Facing AVR Surgery- Which Valve?

[temp69]

well, we all like to weigh in. in some ways i wish i'd gone with the tissue valve because i wouldn't have to take coumadin, but i'm just five months post op and still getting used to it. have a home monitor, it' s no big deal.

now i'm feeling close to normal again, playing tennis,going to the gym, etc. plan on going skiing, so i don't know how my lifestyle is going to change.

good luck, you'll do fine with either one. no cardiologist i've talked to (and I saw five) spoke of tissue valves lasting 20 to 25 years, though i sure hope they do. they said that the tissue valves will calcify, and then do so at a rapid rate the younger you are.

i didn't want to have OHS again so I went with the On-X valve. It works fine. sucker's supposed to last 100 years. and the clinical trials...might not to have to take coumadin at all in a year or so. or...might have to take it for the next 25 years. (i'm 55). the main thing is, the surgery is VERY successful, so you'll do fine. I don't think you're gonna want to do it twice, but hey, Arnold Schwarzenneger had a valve replaced and he went with tissue, the cigar smoker!

good luck!

 

[ruth]

Is there any difference in the noise level with the ON-X?

 

[bvdr]

Welcome to this site. I had a St. Jude mechanical mitral valve implanted when I was 55. I was already in atrial fib and on coumadin prior to surgery so mechanical valve was the natural choice for me. I have found the need to be anticoagulated a very complicating factor when other surgeries or medical conditions occur. On a day to day basis it has not been a big deal but I sure can see the advantage of not having to deal with anticoagulation. Either mechanical or tissue though are good options and we are so blessed to be even be living in a time when these choices are available

 

[Chrish]

Welcome Jeff. I think many of us are in the same boat when it comes to diagnosis. Like you I have a bicuspid aortic valve that is due for replacement on Dec. 27. I'm 36 and have been wrestling with the valve choice ever since I was told the "time has come" back in early October. After consulting with my cardiologist, and two seperate surgeons, I've opted to go with the Medtronic Stentlis bioprothstetic valve. When push came to shove the decision came down to self analysis. I know how I am about taking meds, and I know the lifestyle I currently lead (frequent travel, two small kids, athletic, etc). Knowing this and learning that the fourth generation of Medtronic Valves are treated to prevent calcification, it was the right choice for me. Given that I'm only 36, I know I'll have to have another surgery in the future. But, becasue there is no absolute with the Mechanical I decided the risk and the quality of life issues made it the right choice for me. I think someone put it correctly in a previous post when they talked about having faith in medical advancements. If I can get 15-20 years out of this one, than who knows what will be on the table for me in the future. Best of luck and as its been implied, once you decide, you'll feel a weight lifted.

 

[Arnold Ziffel]

Welcome to the club,
Everyone has spoke of the things to look at when making your decision, you will make the right choice. You need to be comfortable with your choice to avoid "remorse" that will ruin your recovery. In fact I dont think a surgeon will perform the surgery unless you are absolutely ok with your decision.
I am 6 weeks post op, had a porcine tissue installed.

Let me give you a name of a surgeon who did mine at Sequoia hosp in RWC. I cant over emphasize how great this guy is. he works at Peninsula, Kaiser RWC, Sequoia. You can email him at [email protected], His name is Dr Vincent Gaudiani and is a very renouned heart surgeon. He will email you back promptly. Jay here on this sight is going to seek his opinion also.
Good luck to you, Steve

 

[jeffreyjl]

Current Status

Current Status

Hi All,

I spoke to 2 cardiologists at Kaiser San Francisco, both who are very good. My cardiologist went to Harvard Medical School and taught at UCSF. The 2nd cardiologist also taught at UCSF. Both are at kaiser SF. My cardiologist recommends a mechanical because of my age. The 2nd cardiogist recommends the tissue valve because of my age, health and lifestyle.

I will be talking to a surgeon at kaiser this Wednesday. I am leaning toward a tissue valve.

Jeff

 

[Karlynn]

Don't you just love it when doctors can agree???

At your age, you are definitely in the grey area for valve type. I think both are equally good choices, if you're in otherwise good health.

Just an aside - an active lifestyle doesn't preclude a mechanical valve. If you read the Active Lifestyles forum, you'll see that we have many very physically active members with mechanical valves. It kind of peaves us when people in the medical community make it sound that warfarin (Coumadin) is only safe if you're a couch potato.

That being said - make your choice based on what you feel most comfortable with then don't look back.

Best wishes.

