Choosing the type of valve

[Russell Cole]

I am 62 years old and will have aortic valve replacement January 27th. I am trying to decide which type of valve to select. Am in reasonably good health, over weight, but who isn't and reasonably active. I ride a Harley and am concerned about using Coumadin, particularly if I fall. Also worried about any residual weakness. I would appreciate any suggestions.

 

[Phyllis]

Welcome, Russell. You are in the right thread- "Valve selection". If you browse here, you will find many "heated" discussions about biological v. mechanical. You are at that age where your decision may be more difficult, but this is the place to find all the pros and cons. Today, a biological valve has a good chance of lasting 15-20 years and who knows what medical advances will bring in that time. Just remember that whatever you decide, in the end, it is the "right" decision and we wish you the best. By the way, I will put you on the calendar for January 27th and I hope that you will find much support and make many new friends here.

 

[Ross]

Hi Russel and welcome to the club.

At your age, I wouldn't have a problem saying Bovine tissue for you. I think it would last pretty much the rest of your life barring any defect in the valve itself.

One thing the Doctors fail to tell people is, there is a fairly strong chance of being on Coumadin anyhow, should afib set up shop after surgery. Afib is just one of many side effects of heart surgery. Most of us have had a round of it and some, it's a chronic condition.

Should you choose mechanical, Coumadin is not at all what the medical community makes it sound like. I would encourage you to visit our resident Anticoagulation expert and pharmacist, Al Lodwick's site and educate yourself about the drug as part of the selection process.

www.warfarinfo.com

 

[Susie Q]

Susie Q

Susie Q

Russell,
I'm a relatively new member to this website. I had aortic valve replacement and mitral valve repair with annuloplastry ring at age 60 on 11/8/05. I became 61 on 12/6/05. My surgeon basically made the decision to use a mechanical valve because he said I was still "young and active", a statement I questioned. I have an ATS valve which I very seldom hear. My husband said that he's never heard it. As far as taking Coumadin for the rest of your life, that's another issue you'll have to think about. My INR levels have been inconsistent over the 2 months since my surgery, but have been told this is normal. I've learned from the wonderful people on this site that regulating Coumadin levels is not something to be afraid of. The important thing is just to be informed. All the members here are so willing to share their knowledge & expertise because they've "been there done that." Learning how to regulate INR levels is likened to attempting any new activity/responsibility. We learn as we go. I'm thankful for the support & encouragement of these qualified, knowledgeable people.

______________
Aortic Valve Replacement (ATS) 11/08/05
Mitral Vave Repair (Annuloplastry Ring 26mm) 11/08/05

 

[geebee]

Russell,

I just want to welcome you. I don't really have any good advice. I plan on living well into my nineties so, if I were choosing another valve at this point I would go mechanical. It's true that tissue valves can last 15-20 years but that means if you live a long life, you could be facing another OHS in your eighties. I would think recovery would be an issue at that age.

I guess if one goes by life expectancy statistics, a tissue valve could last the rest of your life. However, it might not if you have a long life.

Not much help, I know but food for thought.

Best of luck and have fun riding.

 

[Russell Cole]

Reply

Reply

I appreciate all the responses. I forgot to mention that I had 5 TIA incidents in November and now take Plavix. I am wondering if the possibility of another TIA incident or even a stroke would weigh in the decision. I have had a doc friend tell me he has never had a patient who takes coumadin have a heart attack or a stroke. I definitely don't want to repeat the TIA incident. Does this fact change anyone's opinion on which valve I should consider?

 

[Ross]

No it doesn't. What does bother me is, were these tia's a result of plaque breaking free or clots? Not to make you worry even more, but if your arteries are clogged with plaque or calcium, there is a chance that the disruption in the arteries could dislodge some of it and it could well travel to you brain. Question the surgeon on this until your satisfied with the answer.

 

[Superbob]

Lots to Consider

Lots to Consider

Russell,

It's a tough decision. I was 63 at the time of my valve and root replacement last February, and after weighing all the considerations, I went tissue. It came down to what I was comfortable with. I also perceived some advantage for one stentless device since my extremely enlarged aortic root had to be replaced also. But I don't dispute the testimonials for a mechanical choice. Gina makes a valid point -- someone of my age who goes tissue could face another OHS at 80 years old or thereabouts even if the tissue ages beautifully. That's a chance I'm taking -- I hope to be a hale and hearty octogenarian who could survive replacement surgery in whatever form it took in 2020 or 2025, but I don't have a crystal ball. I'm opting for what I consider to be the best quality of life now.

Good luck to you in your decision.

Bob

 

[Mary]

I shared a hospital room with a lady who had her first valve replacement (aortic) at the age of 80 and told me she had a relatively easy surgery experience.
She was back at the age of 90 to see what could be done about a leaky mitral valve. I was discharged before the decision was made whether to replace the mitral. She wanted it replaced, but the doctors were leery due to her age.
Mary

 

[geebee]

I shared a hospital room with a lady who had her first valve replacement (aortic) at the age of 80 and told me she had a relatively easy surgery experience.
She was back at the age of 90 to see what could be done about a leaky mitral valve. I was discharged before the decision was made whether to replace the mitral. She wanted it replaced, but the doctors were leery due to her age.
Mary

What an encouraging story. I sure hope everything turned out OK for this impressive person. I do know we do what is necessary to stick around longer (at least the majority of us) so I am sure any one of us would agree to an OHS at 80 or 90+ to gain a few more years.

I am so happy to be living in these times.

 

[Mary]

What an encouraging story. I sure hope everything turned out OK for this impressive person. I do know we do what is necessary to stick around longer (at least the majority of us) so I am sure any one of us would agree to an OHS at 80 or 90+ to gain a few more years.

I am so happy to be living in these times.

She didn't necessarily want to gain a few more years; she wanted the quality of life that replacing the mitral valve would bring.
She had been very active after her first replacement and she wanted to continue with her activities. The doctors wanted her to forego surgery and live with what she had. When I first met her, I thought she was 65, rather than 90. She looked and acted decades younger than what I was use to.

 

[Geo]

Russell,

I am a new member just having posetd a few messages. I am having an AVR on 2/2. I am 48 and have been going back and forth on this same issue. I think managing the coumadin can certainly be accomplished, as my wife had a MVR 9 years ago with a mechanical valve. That was her second surgery and she said she did not want to go through that again. I think that some things in surgery have improved in the past 9 years, but it still is OHS. I would be in my mid 60's looking at a re-do. There has been great feedback on this forum with some folks saying to try and avoid a re-do and go mechanical, and that living with coumadin is manageable. Then the other advice is to take the 10-15 years with a Bio valve and not worry about checking your INR or about anyother drug interactions with coumadin. Everyone seems to have a real valid point of view and good arguments pro and con, which is why I am still undecided. I know this is not going to help you nail it down but getting as much feedback from all these terrific people who have gone through this will help us both in ultimatley making the right choice.

Best of luck,

George