Bio vs Mechanical for a 31 yr old

[mrfox]

Hi all!

I've been given the go ahead for surgery recently and am now beginning to submerge myself in the whole mechanical vs bio question.

To complicate matters I have been given conflicting opinions by my surgeon and cardiologist. My cardiologist was very firm on a tissue valve - insisting that by the time it needs replacing it is likely to be a TAVI procedure, followed by a second TAVI and by then - perhaps 20 years from now - the landscape will be very different. My surgeon has told me that mortality figures for younger patients are better with mechanical valves and as a result, recommended one for me.

My understanding is that both routes come with some complication concerns for a young patient. The mechanical valves mean a lifetime of anticoagulants and therefore elevated risk of stroke or thrombosis, whereas the tissue valves mean re-operation risks (If I want to live to a good age it could mean as many as 4 or 5 surgeries) combined with risks surrounding going through a valve deterioration many times.

Additional to this is the sense that if I go mechanical I will close the door on tissue valve developments which seem (to me) to be the promising avenue for research right now.

With all of that said, my head is spinning! I'm not looking for answers - nobody can make this decision for me - but thoughts and opinions are very welcome.

Thanks!

 

[pellicle]

Hi

I side with your surgeon.

Here are my reasons
First

Additional to this is the sense that if I go mechanical I will close the door on tissue valve developments which seem (to me) to be the promising avenue for research right now.

To get such advantage you will need to first go through the first surgery, then in (lets say 20 years, which is unlikely in a young patient, but lets say 20) you will need that other surgery. Which you would likely not need had you chosen the mechanical...

My surgeon has told me that mortality figures for younger patients are better with mechanical valves and as a result, recommended one for me.

In my view the surgeon actually knows the cardio is a much less experienced and expert opinion. Although their ego oftentimes wants tou to think they know more...

My understanding is that both routes come with some complication concerns for a young mechanica

I wouldn't call it complications so much as facts or parameters.

Anticoagulant therapy is well regulated these days and you yourself .ake the biggest difference with proper compliance with taking your pills and regular testing. Yes, it really is just that simple.

whereas the tissue valves mean re-operation risks (If I want to live to a good age it could mean as many as 4 or 5 surgeries) combined with risks surrounding going through a valve deterioration many times.

Which equates to you being back inthe waiting room again. Anxious over visits and anxious again over the progressive structural failure of the valve...

read carefully my blog post here:
http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html

And listen carefully to this excerpt from a presentation byu a senior Mayo Clinic surgeon

https://youtu.be/enluDpPBVaE

​​​​​​​Best wishes

 

[pellicle]

Opps forgot to add the detail about self management of INR

http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html

http://cjeastwd.blogspot.com/2015/10/managing-my-inr-example.html

And down the track, managing INR around surgeries ir procedures

http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html

 

[Superman]

No easy decision to be sure. You are correct. Only you can make it.

I feel compelled to note that mechanical is no guarantee of being free from re-op. I’m currently on my second mechanical due to an aneurysm repair at 36. I received my first mechanical at 17. Sometimes an aneurysm can be the issue. Sometimes scar tissue around the valve. Sometimes infection. That said, mechanical is far less likely to need a re-op. Funny that I had the exact opposite experience for my second surgery. Cardio thought mechanical. Surgeon advocated tissue. I had already known I was going to do mechanical agin, but if I was a newb, I would’ve found the mixed messages confusing.

 

[Paleowoman]

Hi mrfox Have you asked about the new Inspiris Resilia valve ? It's the latest tissue valve from Edwards and designed to be an alternative option to a mechanical valve, especially for younger active people apparently. A 27 year old was given one at King's College Hospital London, last year, here from Cardiovascular News about it: https://cardiovascularnews.com/firs...ces-inspiris-resilia-aortic-valve-take-place/

 

[hx77]

I was faced with the same question before. But i am 24 years older than you so the decision will be less harder for me.

Tissue values get calcified faster in younger patients than older patients. So you want to make sure your are not prone to calcification. If your native valve is deposited with lot of calcium, i would say you are not a good candidate.

