Anyone wish they had chose the other option?

[Julian]

If your a praying man I would seek God on the decision. You probably wont have a problem with warfarin, but you might... You probably wont have a problem with your tissue valve wearing out too fast, but you might... You probably will have an average recovery from the surgery, or it might be rough...

I don't know why doctors wouldn't prescribe a test run of warfarin for patients that are planning on getting a mechanical valve in the future. Be on it for 3 to 6 months to see how the rest of your life will play out. If you don't respond well to therapy then we know that tissue may be the better choice for you...

Personally for me the surgery was bad. I had an average recovery but the toll it took on me mentally was rough. I was glad I went mechanical even though the ticking took awhile for me to get used to. There is no telling how much the ticking/thumping will bother you. As I'm typing this I'm ticking. Sometimes its louder than others.

Many people began to feel great at about 3-6 months post op... It took me over a year, I'm now 1 year and 4 months and I can say I feel better now than I have in 10 years and I'm 29 years old...

Again... If your a praying man seek God on the best choice. At 57 your at that "sweet" spot where you can go either way.

By the way, I never had any heart rhythm issues my whole life but because a complication of the surgery I needed a pacemaker, not common about 5% need a pacemaker after AVR. I'd say the pacemaker is more of a pain than the warfarin. :thumbd:

 

[Julian]

Oh ya forgot to mention, I'm running on the treadmill like a beast now, doing 20 miles a week. Might not sound that impressive but this is coming from a person that couldn't jog a mile ever in my whole life. God and science is amazing...

 

[Heart Of The Sunrise]

Julian: Thanks for the response. I began this journey completely against a mechanical now I realize an open mind on selection is best, especially since I have yet to have my heart catheraztion and TEE or meet my surgeon.. God is already at work in my life. There is a chain of significant life choices and events that played major roles in finally discovering this. Got divorced in 2005....the new woman in my life is a nurse...she had the idea of changing my primary physician.....he discovered my left bundle branch block which has led to learning about my bav and dilated ascending aorta. Add to this her son is an invasive cardio-vascular tech....that is how I got connected to a great cardio.....who has referred my case to one of the best surgeons in the world..who just happens to be based out of U of P in Phila. Then this happen on Thanksgiving:"Wow, what a day! God has truely been at work in my life for the last 7 weeks. My hope and faith for a better life after surgery has never been stronger! We just got back from our new church's Thanksgiving morning service. We had never been to a Thanksgiving Day service there before.
As we were leaving a couple about my age commented on my Penn State University jacket. They also stated that they had been members of the church
for years and had never attended a Thanksgiving Day service before. I told them that I was there to give thanks that I had finally learned about my BAV and dilated aorta and was having surgery real soon. They said that there son had AVR 6 years ago and was doing fine. So I said.. "where did he have the surgery".. They said.....the same hospital ...and the same surgeon... that I will be having...they could not have praised the hospital or surgeon any higher... so we are now going to correspond as I go forward on this unexpected but critical journey upon which I am now embarked.......AWESOME!!!!!! " What made you go with the ON-X as opposed to another valve?

 

[Heart Of The Sunrise]

Julian: I assume that I too will need a pacemaker to resolve my complete LBBB. I now know of the Valsava Graft , I already know what the Bentall procedure is.
I may be a candidate for a VG as opposed to a more basic dacron wrap. My goal is to know many of my options before my meeting with my surgeon. I want to feel confident in the making of theses choice which impact the rest of my life.

Peace,

Heart of The Sunrise.

 

[neil]

hi, am not a doctor as none are on here that i am aware, but i have lbbb and dont have a pacemaker, cardio said i can live with it and will cause me no problems, maybe there is some cases what are worse than others ?

 

[bstew7890]

I like the ticking. It's never kept me up at night. Coumadin has been a piece of cake for me. Checks every 4-6 weeks. If I lived in a rural area without a coumadin clinic it might make a difference for me...

 

[ElectLive]

This is an interesting thread...with an even more intriguing title. You know, there is a somewhat famous quote by Oliver Goldsmith, an Irish poet: "A great source of calamity lies in regret and anticipation; therefore a person is wise who thinks of the present alone, regardless of the past or future."

