone tissue?

I am also concerned about managing the anti-coag drugs if I go mechanical?.
What powers a mechanical? What powers a tissue valve? How do they both work?

I want to feel confident in my decision. Longevity is in the family. My mother is 88 and still enjoying life to the fullest.
I am blessed that my wife is a nurse and will be of great assistance if I go mechanical with regulating my blood.
I assume this is a daily ritual like a diabetic checks their blood sugar levels.

I hear tissue valves last longer in older patients. I turn 57 in April.

Are certain mechanical valves louder than others?

Do you get used to the clicking? Do you find it annoying?
Or is it a comforting sound after living life previously with a defective valve?

Heart of the Sunrise

 

[ski girl]

I've had one of each, tissue first, which had to be replaced 11 months later due to endocarditis. They're both so much better than my original valve that I wouldn't say I regret either decision - although if I'd had the choice second time I would have gone with another tissue valve - but knowing what it's like to have a mechanical valve now, I'd be less likely to want another tissue valve (I'm 41).

The warfarin isn't a pain, it only needs to be checked once a month once your INR stabilises. I actually check mine less than that as I'm really consistent with my diet and exercise and my INR only wavers about 0.1 - 0.2 (from 3.0). It hasn't impacted on my lifestyle nearly as much as I'd thought it might, despite being a competitve ocean paddler and a really awful mountain biker.

The clicking drove me up a flipping wall for months. Lots of months. There is nothing comforting about it. But now I can sleep through it so I'd say you do get used to them.

All artificial valves are 'powered' by the same thing as your native valve - your heart beating makes them open as the blood rushes out, then they shut.

It's difficult to make a decision on valve type because both choices are really good - and infinitely better than what you have now! At 57 you'd most likely need a re-op in 10-15-20 years if you go with a tissue valve so that may impact your decision. Good luck!

 

[RTZdad]

I have a mechanical valve and taking the medication isn't a big deal. It can be a pain to get your INR levels figured out in the beginning, but once you figure that out (proper dosage according to your diet) it is fine. For the most part, the ticking doesn't bother me too much. I do find it annoying if I have trouble falling asleep. It sometimes gets in my head and makes the situation worse. If I had to do it again, I would still choose a mechanical valve. Personally, although my surgery was a lot of fun (tongue in cheek), I would prefer not to have to go through it ever again. The surgery packs a good punch, but I managed to bounce back pretty quickly. No guarantees that it would be the same next time. I would also add that you don't check your blood on a daily basis when you are on Coumadin. I have an at-home machine but only check every few weeks now that my INR has leveled out. My wife also finds that my ticking reassuring. My advice? Pick the mechanical if everything shakes out equally. You won't have to worry about replacing it any time soon (knock on wood).

Tom

 

[Heart Of The Sunrise]

Thanks, Tom!

I was heavily leaning toward tissue....but can not imagine going through the surgery again.
So now I am leaning toward mechanical. My cardio has chosen a great surgeon and has been speaking to him.
The surgeon prefers the ON-X mechanical. Any buddy have one? I heard good things about them...but that was on their website
I like the on-going FDA studies for lower ant-coag dosage...headed toward 81 MG asprin.

Any real life experience good?... bad?

Heart of the Sunrise

 

[OldManEmu]

Heart of the Sunrise
I did a tissue valve the first time as I was always going to require a redo for an aneurysm. I went with a tissue valve again when the redo was triggered by the aneurysm.
20 days in hospital the first time, 5 days for the redo. I place more emphasis on the cardio opinion as they manage the patient in the long term and deal with patient issues over the course of the rest of their life. The surgeon does the surgery and if it is successful has no long term follow-up or management of patient issues.

 

[dick0236]

I want to feel confident in my decision. Longevity is in the family. My mother is 88 and still enjoying life to the fullest.
I am blessed that my wife is a nurse and will be of great assistance if I go mechanical with regulating my blood.
I assume this is a daily ritual like a diabetic checks their blood sugar levels.

