choosing right valve

[geff]

hi i need to have my aorta valve replaced as its severely enlarged and the valves are not working properly and finding it very hard to decide whether a cow tissue or mechanical would be best both have problems i am 67 the mechanical you have to live with the ticking noise and also blood thinners and have also found out that very important to keep your oral health checked as if you were to get an infection it can cause a heart attack ,i already have receding gums so often i have to have a tooth pulled out or take antibiotic's for gum infections also there can be complications as to whether your body will accept the mechanical device then the cow tissue will only last approx. 10 maybe 15 years which would make me 83 years if I'm lucky to get to that age to have another operation my surgeon has suggested the tissue because of my age its very scary even thinking about the operation let alone trying to decide which one to have can someone please help me as i am will be admitted to a hospital soon thank you

 

[pellicle]

also found out that very important to keep your oral health checked as if you were to get an infection it can cause a heart attack ,i already have receding gums so often i have to have a tooth pulled out or take antibiotic's for gum infections also there can be complications as to whether your

This is true irrespective of valve choice. However, it's not heart attack, it's endocarditis.

There is a lot to learn if you intend making an informed choice.

My advice is to go with the surgical guidelines ; which for your age would incline you towards a bio-prosthesis.

I could discuss more if you wish, but searching through the many threads on valve selection will get you across those things in half a days reading.

Hit back with questions if you have them.


Best Wishes

 

[dick0236]

Based on the limited info in your first post I would also be inclined to suggest looking at a "bio" valve rather than a mechanical valve at your age. Research some of the older posts to become familiar with the pros and cons of the different choices. Like Pellicle said above, the oral health issue will need to be addressed regardless of valve choice. Poor oral health will potentially lead to a lot of future heart health problems.

Welcome to the forum.......you will find a lot of useful info here.

 

[pellicle]

Hey Geff ... forgot to welcome you aboard ... I was out picking up some groceries before.

As I mentioned, a bioprosthetic will be an obvious choice for your age group and you may indeed get 15 years from one (I'd consider the Resilia valve). The most important thing to do if you pick a mechanical is self manage your own INR ... which I've done for the last 12 years (and taught many to do it).

To get the best from a mechanical you must fit this profile:

• be the kind of person who will diligently take their tablets,
• check that the dose is what it should be before taking
• test their INR weekly
• make taking all this seriously your new lifestyle
• be active and interested in / about your health (exercise and diet) and also your post surgical management of INR

This will reward you with:

• the highest possibility of avoiding future surgeries
• protection against other things which will cause strokes such as afib or other arrhythmias. The risk of this increases with age and with having had any OHS (I've had 3), the general stroke risks increase as you age too.
• confidence about warfarin and what it does

Best Wishes

 

[tjay]

hi i need to have my aorta valve replaced as its severely enlarged and the valves are not working properly and finding it very hard to decide whether a cow tissue or mechanical would be best both have problems i am 67 the mechanical you have to live with the ticking noise and also blood thinners and have also found out that very important to keep your oral health checked as if you were to get an infection it can cause a heart attack ,i already have receding gums so often i have to have a tooth pulled out or take antibiotic's for gum infections also there can be complications as to whether your body will accept the mechanical device then the cow tissue will only last approx. 10 maybe 15 years which would make me 83 years if I'm lucky to get to that age to have another operation my surgeon has suggested the tissue because of my age its very scary even thinking about the operation let alone trying to decide which one to have can someone please help me as i am will be admitted to a hospital soon thank you

I think your decision is rather easy. Tissue valve at your age (67), and then TAVR when it wears out (as you noted yourself around 83 yrs, let's say). This's consistent with guidelines, and your cardiologist and surgeon would tell you that in a heartbeat.
All the best in valve selection.

 

[carolinemc]

hi i need to have my aorta valve replaced as its severely enlarged and the valves are not working properly and finding it very hard to decide whether a cow tissue or mechanical would be best both have problems i am 67 the mechanical you have to live with the ticking noise and also blood thinners and have also found out that very important to keep your oral health checked as if you were to get an infection it can cause a heart attack ,i already have receding gums so often i have to have a tooth pulled out or take antibiotic's for gum infections also there can be complications as to whether your body will accept the mechanical device then the cow tissue will only last approx. 10 maybe 15 years which would make me 83 years if I'm lucky to get to that age to have another operation my surgeon has suggested the tissue because of my age its very scary even thinking about the operation let alone trying to decide which one to have can someone please help me as i am will be admitted to a hospital soon thank you

Mechanical would be best for it does not always require resurgery, like you would with a cow valve. and due to you having heart issues, you will have to premed before any dental cleaning or work done, and after. Go with the mechanical, Warfarin is easy to manage. I have St. Jude's leaflet and have been on Warfarin for 22 years and counting. And will be given antibiotics to clear up the infection before you even have your Open Heart surgery.

