Bit Confused

[nutty]

Hi... this is my first post here.

My background is Bicuspid valve since birth (currently moderate stenosis and regurgitation). Asymptomatic.

Recently Ive been diagnosed with an enlarged 5.0cm root and was told last month that this will need to be replaced at soon and that they will replace the valve at the same time. Im 29 and Ive decided on a tissue valve when it needs to be done, due to number of things including risk of injury with my current occupation, I do alot of active spots ie mountain biking and want freedom from warfarin. I'm fully aware of the risks of a tissue valve failing in 3-5 years etc

My confusion is coming from the cardiologist ... she says that if they replace the root/valve etc that I will need to go on warfarin for the graft they put in etc. If that was the case there is no point in going tissue and Ill just opt for an On-x with the attached graft.

So my question is .. am i destined for Warfarin because I need a graft ? I was under the impression that the graft after time gets covered with your own cells etc and clotting was down to the valve rather then the graft itself. I also taught the surgeon can sow a tissue valve onto the graft and implants the lot together.

Thanks
John P.

 

[OldManEmu]

Hi John
I have a graft after my second surgery and I am not on Warfarin and never have been.
Surgeons do join grafts and valves during the operation as not all valve manufactures make a combined graft and valve unit in the factory.

 

[Bill B]

I would focus on finding a surgeon and reviewing your options with him/her. You should be able to get a tissue valve, graft and no longterm warfarin, but there are a lot of choices to be made there and you want a surgeon who has experience with whatever you choose. I wouldn't waste any time talking with your cardiologist about surgery.

 

[Mom2izzy]

I had a repair and was on Warfarin just during the healing process. At 5 weeks...no more Warfarin.

 

[Greg a]

I had a repair and was on Warfarin just during the healing process. At 5 weeks...no more Warfarin.

I too was on this thinners and INR regimin for my mitral dacron ring for a few months but still five years later premedicate for dental cleaning etc.

 

[Greg a]

Oh and welcome to the site!!!!!!!!!!!!!!!!!!

 

[Paleowoman]

Welcome from another UK member ! You might want to check this out, but from what I've read most people are put on warfarin post operatively for a time, it's not long term warfarin.

 

[epstns]

I don't have a graft, but I do have a tissue valve. I was prescribed warfarin for the first three months after surgery, then none after that. From what I hear and read, this short-term anticoagulation is fairly normal here in the US. I'm not sure about practices in the UK, though.

Glad you found us. Welcome to the family.

 

[nutty]

Hi Folks

Many thanks for all the replies. I was thinking that it was the surgeon i needed to be talking to rather then the cardiologist regarding this issue.

Back to the waiting room for the moment !!! Hopefully will get some more time from the faulty plumbing before it needs seeing to.

Regards,
John P.

 

[TheGymGuy]

Hey nutty welcome to the board. I am a very active person as well, and recently had my surgery. Most folks think that my recovery is going pretty well. I know that tissue vs mechanical is a very complicated and "personal" choice. Though, if you are very active, and manage your warfarin accurately, your limitations will be very small if any, I believe, lots of people on here can attest to that.

Anyways, the main reason that I am posting in your thread is that my stay in the hospital was only 3 days. I chose a mechanical valve for "personal" reasons, but I have to tell you, that I really do not wish to EVER repeat these 3 days again. Just getting the catheter removed still sends me into shudders. And, there were lots of things, put in, removed, prodded, etc., the list goes on.

By no means am I pushing you to a mechanical valve (and there are many wonderful choices), but I just wonder if you are REALLY willing to go through this surgery in 4-10 years again just to avoid Coumadin. Also, most people with tissue valves are put on Coumadin for first 4-8 weeks, and some have to stay indefinitely - that will always be a risk.

I want to be constructive in my response, but since I came here I have seen at least 2 re-ops, including Jarno (sp? user name) who had a tissue valve for less than 3 years and had to have a re-op and ultimately went with mechanical.

 

[jumpy]

My biggest concern with valve choice is trying to avoid re-operation. However, with heart disease prevelant in my family history, what if I end up having another coronary "event" which would require re-operation anyway? I thought I had made the choice to go mechanical but now I am having second thoughts. Does Warfarin limit or increase the chances of requiring a coronary bypass? If only it would have lasted long enough to have the one-stop servicing....

 

[bdryer]

Hey Jumpy

Warfarin will Not prevent plaque in your arteries. It does it's work in the liver blocking vitamine K, which directly effects the clotting of blood. That's it! Life style changes, diet and supplements are your best bet for avoiding plaque build up in arteries.

 

[Fundy]

I too thought my mind was mad was made up to go with mechanical, however for some reason I got the strong feeling to go with tissue instead. Mostly figuring that all that was really necessary to bypass ACT was a reoperation; which would just really be another surgery. So far I'm actually glad I did go with the tissue choice, but first two days after surgery I thought I made the biggest mistake ever. I couldn't have felt worse in my life ever and had no desire to be that way again.

However, if I lived in the US and had to worry about how the next operation would get paid for I would have chose mechanical for sure. That was kind of my last decision point really. If I went with tissue would the operation still be paid for in ten years. The health risk and pain was secondary to financial concerns really for me. Strangely it doesn't seem to be a point brought up by many others in deciding tissue or mechanical.

 

[Eva]

My biggest concern with valve choice is trying to avoid re-operation. However, with heart disease prevelant in my family history, what if I end up having another coronary "event" which would require re-operation anyway? I thought I had made the choice to go mechanical but now I am having second thoughts. Does Warfarin limit or increase the chances of requiring a coronary bypass? If only it would have lasted long enough to have the one-stop servicing....

This a very difficult time for you and your mind will endlessly wander with the "what if".

My humble advice is to base your valve choice decision on your current situation and on what you and your surgeon think is the best choice for you NOW. NO ONE CAN PREDICT THE FUTURE!

Keep on taking deep breaths.

Good luck.