BeachBumTom

[BeachBumTom]

I stumbled onto this site via Google and think it's the most helpful resource I've found since learning 10 weeks ago that my mitral valve prolapse had reached "severe". I have a HUGE question from you all. I go in for OHS (MV repair/replacement plus one by-pass) this Friday, 6/10. I am almost 60, fit, and very active (no real symptoms). I'm retired, travel for 3 months at a time (trek, hostels), recumbent bike 1,500 miles per year, paint for 8 hours per day, and sing loudly and perform with the ukulele. I'm leaning toward tissue valve choice to avoid coumadin and it's "restrictions." I plan on at least 10 more years of being very active. Don't want to worry about bike crashes, inevitable coral cuts in Hawaii, etc. But of course, I don't want to dread another OHS in 10 years.
My question involves recovery time. If I can recover and be back to semi-normal within 2 months then I'll consider another surgery at 70 to be "no big deal." But if decent recovery takes 6-8 months then perhaps the mechanical valve would be the way to go. 2 1/2 years ago I had radical prostate surgery and rebounded with amazing quickness. If I thought in two months I could even think about riding my recumbent bike or snorkelling in Hawaii then I'd consider OHS more of an inconvenience rather than a "1/2 - year long drudgery." If that's the case I'd probably opt for the "foreverness" of the mechanical valve. If it's a 2 month rehab then I'd take my chances with the tissue and not sweat what'll probably happen in 10-15 years (another OHS). Of course, I realize we are ALL different and recoup time varies...........but PLEASE, give me some ideas about rehab ("back to fairly normal") time. THANKS! BeachBumTom

 

[JimL]

Welcome, Tom!
I was told not to lift anything more than say ten pounds 2-4 months after surgery until the sternum healed. I only cheated a little.
Your question about recovery time is hard to answer, since it varies so much from person to person, but easy to comment on, since it varies...
I definitely felt fragile after surgery. I didn't want to get bumped.
I started a second job on the day after my one year anniversary, but only after protesting ad nauseum that I wasn't up to it. I guess I was up to it, since I made it through.
You make the decision, but it's a decision for life, a decision to live with.

 

[geebee]

Tom,

Welcome to VR.com from an ex-Californian (sure miss the sunshine & the beach ).

You are so right - everyone is different. I opted for a mechanical in 1980 to avoid future surgeries and ended up with 3 OHS so.........

However, 70 is getting up there for a repeat surgery. It helps that you are in good shape now but who's to say what will happen in 10 years. Also, some tissue valves last 15 years (and I think there are some up to 18). That would put you at 75+ for a second surgery - not the best scenario.

If it were me, I'd go mechanical. However, I am looking from a perspective of avoiding additional surgeries at all cost. I am sure you will hear from others who will think tissue is the way to go.

I have been on coumadin for almost 25 years. I have had no problems to speak of and things are much more controlled these days than they were back when I started all this.

Good luck.

 

[Ross]

I'll be the first to say that 2 months recovery is unrealistic. To feel tip top and really back with the program, 6 months or longer is more like it.

 

[Nancy]

Tom-

I guess I'd like to know if there are any other mitigating factors with your mitral valve prolapse, such as rheumatic fever in the past. Many people with mitral valve problems have had rheumatic fever.

My husband is close to 74, and has had 3 valve surgeries. He has an aortic and mitral mechanical and had a repair on the mitral. He has also had rheumatic fever as a teen.

For Joe, the rheumatic fever damaged his aortic first (which is not the norm), and then many years later, his mitral went south. He then developed a leak in the mitral mechanical. He also has a severely leaking tricuspid valve which at this point, no one wants to touch.

If yours is the result of a birth defect and not an ongoing disease situation like Joe, you might consider a tissue valve, as long as it is the ONLY birth defect.

But please keep in mind that repeat surgeries are no picnic at all, in any way shape or form. I've helped Joe through them. He lost big pieces of his health with each one. And in addition to his valve problems, he has many other serious medical problems which have spun off from his cardiac problem.

As we all age anyway, we're going to develop other medical problems. These all have a bearing on whether a valve surgery later on in life will be routine or difficult. No one has a crystal ball to see what's ahead.

Even with Joe's mechanicals he's got major medical problems, if he had tissue valves he wouldn't be in this world.

He is at the point where his cardiologists are saying he's almost inoperable since it would be his fourth open heart surgery.

