Bentall & Freestyle

[Wendel]

Hello everyone,

First of all I want to thank all the users who provide their support in this forum, I have been reading a lot here and it seems very correct to me.

I have a 51mm aortic aneurysm, a dilation of the aortic root and severe aortic insufficiency, I have a bicuspid valve. I will soon undergo Bentall surgery.

I am 38 years old and I am from Argentina, I discovered this through a checkup, when I felt palpitations, I am asymptomatic, I don't know if I should take this discovery as a punishment rather than a blessing.

The surgeon suggested I do a Freestyle with a Dacron tube. I have generalized anxiety syndrome and I think that the “click” of the valve would be very annoying for my mental health.

A 3rd generation Medtronic Freestyle biological valve. He told me that in the large centers of the world and the US, surgeons are leaning toward these valves in young patients because of the duration, hemodynamics, and problems with anticoagulants.

Surely in the future I will have to have reoperation, but in the meantime he has said to “look forward and live life”, that these valves can last between 15 and 20 years.

He is a surgeon with a lot of experience, he has nearly 12,000 surgeries and 180 cardiac procedures, a man of about 70 years old. He was working with Dr. John W. Kirklin in Birmingham for many years.

I have read on the Internet that they can last 10 years, but most of the studies are old and with patients older than me.

I am a healthy person, unfortunately I am smoking (I know I shouldn't, but I'm going to quit), and like everyone I am afraid of not waking up from the operation.

I would like to know what you think of this election.

 

[pellicle]

Hi

I have a 51mm aortic aneurysm, a dilation of the aortic root and severe aortic insufficiency, I have a bicuspid valve. I will soon undergo Bentall surgery.

I am 38 years old and I am from Argentina,

noted

I would like to know what you think of this election.

Firstly I want to say this: there is no definitive cure for valvular heart disease, all we can do is exchange it for prosthetic valve disease. There are two types of this prosthetic valve disease on offer; mechanical valve disease or bio-prosthetic valve disease. One is managed by medication, the other by redo surgery (and perhaps also a need for medication).

I guess that as you well know at your age a mechanical valve has the primary advantage of durability (meaning reduced likelihood for re-operation) especially in a younger patient.

Another advantage is that in combination with proper and diligent maintenance of INR within the therapeutic range of (about) INR 2 ~ 3 you will have about "the age related" risk of issues related to stroke or bleeds.

I placed significant emphasis on INR above and note that you live in Argentina.

Where you live and what your income bracket is has a significant effect on your ability to achieve proper and diligent maintenance of INR. In my view I have absolutely no doubt that at your age to do this means you will need a personal Point of Care (PoC) device such as a Roche Coaguchek. Outside of specific systems (UK, USA, Norway ...) these come at personal expense and are typically (more or less) the same price in local currency as the US Dollar price. These are invaluable in obtaining good outcomes, just ask any diabetic specialist how significant the revolution of PoC devices has proven in better outcomes of managing the disease of diabetes. Its so obvious its not even contested.

https://www.hemocue.com/en/health-areas/diabetes/poct-and-diabetes

Benefits with POCT​

• Operational – reduced staff time, fewer orders to the lab, fewer patients lost to follow-up
• Clinical – increased patient understanding, faster implementation of medications modification , lower HbA1c levels
• Economic – fewer phone calls, less appointments, increased patient satisfaction

Point-of Care Testing offers reduced turnaround time and may promote improved operational efficiency. Implementation of POC can significantly improve clinical operations with cost reductions through improved practice efficiency. ​

​

In 2014 Crocker et al investigated how POC testing may affect operational costs using cost and revenue analysis. Following implementation of POC testing, a decrease in follow-up phone calls and letters by 89% and 85% respectively (P<0.0001 and P<0.0001) and a 61% decrease in patient revisits (=0.0002) was demonstrated. ​

Yet strangely this has not followed through in the management of AntiCoagulation Therapy (ACT) as universally (looks over at the USA).

What I'm saying here is that if you pick a mechanical valve and you pick it for its benefits then you must shoulder also the requirements that go along with it. These requirements are both behavioural and (potentially significant) financial commitments.

