Aortic Valve Dilemma

[sunroofrt]

Hi, All: Am having valve replacement in NYC mid November and am torn between which valve to choose. My cardiologist, angiogram MD, and surgeon have all recommended mechanical because of my age - 53. Have done research online and also talked to people that have had both kinds of valves. Strong arguments can be made for picking either one.

Mechanical---Pros: only one time surgery; valve will last for life; Cons: Must take Coumadin for life; blood testing weekly/monthly for life; will bruise easily and bleed easier; some people are able to hear valve clicking.

Soft tissue/bovine---only type of soft tissue valve surgeon recommends for me. Pros: No medication and no blood testing needed. Cons: 100% guarantee to need surgery again, at a much older age with possibility of scar tissue and age related complications; Valve can last 15 years but can fail before that, and must live with that possibility at all times.

About me: I'm 53 and play year-round softball, basketball, biking. Also, I am self employed; have food distribution route requiring lifting/delivering food supplies 30-40 lbs. cases up/down stairs.

Dilemma: If I get a mechanical valve, will I constantly be bruised and in need of medical treatment if I get cut or injured during sports and/or work? I have heard a lot of negatives about Coumadin. However, if I go the soft tissue route, in ten to twenty years I will have to have major surgery again, and hope to survive it again.

Regardless of which valve chosen, what's the actual recovery time to be able to return to previous lifestyle--work,sports, etc.? Doctors say 5-6 weeks, but I have heard much longer. Thank you to all who reply, and have a long and healthy life.

Jay

 

[Matt]

There have been many past threads on the both valves. I would say you have to look at a combination of things all of which it sounds like you are doing. Mechanical would be the conservative route while tissue valves are usually chosen when one is banking on new technology in the future when the replacement will be needed.
As far as returning to normal. I can only tell you that I am 6 weeks post op and though I can sit at a desk, any lifting of any weight is still out of the picture. I have learned that we all respond differently to OHS but the one thing in common is time.... lots of time to get back to.
Matt

 

[tobagotwo]

Coumadin is not the horror story that some would have you believe. However, it's also not as simple and carefree as it's sometimes depicted, either.

You are truly at an age where the crux is whether you will live with the minor inconveniences and small risks with daily Coumadin or with the knowledge that you will face the operation again.

With a carbon valve and Coumadin, you will likely not be a mass of bruises from your sporting endeavors, and your likelihood of deciding to visit a doctor or ER for a bleeding issue is probably only once in 20 years or more. In some instances, you should be more careful than non-ACT patients to avoid concussions, although it has been my experience that most of us avoid them anyway. Maybe you wear a helmet more often, instead of going commando.

Assuming your aorta doesn't find a new place to bulge, if you have a minimum amount of personal discipline for daily routines, can handle the occasional uncooperative dentist or extended process for colonoscopic or other testing, and don't mind dealing with labs and blood tests in between your home testing, you will probably avoid another chest-cracking. That's nothing to sneeze at (especially right after the operation).

On the other hand, at our age, I would expect the CEP (the bovine valve he was referring to) to last longer than 15 years. It had a 90% rate of lasting 20 years for 60-year-olds even before it had anticalcification treatments. When a tissue valve is used, there is a very good likelihood of physically being essentially normal (and unencumbered) for the next 15+ years. But with it goes a definite re-parting of the ribs and recutting of the heart eventually, and the perils and recovery that go with it.

Statistically, your survival odds are nearly the same, either path you choose. I was 52. I chose tissue, and would again. Let it never be said that we make it easy to decide...

Best wishes,

 

[Jay F]

Its a tough one.

Its a tough one.

As long as you make a desicion and dont wait too long to be in danger of irreversable damage, that is key. I am 44 and exactly 1 month post op today. I chose a tissue valve. I am a strong believer in technology generally and medical technology. Fortunately I had my aortic valve replaced using the minimally invasive technique where they went in through a horizontal incision 3 inches above my right nipple. ( NO STERNOTOMY) I am walking 3-4 miles per day, went back to work 3 days ago, in the IT field. I am also a professional drummer and played my 1st gig last night since surgery till 2:00 am which consisted of 3, 60 minute sets. The music was from 60's - current, funk and soul to very hard fast rock. I did not miss a beat and was shocked as to how much energy I had. It is amazing. Most people who know me are amazed too. I will be on Coumadin for just a few more weeks and then will be switched to asprin. I figure that in 20 years (when I'm 64, (sounds like a song)) there will be even better techniques. Either way is a crap shoot. I had a difficult time deciding just like you. I must say, I never thought my recovery would be so quick and would not change my decision if I had to decide again. I wish you luck and peace toward making a decision. By the way, I can now sleep on my sides and stomach..........amazing. Please email me if you have any questions.....Jay

 

[belajob]

valve decision

valve decision

I went through alot of anguish trying to make the best decision I could- tissue or mechnical. I was 56 and played alot of tennis. I choose mechnical and had the on-x valve. There is alot to be said about what technical advances will be made by the time you might need another surgery. OHS is not easy- but if you have the chose of the minimal invasive surgey, I would vote for that. I returned to tennis in 3 months post op- kinda slow at first but I am back playing 3-4 times a week. Just make the best, informed decision you can - and good luck!