 

[tobagotwo]

Starfish,

The chances are that you are having symptoms, but don't realize it. There are things that you may put down to aging or weight that are really caused by the valve issue. And there's denial.

If your heart is enlarging from the strain of pumping through your damaged valve, symptoms are not far around the corner.

For example, angina is often only felt as a slight tightness at the top of the throat, or may be felt in unexpected places. Or it may just come as a brief sensation similar to breathing in cold air. In women, it not infrequently shows up as jaw pain, rather than chest pain.

Lack of symptoms can keep you from getting surgery before permanent damage is done to your heart. We tend to be the worst at defining our own symptoms until they become flagrant. We minimize our responses or accuse ourselves of being hypochondriacs.

JeffryJ,

The decision is one that should reflect your personality. At your age, there is no real difference in survival statistics, balancing the constant small risks of bleeding/stroke vs. the bigger but very infrequent risk of resurgery.

If you have physical reasons that would preclude further surgeries, the carbon (mechanical) valves are far less apt to require a resurgery. If you are a person who will rebel against the daily requirements and inconveniences of warfarin use, you might be better off with a tissue valve.

My own choice was to trade the probable permanency of a carbon valve for the probable freedom of the tissue valve. I've been happy with my choice, and would (and eventually will, all things being equal) choose it again. I live an entirely normal existence, taking two 81mg aspirins and a 25mg atenolol every day, with no repercussions if I slip or miss.

However, we each have our buttons. Mine was an absolute revulsion at the thought of semicapable people in clinics monitoring me or making decisions for me, or dealing with ignorant healthcare providers. Yours may be resurgery. Entirely understandable.

Best wishes,

 

[gordoncooke]

Re: Struggling with the valve decision

Re: Struggling with the valve decision

I too am conflicted with the decision. I am a 45 year old male and while I no longer ski the trees or hit the big surf, I am an avid golfer and work out every day. I also am not excited about adding something else to monitor,

I am going in for Aortic Valve repair at Mayo in January and need a fall back if the repair does not work. I had a brain tumor removed in 2005 and have a VP shunt.

What brand do you all think is the best for a bioprosothetic value? It is a fantasy to think it will last 20 years? How bad is Coumadin to deal with?

Thanks

 

[davidfortune]

Gordon

The current generation of bioprosthetic valves has a "hopeful/wishful/theoretical-but-unproven" life of maybe 15 - 20 years in somebody our age (mid-forties). The anti-calcification treatments given to these valves is designed to make them last long as calcification is the primary mechanism causing failure in biological valves. The true statistical lifespan of these valves is unknown as the current generation has only been implanted for a few years to the real long-term impact of the anti-calcification treatment has yet to be real-world experience.

So what we have is conjecture and "expectations" based on theory.

Having said that I just had a Ross Procedure but had the Medtronics Freestyle Stentless Porcine as my backup. It WAS NOT an easy choice for me personally. Maybe I'm too analytical but there are serious risks on both sides (tissue and mech). Just because it FEELS EASY to take coumadin DOESN'T actually diminish the statistical risk. Just because it FEELS EASY to have another surgery by an elite surgeon DOESN'T mean that there aren't real risks there too.

So we're left with a hard choice that may have serious impact on our future lives without the benefit of a crystal ball. It boils down to your personal analysis of the risks and how they affect you (both psychologically and physically).

Take heart (pun intentional) that the statistics over the long term hold out that valve type DOES NOT statistically affect longevity or quality of life. Odd isn't it. We agonize over the decision yet the statistics tell us that we will likely live the same lifespan, with the same quality of life, whether we choose tissue or mech.

You will hopefully get some great info regarding coumadin use here but you will find (if you read enough) that there are people on both sides of the coumadin lifestyle (i.e. those that regulate fairly easily and have very few issues with coumadin or complications and those that don't regulate easily or have had serious complications with coumadin) and people on both sides of the multiple surgery philosophy (i.e. those that say "that wasn't the worst thing ever - I can and will do it again" and those that had a terrible/life-threatening/life-altering surgical experience and feel that ANYTHING IS WORTH IT if they can avoid another surgery).

Here's a thought (courtesy of my surgeon) to test your mindset/reaction to coumadin: Start coumadin therapy today before your surgery. IF that totally freaks you out then that kinda gives you insight into your risk analysis matrix - since you will have to take coumadin for the rest of your life if you have a mech valve. It will also give you insight into how easily regulated you will be. I thought it was a very useful suggestion. It certainly helped me to evaluate my own thought processes and feelings.