By the way, he's been on Coumadin for 28 years, and it is the very least symptomatic medication that he takes (he takes 16 different ones per day now).

I would say that to fully recover from valve surgery to the point that you are feeling in tip-top shape, it will take 6 months and sometimes even a year. You will, of course be feeling better and better during that period of time, but you will tire easily for quite a while. And you will be fragile for 6-8 weeks. Mitral surgery is a little more difficult recovery-wise than aortic, at least that is what we've found.

This is major, major surgery.

 

[Phyllis]

Welcome to VR, Tom. Everyone is different, but I can only give you Dick's experience. He was a very active 70 year old when he had his avr replacement with an Edwards Magna bovine valve. He played tennis, golf, boating, climbed ladders to paint our house, etc. At 6 weeks, we went to the surgeon in Boston for his final release after surgery. At seven weeks we flew to our condo in FL. Since he was not allowed to play tennis or golf for 3 months, we flew to Aruba in February (9 weeks) for 8 days and he walked the entire Island while we were there. At 3 months he was playing tennis doubles and hitting the golf ball on the range. From that time forth, there wasn't really anything he did before that he couldn't keep doing. His Dad is 101 and still living on his own and walking 2-3 miles a day, so he has every hope to have a long life with this valve and does not fear a re-op. Who knows, in 15 or more years they may be doing it by cathetar!

 

[tobagotwo]

At sixty, if you get a tissue mitral valve now, you will likely have it for 15 years. As far as the operation, everyone is different, and every operation is different.

The new tissue valves are much better than the ones you have apparently been reading about, especially when you get over a certain age, when you stop calcifying things so rapidly. Ten years at your age or mine is only half of the expected life span in the aortic position. The Edwards Perimount series has a track record of 90% retention at 18 years, 80% at 20 years (also in the aortic position). However, in the mitral position that you require, they do not last as long.

As far as recovery, that depends on what you mean. I was walking five miles a day a week after I got home. If you have minimally invasive surgery, you won't have the issue and weight restrictions of the healing sternum. You won't be 100% of your physical peak, but you should certainly be able to start cranking up your bike by two months.

However, atrial fibrillation sometimes shows up with mitral surgery, and it can cause you to have to take warfarin (Coumadin). You should discuss that possibility with your surgeon. If you had to take it anyway, it would make sense to have the longer-lasting mechanical valve.

And most of the things you are talking about are not contraindicated if you are taking Coumadin. It's not as restrictive as you may think, although there is some regimen involved with food and testing.

Poke around some more. There's lots of food for thought on this site.

Best wishes,

 

[Phyllis]

Tom,
One more thing I forgot to mention. Dick also bikes and was biking 7-10 miles when we first got to FL at 7 weeks. He also used a stationary bike in the 3rd to 6th week of recovery at home.

 

[Rich]

Hi Tom and welcome,
I was 58 at the time of my surgery.
I chose mechanical to avoid any(hopefully) future surgeries.
While Coumadin can be a little pain in the neck, it has not stopped me from doing anything physical.
Though I felt pretty good after about a month, the doctors would not let me do anything for ten weeks.
This was not because of my heart but rather for the sternum to heal.
It is a very personal choice that only you can make, so keep reading a lot of the stories here.
Rich

 

[jeffp]

Welcome Tom and good luck with your surgery. I had the mitral valve replaced 2 months ago today ( and one artery bypass with the mammary artery - was glad they didn't go after my legs!) I'm 10 years younger than you and went mechanical to hopefully avoid doing this again. Coumadin is the least thing I worry about. Was in great shape before the valve went (5 days before surgery). Has some large intestine surgery about 4 years before and heal great in record time. Every surgery is different, and different for everyone. At 2 weeks post OHS any mild activity wore me out. After a shower I was drained. A walk to the mail box meant a 3 hour nap. Now I'm able to do a mile and a half moderate brisk walk before I'm sweating and huffing and puffing. My upper body strength is like a quarter of what is was before (probably less than that) and I feel like I've turned to flab. (sounds wonderful, doesn't it) I'm just glad to be making progress but you can't gauge progress by past performance. I think everyone's 6 month estimates are probably right on. Don't plan on being superman healing wise. There's more than a few threads of folks that got slammed by pushing too hard, too fast. I had great expectations and wound up being human like everyone else. My biggest beef with the whole thing....its just so boringly slow getting back to "normal".