 

[WillieR]

MRFOX, I'm in the same situation. 32 years old, relatively active playing hockey, working out etc. I'm leaning towards the mechanical valve right now in hopes that it is a once and done procedure. I'll deal with lifestyle changes, I'm okay with giving up "contact" sports. I think the fear of bumps and bruises from coumadin is overblown a bit and my surgeon did not think it was an issue either. I met with three surgeons (2 at Mayo, both have done thousands of these) and they all recommended mechanical for me, I value their opinion. They said tissue would be the 2nd option but at my age expect to be back in 5-7 years, that did not sound good to me. If you are a pro athlete it may be worth it.

I am also accounting for the "oh ****" factor and assuming I may need the mechanical replaced at some point (as Superman stated they did above), that would put me at two surgeries, two more then I ever wanted, lol!!!
If i went tissue I would be looking at probably 4-5 surgeries if I lived as long as I hope to. Additionally on the TAVR the surgeons I spoke with were not as high on valve in valve unless it was a really old patient. I think at this point they'd probably recommend a 2nd open heart surgery to replace the failed valve. They also said when they do TAVR they have to size the valve down to fit and then you will get poorer flow. This gets even smaller if you had to do a TAVR in TAVR, now that's not to say the technology can't change in the future but I'm not gambling with what ifs. I mean down the road they may be able to grow you a new valve with stem cells, but its all anybody's guess at this point.

I'll probably go with the ON-X due to the lower anti-coagulation levels but the surgeons seem to think the super annular valves (such as the Carbomedics "Top-Hat") that sit above the old valve position are a good as well because they can fit a bigger valve in that way and it will have better flow than a valve that sits inside your old valve position.

I'll also second Pecille in saying from my experience the surgeons seem to know way more than the cardiologists. I would place way more emphasis on the surgeons opinion.

 

[hx77]

Another thought. If you are candidate for TAVR, e.g., not BAV, get a TAVR now to see how a tissue valve works in your body without the pains of OHS.

 

[ForeverThankful]

Hi mrFox!

I was 55 when I had my surgery and after some thought I pretty quickly decided on a mechanical valve. I knew I didn't want to be going in for a second surgery at 75 years old and I didn't want to be walking around for a couple of years before said surgery with a degrading valve. If I had been 31 instead of 55 I wouldn't even have had to think about it at all, I would have decided on mechanical right away.

As far as anticoagulant therapy is concerned I find it to be no big deal, take the medication and self test regularly and as Pellicle said "Yes, it really is just that simple".

This is a personal choice and everyone has to make their own decision and be comfortable with it. I'm sure you'll make the right choice for you!

 

[mrfox]

Superman are you actually able to go tissue after a mechanical valve? My understanding was that isn't possible.

Thanks for the replies everyone! food for thought. I've been oscillating from one to the other pretty frequently right now!

One issue I have with the anticoagulant stuff is - I like to wilderness hike (days from civilisation) and ride motorbikes - two activities which come with a decent risk of a big bleed...

 

[mrfox]

Paleowoman - I keep seeing the Inspris mentioned here. It's an artificial bio valve? What's the advantage? I'll definitely ask about it as the article you posted mentioned the first surgery was done at Harefield which is in fact my hospital!

 

[Paleowoman]

Paleowoman - I keep seeing the Inspris mentioned here. It's an artificial bio valve? What's the advantage? I'll definitely ask about it as the article you posted mentioned the first surgery was done at Harefield which is in fact my hospital!

mrfox - Yes it's a new generation of tissue valve (bio valve) which was designed to last a long time, and, as the article suggests, is meant to last as long as a mechanical valve, but without anticoagulation since it's bio/tissue. It seems to be being used a lot in the UK and Europe now as it was approved here last year.

Who are you under at the Harefield ? I saw a cardiac surgeon at the Brompton last year but now under one who is at Barts Heart Hospital (though Bupa pay for me to see him). Not that I'm having my re-do yet.

 

[astle9]

I have the new inspiris valve mrfox and i chose it mainly due to its claimed longevity and the fact when it needs replacing TAVI will be the norm (no guaranteed of course) i could not face a life of hearing a ticking noise (i hate the sound of clocks already) and the anticoagulants could potentially be a hazard as i am sometimes out in the middle of nowhere alone with my dogs and bleeding could be a factor if an injury occurs. All of these are what ifs but on balance i took a chance and hopefully i will be proved correct in my choice both my surgeon and cardiologist were very supportive of this valve. The valve is treated with a coating that holds off calcification, i feel good after 5 weeks of recovery gone. Good luck with your choice.

