First surgery, bicuspid aortic valve replacement

[Bonbet]

Hi, I feel compelled to weigh in on this discussion. I am 64, female, and will likely have AVR for my BAV with "severe" stenosis, this year. I am asymptomatic and exercise at least 4-5 days a week. No CAD or BP issues. I have been in the waiting room for over 7 years. I used to be a nurse so I am pretty skeptical, and don't assume docs know it all. And I like docs willing to admit the there is gray area. I have heard some doozies from some of the cardios I have seen over the years. Anyway, at my last check-in with my cardio and surgeon at Mayo in 2015, they recommended a mechanical valve for me. I was surprised because I assumed at my age I would be getting a tissue valve.

So after thinking about their comments and my research: I agree, and here are the factors that inform my opinion: A tissue valve is "bio" tissue and begins deteriorating the moment it is implanted, sometimes slow sometimes fast. My docs think that due to my activity level (and desired activity level post-op there is some evidence that "more active" lifestyles might contribute to a hastening of the tissue valve deterioration. I have not enjoyed the slow deterioration of my native valve, or wondering whether this or that may be a cardiac symptom, or having surgery hanging over my head for years. I think second OHS are riskier, especially at whatever advanced age I may be when I need it - and I don't really want another OHS anyway (think how advanced the superbugs will be by then.) I do not have faith that TAVR will be an option for me when I need the second valve. It takes decades to gather data and refine medical interventions like that. So I'm not counting on it. Not to mention there is a significant percentage of tissue valvers who end up on anti-coagulation anyway.

That doesn't mean that I am blind to the downsides of mechanical either. I am comfortable with the nuances of managing and testing myself. But I worry about what happens as I age and my faculties diminish. I may end up depending on someone else to do it for me. I worry about less-than-thorough bridge coverage if I need a medical procedure (again my medical background kicks in here.) I don't worry about the sound, I can hear my heart now.

I have found doctors that I trust, but not blindly. I question all the assumptions that I recognize as assumptions. BTW a Mayo cardio did a talk on mech vs tissue, and Pellicle posted a link to it a while back
maybe you can find that. It was informative. Also, you say you are sedentary, and at the risk of sounding preachy, I'd say almost more important than any other factor going into OHS is your underlying health.
You know what to do.

It is good to have your surgery where they perform hundreds, possibly thousands per year.
And pick a surgeon who is extremely experienced and has a crack team to work with (again, past work experience- sometimes the nurses are key to your outcome good or bad.)
I am comforted by the fact that this surgery has become so common and people survive and thrive every day post-op. I hope that reassures you as well.
Good luck with your decision making. Happy Trails, bonbet

 

[hevishot]

The notion that tissue valves wear out faster in people with active lifestyles does not compute with me. It is a proven fact that athletic people have. a much slower heart rate then people who are sedentary. This would indicate that the valve would last longer in active people not shorter. Also for what it's worth when I discussed valve selection with my surgeon he recommended mechanical "on the record". Off the record he told me if he was in my shoes he would take a tissue valve. I suspect that the recommendation of a mechanical valve has more to do the the hospitals insurance companies and lawyers then it does for medical reasons.

 

[pellicle]

Firstly let me state that I've not pushed Holly towards anything, just presented the facts. I have observed that she is not younger nore more athletically inclined so I am not (nor have I been) pushing her in any direction, simply informing and encouraging her to consider angles as yet unconsidered.

The notion that tissue valves wear out faster in people with active lifestyles does not compute with me.

I will agree that the data supports the idea of "younger" as being a more significant factor than "more active" for early SVD (Structural Valve Degradation).

Let me propose an alternative to your theory. There is not just Heart Rate averaged through out the day, there is heart rate at exersize (that a sedentary will not encounter. In winter I XC ski 4 or 5 times a week and during my training my HR average is 140 and my peaks are 176. This will mean that during those periods that the valve is being mechanically stressed (bend and straightened at its pivot) and exposed to a whole raft of biochemical materials that would not be seen in a couch potato.

However I do wonder if the observed correlation between exersize and SVD is not incorrect and actually a reflection also of youth and SVD because patients under 65 are in the main more likely to be active. The problem is data amounts as people under 50 having AVR or MVR are quite rare statistically.