 

[Kate]

Hi Jay!
I agree with everything posted above and chose a bovine valve for my aortic replacement at age 38 (younger than usually recommended, but it made sense for me based on a variety of factors, including living in a rural area with limited health care, dislike of routine required by coumadin, etc.) I'm very happy with the choice I made, but noticed in your post that you are self-employed. Do you have to buy your own health insurance or are you covered under a spouse's plan? If you are buying your own health insurance, I strongly encourage you to look into how this surgery will impact the cost of your coverage before deciding which valve to choose. Others on this forum have had issues with getting / keeping health insurance and, although this was not an issue I dealt with, I imagine the specifics of your coverage plan could effect whether it makes more sense to take on the on-going drug / testing costs related to Coumadin or the huge one-time cost of another surgery.

As stated above, the recovery time for OHS seems to vary widely. I was back at work within 4-6 weeks (no longer remember exactly ) but didn't feel like I had my full energy and stamina back for about 10 months. Best of luck! Kate

 

[JimL]

Jay, I think you have a good handle on the vairous reasons for choosing one valve over the other: it remains your decision.
If you have a sternotomy, you don't want to break that open; I was told it takes 2-4 months for the sternum to heal up, but I've heard lots of different figures. You definitely want to be careful with the lifting for a while.
In 5 years, I haven't noticed any bleeding issues on coumadin, nor any bruising issues, but people are different there. I still get cuts all over and can't remember how I got them. I occasionally get bruises, and can't remember how I got them either. Perhaps the memory issue is a bigger problem, but that comes with either kind of valve.

 

[Dan Campbell]

Jay:

I had a St. Jude valve replacing my natural aortic valve in 1998, when I was 60 years old. My decision was based on my age...I did not want them to saw my chest open at the age of 75.

The coumidin issue is a constant annoyance, in that you have to have monthly checks at the minimum, and sometimes more freguently. However, I have not noticed any serious bruising problems. But with the mechanical valve, you must use coumidin.

You are somewhat younger than I was, so maybe you would choose a natural valve, and then face a second surgery in your late 60's. I think a mechanical valve lasting a lifetime (hopefully) is a good choice for someone close to 60.

Regarding recovery time.....forget about being back to work in a month. I was very weak for the first 2 months, and did not feel 100% for close to a year. You are a younger man, so it probably will not be as slow for your recovery.

Other than that, I am a happy healthy retired guy living the good life in Florida...working out on a regular basis in between my 3 or 4 golf games each week.

Good luck in your surgery. Your choice will be the right one.

Dan

 

[Susan BAV]

I can't imagine lifting that heavy of a weight that quickly after having your sternum sawed in half and wired back together! I still have strong discomfort, three years out, just lifting those big cases of small water bottles from Costco, that I didn't have pre-op (although I have wondered if some of the discomfort is just in my head). But I feel CREAKY now in the sternum when I lift heavy stuff. I used to barely be able to load a 45 pound box of bird seed out of those deep carts at Costco and heave that monster into the back of my SUV pre-op, but I ask my husband to pick up the heavy stuff now.

Also, my surgeon didn't want me driving for eight weeks post-op although I don't think most other Valvers waited, or were even supposed to wait, that long.

The valve decision is a big one. One suggestion that I read here was to find a surgeon that you are really comfortable with and let him know your issues and see what he recommends. I absolutely wanted a tissue valve though and I was 42. But remember that tissue valves don't guarantee that you won't have to be on Coumadin. I have a paternal uncle, who's about 74 I think, who has been on Coumadin for well over 20 years for perpetual A-fib and he still has his own mitral and aortic valves (although they were repaired those decades ago).

 

[KMS]

Welcome

Welcome

Hey Jay,

Welcome to our group.

Six months ago I faced the same decision you're making right now. I'm 43, very active (golfing, running, hiking) and was essentially asymptomatic. The diagnosis was a bolt from the blue, so I spent the long month before surgery reasearching websites, talking to medical professionals and ultimately making that difficult valve decision.