This leads me to consider the future (yes, life doesn't cease after your surgery) where I see this headwind (and perhaps worsening storm on the horizon) for Argentina:

Inflation in Argentina has hit 161%.​

So not only will this put strain on the availability of medical treatments it will also increase the financial burden for accessing medical testing. Naturally in the 10 to 15 year timeframe the same issue will confront redo surgery driven by the choice of a bioprosthesis.

I see this as something that should factor in.

However all things being equal, unless there is something else you haven't told me about then I would lean strongly towards mechanical and view with a wary eye the wording you've given here:

A 3rd generation Medtronic Freestyle biological valve. He told me that in the large centers of the world and the US, surgeons are leaning toward these valves in young patients because of the duration, hemodynamics, and problems with anticoagulants.

it sounds more like marketing than truth. Feel free to reach out if you wish to discuss this.

Some additional reading about ACT

https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
Best Wishes

 

[dick0236]

Welcome to the Forum Wendel. There are many posts on this Forum about the noise or lack of noise with a mechanical valve. There is a current thread being circulated, "Mechanical valves....but what the ticking?", that you should read.

If you are looking for durability and perhaps having a "one and done" surgery get a mechanical valve and quite possibly eliminate the need for any future proceedures. What you have heard about "ticking noise" and problems with warfarin and INR are, pretty much, unfounded after an initial learning curve of a couple of months.

Regardless of your valve decision, you will find a lot of good information about living successfully after surgery.

 

[ChuckM]

Hello everyone,

I have a 51mm aortic aneurysm, a dilation of the aortic root and severe aortic insufficiency, I have a bicuspid valve. I will soon undergo Bentall surgery.

I was 48 and had the same thing, accidentally discovered during a calcium score scan. I've been reassured multiple times that this is a blessing and definitely not a curse. I think its generally accepted that the alternative would have been toes up in the dirt.

The clicking and the warfarin worries are pretty much unwarranted. Either valve will allow you to continue to live and thats a good thing. One of the two has a much higher percentage chance of you never needing another surgery. I can't imagine the guys on here who've had to go through this more than once, and if I have ANY opportunity to avoid that same situation, I'd take it in a heartbeat (pun intended).

Have a heart cath scan prior to surgery as well, since if they have the hood open and if you need a bypass, they'll take care of that as well. Listen to your doctors and read as much as you can. This place is a great resource..

 

[tom in MO]

I chose mechanical because I'd had previous major surgery and wanted to avoid any future ones. There have been some type of complication in every surgery I've had. Besides the physical risk of the reoperation there is the disruption of your and your family's life plus the expense. Also, if I had a biological valve implanted, I would suffer the same degradation of cardiac performance over time as I did with my native valve. So I went mechanical and after several months, my ticking valve no longer can be heard unless I am in a quiet small room and concentrate.

There are two negatives of a mechanical valve in my life. One is the small risk of stroke when you need to go off anticoagulation for a medical procedure. Second is the fact there are a class of arthritis medications you cannot take (nonsteroidal anti-inflammatory drugs or NSAIDs). I have arthritis and would love to take those medications.

 

[vitdoc]

Back in 1977 when I was 29 and very active and before home INR testing I had my aortic valve replaced by a pig derived valve. This was done at one of the major cardiac surgery centers at that time. I had severe stenosis. The surgery was uneventful other than having to be taken back to the OR due to excessive blood drainage. I survived got lots of blood products and probably just avoided getting AIDS by a few years from the blood products.

Five and a half years later the valve failed and in 1983 a St. Jude valve was placed. No complications. Went back to skiing, basketball, bicycling. Hated being stuck for blood tests so I didn’t manage my INR very well. Lucked out without any issues from warfarin.

Twenty three years later in 2006 had a large 6.5 cm aneurysm. Third open heart.
Survived with a new Dacron aorta and a new St. Jude. Around that time started self testing for INR.

I personally absolutely detested the surgical experience every time. I was treated at some of the busiest and experienced heart centers at the time.
So at age 38 you can bet a non mechanical valve will probably last on the shorter end of the expected life range of the valve. So if the guesstimate of the range is 10-20 then be prepared for maybe 10-15 or less.