 

[catwoman]

BeachBumTom:

Saw a friend this weekend who had MVR (bovine) in December 2002. She's on Coumadin despite having a tissue -- she has atrial flutter.
Tissue recipients are frequently prescribed Coumadin for a while post-op to prevent clots from forming during the recovery. My father-in-law took Coumadin for maybe 3 months after his 2nd MVR. He was 63 when he had his first MVR (family doesn't know what type of tissue he got) and 74 when he has his 2nd (porcine). He stopped going to the cardio annual when he got good reports and didn't know/didn't want to know/ignored the fact that his valve would not last forever. When it went, so did the aortic valve & aortic root, another valve (I don't remember which) and he needed 4 bypasses in the same surgery.

I was 1 month shy of 53 when I had my MVR. I chose mechanical, because of what my father-in-law went through.

I also will be very very faithful about having annual cardio check-ups.

 

[coryp]

Dear Tom,

I am 34 and going for AVR with root remodel and ANEURYSM repair tomorrow.
I chose to go tissue (after visiting 4 surgeons in Los angeles) I opted to go with the last and "best" in my mind. My thought on it was that if I could get 15-20 yrs (maybe less because I am so young, but my surgeon really pushed the 18) that by then my next and hopefully final valve replacement could be dine by cath as PGRUSKIN stated (meaning no more OHS) medical studies show that they are on the way currently and estimate (by what I have read) that is will be common practice in 6-8 years. I am young and active and did not want to subject myself to the Coumadin (my surgeon also beleives that long term Coumadin for people with tissue disorders (me) is not good, I do not have the reasoning yet but will post it soon.

I can add only add that you should talk and interview various surgeons prior to making a decision, each may have a different perspective and hopefully you will find one that you trust.

If I can help let me know. I see you are a SOCAL person so we are neighbors

Cory

BeachBumTom:

Saw a friend this weekend who had MVR (bovine) in December 2002. She's on Coumadin despite having a tissue -- she has atrial flutter.
Tissue recipients are frequently prescribed Coumadin for a while post-op to prevent clots from forming during the recovery. My father-in-law took Coumadin for maybe 3 months after his 2nd MVR. He was 63 when he had his first MVR (family doesn't know what type of tissue he got) and 74 when he has his 2nd (porcine). He stopped going to the cardio annual when he got good reports and didn't know/didn't want to know/ignored the fact that his valve would not last forever. When it went, so did the aortic valve & aortic root, another valve (I don't remember which) and he needed 4 bypasses in the same surgery.

I was 1 month shy of 53 when I had my MVR. I chose mechanical, because of what my father-in-law went through.

I also will be very very faithful about having annual cardio check-ups.

 

[bvdr]

Welcome, Tom. I think you have already gotten a pretty good flavor of opinions here on this board. There is no consensus on whether one choice is better than another. Whatever you pick don't second guess yourself later. There are circumstances with mechanical valves that will end up requiring another heart surgery and well as problems that arise in tissue valve recipients, such as rhythm disturbances, that require coumadin on a permament basis. There just aren't any guarantees.

I didn't have a real choice. I was already on coumadin pre-op for atrial fib and there wasn't the expectancy that I would be able to come off of it after valve replacement. I have a St. Jude mitral valve.

I think planning on resuming your active lifestyle 2-3 months post-op is not really very realistic though in my opinion.

 

[catwoman]

BeachBumTom:

There is no #1 wrong and no #1 right valve for every one, every situation. As you can tell, valve choice is a very personal decision here.

 

[BeachBumTom]

Thanks for All the Input!

Thanks for All the Input!

Great thanks to each and every one of you for all the input! I repeat that this site has been the most helpful thing on my journey. Fortunately yesterday I met my surgeon (whom I had "handpicked due to trustworthy recommendations), and I was completely impressed. I feel like I am in great hands (between this surgeon's and God's). Thanks again so much.
BeachBumTom

 

[Nancy]

Good for you! Having a great surgeon is top on the list. You just keep posting here during your waiting period.

 

[Phyllis]

That's great news, Tom. I think one of the most important things is to have faith in your surgeon and his abilities. Looking forward to more posts as you make this journey.

 

[tobagotwo]

That's the hardest part, being sure of your surgeon. If he made you feel confident, you're a big step closer to success.

I'm glad your meeting was positive and that you feel good about moving forward.

Best wishes,