Now, more relevant, a very wise member of our community here once said something to the effect of this about the valve selection process: "Everyone swings at the best pitch they see. It may be a home run, or it may be a pop fly, but no matter what, it was the right decision to swing."

Ok, now here are my two cents. Chances are, if before you'd done any homework, you'd been presented with only one option by a surgeon, no matter which one, you would have been very pleased. Instead you have a choice, two good choices in fact, and therein lies the dilemma. This is not 2+2=4 math we're dealing with either. This is 2x+3y-4z ~ etc etc. For every variable you consider and base your decision on, there might just be another variable down the road that changes everything. Life just works that way sometimes.

I'm fairly young so somewhat at risk of my new valve not lasting very long. I knew that going on, and I know it now. I haven't wavered at any point along the way though, crazy as that sounds since I'm pretty much guaranteed at least one more opportunity to have my heart stopped, assuming some other fate doesn't intervene first. Well, once I made my decision, that was my present, no looking back. Whatever happens from here on out, I'll deal with it just like I dealt with my last valve, which just so happened to be my own. See...I didn't get to choose that valve. I was born with it. But what's the difference really? Pretend for a second I had chosen a bicuspid aortic valve. Well, on one hand, I might have made it my whole life without intervention. On the other hand, I could have had surgery much sooner in life also. There's just no guarantees with anything, some just have better results than others, whether it be luck, fate, or whatever.

If my valve needs replacing tomorrow, I won't regret it. I made the best decision for my particular circumstance with the available information at the time. This valve of mine is a part of me now, we're in this together. I'm going to back it up and hope it does the same for me! :thumbup:

Now, I've kind of strayed a bit from the much more medically inclined posts above me. I've been known to do that quite a lot to. I just thought it was important to speak to the big picture of things as well. It's a very hard decision for all of us, but no matter what, you should expect nothing but good results from your decision, and no matter what you choose, it will be the right decision for you. Best wishes to you and hope you hit a home run!

 

[DMS]

There is a great study done by the U of SC of a 25 year follow-up of some various mechanical valves. You can Google query to find it easily. Good information, easy to understand and reassuring if you are concerned with valve failures. Of the thousands of patients in the study over 25 years, there were no mechanical failures! Valve choices are personal. My choice was heavily influenced by not wanting to do it again if possible. Basic odds were an influence also. If 93% successful with no events is a pretty good and accurate number, then you know that multiplying it and adding 20 years of age will definitely result in a lower percentage. Still good, but lower. I went with the higher number.

I can hear it, but mostly not. It does not bother me after 8 weeks. My INR has been stable for three of those now and I test once a week and plan to do home testing as soon as I can arrange it. The surgeon and GP are both advocates. The valve I chose has a target INR of 1.8-2.5 and is one of the reasons for the choice. The pivot design has a mechanical cleaning action that results in less thrombus forming situations.

Good luck with whatever you choose and be confident. It is all an adventure.:thumbup:

 

[Julian]

Julian: Thanks for the response. I began this journey completely against a mechanical now I realize an open mind on selection is best, especially since I have yet to have my heart catheraztion and TEE or meet my surgeon.. God is already at work in my life. There is a chain of significant life choices and events that played major roles in finally discovering this. Got divorced in 2005....the new woman in my life is a nurse...she had the idea of changing my primary physician.....he discovered my left bundle branch block which has led to learning about my bav and dilated ascending aorta. Add to this her son is an invasive cardio-vascular tech....that is how I got connected to a great cardio.....who has referred my case to one of the best surgeons in the world..who just happens to be based out of U of P in Phila. Then this happen on Thanksgiving:"Wow, what a day! God has truely been at work in my life for the last 7 weeks. My hope and faith for a better life after surgery has never been stronger! We just got back from our new church's Thanksgiving morning service. We had never been to a Thanksgiving Day service there before.
As we were leaving a couple about my age commented on my Penn State University jacket. They also stated that they had been members of the church
for years and had never attended a Thanksgiving Day service before. I told them that I was there to give thanks that I had finally learned about my BAV and dilated aorta and was having surgery real soon. They said that there son had AVR 6 years ago and was doing fine. So I said.. "where did he have the surgery".. They said.....the same hospital ...and the same surgeon... that I will be having...they could not have praised the hospital or surgeon any higher... so we are now going to correspond as I go forward on this unexpected but critical journey upon which I am now embarked.......AWESOME!!!!!! " What made you go with the ON-X as opposed to another valve?