It is also amazing how fast the time passes. Facing another procedure in 10 years is not that long.

So the bottom line is there is no free lunch. Either choice, mechanical vs tissue has it’s issues. Personally I would go for the fewest procedures. As I mentioned in a previous post the only thing you lose with a mechanical is hope of something better down the road and the need for anticoagulation . With a tissue valve you will have a choice of whatever is new when the tissue needs replacing. With the mechanical you may be one and done.
Good luck.

 

[tommyboy14]

I will add a couple of things:

- I had a bio-bentall when I was 34. I had the ATS 3F valve, which was apparently a more advanced version of the Free style valve. I was told at least 10 years. IT lasted 8. The surgeon said that the valve wouldnt calcify. It didnt. But one of the leaflets just ripped. Stentless valves like mine and the Free style have better hemodynamics than stented bio valves (but still not as good as mechanical). But there are downsides to this. When they fail, they regurgigate, which is more dangerous for your heart and then you cant do TAVI, because there is no calcium to anchor the new valve in. When they discovered my valve failed my heart was already expanding quite a bit from the overload.

- You also need to be aware of the following: You will have your aortic root replaced. When the re-op comes (as it did in my case), I thought that the chance of them just re-replacing the valve was a 100%. The surgeon said that it is more like 70%. Re-replacing stentless valves when your root has been already replaced is a bit more complex. Why does this matter? If they cant just replace the valve, they will need to re-replace your root. This is an operation that carries a 5% mortality risk even in excellent hands.

- finally, you are still very young and a good fractiojn of people on this board needed mitral valve replacements later in life. But you only get three relatively risk free (Meaning mortality risk <3%) OHS attempts. After that the risk rises due to scar tissue.

I think for all of these reasons, a mechanical valve is a better option. If I had to do it all over again, I would have gone with a mechanical valve to start with.

However, @pellicle point about quality of anti-coagulation is key. You should research the costs and medical acceptance of self-testing. If you can do that, then I think mechanical valve is the best option at your age. However, if anti-coagulation support is poor, the bio valve is also a reasonable option, but you need to be aware that once you have had a root replacement, reoperations get riskier.

Good luck in your decision.

tommy boy

 

[pellicle]

but you need to be aware that once you have had a root replacement, reoperations get riskier.

just as an aside, I'm not sure if I had root replacement when I had my homograft (which for the OP lasted 20 years in me) done at OHS #2

I should try to remember to ask that (as if it makes any significant difference to me where I am now in my surgical pathway).

Happy New Year mate!

 

[tommyboy14]

Happy new year to you and to everyone on this wonderful forum as well.

 

[Wendel]

Thank you all for your comments, and Happy New Year!

I would like to know why a surgeon with so much experience chose to recommend a Medtronic Biological valve that comes with an aortic root included, if, as you say, they are so bad for someone my age. I do not get it. Do I have to think that all the centers that recommend biological valves to young patients want to harm them? The trend is on the rise…

Regarding reoperation, no one is exempt from it; thousands of factors can occur for this to happen. Reintervention on the aortic root is something more complicated, as @tommyboy14 said

Regarding warfarin, it is not a problem in Argentina, I have met people with mechanical valves in the hospital and they have told me about their experiences (Argentina is not in Jupiter)

And the most important thing is that no comment spoke about “quality of life”, as I said, I am a psychiatric patient and the “clicks” would be unbearable to me, I also believe that within “quality of life” is the use of warfarin and the problems What this entails if by mistake it is administered poorly, or an accident occurs (no one is exempt from accidents)

Before writing here, I have been informing myself only from “prestigious” sources and scientific reports. Each person is different and I was really interested in knowing your opinions.

I am not a defender of any type of valve, I currently do not have one, and I do not obtain any benefit or harm.

Maybe I am in a process of denial that I cannot understand how until 2024 biological valves have not undergone any improvement compared to previous decades.

