My re-do took 11 hours. They spent more than 4 hours alone getting throught the scar tissue from my first surgery. Maybe everyone isn't the same, but 3 - 4 hours seems kind of low for a re-do.
AVR replacement at 41yo.. Which way to go ?
- Thread starter zztimeout
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My re-do took 11 hours. They spent more than 4 hours alone getting throught the scar tissue from my first surgery. Maybe everyone isn't the same, but 3 - 4 hours seems kind of low for a re-do.
I agree with BigSidstr. I'm 2 weeks after surgery, the first 2 days post op are still fresh enough that I know I don't every want to do that again if I don't have to. Not to scare you, but it is not fun or easy. It's doable and you feel better pretty fast, but the surgery is not something I'd want to repeat if I didn't have to. And I had the mini-sternotomy. I think seeing me go through this made an impact on my parents, too, as they are eating better and working out after hearing what it feels like to have OHS.
It the subcutaneous procedure or the stem cell research to grow a new valve were closer to available and recommended for someone my age, I would have taken a different route. I went with the most appropriate technology available in 2010 rather than count on the technology that may or may not be ready in the future.
It the subcutaneous procedure or the stem cell research to grow a new valve were closer to available and recommended for someone my age, I would have taken a different route. I went with the most appropriate technology available in 2010 rather than count on the technology that may or may not be ready in the future.
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but theres a lot of us guys who dont want to be on anti coags if possible, the same as you dont want another re op, the risks involved in a re op are more or less the same as major problems with anti coags, to think otherwise is naive at best,
As you see in my first post- I think tissue is just fine if that's your choice, too. 2nd post, I was just chiming in that I personally would not want to do the surgery again if I can avoid it. I'm an "good" pill taker, so I'm okay with anti-coag risks. That's my personal preference and not a criticism of anyone else's choice.
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Regarding valve composition selection
As a relative newbe, I know we come to this site with eyes wide open, a little scared and accepting of the council found here. We are very respectful of each others experience. Please inform those whom you are counseling of your age and perhaps a little of who you are when they pose the valve selection question. This will allow you to provide informative guidance to our junior members with consideration to their age, allowing them to consider your age. They will better understand your position regarding valve selection.
Since joining in Oct 2010, I took for granted that neilbrewer was a young guy based on his avitar. I finally checked his profile and found he is close to my age. IE mid 50's. Here I was calling neilbrewer the young guy! OK you are one year my junior so I guess that makes you a young guy!
As a relative newbe, I know we come to this site with eyes wide open, a little scared and accepting of the council found here. We are very respectful of each others experience. Please inform those whom you are counseling of your age and perhaps a little of who you are when they pose the valve selection question. This will allow you to provide informative guidance to our junior members with consideration to their age, allowing them to consider your age. They will better understand your position regarding valve selection.
Since joining in Oct 2010, I took for granted that neilbrewer was a young guy based on his avitar. I finally checked his profile and found he is close to my age. IE mid 50's. Here I was calling neilbrewer the young guy! OK you are one year my junior so I guess that makes you a young guy!
Philip B
Well-known member
"The risks involved in a re op are more or less the same as major problems with anti coags, to think otherwise is naive at best." Really? Okay, I'm happily naive. Where are the numbers to back this statement.
Regardless of my personal preference for going mechanical, I really believe whichever way you go will be a great choice for you. The worse choice you can make is to do nothing. The result of doing nothing is much worse than a re-op or taking coumadin the rest of your life.
Don't let the spirited, well-meant discussion get you confused. You'll find the same level of support from us regardless of which valve you opt for. We do like to thrash this topic around whenever the opportunity is presented.
-Philip
Regardless of my personal preference for going mechanical, I really believe whichever way you go will be a great choice for you. The worse choice you can make is to do nothing. The result of doing nothing is much worse than a re-op or taking coumadin the rest of your life.
Don't let the spirited, well-meant discussion get you confused. You'll find the same level of support from us regardless of which valve you opt for. We do like to thrash this topic around whenever the opportunity is presented.