You clearly see the pros and cons of the choices. I opted for the tissue valve mainly because I couldn't get comfortable with the clicking noise of the mechanical valve and the routine of Coumadin. The only medication I'm on is an aspirin a day. I'm very happy with the decision I made.

The recovery is what you'd expect: a couple of very blurry, drug-induced days, followed by lots of resting and walking (aided by great pain management...I felt more soreness and discomfort as opposed to pain). The worst for me was trying to get comfortable sleeping during that first month. Cardiac Rehab was terrific; I highly recommend it. I felt pretty much back to normal after a couple of months (I resumed jogging after 12 weeks and it felt terrific).

I wish you well as you make your choice, Jay. Once you've made peace with your decision, move forward and prepare for a good, positive recovery. You'll do just fine.

Best regards,

Kristine

 

[temp69]

Hey J:

am 55, went with on-x mechanical. good backup stats...in case your coumadin doseage isn't right on or something, patients in south africa who don't use coumadin don't clot...at least statistically speaking so far.

at your age, surgeon will most likely opt for mechanical. i'm 4 months post op with mechanical and coumadin is just another pill to take.

I wish I didn't have to take it, along with lipitor, etc. But the meds bring numbers down (cholesterol, etc.) -- so no biggie. Don't seem to bruise easily, I did when I first got out of the hospital, but not now.

So...if you do the tissue, most likely you'll have to do it again. And...I would try to avoid it. email me if you like...

t

 

[sylviayasgur]

hi jay,
welcome to this great site.
i see you live in nyc. you have some of the best doctors/surgeons right in your backyard!!!
who is doing your surgery and where are you having it done?

in the end, this surgery will save your life. please try to realize and remember that no matter what valve you end up selecting (and it's a very personal choice), it will be the right valve and will save your life.
it's amazing what we can get used to... my father takes coumadin for his mechanical av and chronic afib, and he has no problem living with it whatsoever. my husband, joey, was very very anti-coumadin and opted not to go mechanical. again, i think it's amazing what we can learn to get used to (especially if you have to and it is saving your life).

please let us know what you decide to do... educate yourself (it's very empowering) and meet with several surgeons... get a feel and different views from the pros.....

stay well and keep us posted,
sylvia

 

[ALCapshaw2]

I can understand your interest in the Bovine Pericardial Vavle. That was my First Choice but complications required a mechanical valve.

I suggest taking a hard look at the On-X third generation mechanical valve which has improved fluid dynamics and a lower propensity for clot formation. Studies are underway for reduced Anti-Coagulation regimens using either reduced INR range for Coumadin patients or Aspirin Only Therapy for Low Risk patients.

See www.onxvalves.com or do a SEARCH for On-X to see the considerable discussion on this valve. Their contact person can tell you what surgeons are implanting their valves.

'AL Capshaw'

 

[MarkU]

Valve selections is really an individual choice and all I can do is share my own experiences.
I got a mechanical six years ago at age 47, primarily to minimize the risk of having future surgeries. I continue to lead a very active lifestyle; I took up triathlons four years ago after my cardioloigist encouraged me to do more aerobic exercise as opposed to the weightlifting I had been doing prior to surgery.
Coumadin has not been a major issue for me. My INR has been relatively stable and I only need to be tested every 6-8 weeks. I've not had any significant problems with either bruising or bleeding (even after a 20 mph bike crash earlier this year). The only major inconvenience was doing a Lovenox bridge prior to my colonoscopy last year - something I unfortunately need to do again next spring.
Good luck,
Mark

 

[Sir Reel]

I was 47 when I had my valve done and have a tissue for the reasons many others cite - I am highly active (biking, tennis, fishing, other outdoor activities, busy around the house with various tools, etc.) and prefer no coumadin at the cost of a return visit to the surgeon.

One thing you can take comfort in is that people on the forum are happy with their choice of tissue or mechanical, so you can't make a bad choice (and, as noted above, the valve is saving your life). I don't recall any posts where someone says they wish they chose mechanical over their tissue or vice versa.

My surgeon told me 2 two years ago that my model tissue valve is still going at 12 years in 98% of patients. Thus, I am hoping the 15 year expectancy typically cited for tissue valves is lengthening as the valves get better and is longer for someone otherwise active and in good health. Also, let's hope the minimally invasive route becomes standard over the next 10 years. Finally, other than the pain of recovery, I don't think the risks of a second surgery are particularly greater than the first one for someone who is active and otherwise in good health and who has a good surgeon. While it is a major surgery, it is fairly common and the mortality rate is pretty low (1-2-4% range). I suspect if you are in your 40s and in good health, the rate is very low.