I chose the ON-X valve based upon the clever marketing campaign they have... LOL! I thought I understood the basic statistics of the ON-X valve VS the competition. After surgery I found out the positive stats of the ON-X may have been sensationalized.

Truly one thing that really sold me on the ON-X was the fact that a small percentage of people develop what is called pannus growth over traditional mechanical valves. In short the ON-X has built in protection against this, and from my readings there has not been one reported case of re-op with an ON-X valve because of pannus.

Before surgery I was also sold on the fact that the ON-X valve had the best design to avoid blood clots. The Proact study was a big plus, proved that ON-X was confident in their design enough to pioneer the low anticoagulant therapy option.

After surgery comparing statistics with a better understanding it seems as though all the modern valves perform about the same depending on what study you read and who funded the study. Deep down inside I truly think that the ON-X valve has the most advanced design at the moment but I don't think its enough to say its the clear choice as far as blood clotting is concerned.

When I chose mechanical I wanted to avoid another surgery as much as possible, it was the pannus defense that really tipped the scales for me, the proact study and yet to be proven superior clot performance was a bonus.

I know people have mixed reactions to the heart lung machine and some say its harmless but I basically felt some similar symptoms to a concussion for several months after surgery (forgetful, mood changes, forgetting how to spell simple words and names, forgetting peoples names, missing words when I would type or write). I've had 2 concussions in my life and after you have one sometimes you ask yourself if the way you feel/think after a concussion is normal or just the "new normal" after you've taken a blow to the head. I found myself asking this question again for a third time after surgery. I'd like it to be the last time I ask myself this question if I can.

God Bless you man. May The Shalom, Shalom (nothing missing, and nothing broken) of God Bless you.

 

[Rachel]

I just LOVE this post ElectLive,

IMO - Really does give the big picture!

Rachel

This is an interesting thread...with an even more intriguing title. You know, there is a somewhat famous quote by Oliver Goldsmith, an Irish poet: "A great source of calamity lies in regret and anticipation; therefore a person is wise who thinks of the present alone, regardless of the past or future."

Now, more relevant, a very wise member of our community here once said something to the effect of this about the valve selection process: "Everyone swings at the best pitch they see. It may be a home run, or it may be a pop fly, but no matter what, it was the right decision to swing."

Ok, now here are my two cents. Chances are, if before you'd done any homework, you'd been presented with only one option by a surgeon, no matter which one, you would have been very pleased. Instead you have a choice, two good choices in fact, and therein lies the dilemma. This is not 2+2=4 math we're dealing with either. This is 2x+3y-4z ~ etc etc. For every variable you consider and base your decision on, there might just be another variable down the road that changes everything. Life just works that way sometimes.

I'm fairly young so somewhat at risk of my new valve not lasting very long. I knew that going on, and I know it now. I haven't wavered at any point along the way though, crazy as that sounds since I'm pretty much guaranteed at least one more opportunity to have my heart stopped, assuming some other fate doesn't intervene first. Well, once I made my decision, that was my present, no looking back. Whatever happens from here on out, I'll deal with it just like I dealt with my last valve, which just so happened to be my own. See...I didn't get to choose that valve. I was born with it. But what's the difference really? Pretend for a second I had chosen a bicuspid aortic valve. Well, on one hand, I might have made it my whole life without intervention. On the other hand, I could have had surgery much sooner in life also. There's just no guarantees with anything, some just have better results than others, whether it be luck, fate, or whatever.

If my valve needs replacing tomorrow, I won't regret it. I made the best decision for my particular circumstance with the available information at the time. This valve of mine is a part of me now, we're in this together. I'm going to back it up and hope it does the same for me! :thumbup:

Now, I've kind of strayed a bit from the much more medically inclined posts above me. I've been known to do that quite a lot to. I just thought it was important to speak to the big picture of things as well. It's a very hard decision for all of us, but no matter what, you should expect nothing but good results from your decision, and no matter what you choose, it will be the right decision for you. Best wishes to you and hope you hit a home run!

