Avr #2

[tom in MO]

I was told by my cardiologist and surgeon that a mechanical valve will out last me at age 55 when I had an AVR. I've read that many places. If you have a doctor who tells you otherwise, they should have a reason specific to your body as to why this is not true.

It's great being on the cusp of new technology, but when it's your heart valve, it's a risk that should have a good personal payoff. The payoff of TAVR when they were first introduced was less trauma, but at your age that's not as big of risk as if you were 70 and riddled with other disease. Maybe the other pay off is an easily replaceable tissue valve and thus no warfarin. It used to be if your tissue valve went bad quickly, you went mechanical to avoid successive valve replacements.

Per "This particular hospital and these particular specialists seem to be pushing me toward the TAVR and I am suspicious that maybe they aren't considering what is best for me and are more concerned with what is best for the general public as a whole."

• Don't forget surgeons and hospitals get paid to do clinical trials. I believe they get paid per patient signed up for the trial.
• A clinical trial also increases their worth to the hospital and their overall prestige which can give a higher lifetime salary. Clinical trials and being "leading edge" are marketing tools for both doctors and hospitals.
• A mechanical valve is "one-stop-shopping" and you will never see the surgeon again, unless something new happens. TAVR in your situation sounds like you'd be back every 8 years for the next 40 years (5 replacements.)

 

[pellicle]

I was told by my cardiologist and surgeon that a mechanical valve will out last me at age 55 when I had an AVR. I've read that many places. If you have a doctor who tells you otherwise, they should have a reason specific to your body as to why this is not true.

to provide evidence for Tom's assertion:

https://www.sciencedirect.com/science/article/pii/S0735109710011964

Very long-term studies have shown good outcomes with virtually no Structural Valve Deterioration (SVD) with the:
* Starr-Edwards valve up to 40 years ,
* the Medtronic-Hall valve (Medtronic, Minneapolis, Minnesota) up to 20 and 25 years,
* the old Bjork-Shiley valve ,
* and with St. Jude Medical valves

his other points are not insignificant factors in understanding their motivations in presenting data either (and those motivations may not be your best interest)

​

 

[Protimenow]

I'm in agreement with those suggesting a mechanical valve. I had a St. Jude aortic valve implanted with I was 41 years, one month old. At that age, my surgeon gave me little choice - a mechanical should keep working as long as I live (and he didn't mention dying because my valve stopped working) but a tissue valve would only last 10 - 20 years. The surgeon didn't recommend tissue valves to anyone under 60 or so, with a lower expectancy of outliving the tissue valve. This logic still seems pretty reasonable advice.

We've had people on this forum who had mechanical valves and were still extremely active - mountain climbing, cycle racing, and a lot of other things that you wouldn't expect someone on coumadin would do.

There's a lot of nonsense that still continues to be written about being on coumadin/warfarin. Sure, bruising can be more intense than it is for those not taking warfarin, but it's not the terrible thing that a lot of people assume that it is.

I've been taking warfarin for more than 20 years - putting me in a 'don't trust anyone over 60' box that Pellicle mentioned. You can (probably) trust me.

Self-testing and either self management (if you learn some of the basics) of dosing, or trusting a doctor or clinic that SHOULD know what they're doing can reduce your risks of problems that can happen if your INR is out of range.

Meters do a good job, and new ones come out every few years (a new one was released on Monday). The current meters can help you keep your INR in range.

If it was me, at your age again, I'd still go with a mechanical valve.

Although they're still working on better procedures for heart valve problems, it's not clear when an advancement will come out to help YOU. Also - I'm sure that the drug companies are continuing to work on anticoagulants that will work with mechanical valves and not require testing. (And the testing really isn't that big a deal, anyway)

If these guys talked you into a tissue valve at age 37, I'd wonder about their judgement You might seek either a second opinion or, maybe better, some other surgeons.

 

[epstns]

I'm really surprised to read/hear that Dr. McCarthy is "pushing" TAVR for a young patient. He did my AVR in 2011, and at that time he left the tissue vs. mechanical valve choice up to me. I was 63 at the time. We discussed that TAVR might "some day" be a viable choice, but it didn't play a role in my decision-making. Dr. McCarthy was then one of the top AVR surgeons in the country, having recently been recruited from Cleveland Clinic, and having worked as a member of the development team which designed the Edwards Pericardial Valve.

Did you (the OP) perhaps spin the conversation toward TAVR by bringing up a question like "Is there any way I can buy some time until my children are older, etc.?" That could have brought them to believe that the patient didn't want to undergo traditional OHS at the present time, perhaps bringing up the TAVR trial as a means to hold off the traditional surgery for a few years.

All things considered, I would tend to agree with the others in that a modern mechanical valve would likely be the patient's best option for long-term lifestyle management and freedom from explant.

 

[Eva]

I'm really surprised to read/hear that Dr. McCarthy is "pushing" TAVR for a young patient...........

Did you (the OP) perhaps spin the conversation toward TAVR by bringing up a question like "Is there any way I can buy some time until my children are older, etc.?" That could have brought them to believe that the patient didn't want to undergo traditional OHS at the present time, perhaps bringing up the TAVR trial as a means to hold off the traditional surgery for a few years.

All things considered, I would tend to agree with the others in that a modern mechanical valve would likely be the patient's best option for long-term .......

I agree this was why TAVR was suggested.
Did Dr. McCarthy mention any other issues with your other valves?! Could you ask him?! If so, he could be saving you time until next time! Just my 2-cents thoughts!

Keep us posted. Continue to breathe deeply with optimism and guidance for the right decision.

Good luck.