-Philip
Philip B
Well-known member
Omg
Omg
OMG, bdryer... I hope you don't continue to skydive after you get your mechanical valve... geez, your parachute might not open and...well... you could bleed to death if you're taking coumadin and you hit the ground after jumping from a perfectly good airplane at 10,000 feet...
Sorry guys, I couldn't resist being stupid... it's been a long day.
-Philip
Omg
OMG, bdryer... I hope you don't continue to skydive after you get your mechanical valve... geez, your parachute might not open and...well... you could bleed to death if you're taking coumadin and you hit the ground after jumping from a perfectly good airplane at 10,000 feet...
Sorry guys, I couldn't resist being stupid... it's been a long day.
-Philip
Jkm7
Well-known member
Not everyone.
My second surgery was valve replacement and I chose tissue.
As to a-fib or blood clots in legs....... we've discussed Pradaxa here. A new drug that is now approved and being prescribed. There is good liklihood that could be an excellent replacement of coumadin for those particular conditions.
Something new to consider in the whole 'mix'.
Philip
The only sky diving I do now is in my mind! I laugh when I read posts equating sky diving to ACT. We used to joke on the drop zone that from the time we left the aircraft, until the time we did something about it, we were dead. So ACT and skydiving could not be further apart in correlation to each other. You kill me, oops froiden slip, excuse me, break me up, ahhh I mean you kidder. LOL.
The only sky diving I do now is in my mind! I laugh when I read posts equating sky diving to ACT. We used to joke on the drop zone that from the time we left the aircraft, until the time we did something about it, we were dead. So ACT and skydiving could not be further apart in correlation to each other. You kill me, oops froiden slip, excuse me, break me up, ahhh I mean you kidder. LOL.
Just want to say Hi and welcome you aboard, Dave. I choose a mechanical because I am the world's biggest coward. Thinking that a mechanical valve there will be no re- do. There is no guarantee. You do what is right for you. Good luck and keep us update.
Gemini13
New member
Not everyone gets a mechanical when having a redo. I had a tissue mitral valve replacement at 34, and a tissue for a redo at 44, three years ago.
Gemini13
You have captured my absolute respect and provide supportive food for thought for zztimeout to consider in HIS thread, be it ever so minimal in content. Why, because he knows your age. Age is so important to those who pose the valve composition question. Now zztimeout knows that a peer has chosen tissue, not once but twice.
Jkm7, what is your approximate age? It would really help zztimeout if he knew where you are coming from. If you are in your senior years a second tissue is a no brainer, as the implant will possibly suffice until you reach your final days. Hence no reop. Are you unable or do not want to be on warfarin? These are the things we want to know. Sir, you post some excellent material. Just know that supporting your valve selection choice with at least an approximate age, will really provide strength to your decision.
You have captured my absolute respect and provide supportive food for thought for zztimeout to consider in HIS thread, be it ever so minimal in content. Why, because he knows your age. Age is so important to those who pose the valve composition question. Now zztimeout knows that a peer has chosen tissue, not once but twice.
Jkm7, what is your approximate age? It would really help zztimeout if he knew where you are coming from. If you are in your senior years a second tissue is a no brainer, as the implant will possibly suffice until you reach your final days. Hence no reop. Are you unable or do not want to be on warfarin? These are the things we want to know. Sir, you post some excellent material. Just know that supporting your valve selection choice with at least an approximate age, will really provide strength to your decision.
phillip that infor about re ops and anti coags has been talked about before on here,and the RISKS are the same,am sure somebody will let you know where the info is,also was told that info by my cardio,maybe the guys and girls who choose tissue over mech should all wear dunces caps and sit in the corner? ,why cant everbody on here see that we pick our choice because we think that is the best for us, not for anybody else,there is risks whichever you pick and hopefully we will all pick the right one for us,who ever comes on here looking at choices i will say this, look at everything ,speak to the experts and hopefully you will get the support of everbody on here, if you choose tissue good luck,if you choose mech good luck,you have made the right choice FOR YOU..................bdryer thanks for the comp about the pic 
though i have to say it was taken 4 yrs ago
though i have to say it was taken 4 yrs ago
Dave,
I think 41 is young to get a tissue valve if, as you say, "the thought of going through all of this in maybe another 5-9 years with a tissue valve scares the hell out of me".
