BAV & Aortic Aneurysm surgery candidate's question

[canon4me]

I figure I will need a new valve and repair for a 4.5 cm ascending aortic aneurysm in 2-3 years or possibly shorter. My chest keeps feeling tighter each year. I'm 57 years young. Cancer survivor for 9 years with partial nephrectomy for renal cell carcinoma. That was tough but not as scary as somebody messing around with my ticker. I would like to go to Cleveland Clinic when it's time. I know they are big on tissue valves and Mayo is big on St. Jude's plastic. I know tissue valves don't last very long so does it present nasty challenges to replace a tissue valve when it's time? Coumadin seems to scare me a little too because I love green leafy vegetables so much. Also, I'm a prepper and if SHTF ever occurred, it might be a game changer if you couldn't get your hands on Coumadin.

I can run all day on a treadmill and do,just fine, but when I walk to my car after work with my briefcase I'm out of breath and my chest feels like it won't expand. Every year I have my echo they keep telling me I'm a few years away. They've told me that for ten years. I did a stress treadmill last year and they stopped after 16 minutes because I was doing so well.

 

[JimL]

Welcome, Canon, I'm also 57 years alive, 11 years post AVR. The debate about mechanical versus tissue has been going on a long time and there are fairly equal arguments on both sides. One basic piece of advice which seems to make sense is to go with what your surgeon recommends. As far as a shortage of coumadin, I usually keep six months to a year's supply on hand, so that should never be a problem for me. I do not understand how you can run all day on the treadmill and then get out of breathe carrying your briefcase to your car -- must be a very long walk!

 

[canon4me]

Actually, the walk is about one block but is slightly uphill. If I elevate the treadmill, it's game over. Anything that puts a demand on my heart causes me to be out of breath. I want to resume lifting weights but I am scared of the risk of dissection and sudden death.

 

[JimL]

When to have surgery is for your card and surgeon to decide. Due to various circumstances, my surgery was delayed to the last possible moment. Before surgery, I couldn't walk across a room without sitting down to rest. The surgeon said that my valve had closed completely (= death). Now, I take the stairs whenever I can find them, and enjoy walking uphill for a change.

 

[epstns]

Hi, Canon, and welcome to The Waiting Room - the virtual room where many folks await their own turns at valve replacement. I spent nearly 10 years waiting myself, so I know a bit about what you're going through.

I was 63 years old when my valve was replaced, and I chose a tissue valve. My surgeon advised me that in patients over about 60 the rate of deterioration of tissue valves rapidly declines and they expect most tissue valves implanted in patients of that age to last 15 to 20 years or more - especially with the newest generations of tissue valves that have advanced preservative treatments. Cleveland Clinic now advises tissue valves for most patients over the age of 50 to 55, for the same reasons. I'm perfectly comfortable with my choice. I know there is a possibility that my valve may need to be replaced again, but there is also a possibility not. There are also new advances in minimally invasive valve replacement techniques being worked on, and by the time I might need another valve, these may make the procedure much simpler than it is now.

I think that each of us needs to make their own valve choice, and that the choice made by each of us is the best for us as individuals. The only bad choice is that to do nothing, and we all know the eventual outcome of that one.

In the meantime, stay as active as you are able, given your condition. That will make surgery and recovery easier. If you are like me, I was carefully logging my daily training, and I was well aware as things began to decline toward the need for surgery.

P.S. I am now almost 2 years post-op, and I'm back in the gym 5 days a week, at higher intensity than during the couple of years prior to surgery. Not bad, considering I'm older now, too. Go for it!

 

[Guyswell]

Canon,

I've had both kinds of valves implanted at the Cleveland Clinic. Both were good choices. My tissue valve allowed me to go about my business without any thoughts about what I ate. I simply took a baby aspirin once a day. Unfortunately, my body calcified the first valve after only 8 years (I was 41 years old when I received it). The first valve should have lasted longer even though I was a relatively young patient. Since we had to assume another tissue valve would calcify quicker than normal again, my surgeon and I felt a mechanical valve was better than doing AVR surgery every 8-10 years. On July 3rd of this year, I had the tissue valve replaced by a mechanical valve. Replacing my tissue valve with a mechanical valve did not present any nasty challenges. It was actually a simpler operation since we didn't have to mess with the aorta the second time. Any open heart surgery the second time around can be a little tricky due to scar tissue that may have formed between the heart and surrounding tissues or the sternum. I had a CT scan to give the surgeon a better idea of what he would find when he opened me up again.

Now that I have a mechanical valve, I take warfarin and I do pay attention to what I eat. I've been advised to eat whatever I want but try to be consistent. The warfarin dose has been adjusted to meet my particular diet and lifestyle. I'm still having my INR checked regularly and we have had to adjust the dose a few times. In the very unlikely event the SHTF, I'll have bigger things to worry about (like an EMP frying my pacemaker). I'll leave you with that happy thought. Let me know if you have questions.