Choosing tissue valve but.......

[Duffey]

I'm choosing to have a tissue valve when I see the cardiac surgeon (a couple of weeks). The cardiologist says I will probably be able to stave off having OHS for about six months BUT although he is not critical of my choice of tissue valve he made the implications of my choice clear, ie that I will need another replacement in about 15 years time. I am just 60 so that would mean another OHS when I am 75, when I am older and not so strong. Anticipating a similar conversation with the cardiac surgeon, I am wondering how best to put my case. I know I don't want a mechanical valve because a) I have very sensitive hearing and my life would not be worth living hearing even a tiny bit of the noise, and b) I have diabetes and osteoporosis so the complications with warfarin do not bear thinking about for me, I already have complicated enough dietary requirements, plus I eat a high vitamin K diet with tons of leafy greens for the calcium, so I don't want more complications. In other words, my choice of valve is driven by what I don't want. Obviously I'd rather a valve which never needed replacing but I don't want what comes with the current mechanical valves. I know things are advancing in the valve world but I don't have time now to wait for change.

What did others say when asked why they wanted a tissue valve ?

Anne

It's quite likely the surgeon won't ask you why you want tissue. Mine didn't, and that was 8 years ago.

 

[clay_from_nj]

Being on Coumadin brings about a 1%-2% per patient year change of having a significant internal bleed requiring prompt medical attention. Although this is a relatively small number for one specific year, the cumulative risk over say 20 years becomes not so insignificant… In fact, I read several medical journal articles concluding that this risk is actually a fair amount higher than the mortality risk presented by a redo surgery required for a younger person receiving a tissue valve.

I have to comment here, especially as mortality is very important (after all, we are replacing these valves in order to extend our lives), and the research I have seen just plain contradicts the above. See: http://circ.ahajournals.org/content/127/16/1647.figures-only

Also of note are the "limitations" and "dangers" of warfarin. Exaggerated once again. I still bicycle, motorcycle, work out at the gym, use power tools, etc, etc. I have been scratched, scraped, burned, bruised, and cut, without being in any "danger." I live without change or compromise. I don't fuss over my diet any more than anyone should for their general health and well-being. Yes, I test my INR; I also weigh myself and check my blood pressure, and have other medical tests done less frequently, but regularly. I doubt you'll find a person with a tissue valve with a more positive opinion of their health than I.

I think that the reason the choice can be so difficult is that the outcomes are so similar. If one were significantly "better" than the other, we wouldn't have to put so much thought and effort into the decision. What really makes it difficult is that the real reasons to choose one over the other are personal and subjective. Which is more important to you or bothers you the most? The noise, reoperation risk, maintaining the warfarin testing and dosing regimen... Maybe you just don't like the idea of a bit of metal in your heart for the rest of your life. I did not want to have to deal with declining health as a tissue valve deteriorates before needing to be replaced. Equally valid. Whichever you choose, you have to live with. Facts and statistics can inform you about your various personal concerns, but do not point definitively one way or another. If one conferred a longer life or better quality of life, the choice would be easy.

 

[Paleowoman]

Thanks again everyone for your input on this. Very interesting too what you wrote kenkahle. I'm sure I want to go with tissue valve even though it will mean a re-op at some point in the future, but I've written down some questions for the surgeon.

 

[dick0236]

Longevity
Statistically speaking – a mechanical heart valves will outlast most people’s lives. Very few valve redo surgeries are required for mechanical valves as it’s very durable.
Tissue valves aren’t as durable as mechanical valves. In addition, the valves last longer in older people and not so long in younger people. Example: for a 60 year old person a tissue valve typically has a ~ 70%-80% probability to last 15 years or more. For me, 52 year old, a tissue valve typically has a ~ 60% probability to last ~ 12 years. The data does vary somewhat from study to study but this is on average what the data shows.
For me – this suggests that I will require a redo surgery which will most likely occur when I am in my mid 60s but could occur sooner or even later. typically being seen today.
.

"Statistically speaking" - if I had gotten a tissue valve when I was 31(although they had not been invented when I had the surgery) - and using the statistical averages of 10 year life in young active men...12 years(your figure) at middle age and 15 years(your figure) at senior age...I would be looking at my 5th surgery next year at 78.......OMG. However, in the real world, they probably would've put in a mechanical valve after my first, second or third surgeries.

PS and FWIW.....Edwards Lifesciences was built around the Starr-Edwards mechanical valve....that was in production from 1960 to 2007......with the same basic design. It's like my Cardio recently told me...."those valves last forever".

Now excuse me.....it's time for me to go "walk" my nine holes of golf.

 

[neil]

good thing about this thread is all the positive stuff said about both options,