 

[3mm]

surgeon with so much experience chose to recommend

Wendel - Remember that a cardiac surgeon is focused on ensuring a patient survives the first month after surgery. That is their job. After that, care transitions back to a cardiologist. Please ask your surgeon for the specific reasons for his recommendations. Then you need to decide if those reasons and recommendation align with your needs. For example, I am 65, so a lot of people would automatically recommend a bioprosthetic valve for me. But a nurse from Mayo Clinic in Minnesota, USA, interviewed me for a full hour prior to my surgery. When she heard how active I am (martial arts, walking, weight lifting, work around house and yard, etc), she encouraged me to consider a mechanical valve because I might wear out a bioprosthetic valve in less than 10 years. A different 65 year old may make a different decision.

“clicks” would be unbearable to me

I only hear my valve in a silent room when I listen for it. Everyone is different. Pellicle put a recording of his valve in a thread recently; listen to that and read that thread.

by mistake it is administered poorly,

Warfarin is just some more pills to take every day. You need to consider how well you manage any other pills that you currently take. A weekly pill organizer with a compartment for each day seems to work well for most of us.

or an accident occurs

Carry a "stop the bleed" kit: tourniquet, quik-clot, bandages, etc. When cycling or riding a horse, wear a good helmet. Which everyone should do even if they are not taking warfarin.

psychiatric patient

Please talk with counselors, psychiatrist, etc, who treat you about your heart valve concerns. They know you and can help you understand how this will impact you.

Good luck! I hope this is helpful.

 

[pellicle]

I am not a defender of any type of valve, I currently do not have one, and I do not obtain any benefit or harm.

me neither, each has advantages and disadvantages. There is no definitive cure for valvular heart disease; all we can do is to exchange it for prosthetic valve disease. This requires we make a choice. One choice trades durability for relative (not absolute) freedom from the required commitment to management of post surgical anticoagulation therapy.

I personally see this as the choice and if you want A or B its best to know and understand them well and know and understand yourself well.

That's the best you can do.

Best Wishes

 

[Chuck C]

Welcome to the forum Wendel!

Sorry to hear about your BAV condition, but glad that you found us. This forum has been an incredible blessing to me and I'm very glad that I found it before my aortic valve surgery. I had a Bentall Procedure 33 months ago, like you are now facing.

The surgeon suggested I do a Freestyle with a Dacron tube

I would like to know what you think of this election.

I'll be happy to give you my thoughts, per your request.

The guidelines for most of the world call for young and very young patients to get a mechanical valve if they are under 60 years old. 60 to 70 years old is the range in which either valve choice is considered reasonable and over 70 a tissue valve is recommended. I've linked an article below discussing biological vs mechanical valves for young patients. It is important to keep in mind what the heart valve community means when they use the term 'young' patients. Some mean patients under 60 or 70. In the article below, the term 'young' means under 70. When discussing patients in their 30s and 40s, the term 'very young' is used.

The guidelines are determined by the top experts in the field who rigorously pour over all of the data available on a medical practice. They are not arbitrary. But, they are not set in stone. Usually, the patient is the one who gets to choose the valve, regardless of age. It is a personal choice and only you can make that choice. Your surgeon and the members on this forum are not the ones facing either a lifetime on warfarin or future procedures. You are the one that will live with these realities and the choice is yours to make, as it should be.

If you said nothing else other than your age, assuming that you do not have contraindications to warfarin, I would suggest that you follow the guidelines and get a mechanical valve, in order to give you the best chance at having a normal life expectancy. However, you did provide some key additional information, which in my view tilts the scales towards the direction which you seem to already be leaning towards.

You said the following:

I have generalized anxiety syndrome and I think that the “click” of the valve would be very annoying for my mental health

As well as:

I am a psychiatric patient and the “clicks” would be unbearable to me,

Now, if you had come here and asked us folks living with a mechanical valve whether the 'clicking' bothers us, I would give you my personal feedback that it has not bothered me and direct you to the several threads we have here discussing this topic. The reality is that the vast majority with a mechanical valve are not bothered by the sound. Personally, I rarely hear mine and have never been bothered when I do. But, you did not ask this question and rather seem to have indicated that you have already decided that it "will" be unbearable for you. I believe my cardiologist got it right when he indicated that in his experience, in following up with hundreds of valve patients, that being bothered by the sound is psychological. I believe he mentioned that only one of his patients expressed regretting getting a mechanical valve because of the sound it makes. It would seem that his anecdotal experience with his patients is in alignment with the members of this forum who have mechanical valves. In fact, I don't recall any member here indicating that they wish that they had chosen a tissue valve, due to the sound.