I went tissue in 2005 at the age of 53. The thought of another re-op didn't really concern me. No surgery is fun, so the argument that "you don't want to do this again" doesn't hold much water with me. I've had three major abdominal surgeries, and my valve replacement was no worse than those.
By the way, you suggested in your post that a mechanical valve means a stroke could just be around the corner. That thought paid no part in my decision to go tissue.
I think 41 is young to get a tissue valve if, as you say, "the thought of going through all of this in maybe another 5-9 years with a tissue valve scares the hell out of me".
I went tissue in 2005 at the age of 53. The thought of another re-op didn't really concern me. No surgery is fun, so the argument that "you don't want to do this again" doesn't hold much water with me. I've had three major abdominal surgeries, and my valve replacement was no worse than those.
By the way, you suggested in your post that a mechanical valve means a stroke could just be around the corner. That thought paid no part in my decision to go tissue.
I thought I would chime in as I am considered one of the "younger" ones (under the 50 years of age category) who opted for a tissue valve. It was a very difficult decision to make and it was based on many factors, including input from a very well reputed and highly respected surgeon in the area of valve surgery. I was told that the risk of a second op. was statistically the same as the first op in an institute with lots of experience in re-ops. Of course there are no guarantees and I am aware of that.
I agree with the others that valve choice is a very personal one. Hopefully, we can all be respectful of each other’s choices. As stated on numerous occasions, valve choice depends on a number of factors. i.e. current co-morbidities, gender, age, compliance to take anti-coags, consultation with the medical experts, your lifestyle and the list goes on. I hope that we can all agree that there is no wrong choice. The hope in getting a new valve is to prolong our lives no matter what valve we choose.
There are numerous threads on this discussion.
You may want to check out Famous Tobago’s Writing on Valve Selection post under Valve selection.
I hope LynW does not mind, below I have cut and paste her reply to the re-op risk question from another thread. Hopefully this will help clarify the ‘statistical’ side of the question regarding a 2nd re-op.I don’t think that Neil was referring to 3rd and 4th surgeries, but the risk of a second. In my case, I figure I may end up with a mechanical valve second time around to help reduce the risk of a 3rd or 4th surgery (unless transcather is the treatment of choice, but I am not banking on it
). As we all know NO ONE has a crystal ball and therefore will not know where he/she is going to fall in the statistics category. Lyn’s reply: http://circ.ahajournals.org/cgi/cont...11_suppl/I-294 Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age
under conclusion
"In this cohort of adult patients <60 years of age followed for >20 years after AVR or MVR, the use of a tissue versus a mechanical prosthesis at initial implant was not associated with a significant difference in long-term survival, despite higher reoperation rates with bioprostheses. Our experience therefore suggests that a mechanical prosthesis may not necessarily be warranted in the younger adult patient population in need of first time, single left-heart valve replacement".
Most studies I see and most stats for REDOs , at least for centers/surgeons with alot of experience in REDOs show the 2nd surgery stats pretty much the same as a first OHS about 1-2% or less.
I'm pretty sure the stats for mechanical show 1-2% for a major bleed event and another 1-2% risk of clot/stroke event for people whose INR is managed well in range most of the time altho the risk of bleeding is higher for "elderly patients"
All the very best with your decision. When you make it, I hope you find some peace so that you can move forward. We will be cheering you on. :smile2:
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Jkm7
Well-known member
I'm Ma'am, not Sir.
I have 'oft stated here I am not yet on Medicare which translates to under 65. My valve surgery was three years ago. That is as much info I care to share about this lady's age.