I started riding my bike again in my third week (indoors on a trainer), was playing tennis at 9 or 10 weeks, and otherwise recovered pretty quickly although I remained unusually tired for about 6 months. I was back at work at week 5. Having said that, I will be surprised if you will be able to perform your delivery functions in 5-6 weeks, particularly for more than a couple of hours a day. Your sternum will be in pretty good shape at 6-8 weeks (I think it is about 80% healed, with the remainder taking many months/up to a year), but you are likely to tire easily.

 

[catwoman]

Jay:

I was 1 month shy of 53 when I had my MVR. I chose a mechanical.
It takes about 6-8 weeks for the sternum to heal, but it takes much longer than that to return to "normal." The left side of my heart had become enlarged, so it took me at least 8-10 months before I no longer experienced periods of fatigue (i.e., from weekend travel, not enough sleep, etc.).

I take warfarin & home test. No problem. Not much problem with bruising. I don't bleed any more than the next person. I may have to apply a little more pressure to stop bleeding, but it's not a problem. I carry antibiotics with me when I exhibit or judge at cat shows, to protect against bacteria; however, anyone who's had valve replacement should do the same, not just those with mechanicals.

I would caution anyone facing OHS:
Ride in the back seat until your sternum is completely healed!
Don't just put a pillow between your chest & the seat restraint and jump into the front seat.

My husband's car was hit head-on in early December 2005. (Other driver was at fault.) His car was totalled, the airbag went off & his sternum was fractured. It was quite painful. He was released by our PCP in late February.
Less than 7 months later, he was diagnosed with mitral valve prolapse during his yearly physical. He now sees my cardiologist, who believes the problem is due to "deceleration trauma" from the car crash, that the chordae may have been damaged during the crash and later ruptured. He had an echo + CT scan in October and in January will have another echo + ultrasound + nuclear stress test.
He says if he has to have MV surgery, he'll have it and will probably go mechanical. He's seen me and his dad go through it (twice, tissue valves, 10 years apart).

Most people jump -- well, they do it somewhat gingerly -- into the front seat immediately post-op. Few people will consider the "what ifs."

 

[Susan BAV]

That is a good reminder, Marsha. My surgeon was concerned not about the seatbelt hurting me but about the airbag hurting me. He told me to ride with a pillow in front of my chest for the first eight weeks post-op and I put the seat all the way back also. About two and a half weeks, post-op, I HAD to drive one of our cars when we were evacuating from a wildfire and I was really surprised about how unpleasant all the steering was from shoulder to shoulder across the sternum. I have read on this site about lots of other valvers who drove VERY soon after their surgeries, and I just scratch my head and wonder, "why take that chance?!"

 

[sunroofrt]

Aortic Valve Replacement Dilemma

Aortic Valve Replacement Dilemma

Thanks to everyone who wrote to me. I have read all of your stories and appreciate all of your input. Will make my final decision any day now and let you know. Thanks again, and will talk soon.

Jay

 

[sfconstrct]

valve update

valve update

I am a or was a 50 year old male. Very athletic play full court basketball or surf almost daily, also a gym rat.

Had an avr about 7.5 months ago, March 16th to be exact. Went well went tissue. Didn't want to go blood thinners and change my lifestyle, surfing, snow sking, didn't want the helmet etc.

I believe the key to recovery depends on the shape you are in.

I was in the gym the day before surgery. Within two weeks I was walking about a mile on hilly terrain. California.

By the second month I was walking 3 to 4 miles and some stairs.

Started rehab 16 weeks, blew through that was running the full 18 minutes at 4.5 miles per hour with not alot of effort.

Was back on the court in month 4 and in the water as well.

Not trying to brag just want others to know I feel that if you are already in good health that the surgery and or recovery wasn't that bad.

AS for the valve didn't want to severly alter my lifestyle, however I am hoping to get 15 to 20 plus and hopefully by then they won't be going through the chest then, that is what I am banking on.

Hope this inspires and helps.

Steve in So Ca.

 

[MrP]

At 50, I chose a mechanical aortic valve with composite Dacron graft (BAV, aneurysm), and like sfconstruct (Steve...tissue valve), I was in good physical shape prior to surgery and continue to work out nowadays...running 2 miles daily at 4.9 mph. I am active also...play golf, backpack, camp, swim, some surfing, and plenty more (haven't lost my sex drive). Although I drive my car at fast speeds sometimes, I have decided to give up downhill skiing to avoid possible head injury. While coumadin and the ticking are indeed negatives, I'd choose this again in a heartbeat as opposed to having another major open heart surgery hanging over my head with certainty...just another perspective to consider.