But, our experience is our experience. You know yourself far better than any of us could ever hope to. In my view, there is an element of self fulfilling prophecy in such issues which are largely psychological. If you have already decided that the "clicking" will be unbearable, then it likely will be for you. It is for this reason that, in my view, you are leaning towards the correct decision for you.

Surely in the future I will have to have reoperation, but in the meantime he has said to “look forward and live life”, that these valves can last between 15 and 20 years.

I do believe that you are making the right decision, but I have to take issue with the guidance that you have been given as to expectations for how long your valve will last. I had consults with two different surgeons prior to my surgery. Both the heads of their departments, one UCLA the other Cedar Sinai, which are among the top valve centers in the US. They both told me about the same- to expect about 10 years from a tissue valve. Keep in mind that I was not 38, but 52 at the time. The younger a patient is, the quicker they go through tissue valves. I am not aware of any study which indicates that a 'very young' patient in their 30s can expect 15 to 20 years. I'll comment further on this after quoting you again below:

I have read on the Internet that they can last 10 years, but most of the studies are old and with patients older than me.

True, that most of the studies involve patients much older than you, but it is very well established that younger patients go through tissue valves much faster than older patients. If you read some of the threads here, you will see that many patients who chose a tissue valve in their 30s and 40s had to get reoperations after 5 to 12 years. Very often it seems to be less than 10 years if the patient is under 40.

I really don't know if the valve lasting 15 to 20 years is key to your decision. If you knew that the limited evidence that we have would suggest that you should probably expect only 5 to 12 years from your valve, would that change your decision? If the answer is 'no', then it does not matter which expectation is correct. Go in the direction that you are leaning. If your answer is that 'yes' such a short-term expectancy for your valve would influence your valve choice, then, rather than trust me or other 'random' internet people here, please seek a second opinion on the expected valve life for you. This is a major decision and you should not trust a bunch of 'randoms'. If you do seek a second opinion on this matter and you get the same guidance, to expect 15 to 20 years, even though you are only 38, it would be great if your consultant could provide you with the study which he is basing this expectation on and it would be much appreciated if you could, in turn, share it here on our forum. Although, I can almost assure you that there is no such study. I would love it if you are able to prove me wrong about that. The two long term studies I was able to locate on the Medronic Freestyle had average patient ages of 69 and 75. This data can not be relied upon for a 38 year old patient.

Again, the expected valve life is probably a moot point, as you have determined that the clicking will be unbearable. But, for the sake of informed decision making, I wanted to address what I believe to be an overly optimistic expectation which you seem to have for tissue valve life for someone your age, so that in the event it does matter to you, you can seek additional consultations on tissue valve life durability expectations.


Below please find the article which I mentioned above. Some key points, including one which is consistent with the trend you mentioned:

"The use of biological valves for surgical AVR is steadily increasing, but there are limited data addressing potential differences in outcomes between biological and mechanical valves for the procedure, particularly in younger patients with a longer life expectancy."

"Indeed, the growing use of biological valves in younger patients, said Witberg, is proceeding without any clinical evidence supporting their use."

https://www.tctmd.com/news/more-deaths-bioprosthetic-mechanical-avr-young-patients
Regardless of which valve you end up choosing, the community his here to support you. Pleaes feel free to ask any questions which you have and wishing you the very best of luck with your operation.

 

[Chuck C]

I don't know if I should take this discovery as a punishment rather than a blessing.

For many reasons, I believe it is a blessing. This was the genetic hand that many of us have been dealt. We can't change that. But, I'm grateful that mine was detected about 4 years ago, so that I was able to have it monitored and taken care of. Valve disease has an amazingly successful cure- surgery. I'm also grateful that we live in the age we live in. If we lived 65+ years ago, we would have faced near certain premature death. We can't change the genetic hand that we have been dealt, but being grateful can go a long way.