I hear tissue valves last longer in older patients. I turn 57 in April.

Making a "valve" decision solely to avoid warfarin is, in my opinion, "letting the tail wag the dog". There are many good reasons for choosing a tissue valve.....potential childbirth, advanced age, other medical issues.....but NOT fear of managing warfarin. It requires only a simple regimen of taking a daily pill and testing routinely, weekly, bi-weekly or monthly....never daily. For most, it does not require changing diet or activity.....although I did give up my dream of skydiving(LOL). My wife is also a nurse(retired), but I have never needed her to "assist me in regulating my blood". If I were 57 and "longevity is in my family", my bigger concern would be in the second surgery in my 70s or 80s.

 

[Heart Of The Sunrise]

dick026:

This is indeed an interesting journey. I started out thinking tissue but I can not imagine going through surgery again at an older age.
I am starting to get some comfort with the need to take warfarin and regulate my blood. A mechanical valve is now seen as a better solution for me.
One and done!!!! See my other post about my experience at church day...it was awesome!
I appreciate everyone's input.

Heart of the Sunrise[

 

[drphil9001]

Heart,

I am in the same phase and faced with the same choice...I am still up in the air on which type of valve to get. The first surgeon I met with wants to do a tissue valve (I am 46) and he mentioned coumadin management as a factor to not go with mechanical...that plus when I would need a new tissue valve they could do a through a catheter procedure and it would not need to be another OHS. So something else to think of...

Oh, and the kids want me to be a "pig daddy" instead of a "robo daddy" so there is that too!

 

[Cooker]

I think many of us have “what-if-ed” our valve choice ... I went mechanical and when I had to come off of warfarin for a medical procedure I wondered if I should have gone tissue ... the procedure went fine, I’m fine and glad I’m ticking ... warfarin and anti-coagulation has never been a problem ...

Talk to your doctors, listen to you gut feeling and all will be well ... whatever you choose will be right for you.

 

[neil]

remember whatever you choose is best for you,i choose tissue because warfarin is a route i didnt want to take, others dont want a re op, both have they good and bad points anyone saying they dont is naive at best, bottom line is which ever you go with is gonna save your life,

 

[katm]

I too am facing the same decision soon. Wondering if in a choosing a mechanical first that if something went wrong with it and it had to be replaced if getting a bovine is less likely an alternative as a replacement (I've heard this). My doc really made the arguement against mechcanical due to long term side effects of drugs. Yet in reading what I have read it seems less of a problem than I thought. Wish there was a more scientific approach to making this decision.

 

[Lynlw]

dick026:

This is indeed an interesting journey. I started out thinking tissue but I can not imagine going through surgery again at an older age.
I am starting to get some comfort with the need to take warfarin and regulate my blood. A mechanical valve is now seen as a better solution for me.
One and done!!!! See my other post about my experience at church day...it was awesome!
I appreciate everyone's input.

Heart of the Sunrise[

Have you met with a surgeon yet/ I'd probably keep a pretty open mind until you do discuss options with your surgeon/surgeons. My guess since they are being done right now, is that IF you chose tissue now (yes they do last longer in older people the earlier generation Bovine valve with anticalcification treatment something like 80% of people 60 and up still had their valves with good hemodynamics 18 years +..of course thats no guarantee yours would) By the timee THIS valve needed replaced if ever would most likely have a good chance of being replaced in the cath lab and not another OHS. Since Penn has been doingthe percutaneous valve a few years now, they should be able to give good u to date, info on them.

Also mech valve is a good choice altho I'm quoting you above "I heard good things about them...but that was on their website
I like the on-going FDA studies for lower ant-coag dosage...headed toward 81 MG asprin." YES they are doing trials on lower INRs for Coumadin or even plavix and aspirin, but there are NO trials going on that would be aspirin only for mech valves and I dont imaagine there being any in the forseeable future, since the 1 trial in Germany was stopped. There are also alot of things going on with new Anticoagulants that are not Vit K antagonists and dont need blood work, but again they are not for valve patients, just AFIB so far.