At the time I chose my valve, I certainly expected to look to the future and still do.I have many times written here I had a brief course of coumadin following my surgery. Pre-op, my surgeon advised he would order three months coumadin while my own tissue grew over the implant and 'smoothed the edges.' Because I metabolised coumadin at extremely high rate and my Excellent coumadin managers followed all up to date and current dosing recommendations and kept increasing my dose in small percentages and my activity level increased as I healed etc, I never even reached 2.0 INR level which, of course, is what they want for therapeutic level. I was up to almost 100 mg weekly and still was under 2.0. My Mass General surgeon did not like that and had me stop ACT two or so weeks sooner than he usually orders.
It was not knowable in advance I would have that difficulty with coumadin. How lucky for me I had chosen tissue valve.
No matter how many times everyone says 'the correct dose of coumadin is that which keeps one in their prescribed range', it does not change the fact I was taking A LOT of coumadin and had I gotten a mechanical valve, it is likely I would have settled at someplace around 110+ mgs per week for life. I hated that drug and taking that much. It makes me shiver now just thinking how much I had to take. As I aged, it unquestionably would have presented very real problems. This is only my personal opinion but seeing as you asked...... You'll notice I've been around here a few years and have written this a number of times.
For posters to blithely say 'No big deal taking a pill a day' are not exactly open and honest. There are very real exceptions. Rarely do we see discussion of the problems some have dealing with untrained/unknowledgeable coumadin managers in the threads discussing valve selection. Rarely do we hear about the bleeds that happen with lovenox bridging.... the angyst and problems sometimes encountered when facing medical procedures that may produce some amount of bleeding in the valve selection threads. This is critical information IMO that should be included in any discussion of this sort. One needs to go to Anti-coagulation threads to see that info but I think it pertinent to include in discussions regarding valve selection.
No one should feel the need to defend their choice.
There is no wrong choice. Each decides for themselves in consultation with their medical experts who know their history and other conditions etc
My own experience with warfarin(coumadin) is that my dosage was directly associated with my activity level. As a young man 30-40 I took 70+ mg/wk because of a very active lifestyle. As I grew older and my activity level declined....so did my warfarin dosage. Currently I take 35mg/wk and am thinking of reducing to 32.5 to lower my INR to 3.0.
Warfarin management should pose few problems for most patients....there are always exceptions to everything.
Warfarin management should pose few problems for most patients....there are always exceptions to everything.
Jkm7
Well-known member
The tricky part is that those who will have problems with coumadin do not usually know it in advance. Once they have the mechanical valve, what are they to do if they are one of the 'exceptions'?
ALCapshaw2
Well-known member
One member persuaded his Cardio (or Surgeon - I forgot which) to let him go on Coumadin before surgery just to see how he did on it so that may be an option to consider.
The New Genetic Testing is another option, albeit, a rather expensive one from what I hear.
It would be especially interesting to know the results of genetic testing for Coumadin 'sensitivity' in people at both the Low and High End of the Normal Range. Any Volunteers for the cause of Science?
This might be a good canditate for some Doctor to conduct a Study. Sponsored Testing would be a nice incentive.
'AL Capshaw'
The warfarin "question" seems to be a leading factor in valve choice. Many of the concerns seem to come from folks that had been on warfarin for only a short time.....or have had no experience with the drug at all.
It is fact that if you begin the drug you must follow a very simple regimen of "take it as prescribed and test routinely"....and that is about all you need to do. If a person is unable or unwilling to follow this regimen, find another solution for your problem.
Normally, you find no long term user of warfarin complaining about the "horrors" of the drug. Anybody out there that has been on warfarin for a few years and continues to have "grave" problems with the drug?
It is fact that if you begin the drug you must follow a very simple regimen of "take it as prescribed and test routinely"....and that is about all you need to do. If a person is unable or unwilling to follow this regimen, find another solution for your problem.
Normally, you find no long term user of warfarin complaining about the "horrors" of the drug. Anybody out there that has been on warfarin for a few years and continues to have "grave" problems with the drug?