Ultimately if you pick a stellar surgeon and one of the premier valves you can't make a 'wrong' choice. I think the hardest thing once you come to grips with true risks of each choice is to determine how those real risks affect how you feel about each option.

Best wishes on your own risk analysis. Whatever you choose will be right for you.

David

 

[Turkey Hunter]

Gordon

The current generation of bioprosthetic valves has a "hopeful/wishful/theoretical-but-unproven" life of maybe 15 - 20 years in somebody our age (mid-forties). The anti-calcification treatments given to these valves is designed to make them last long as calcification is the primary mechanism causing failure in biological valves. The true statistical lifespan of these valves is unknown as the current generation has only been implanted for a few years to the real long-term impact of the anti-calcification treatment has yet to be real-world experience.

So what we have is conjecture and "expectations" based on theory.

Having said that I just had a Ross Procedure but had the Medtronics Freestyle Stentless Porcine as my backup. It WAS NOT an easy choice for me personally. Maybe I'm too analytical but there are serious risks on both sides (tissue and mech). Just because it FEELS EASY to take coumadin DOESN'T actually diminish the statistical risk. Just because it FEELS EASY to have another surgery by an elite surgeon DOESN'T mean that there aren't real risks there too.

So we're left with a hard choice that may have serious impact on our future lives without the benefit of a crystal ball. It boils down to your personal analysis of the risks and how they affect you (both psychologically and physically).

Take heart (pun intentional) that the statistics over the long term hold out that valve type DOES NOT statistically affect longevity or quality of life. Odd isn't it. We agonize over the decision yet the statistics tell us that we will likely live the same lifespan, with the same quality of life, whether we choose tissue or mech.

You will hopefully get some great info regarding coumadin use here but you will find (if you read enough) that there are people on both sides of the coumadin lifestyle (i.e. those that regulate fairly easily and have very few issues with coumadin or complications and those that don't regulate easily or have had serious complications with coumadin) and people on both sides of the multiple surgery philosophy (i.e. those that say "that wasn't the worst thing ever - I can and will do it again" and those that had a terrible/life-threatening/life-altering surgical experience and feel that ANYTHING IS WORTH IT if they can avoid another surgery).

Here's a thought (courtesy of my surgeon) to test your mindset/reaction to coumadin: Start coumadin therapy today before your surgery. IF that totally freaks you out then that kinda gives you insight into your risk analysis matrix - since you will have to take coumadin for the rest of your life if you have a mech valve. It will also give you insight into how easily regulated you will be. I thought it was a very useful suggestion. It certainly helped me to evaluate my own thought processes and feelings.

Ultimately if you pick a stellar surgeon and one of the premier valves you can't make a 'wrong' choice. I think the hardest thing once you come to grips with true risks of each choice is to determine how those real risks affect how you feel about each option.

Best wishes on your own risk analysis. Whatever you choose will be right for you.

David

Well stated, not alot I can add.
The suggestion from the surgeon to start coumadin pre surgery to get a feel for how your body will deal with it sounds like a very good one.

Valve choice is a personal choice that no one can help make for any individual. There is no wrong choice, as long as you are comfortable with the decision.

God Bless,

Ben

 

[Karlynn]

Welcome Gordon.

You have been given some good advice. To get an idea of how "limiting" being on Coumadin is, I recommend reading the Active Lifestyles forum here. Try and locate Mtkayak's lastest photos. You can also give this thread a read - http://valvereplacement.com/forums/showthread.php?t=17116

Truly - the worst thing about being on Coumadin is having it managed by someone who doesn't know how to manage it. A lot of people in the medical community operate off of 20 year old information. If you read our anticoagulation forum here it may seem like there are a lot of issues living with Coumadin. I would caution that people don't post who are doing well - so it could give you a skewed perspective of life on the drug.

I can't say I agree with trying Coumadin prior to surgery to see how your body reacts. The reality is, when managed properly, the vast majority of people do not have problems with it. It's not a drug that gives you side effects that you feel, so trying it out to see how you do, isn't going to let you know if you get dizzy or nauseous etc - because it doesn't do that. What it will tell you is if the person managing your dosing (and many of us here manage our own) knows what they're doing.

So my recommendation is if you decide to "go mechanical", let your doctor know that, just like if you were diagnosed as a diabetic, you plan on educating yourself and do your own dosing and testing.

Best wishes!