Here is an interesting artcile about valve choice differences between 96 and 2006 http://jtcs.ctsnetjournals.org/cgi/content/full/137/1/82#FIG1 And most of those years, the possibility of having their tissue valve replaced by cath, most likely didnt play any role in choice, since there hadnt been any trials even talked about, let alone any approve percutaeous valves, so those choices were made for te most part being pretty sure IF they chose a tissue valve and were younger than 70 they most likely were signing up for at least 1 more heart surgery, altho by then, the success rates for REDOs were already improving quite a bit and tissue valves were lasting longer. On the mech side, Coumadin testing was already being reported as INR, so that helped lessen some of the risks that go along with mech valves increased risks of forming clots so require anticoagulants and everthing that can go along with that.
there is an updated one but dont have the link handy right now

 

[Heart Of The Sunrise]

No, I have not met with my surgeon yet. Agreed I shouldy keep a pretty open mind until I discuss options with my surgeon. I have cath and TEE on 12/4
Follow-up with cardio on 12/18. Then he will consult with surgeon I assume and then I will meet with surgeon and plan strategies and schedule the procedure.

Thanks for your response.

H.O.T.S

 

[2003miata]

I made the choice to go with an ON-X valve for my AVR last year - don't regret it a bit. Warfarin has not been an issue, nor the ticking (it's actually kind of nice, I can take my pulse without feeling for a pulse). One bit of advice - discuss the ON-X valve with your surgeon and cardiologist. I was the first ON-X valve patient for both (I'm still the only one my cardiologist has). It wasn't a big deal, but I was a little bit surprised that neither of them had experience with the valve.

 

[Fundy]

Almost since the start of knowing I would need a valve replacement for sure at sometime I was certain I would choose a mechanical valve. That was Sept 2008.
In October 2011, when I found out it was necessary to replace it now and cardiologist mentioned she would choose a tissue if it were her in my situation, I reconsidered the choice. And decided I would rather a tissue valve. So that's what I got.

The morning after surgery, I did deeply regret the choice. I felt real awful, and not only wished I didn't have to do this again, I felt like I couldn't get through it this time. That morning I did feel like I made a huge mistake.

However, by the end of the following day I felt much better and am once again glad I made the choice I did.

 

[Lynlw]

No, I have not met with my surgeon yet. Agreed I shouldy keep a pretty open mind until I discuss options with my surgeon. I have cath and TEE on 12/4
Follow-up with cardio on 12/18. Then he will consult with surgeon I assume and then I will meet with surgeon and plan strategies and schedule the procedure.

Thanks for your response.

H.O.T.S

Do you have a surgeon in mind? There are quite a few great ones at Penn.
Justin as had most of his heart surgeries at CHOP next door and even tho they are different hospital systems (last i checked at least things change fast lol) alot of his docotrs are on staff at both hospitals and work well togther,for example the Adults with Congenital Heart Defect center, is combined and covers both hospitals, to the point even since Justin was 19 for his 5th OHS, he had a choice of which hospital he'd prefer to have his surgery, well mainly for him recovery at, he chose CHOP, since he knows many of the staff well and since it is for children it is much cheerier place with lots of game systems in each room, and he prefferred to be on a floor with younger adults and children than much older patients. But either CHOP or HUP have many of the best of the best, so we knew even with his complications, he'd do well either center. (after getting 2nd -3rd etc opinions from the top CHD hospitals across the US, alth it helps for PED Heart centers pretty much boston and Philly are ranked 1-2 and then there is quite a drop off as far a results for the rest of them) Oh and since one of Justin's fav things to do is eat, altho youd never know by looking at him, he likes all the food carts outside both hospitals.

 

[Heart Of The Sunrise]

I made the choice to go with an ON-X valve for my AVR last year - don't regret it a bit. Warfarin has not been an issue, nor the ticking (it's actually kind of nice, I can take my pulse without feeling for a pulse). One bit of advice - discuss the ON-X valve with your surgeon and cardiologist. I was the first ON-X valve patient for both (I'm still the only one my cardiologist has). It wasn't a big deal, but I was a little bit surprised that neither of them had experience with the valve.

