eeny meeny minee mooooo

[kman]

Actually Im doing my homework as well as talking to the experts including you guys, and thought I had come to the conclusion that mechanical would be the right choice for me. Im 55 very active ( or was ) ride a motorcycle, bicycles,and untill recently I was into trail running,tennis, white water kayaking, third world travel, and hiking. I am really looking forward to the resuming these activities. the last couple of years I havent felt up to speed and cut way back on my activities,I new something was wrong but couldnt figure out what it was. Discovering the stenosis about nine months ago was a shock but now that I have a solution to my lack of energy I have real incentive to get it done. Now after talking to the big guns at Stanford and my own guys at Kaiser, and getting various opinions, my gut ( which I trust) is telling me to go with the tissue valve even though I will probably have it replaced in 10 years or so. My question, which I forgot to ask is will it wear out sooner in someone who taxes it on a regular basis. Im trying not to be to optomistic about the resumption of my activities but cant help it.

 

[tprice54]

Imho

Imho

All I can tell you is I asked my cardio and surgeon the same question, as I am a marathoner and wanted to know if I should stop. The answer from both was it would have not effect on longevity of the valve. I ended up with a bovine and am running my first marathon Sunday, 8 months post op. Let me know if you hear anything different!!

 

[kman]

voices of experience

voices of experience

Thanks Tom, and enjoy your marathon, its valuable to hear others choices, experience and reasoning.I will let you know if I learn anything else about longevity in active adults.
Thanks Rachel, I hope to outlive the thing even if it lasts 20 years, the problems involved in second surgery is something I will look into thanks for your input.
Keith

 

[Susan BAV]

Re: Homework and various opinions...

Re: Homework and various opinions...

Keith - My surgeon put in some kind of material, to act as a screen between my heart and my sternum, in anticipation of a future OHS. One of the troubles with some second OHS's is when the heart has scarred and bonds to the sternum after the first OHS--I hope I'm wording that correctly--so the material within me should help as a scar barrier.

 

[dlangton]

oink

oink

I was in pretty much the same dilemma one year ago at age 56. I got some good advice from cardio-folks, who recommended tissue, and my surgeon, who told me he'd go with the third-generation Medtronics porcine valve himself, so that is what I got. He didn't say how it compares with bovine pericardial, so I have no advice on that, but I lead a very active life with a lot of strenuous physical activity, and my cardiologist thinks the valve will probably last me 25+ years. See my signature for the designation/trade name of the valve. Less than a year after surgery I'm feeling very good. There are some vague effects, but no pain and no real limits. (The only problem I have is with the drugs that I'm supposed to continue taking for one to two years, specifically the beta-blocker called metoprolol.)

 

[Karlynn]

Kman, my response to you if I were to ignore your age, would be that there is nothing you mention in your activities and life style that would preclude Coumadin use. A look at our active lifestyles forum will corroborate that. And the only reason I mention this is for someone else coming along, and viewing your post, reading your activities and think that warfarin would be contraindicated for themselves because they share a similar lifestyle.

That being said - at 55, I would hope you'd get many more years than 10 out of a tissue valve. If doctors are saying 10, they are being conservative for someone your age.

And I'm hoping you will outlast your tissue valve as well! Best wishes.

(What motorcycle do you ride. My husband and I just got back into riding again this summer and LOVE it. We have a Harley Dyna Super Glide. Not huge, but we do enjoy it so much.)

 

[Marguerite53]

Hi Keith. I was 52 when I chose the Carpentier-Edwards Perimount Magna valve. It's bovine (cow, well, steer, I was told) tissue (remodelled from the pericardium of the cow's own heart, I think.) The porcine tissue is, I believe, the actual pig's heart which is resized or otherwise obviously restructured somehow to fit the human.

I'm not sure why my surgeon chose the CE Perimount Magna.....better salesman, perhaps! There is something about getting a better fit per client, too.....only the surgeon can know which brand would be best for you in that regard. My particular surgeon was not fond of using ones with stents because for him, personally, they were awkward to deal with. These are all things you will discuss with your surgeon, of course.

These valves seem to get better every month!! I think that was why my doctors wanted me to wait as long as possible to have mine replaced....new technologies replacing old. My stenotic valve was at .53 when I went in.....too small! But no other damage or lingering effect on the heart overall.

I'm counting on getting 20 years out of this thing!! And I mean counting on it!!! But then I'm the eternal optimist in this club and I just won't have it any other way!!

The decision can be frustrating. Just remember, as we tell everyone.....the best choice is having the surgery....it will save your life. Some surgeons take a look inside and plop in a mechanical, anyway, because your interior structure demands it. Be open minded......it's all good!

Best wishes.

Marguerite

 

[Superbob]

I oink! As I understand it, mine is a third generation device, treated for anticalcification --and since I was 63 at time of OHS, it might -- MIGHT -- be the only one I'll ever need. (No guarantees.) Since you are 55, chances are greater you would need an eventual re-op. That's something you need to weigh in your decision. It is a difficult decision, but there are people and sources of information to help you clarify your decision-making.

 

[CathyK.]

I moo! I am 8 months post-op and am 45 yrs old. I chose bovine just because my gut was telling me also. So far, so good and my Surgeon told me 20 to 25 plus years hopefully. Good luck!