 

[3mm]

i need to have my aorta valve replaced as its severely enlarged and the valves are not working properly and finding it very hard to decide whether a cow tissue or mechanical would be best

Hi Geff - I'm sorry to hear that you need heart surgery. However, I am glad you are researching this while you have time. There are many reputable places to learn about your options. Mayo Clinic and Cleveland Clinic are 2 major hospitals in the USA which have excellent websites with educational material. As Pellicle said above, search the valve selection threads on this forum. I'm sure there are other sources as well. Please use reputable sources of information, and not just random youtubers! Always ask yourself what scientific evidence a person has for what they say.

I do not know what is best for you; please remember that guidelines are GUIDELINES, and you need to consider your individual situation. For example, I choose a mechanical aortic valve 9 months ago at age 65. I am very active, and I worried about wearing out a bioprosthetic valve which could lead to a 2nd open heart surgery. Remember, not everyone will be eligible for a TAVR when they need a replacement valve.

 

[tom in MO]

Rest easy with the thought that both choices are good ones since they lead to life. The reason it is hard to chose is both paths have merit, which kind of means there is no wrong choice.

At your age, if you have significant arthritis you may want to opt for a bio valve since warfarin keeps you from taking many arthritis treatments like NSAIDs. If you have significant arthritis, I'd suggest talking to your doctor who handles your arthritis to help with your choice.

 

[pellicle]

@geff
this ...

Rest easy with the thought that both choices are good ones since they lead to life. The reason it is hard to chose is both paths have merit, which kind of means there is no wrong choice.

is correct ... there is no perfect choice; everything is a trade-off. The preamble for this article makes that clear

http://circ.ahajournals.org/content/119/7/1034.full

Despite the marked improvements in prosthetic valve design and surgical procedures over the past decades, valve replacement does not provide a definitive cure to the patient. Instead, native valve disease is traded for “prosthetic valve disease,” and the outcome of patients undergoing valve replacement is affected by prosthetic valve hemodynamics, durability, and thrombogenicity. Nonetheless, many of the prosthesis-related complications can be prevented or their impact minimized through optimal prosthesis selection in the individual patient and careful medical management and follow-up after implantation.​

Best Wishes

 

[Chuck C]

Welcome to the forum Geff.

At age 67, you are right in that range in which either valve is considered a reasonable choice. There is no wrong choice here, it's just a good idea to be informed in making said choice.

Pellicle laid out some good points to ask yourself before considering a mechanical valve.

One thing that you might consider is getting your Lp(a) tested. It is a simple blood test. Elevated Lp(a) is a associated with the development of aortic stenosis and a study published this year found that elevated Lp(a) is associated with quicker development of SVD for bioprosthetic valves. See link below.

https://heart.bmj.com/content/110/4/299

If it were me, and I did not have elevated Lp(a), I would probably lean towards a tissue valve at age 67. But, it is important to understand that this could mean getting another procedure in your 70s or 80s. By then you will likely be at an age at which TAVI would be the optimal way to go, thus avoiding a second OHS. But there is no certainty that you will be eligible for a TAVI, so a second OHS might be needed. So, no bad choice, but also no perfect choice. Pros and cons with each option.

Best of luck with your decision and with your procedure. Please keep us posted as to your choice and how things go. You'll be on the other side in recovery before you know it.

 

[Timmay]

I can’t tell ya what’s right for you. But I CAN tell you about me.

At 50 I got a mechanical. I’d make the same choice again.

However, if I was 67, I’d specifically get the Inspiris Resilia tissue valve and gamble that I could do a TAVR later (if I needed it).

The Inspiris Resilia theoretically should last a bit longer than the standard tissue valves. AND, it’s designed with TAVR in mind. The ring on the Inspiris Resilia is designed to expand at a later date so that a good sized TAVR can be inserted. Granted, a TAVR isn’t guaranteed. Might not be eligible for one. But if I were 67 I’d take that gamble.

See everybody? I’m not against tissue valves!

 

[geff]

Hi Geff - I'm sorry to hear that you need heart surgery. However, I am glad you are researching this while you have time. There are many reputable places to learn about your options. Mayo Clinic and Cleveland Clinic are 2 major hospitals in the USA which have excellent websites with educational material. As Pellicle said above, search the valve selection threads on this forum. I'm sure there are other sources as well. Please use reputable sources of information, and not just random youtubers! Always ask yourself what scientific evidence a person has for what they say.

I do not know what is best for you; please remember that guidelines are GUIDELINES, and you need to consider your individual situation. For example, I choose a mechanical aortic valve 9 months ago at age 65. I am very active, and I worried about wearing out a bioprosthetic valve which could lead to a 2nd open heart surgery. Remember, not everyone will be eligible for a TAVR when they need a replacement valve.