Thanks,Miata 2003.

I searched the designated surgeon who my cardio is corresponding with and I saw that he may heavily favor the ON-X VALVE. I am still fairly new on this journey. What an emotional roller coaster it has been. Next-up is a cath and TEE on 12/4. I am comforted with the many reports of the ease of having to deal with Warfarin monitoring. I have yet to meet with my surgeon. Being that my follow-up with my cardio is not until 12/18. It is likely that I will meet with my surgeon until January. My cardio group is specifically affiliated with my surgeon and his hospital. All that being said perhaps it will be an ON-X valve. My cardio is excellent!! My research on the surgeon is that he is one of the best on the planet. I will reveal more specifics once I finally meet with him. Although I wonder if I may be a candidate for the Bentall procedure due to the condition of my ascending aorta. I would hope that the ON-X VALVE would be compatible with that procedure? What other valves were you considering and why did you decide on the ON-X? How was your recovery?

Thanks, Heart of the Sunrise

 

[Heart Of The Sunrise]

My cardio has designated one at Penn and is corresponding with him. I hear he is one of the best.

 

[Heart Of The Sunrise]

Heart,

I am in the same phase and faced with the same choice...I am still up in the air on which type of valve to get. The first surgeon I met with wants to do a tissue valve (I am 46) and he mentioned coumadin management as a factor to not go with mechanical...that plus when I would need a new tissue valve they could do a through a catheter procedure and it would not need to be another OHS. So something else to think of...

Oh, and the kids want me to be a "pig daddy" instead of a "robo daddy" so there is that too!

Good point on the TAVR procedure when I would need another tissue valve down the line and not need another OHS. So now I am on the fence again. I am looking forward to my next set of tests, and seeing my surgeon to discuss all the plus and minus aspects of my choices. I appreciate everyones input.

 

[normofthenorth]

We've had a number of people strongly regret their valve choice post-op, and in both directions. A very small minority for sure. Most of us are so relieved to have a solid working valve, and have mostly made peace with our decision, that the downsides of either choice doesn't drive us nuts. A few people have been driven nuts by the clicking, and a couple have responded unusually badly to Warfarin or to stabilizing their INR (though the ones of those I can remember were actually only on Warfarin temporarily, but did so badly that they said "Whew! about choosing tissue). And several tissue folks have had to have re-ops unusually soon, which naturally leads to regrets. Also, a small number of mechanical types chose mech to avoid re-op then had to have a re-op anyway -- almost always because of some reason OTHER than valve failure, which is extremely rare. And on the flip side of THAT coin: it's quite possible to choose tissue to avoid ACT/Warfarin, then have to take it anyway for another reason, including A-Fib. (I think it's On-X who says that THAT outcome is extremely common, but I can't actually recall anybody here reporting it personally. Biased sample maybe?)

So there are no guarantees anywhere, which is one of the reasons the choice is so. . . interesting.

There have been a few studies on mech-valve noise, and the On-X wasn't the quietest. I'm blanking out on the precise name of the one that was quietest in most of the studies, but the company that designed it was taken over by Medtronics, so it's now made and sold by them. It's also called the "ATS Open Pivot" or something close to that, IIRC. One of the guys here chose that valve (over the On-X) after doing a bunch of research and discussing it here. Not everybody agreed with his conclusion, natch. . .

Yup, it's easy to find the ATS Open Pivot and lots more with a Google search -- and Medtronics has even started a web page called http://www.thequietvalve.com/ (!). They've also got some fascinating research that seems to show that their valve is every bit as good with low INR levels as the On-X -- though it' s not as easy to find online as it was a year or so ago. The discussion about the two valves here is mostly summarized at http://www.valvereplacement.org/for...On-X-vs-ATS-open-pivot-The-Truth-is-Out-There .