Confused. Need input on ACT

[Fast Eddie]

Hi all

I'm 10 days away from my surgery now. They will repair an ascending aortic aneurysm and very likely replace the AV. I am leaning toward the On-X valve at this point. I'm 60 now, and really don't want to face re-surgery at 70 or 75.

But as I research Coumadin more I'm getting confused.

I talked with the surgeon's PA about getting surgical procedures done while on Coumadin, and the fact that I would have to bridge with Lovenox. She interrupted me to tell me that they don't support using Lovenox bridging with the On-X valve. It sounded to me like their group ONLY supports in-hospital procedures while on Heparin.

Indeed, with more reading it does seem that there is currently insufficent data regarding mechanical valves and Lovenox bridging to know if it is completely 'safe'.

But doesn't that mean that a simple procedure, like a gum graft (which I do need!) may become a multiple day hospital visit to clear the Coumadin, get the procedure while on Heparin and then re-establish the INR with Coumadin?

Or maybe I have this all wrong?

Anyone out there with an On-X that has had to deal with these issues?

It's still not too late to tell them I want a tissue valve.

Ed "Fast Eddie" Friedman

 

[Ross]

As for a gum graft, it's possible. I don't know exactly what all is involved, but your right, sounds more like they'd rather use Heprin then use Lovenox.

I certainly wouldn't use bridging therapy as an excuse to risk yet another surgery. It may be a pain in the tail when it comes to that, but at least your for sure going to wake up from the procedure, where with another heart surgery, you don't.

 

[Fast Eddie]

What's a gum graft

What's a gum graft

As for a gum graft, it's possible. I don't know exactly what all is involved, but your right, sounds more like they'd rather use Heprin then use Lovenox.

I certainly wouldn't use bridging therapy as an excuse to risk yet another surgery. It may be a pain in the tail when it comes to that, but at least your for sure going to wake up from the procedure, where with another heart surgery, you don't.

Ross

I have had 3 of them. The periodontist removes a flap of skin from the roof of your mouth and sews it onto the gum where recession has occurred. If I weren't such a procrastinator I would have had the stupid thing done long ago when it SHOULD have been done. But now I don't want to push the heart surgery back.

I plan to talk to several docs this week about handling Coumadin patients. Not to mention my HMO to see how they cover what should be outpatient visits that become hospital stays.

Yeah, if I were five years older I MIGHT go for a tissue valve and hope for 15 years, but at 60 and in good health it seems virtually certain I'd be back for a new valve eventually. And it sure seems that re-surgeries are a lot riskier than the first one.

Fast Eddie

 

[Ross]

Eddie people disagree with me all the time, but both of my surgeries were nightmares, with me nearly losing my life both times. I'm guaranteed I won't make it during a 3rd, so I profess to all. Do this once, hope that is all you'll ever have to do and minimize the chances of additional surgeries. I can agree where you are in age. If you were in poor health and really didn't expect to be around a long time, then tissue would be fine, but I think you'd out live your first tissue.

 

[geebee]

Eddie,

I have had 5 procedures/surgeries that required in-hospital heparin bridging and it was really not a big deal. Yes, it involved a hospital stay but I just kind of looked at it as a 2 or 3 day vacation, meals in bed, leisure time, etc.

My cardio also doesn't like Lovenox - he is a bit conservative despite being fairly young. I think he is a great cardio so I go along with his suggestions.

Like Ross said, I would avoid future OHS if at all possible especially since you would be in your seventies for the next one if you went tissue.

Just my opinion of course.

 

[Guest]

No product has ever been determined by the FDA to be safe for bridging. There is a lot more knowledge about using Lovenox for this than there is about using heparin. However, if you have a bleeding complication, then heparin is easier and faster to reverse. But Lovenox produces fewer serious side effects than heparin. Bottom line - no easy answer.

One of my friends who is in the anticoagulation field (but does not work for a valve company) says that friends have said (whatever that means) that the new tissue valves are lasting so long under test conditions that they have the mechanical valve makers worried. Of course since this has not been approved by the FDA, they tissue valve makers cannot legally say this. It is just things that you pick up from sharing a few with friends at conventions etc.

Not much to peg a serious life-changing decision on, but the questions that you are asking just have no solid answers.

 

[Karlynn]

I wonder what test conditions they are referring to? Mechanical valves in test conditions last for 100's of years. But we all know that the human body presents things that cannot be duplicated in test conditions. However, the newer tissue valves are expected to have longer lives, but these valves haven't been around long enough yet to know this for certain. That being said - it would be very nice if they did come up with a tissue valve that had an indefinite "shelf life".