 

[pellicle]

- Yes it's a new generation of tissue valve (bio valve) which was designed to last a long time, and, as the article suggests, is meant to last as long as a mechanical valve.

I wouldn't give that claim much credence with zero historical evidence to back it up. It's probably quite right for a 70 year old, but to expect 40 years out of a bioprosthetic in a 30 year old moves from wishful thinking into something else...

 

[pellicle]

Superman are you actually able to go tissue after a mechanical valve? My understanding was that isn't possible.

Its entirely possible. Both just have stitching rings and replacing one is like replacing another.


I ride motorcycles too. I think the bleeding risk is totally misunderstood and exaggerated beyond reality.
The risks are usually stated within specific medical contexts and written by and to medical professionals.

It's always the same, those who are on warfarin are chill with it and those with zero experience and "read a lot of stuff" are shrill about it.

What does that tell you about it?

 

[astle9]

I wouldn't give that claim much credence with zero historical evidence to back it up. It's probably quite right for a 70 year old, but to expect 40 years out of a bioprosthetic in a 30 year old moves from wishful thinking into something else...

things move on at one point all heart surgery had no historical evidence, every valve ever made at one point was a first, i mean the future will be valves grown from your own cells that will last a lifetime if looked after. You would be a fool to accept claims as truths but on balance i will listen to those who diagnosed and then treated my problem and they were happy with this choice. As the surgeon said if it fails after 10 years what is the problem as we will have moved away from invasive heart surgery. Mechanical valves have no guarantees, if they could have said to me have this mechanical valve and we will 100% guarantee it will see you to death then i would have been convinced, they could not so i took a chance. The rest of this is up to me and how i approach it will determine the outcome as much as the valve, i was told no more alcohol of any description as it will destroy the calcification coating, happy with that, eat clean and avoid too much calcium in my diet, happy with that, exercise daily and maintain a health weight (once on cardiac rehab) i am happy with that. Very happy with my choice and if it fails it was my choice so we will do it again.

 

[pellicle]

Very happy with my choice and if it fails it was my choice so we will do it again.

I made no criticism of your choice, you mentioned other criteria. I am discussing points with someone ele who has yet to make a choice.

Every time makers of tissue valves make marketing claims about their products, but the facts are things only extend a little.

Each makes their own decisions and is entitled to a variety of views.

Informed rebuttal of points is welcomed, passionate views of faith are in my view unhelpful. The purpose should be to inform, not to get someone "to pick whst I picked".

 

[pellicle]

Some reading from users here

http://www.valvereplacement.org/for...90-my-second-time-around-avr-only-lasted-2yrs

http://www.valvereplacement.org/for.../43088-the-surgeon-choice?p=785569#post785569

 

[astle9]

I made no criticism of your choice, you mentioned other criteria. I am discussing points with someone ele who has yet to make a choice.

Every time makers of tissue valves make marketing claims about their products, but the facts are things only extend a little.

Each makes their own decisions and is entitled to a variety of views.

Informed rebuttal of points is welcomed, passionate views of faith are in my view unhelpful. The purpose should be to inform, not to get someone "to pick whst I picked".

Yes and in order to make his choice i hope he discusses this valve with his cardiologist/surgeon and if they dismiss it as a marketing claim at least he would have had the option discussed with his team.

 

[Paleowoman]

I wouldn't give that claim much credence with zero historical evidence to back it up. It's probably quite right for a 70 year old, but to expect 40 years out of a bioprosthetic in a 30 year old moves from wishful thinking into something else...

Hi Pellicle - this Inspiris Resilia valve is a new generation of bioprosthetic valve - it is not like the previous bioprosthetic valves. if you read the articles on it you will find that it is actually meant for the younger patient too, though I suspect plenty of older patients would want one. You can't extrapolate how long this new type of bioprosthetic valve will last based on the 'older' bioprosthetic valves like mine for example !