If you read what I say I normally say:

• its your choice, make it informed or flip a coin but you can't change you mind later so make it a proper choice
• elderly have less clear benefits to having a mechanical so unless are likely to be on warfarin for stroke issues will be well served by a tissue prosthetic
• anyone with actual medical reasons to avoid AC therapy should select a tissue prosthetic
• youth have clear benefits of selecting a mechanical and may even avoid a reop with a mechanical. The only reasons a younger person would avoid a mechanical are related to issues surrounding AC therapy.
• younger women who wish to fall pregnant should consider a tissue as AC therapy is a problem

For your interest this is what the Surgeons have at hand and are well trained in. Following are excerpts from the Surgical Guidelines, it echos what I normally say: [IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/4\/3716\/12012826266_6b963853ca_o.jpg"}[/IMG2]
[IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/8\/7372\/12220845216_261cceb5c3_o.jpg"}[/IMG2]
[IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/8\/7410\/12220655884_58760fc0cd_o.jpg"}[/IMG2]




its pretty clear stuff really (if you take the time to read it) ...

I'd point you also at this letter to a journal [IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c1.staticflickr.com\/1\/718\/32050757684_e30552452e_o.png"}[/IMG2]




and then suggest strongly that you do some research on Google Scholar using key words like "SVD" (which is Structural Valve Degradation) and "bioprosthetic" and you'll get the data

By all means question anything ... but when a consensus of scientists and medical professionals lean one way then ... well you'd have to have some sound reasons and sound experience to guide you toward that leaning.

 

[Bonbet]

Yeah, my heart rate is pretty slow, except when I'm doing stuff- like hiking or working out- Bonbet

 

[hevishot]

Forget what I said. I don't know anything. Just sit on the couch and eat chips, listen to your arteries harden, blow up to 400 lbs. and then drop dead. That's a great alternative.

 

[Agian]

Forget what I said. I don't know anything. Just sit on the couch and eat chips, listen to your arteries harden, blow up to 400 lbs. and then drop dead. That's a great alternative.

Welcome back btw.

 

[bugchucker]

Forget what I said. I don't know anything. Just sit on the couch and eat chips, listen to your arteries harden, blow up to 400 lbs. and then drop dead. That's a great alternative.

Wow, not sure the sarcasm was warranted. We get your point and it is a valid one, from what I've read those who have posted are simply giving their experiences and how that related to them and how it could potentially help others.

 

[cldlhd]

I think I must have missed something in this thread

 

[Warrick]

maybe it's this...

"I would go with tissue. That archaic piece of plastic they call a mechanical valve will be obsolete before your tissue valve wears out. I fully expect the mechanical valves will be on the junk heap in 20 years."

 

[Warrick]

and something about pants....think they were fancy ones, and a blue beta max VHS wearing ray bands

 

[pellicle]

and something about pants....think they were fancy ones, and a blue beta max VHS wearing ray bands

I think that's a good summary ... along with the view by bugchucker about the benefits of sarcasm warranted in this thread...

 

[pellicle]

Forget what I said. I don't know anything..

I would tend to agree with that .. with respect to valves.

With respect to exersize however I'm always harping on about getting some.

To Wit

https://cosmosmagazine.com/biology/how-exercise-stops-the-ageing-process

As it happens I do about 45min daily of what amounts to interval training throughout winter doing skiing (and cycling when there isn't snow).

I think exersize is linked to reduction in depression too

 

[Agian]

and something about pants....think they were fancy ones, and a blue beta max VHS wearing ray bands

Yep, funny guy.

 

[Hollyn]

Wow, gone a few days and look at what I've missed. I think I've decided to put my head in the sand and hope this all goes away. Seriously, good point about getting older and possibly no longer being able to self manage the warfarin. But at that point it probably wouldn't be hard to give it up anyway, not to be judgey. I guess I am at the age that I could go either way and it's good to have options. But sometimes my brain just says "enough for now". I love that you all seem so sure in your choices and views. (and I'm not being sarcastic). I hope I will get to that point soon.

 

[dick0236]

...........Seriously, good point about getting older and possibly no longer being able to self manage the warfarin.

There are a lot of things that "getting older and possibly no longer being able to" can, an do, occur.......but self-managing warfarin is not one of them. It's a lot more difficult to be steady enough to make a 3 foot putt than pricking my finger for my weekly INR test.....LOL.

 

[hevishot]

No I don't have an armchair degree in cardiology, biology, microbiology, psychology or parapsychology like some of you have. All I got is common sense. Something I find lacking on this forum. Don't bother commenting. I'll be gone for a few months. I have better things to do with my life. 4,000 posts? 2,000 posts? Seriously? Get a life.

 

[pellicle]

.... I'll be gone for a few months. I have better things to do with my life.

other forums to troll?

you won't be missed ... hope to not see you again

 

[cldlhd]

Oh ok now I'm all caught up.

 

[neil]

hevishot, whats the point of you on this forum? you seem to be shooting at the hip to everyone

 

[Paleowoman]

I'll be gone for a few months. I have better things to do with my life. 4,000 posts? 2,000 posts? Seriously? Get a life.

Some of us stick around to offer support to others who come on the forum for help. Forums like this wouldn't exist if everyone who came on here for help just left right after getting it !