 

[Heart Of The Sunrise]

Thanks to all who posted pn my thread...your input has been thought provoking and comforting.
This coupled with the input from the pastors and members of my church I will make the wise decision when discussing options with my surgeon.

Heart of the Sunrise

 

[Duffey]

I picked a tissue valve for my replacement at the age of 53. Seven years later, my valve is doing great, and there have been no regrets.

 

[chaconne]

I don't know why doctors wouldn't prescribe a test run of warfarin for patients that are planning on getting a mechanical valve in the future. Be on it for 3 to 6 months to see how the rest of your life will play out. If you don't respond well to therapy then we know that tissue may be the better choice for you...

My cardio actually did offer to do this for me a few months pre-surgery. My dad ended up taking temporary Warfarin during that period, for his hip replacement, so I figured I would do well since he did and opted out of the trial run.

 

[blackdodgepu]

I wasn't really given a choice. I was 29 when I had my surgery. When my wife and I met the surgeon I had reservations and concerns about the mechanical and even asked for a tissue valve. The surgeon looked at me and asked "why"? I told him it was because I didn't want to be on blood thinners forever, it would alter my lifestyle too much. His next questions caught me off guard a bit, he asked "do you eat spinach for every meal?" Of course my answer was no and he said "then you probably won't notice a difference."

He was right, I haven't noticed a difference. I take my medication and I got the largest valve they make so there is a chance that in a few months I might not have to take warfarin anymore.

There are nights when the ticking of the valve keeps me awake but that will fade the more and more I get used to it. I am happy with what I got and wouldn't change a thing.

 

[escargome]

He was right, I haven't noticed a difference. I take my medication and I got the largest valve they make so there is a chance that in a few months I might not have to take warfarin anymore.

Maybe since I have a tissue valve I don't quite understand this. I thought that once you got a mechanical valve, you would take warfarin for as long as you had that valve regardless of valve size. Am I incorrect:?

 

[pellicle]

my own addition to this is that I now have a mechanical after a valvotomy, a homograph, and now a mechanical I can assure you that the trauma of repoeration + risks of post operative infections + the stresses on your family do seem rather trivial in comparison to warfarin.

Further with a modern valve like my ATS or the On-X it would seem that evidence is emerging that current anti-coagulation is perhaps unnecessarially conservative. Google the On-X trials in south africa where very good results were obtained in a cohort with "none" or "inadequate" anti-coagulation therapy.

I for one would like to see those results compared with data for thromobembolyitic events in tissue valves which traditionally do not require anti-coagulation.

So in summary I have a clicker and am totally certian that I do not want to have a disposable tissue valve rather than this one.

I would only prefer my own to have been tricuspid from the start.

 

[pellicle]

This coupled with the input from the pastors and members of my church I will make the wise decision when discussing options with my surgeon.

give greater credence to the surgeons than to your pastors.

They may give you good spiritual guidance but leave the technical stuff to the engineers

 

[pellicle]

Truly one thing that really sold me on the ON-X was the fact that a small percentage of people develop what is called pannus growth over traditional mechanical valves. In short the ON-X has built in protection against this, and from my readings there has not been one reported case of re-op with an ON-X valve because of pannus.

I understand that the ATS also posesses this. Further I have read that any of the pyrolytic carbon valves have good thromboembolytic properties. Also from reviews I have read the flow dynamics of the ATS valve on the closing are lower velocity and less likely to trigger platelet formations.

My surgeon took the choice based on the ATS having a pre attached aortic riser, and since I also had an aneurysm that tipped it in that direction.

 

[Duffey]

I really think it is hard to determine how one is doing with a valve until you're 5-6 years down the road. Many say that they've had no trouble with coumadin, but then they've only been on act for a few years. On the other hand, a member may say that they've had no trouble with their tissue valve, but no one expects a tissue valve to wear out in only a few years. There are no easy choices to be made by relying on one thread. I'd encourage you to read extensively in the Post-surgery Forum to see how members have fared with their replacement valve with the passage of time.

 

[pellicle]

I really think it is hard to determine how one is doing with a valve until you're 5-6 years down the road. ....

just wished to +1 this post