 

[tommyboy14]

Hi @Wendel, I would like to add one more thing.

There is something called cardiac depression (that is the term the surgeon who first operated on me used). Some patients are prone to a bout of depression about 6 month after surgery. I got this after both surgeries. After the first one, after four month after the surgery, I was depressed for about 3-4 weeks. I had all the classicial symptoms of being very unhappy and I became very grumpy. 6 months after the second surgery it was even worse. I was close to getting medical attention because I was really very depressed for 4-6 weeks.

So if you think that this could be a consideration for you (repeated bout of cardiac depression), then perhaps this is another argument for mechanical.

Finally, if you look at the article below, which describes redo operations after the Free style valve implantation, the mortality rate of a redo surgery ranges from 6%-9%. Now surgeons have become better over time and you would also be younger when you need a redo than the median patient of the study, but that rate of mortality at OHS is very high, compared to the <1% mortality rate at the first surgery.

To be clear, I am not trying to sway you either way, but I think that it is good to have all of the information before making your decision.

As @Chuck C said, you should ask your surgeon why his recommendation goes against the globally accepted guidelines for patients in your age group.

I will keep my fingers crossed and wish you the best possible outcome whichever valve you chose.

Happy new year,

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911150/

 

[V__]

Do I have to think that all the centers that recommend biological valves to young patients want to harm them? The trend is on the rise…

If you go with the mechanical valve, you'd have to be diligent about taking warfarin. This should be "doable" for most people. But in practice there can be issues with maintaining this regiment.

As an example, I've seen a close relative obtaining a prescription (for a different medicine) and not taking it at all (*). So, as a guess, the medical community might be skeptical about a patient's ability to take drugs regularly, without explicitly saying so. To paraphrase Dr. House, "I don't know why patients don't take drugs, I just know they don't".

(*) Not sure what the point of getting the drug was then. But it all makes sense (to somebody).

 

[tommyboy14]

Hi @Wendel,

I just read your profile, it says that you have an Aneursym and Aortic insufficiency. But not that you have Aortic stenosis.

Have you spoken to any surgeons about Aortic valve repair? This is also called the David procedure. If your valve is insufficient because it is being stretched by the Aneurysm, they just replace the Aorta, but you get to keep your own valve. The Freedom of reoperation is around 85-90% 15 years after operation, so almost as good as a mechanical valve.

Perhaps this is something you could be eligible for and it is certainly worth exploring? Have you spoken to a surgeon who does Aortic valve repairs?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10405344/

 

[David Robbins]

Hello everyone,

First of all I want to thank all the users who provide their support in this forum, I have been reading a lot here and it seems very correct to me.

I have a 51mm aortic aneurysm, a dilation of the aortic root and severe aortic insufficiency, I have a bicuspid valve. I will soon undergo Bentall surgery.

I am 38 years old and I am from Argentina, I discovered this through a checkup, when I felt palpitations, I am asymptomatic, I don't know if I should take this discovery as a punishment rather than a blessing.

The surgeon suggested I do a Freestyle with a Dacron tube. I have generalized anxiety syndrome and I think that the “click” of the valve would be very annoying for my mental health.

A 3rd generation Medtronic Freestyle biological valve. He told me that in the large centers of the world and the US, surgeons are leaning toward these valves in young patients because of the duration, hemodynamics, and problems with anticoagulants.

Surely in the future I will have to have reoperation, but in the meantime he has said to “look forward and live life”, that these valves can last between 15 and 20 years.

He is a surgeon with a lot of experience, he has nearly 12,000 surgeries and 180 cardiac procedures, a man of about 70 years old. He was working with Dr. John W. Kirklin in Birmingham for many years.

I have read on the Internet that they can last 10 years, but most of the studies are old and with patients older than me.

I am a healthy person, unfortunately I am smoking (I know I shouldn't, but I'm going to quit), and like everyone I am afraid of not waking up from the operation.

I would like to know what you think of this election.