 

[dlangton]

avr surgery - valve type

avr surgery - valve type

I underwent an Aortic Valve Replacement procedure 9 days ago. I also had a congenital bicuspid valve and was in your exact position, though I am one year younger than you. I did a lot of research and looked at all the options. Everyone I spoke to had a different story. Cardiologists have their own preferences, and many will tell you that you MUST do this or that. It is just weird. I guess it just means that the technology is changing rapidly, but n any case, I ended up going with a porcine valve -- the Medtronic Mosaic Ultra -- because I found a surgeon I trust who uses the latest techniques and that is the valve he said he'd get himself. It should last me around 20 years, though some say it will be more like 25 -- nobody knows for sure yet. At that point, maybe technology will have been developed that will enable easier replacement and I'll do it again. This is the difficulty, that technology is changing and the options five years down the road are always better --- but you are in a position where you have to jump on the merry-go-round now, as was I.

One thing that might interest you: I was surprised by the diagnosis last august and the insistent recommendation to get an AVR, because I had absolutely NO symptoms. That is, I thought I had no symptoms, but now that I have had the procedure, I already feel a difference, and I understand that I have been short of breath my whole life. There has always been something strange about my breathing, and now that is all cleared up. No doctor has said anything to me about this, so i might be wrong, but I think that my blood wasn't getting oxygenated properly and I was always trying to breathe in more air to compensate. I now breathe properly, like other people, and I am immensely happy about having done this. You might have a different situation, and so I emphasize that this is only my experience. If your case is similar, if you have breathing issues that have never been understood or diagnosed, you might consider this as an encouragement. Otherwise, I don't know. But good luck to you, whatever you decide to do.

William Langton

 

[Keithf]

I guess it just means that the technology is changing rapidly, but n any case, I ended up going with a porcine valve -- the Medtronic Mosaic Ultra -- because I found a surgeon I trust who uses the latest techniques and that is the valve he said he'd get himself. It should last me around 20 years, though some say it will be more like 25 -- nobody knows for sure yet. At that point, maybe technology will have been developed that will enable easier replacement and I'll do it again. This is the difficulty, that technology is changing and the options five years down the road are always better --- but you are in a position where you have to jump on the merry-go-round now, as was I.

You tissue valve people are always talking about how in the future 25 years from now there will be some advanced surgery that will make it easier to replace your old valve. Maybe.

But what about for mechanical valves?

Don't you think that it's possible that 5 years from now someone will figure out that you can take a single pill with 1mg Warfarin, 60mg Aspirin, 45mg Clopidogrel and 25mg of something else, which will make our Thromboembolism problems go away? Do you want to place your hopes on a few heart surgeons or the Pharmaceutical industry with all their research? For myself, I would suggest a mechanical valve unless there is a good reason not to.

At least I can enjoy the benefits of better research without undergoing another operation.

 

[jeffreyjl]

Made a Decision

Made a Decision

Well, I spoke to the surgeon 10 days ago and chose to go with the Carpentier-Edwards PERIMOUNT Magna valve (bovine tissue). I was surprised when he set the date for January 8th. Getting nervous and second guessing myself a little.

The surgeon pretty much let me make the choice. We spoke of the pros and cons of tissue versus mechanical. But in the end it was my choice.

 

[Mary]

Well, I spoke to the surgeon 10 days ago and chose to go with the Carpentier-Edwards PERIMOUNT Magna valve (bovine tissue). I was surprised when he set the date for January 8th. Getting nervous and second guessing myself a little.

The surgeon pretty much let me make the choice. We spoke of the pros and cons of tissue versus mechanical. But in the end it was my choice.

I'm glad you've made your decision, and I've put you on our calendar for January 8th. Best wishes, and relax!

 

[Phyllis]

It's always a relief to have made the valve decision. Best wishes to you for a successful surgery and uneventful recovery.

 

[Traveler]

That valve is stentless which should make replacement easier in the future.

Hi - I'm new here what do you mean by stentless and does it matter - I need aortic valve replacement and aneurysm repair.

Thanks

Mark

 

[Susan BAV]

Hi - I'm new here what do you mean by stentless and does it matter - I need aortic valve replacement and aneurysm repair...Thanks...Mark

Hi Mark and welcome to the site; glad you found it! For some good information, be sure and read the "sticky" listed as the first thread at the top of this "Valve Selection" forum.

 

[Traveler]

Hi Mark and welcome to the site; glad you found it! For some good information, be sure and read the "sticky" listed as the first thread at the top of this "Valve Selection" forum.

Susan - thanks, I missed the sticky (and it was helpful)

Mark