 

[Rebecca]

Twelve and half years ago I had my first surgery and got a aorta porcine valve. At 67 I just had my second open heart surgery 3 months ago. This time I got aorta bovine pericardial valve and my aneurysm fixed. My surgeon told me I could get two TAVR done when it was time to replace my heart valve. This is what I got:
https://www.edwards.com/healthcare-professionals/products-services/surgical-heart/konect-resilia

 

[Chuck C]

if I was 67, I’d specifically get the Inspiris Resilia tissue valve and gamble that I could do a TAVR later (if I needed it).

It is indeed a gamble as to whether a patient will be qualified for TAVI on the next round, something which many surgeons fail to convey, sadly. It is a "hope", not a certainty.

 

[pellicle]

It is a "hope",

people love hope ... seems more popular than it should be.

 

[geff]

Thank you very much for your helpful advice and the others who have also shared advice for me, i`m lucky that i have a few weeks to do my research and looking at going at the moment for the mechanical valve as i already have to take pills so an extra 1 or 2 a day wont effect me also if i`m lucky to reach 85 then at that age i wouldn't need to worry about another operation and like many i guess i`m absolutely terrified of the operation what makes it even harder is the fact the the heart specialist tells you what is available to have done i think doing this makes it also so much harder for patients to make a decision i think they should not tell you what there is and do what they think is best for you then you have a little less stress before the operation, i think all i need to find out is from people who have the mechanical valve as to what type of lifstyle can they still do and does it change your diet

people love hope ... seems more popular than it should be.

just a quick update my surgeon has told me he has done aggressive research of what's out there and what can be used but still only uses the cow or pig tissue or the st judes mechanical device so i would presume after years of research that these are still the best three options for patients are there many people who agree also after the operation is there anything I need to prepare myself for or will they have me fully doped up that I wont even know I'm there as I've already requested sedative's once I'm admitted any advice is always helpful and appreciated

 

[3mm]

my surgeon has told me he has done aggressive research of what's out there and what can be used but still only uses the cow or pig tissue or the st judes mechanical device

I asked my surgeon's team from Mayo Clinic why they gave me an On-X mechanical versus the other brands. They said the Mayo surgeons consider all of the mechanical valves to be very comparable. They are about 50-50 between On-X and St Judes, with a slight lead to the On-X.

 

[Deidra]

i think all i need to find out is from people who have the mechanical valve as to what type of lifstyle can they still do and does it change your diet

Hi! I just had my aortic valve and root replaced with a mechanical valve + conduit a month ago.

As far as lifestyle goes, we have people here who ride motorcycles, do manual labor, and lift very heavy weights at the gym and they are doing just fine. A woman climbed to the top of Mt. Everest with a mechanical valve. Realistically, there aren't any absolute lifestyle restrictions just for having a mechanical valve. You should just be conscious of the risks of a given activity and take the appropriate safety measures, but people should be doing that anyway.

In terms of diet, cranberry juice and grapefruits are the only common things I've heard to avoid. Other than that, there isn't any dietary restrictions. The main recommendation is to just keep the amount of food you eat with Vitamin K in it (dark leafy greens, broccoli, herbs, etc) fairly consistent from week-to-week. You shouldn't avoid those foods, and in fact there is some evidence that consistent Vitamin K intake can help to stabilize INR levels. I don't drink but many people here do without any issues.

It seems to me that the perception of the risks and "lifestyle modifications" associated with mechanical valves is overblown by some people (and medical professionals.)

Edit: Also, personally, the ticking is very minimal and I don't find it to be a problem at all. If anything, it's reassuring. And this is coming from someone who is sensitive to certain sounds and sensory over-stimulation.

 

[Timmay]

It is indeed a gamble as to whether a patient will be qualified for TAVI on the next round, something which many surgeons fail to convey, sadly. It is a "hope", not a certainty.

Thanks for drawing extra attention to this Chuck. Extremely important. Definitely a high stakes “gamble”.

 

[pellicle]

It seems to me that the perception of the risks and "lifestyle modifications" associated with mechanical valves is overblown by some people (and medical professionals.)

I just wanted to throw in that the "overblown" aspect comes from a combination of the following (add some weighting between 0 and 1):

• failure to take doses
• failure to take correct doses
• lying about this to the medical practitioner
• failure to mention taking other drugs (to the clinic) which can effect INR
• general slackness

I hear all the time from people I know (pharmacists and doctors who are trying to work with patients) that these are the main problems. If you are a patient who knows these things and wants to follow what's needed then

1. you're rare
2. doctors will love you.

Best Wishes