I am 69 and had my aortic valve replaced in March 2008 at 53. They implanted a 27mm St Jude mechanical valve; in July the valve failed and they reoperated implanting a 23mm St Jude. They found a hole in my left ventricle which wasn't discovered in the 2008 diagnosis. The team at Stanford who did the redo did a Transesophageal Echocardiogram which identified the full extent of the damage not originally discovered. I have been on Warfarin ever since and self test against the advice of my cardiologist, but prescribed by my original cardiologist. My current cardiologist, who I am using as a result of my current network under my Medicare Advantage plan actually recommended I take aspirin daily with the Warfarin, which was not advised by my original cardiologist, due to having a clip on a vessel in my brain placed after heart surgery due to further complications of the endocarditis I contracted before my hospitalization. I acquired Afib afteer my redo and had two unsuccessful cardioversion attempts and was prescribed Difetolide to keep me in sinus rhythm. Because of chances of sudden heart death related to this medication, especially for amateur athletes like myself, I opted out of drug treatment. The Afib was not limiting my activity. i do try to keep the INR near the top of the range to reduce the risk of clotting. I inquired this last year about ablation, but was informed that my heart had remodelled after 15 years and it would likely be unsuccesful. I have an athletes heart and resting heart rate dips as low as 30 bpm while sleeping which may be dangerous when I'm in my 70's and require a pacemaker. Pacemakers are different now and can be implanted through the femoral artery because of their small size. I will get a second opinion from Standford when I am in my mid 70s to determine a course of action. This valve relacement has not altered my lifestyle in any way other than INR self testing which takes all of 5 minutes every two weeks. I still lift heavy weights in the gym and routinely walk 5 miles and hike 7-10 miles weekly. I eat what is nutritious and adjust the Warfarin, not my diet to stay in INR range. I plan to defy the statistics and live into my 90's without reoperation. When I am forgetful or silly, some would question my mental decline and I just tell them I have brain damage, which is a fact but not a problem. I tested at 128 IQ after my brain surgery, so I haven't lost intelligence, although I don't recall being tested before my brain surgery.
Sorry about the long winded personal story, but rest assured, my choice of haeart valve(as recommended by my sister, a Director of Cardiology was a good choice.

 

[pellicle]

They implanted a 27mm St Jude mechanical valve; in July the valve failed

because this is so unusual, can you clarify how "the valve failed" please?

Also, I've never heard of this and can't find any references for it

Pacemakers are different now and can be implanted through the femoral artery because of their small size.

are you sure you're not confusing this with TAVI?

For anyone else interested in this point:

...was prescribed Difetolide to keep me in sinus rhythm. Because of chances of sudden heart death related to this medication...

https://en.wikipedia.org/wiki/Dofetilide#Adverse_effects
Torsades de pointes is the most serious side effect of dofetilide therapy. The incidence of torsades de pointes is 0.3-10.5% and is dose-related, with increased incidence associated with higher doses. The majority of episodes of torsades de pointes have occurred within the first three days of initial dosing. Patients should be hospitalized and monitored for the first three days after starting dofetilide.[7]

https://en.wikipedia.org/wiki/Torsades_de_pointesTorsades de pointes, torsade de pointes or torsades des pointes (TdP; also called torsades) (/tɔːˌsɑːd də ˈpwæ̃t/,[2] French: [tɔʁsad də pwɛ̃t̪], translated as "twisting of peaks") is a specific type of abnormal heart rhythm that can lead to sudden cardiac death

Quite interesting, thanks for sharing.

 

[V__]

There is something called cardiac depression (that is the term the surgeon who first operated on me used). Some patients are prone to a bout of depression about 6 month after surgery. I got this after both surgeries.

Hi @tommyboy14 ,

Thanks for the message. It's interesting to me, since I noted the cardiac depression as a possibility when looking at the heart surgery circumstances. Apparently, 10-15% of patients get it, if I recall correctly. I didn't get it, but was imagining that, if the recovery process pauses for a couple of weeks, this might be difficult physiologically. But it's just a guess. Would you venture to describe the possible origin of your occasions? (No problem if you don't want to go there either. I'm only curious.)