 

[gageyk]

I've asked my cardiologist and surgeon the same thing about stress on the valve causing faster wear and tear. Both said they just didn't know.

My surgeon was very reluctant about putting a tissue valve in me, age 46, I had to convince him that I knew,that at my age, there was risk of re-op in less 10 years or less. In fact, my surgeon went to a Thoracic Surgeons seminar a month before my surgery and was warned by many of his peers that a tissue may only last 5-10 years in younger, active people. Oddly enough one of those peers was from Stanford. Apparently 1 or 2 of the surgeons were speaking from recent experience.

I went with tissue mainly because I spend a lot of time in remote areas with no phone coverage and miles from help. I figured even if I get only five years it will be 5 more years of doing what I love, it was worth the risk to me.

While enjoying some solitude at a remote Sierra lake this past weekend I thought to myself that after going through OHS I do not fear a second OHS. The anxiety prior to the first was torture though.

My current line of thinking has me planning on an ON-X valve at time of re-op.

At my 6 week follow-up with the surgeon, he told me that just a week earlier he replaced a tissue valve in a 75 year old patient that had been functioning for 29 years .

 

[kman]

Susan,
that is the first Ive heard of any kind of screening in anticipation of a second surgery , thanks I will look into it.
Karlynn, a dual purpose BMW,and I dont think that coumadin is my major reason( although I dont like the idea of taking drugs on a daily basis), I have heard that your a little more likely to have a stroke with a mechanical valve and if thats true then that does affect my decision. I dont meet with the surgeon untill next tuesday and am hoping that I,ll just know by then, I am also a believer in listening to what the artist has to say, in this case my surgeon so I will try to keep an open mind till then.
Thanks again for the valuable information.
Keith

 

[Karlynn]

Risk of stroke for tissue and a properly anticoagulated mechanical are the same - just a FWIW. I think some of our tissue members take low dose aspirin, so maybe that's something to ask about.

A BMW - cool. A friend of ours just bought a big BMW touring bike. SHE's already taken it to North Carolina twice (from Chicago).

 

[tobagotwo]

At 56, ten years would be an extremely low estimate for a modern tissue valve. It's very unlikely that you would need more than one replacement in your lifetime, should you live to your 90s.

At your (our) age, there is also no discernable difference in your projected lifespan, whichever valve type you choose.

The real issue is your personality and your own perceptions of risk. There are compelling personal reasons to choose either route, and no bias-free reasons to eliminate either option.

Some people prefer to live with smaller risks on an irregular, but more frequent basis over the course of their lives. Others would rather not think about it until the time for a reop starts coming around, and then hope to get the larger, single risk out of the way again all at once.

Some people who use Coumadin feel that it enables them to exert some control over their valve issue, or that they're contributing parters with their valves in that effort. Many feel that the likelihood that they will never have to have that surgery again is worth whatever minor inconveniences the use of the drug entails. Some had no real choice when the surgery was done, but find that it's not such an imposition over time. Most realize that the click, click in their chests is the sound of a pyrolytic carbon miracle that has the capacity to outlast their lives several times over. No reason that thought can't be considered reassuring.

Others who have tissue valves may want nothing impinging on their daily lives that they can possibly avoid. Some may feel that daily warfarin use would be an onerous reminder of their heart problem. There are those who are concerned that they will be treated improperly by doctors who don't understand the drug. (Others are irritated by contact with the medical profession in general.) There are no extra rules with a tissue valve. A tissue valve is not permanent, but it does last an increasingly long time, and it can allow you to go back to your life pretty much as it was (with an added annual stop at the echo tech and cardiologist). That can be an immensely pleasing thought as well.

Consider yourself first in this. It's entirely about you: it's your beating heart. Those around you will benefit most from someone who didn't compromise his feelings about this, or settle for someone else's dictates of what the right or best thing to do is. Research says there hasn't been a right or best way invented yet. Just a few really good options that each have some shortcomings.

There's a lot of great advice available, and there are lots of contradictory experiences to consider (not all operations go easily - not all people take a long time to heal). Listen to the voice inside you that makes you most confident and comfortable.

Best wishes,

 

[Jim P]

kman,

I was 63 at the time of surgery. After doing a lot of research, I had decided on a mechanical valve before talking to my surgeon. He was comfortable doing mechanical but thought that the latest versions of tissue valve were just as good a choice for me. We talked a lot more, and I changed my mind to the Carpentier-Edwards Bovine Pericardial Tissue Valve, with ThermaFix process. Older versions of this valve are apparently doing well at the 20-year point (in older patients), and the ThermaFix process is expected to decrease the chances of calcification (stenosis), thus extending the valve life (theoretically). My surgeon believes that odds are fairly good that I may get 25 years from mine; but, of course, there are no guarantees.

Of course, we will not know for another 20-25 years how well and how long these latest versions of tissue valves will perform. Also, each individual's body is different and should be expected to respond to the new valve differently.

As many before me have said, the important decision is to replace the defective valve and then get on with your life without looking back on your choice of mechanical or tissue. Either way, you stand a far better chance for a longer, healthy life than if you had not taken any action.