For reops: are you glad you started with tissue?

[pem]

I hope today will be my last day on the valve selection forum and my first day on the pre-op forum I'm meeting with my cardiologist today to make a final valve decision.

I've noticed quite a few people on the forum who started with a tissue valve, and then when that failed, got a mechanical valve (sometimes earlier than they expected).

My question is: are you glad you started with a tissue valve and didn't have to deal with ACT or, in hind sight, would you have just started with a mechanical valve to avoid the trouble of a reop?

I realize I'm probably placing more importance on the valve type decision than I should. :rolleyes2:

Thanks a lot,
pem

 

[scott.eitman]

I do not believe you can place more importance on the vavle decision that you should. This is a pretty major decision. It is right up there with the surgeon and hospital decision.

I am extremely happy with my "decision" for a tissue valve. I put decision in quotes as I was not a part of the decision, but it is very much what I wanted. The valve you get today, may not be the same valve you would chose tomorrow. Things change: older, less or more active and many more variables. Therefore, I think it would be a bad thing to look back and second guess yours or anyone elses decision.

I would not have wanted anything else for me at 34 years old. It gave me the ability to do so many things that I do not believe I would have participated in with ACT.

For me, the decision the second time was actually harder because I was willing to consider mechanical. I changed my mind minute by minute for weeks as I wrestled with the decsion. Thank you ValveReplacement members for helping with this decsion!

Scott

 

[Lynlw]

Don't forget there are also a few members here, who chose a tissue valve as their 2nd (or more) heart surgery, -not always 2nd valve surgery, but 2nd heart surgery. So they already knew what it was like having heart surgery, but still chose tissue knowing/hoping most likely they would be living long enough to probably need that valve replaced and a 3rd surgery, unless of course they could avoid another OHS and have it replaced by cath.

Good lucck with your appt. I hope you can get all your questions answered and make decision you feel at peace with..
Since you are meeting with a cardiologist and not a surgeon today, I would still keep an open mind until you meet with a surgeon, often (not always) surgeons have a little more knowledge of the different valves than Cardiologists.

 

[pem]

I do not believe you can place more importance on the vavle decision that you should. This is a pretty major decision. It is right up there with the surgeon and hospital decision.

I am extremely happy with my "decision" for a tissue valve. I put decision in quotes as I was not a part of the decision, but it is very much what I wanted. The valve you get today, may not be the same valve you would chose tomorrow. Things change: older, less or more active and many more variables. Therefore, I think it would be a bad thing to look back and second guess yours or anyone elses decision.

I would not have wanted anything else for me at 34 years old. It gave me the ability to do so many things that I do not believe I would have participated in with ACT.

For me, the decision the second time was actually harder because I was willing to consider mechanical. I changed my mind minute by minute for weeks as I wrestled with the decsion. Thank you ValveReplacement members for helping with this decsion!

Scott

Thanks, Scott. This is very helpful. I'm quite divided between the two valve types. I think I would self-manage ACT well and it might give me longer overall survivability. On the other hand, I would probably spend a lot of time thinking about it. I have two young children, so the idea that I could be "worry-free" for 15 years with a 3rd gen tissue valve is appealing. I am very averse to the idea of a reop, but seeing many folks on the forum who have weathered through reops helps me relax on that question. I'm also optimistic about both the On-X valve and the ATS open-pivot valve. If I got the On-X, Dr. Pettersson would be my surgeon.

Anyway, thanks again!

 

[pem]

Don't forget there are also a few members here, who chose a tissue valve as their 2nd (or more) heart surgery, -not always 2nd valve surgery, but 2nd heart surgery. So they already knew what it was like having heart surgery, but still chose tissue knowing/hoping most likely they would be living long enough to probably need that valve replaced and a 3rd surgery, unless of course they could avoid another OHS and have it replaced by cath.

Good lucck with your appt. I hope you can get all your questions answered and make decision you feel at peace with..
Since you are meeting with a cardiologist and not a surgeon today, I would still keep an open mind until you meet with a surgeon, often (not always) surgeons have a little more knowledge of the different valves than Cardiologists.

Wow - that's a really good point. Thanks. Perhaps I'm attributing too much risk or worry to reops. I have met with two outstanding surgeons. One advocates a 3rd generation tissue valves strongly and the other is more agnostic about valve choice. When I mention my prior experience, stability, and high compliance with ACT, almost everyone relaxes about tissue valves and seems to think mech valves are more worthy of my serious consideration.

Thanks again!

 

[Lynlw]

I'm sure you'd be happy with either choice, since whatever you decide on, you know you've done your homework and really thought about choosing which "cons" in the pro/con list you rather live with.
I'm curious did either surgeon discuss their thoughs on the chances that if you go a tissue valve now if/when it would need replaced having it done by cath? Altho even if someone needed a 2nd surgery even now the risks are about the same as a first time.

 

[neil]

hi pem......re ops are more or less the same outcome as first time ops, that is there are very very good,i will need a re op somewhere down the line and am at ease with myself on that, i found the ohs better than i expected as a lot of people do,saying that everbody is different, which ever you choose is better than the one you got now, and is right for you, good luck and am sure you will do just fine

 

[pem]

I'm sure you'd be happy with either choice, since whatever you decide on, you know you've done your homework and really thought about choosing which "cons" in the pro/con list you rather live with.
I'm curious did either surgeon discuss their thoughs on the chances that if you go a tissue valve now if/when it would need replaced having it done by cath? Altho even if someone needed a 2nd surgery even now the risks are about the same as a first time.

One surgeon believes that the newer "3rd generation" tissue valves will last 20-25 years or even longer(!) However he is extrapolating and the data doesn't yet exist to support or refute that. The other surgeon (both are world class) is more cautious about projecting with regard to the newer tissue valves.

I would suspect that the 3rd gen valve will perform better than the 2nd gen, but who knows if they will truly approach the longevity of mech valves. Based on my reading, it looks like tissue valves simply don't last as long in people under 60. I'm 41, so I put myself in the category of a shorter tissue valve lifespan - even with the newer valves, I think I'd be lucky to get 15 years. Which isn't bad. But I'm 41, so 41+15+15+15 get's me to 70.

For this reason, and because I think I would manage my ACT well, I have decided to get a mechanical valve (did I just put that in writing??). Now I'm trying to decide between On-X and ATS. I think I prefer the latter from a technical standpoint, but with the On-X there's the more immediate prospect of Aspirin/Plavix or lower INR in a few years. I think the same prospects exist for the ATS valve, because if the ON-X is successful, I don't see why they wouldn't follow suit, but there would be a longer wait.

Thanks for your reply!

 

[pem]

hi pem......re ops are more or less the same outcome as first time ops, that is there are very very good,i will need a re op somewhere down the line and am at ease with myself on that, i found the ohs better than i expected as a lot of people do,saying that everbody is different, which ever you choose is better than the one you got now, and is right for you, good luck and am sure you will do just fine

Thanks a lot - that is encouraging. Even though I decided to get a mechanical valve, it is nice to know that my first surgery may be easier than I expect.

 

[mainframe]

Hate to break up the tissue love fest, but everyone is different. I hoped for 15 years from my tissue valve. I got 7. I hoped for an easy re-op. It wasn't.

 

[njean]

Just my two cents worth.....I was told many, many years ago, that the valves implanted in my heart (mechanical), were suppose to last a life-time. Well, that proved NOT to be the case. Sadly, due to scar tissue and other circumstances beyond my control, I've endured 3 OHS in my life-time and there's a great possibility that I'll have to endure one more before it's all over. But keep in mind one thing, my case was an isolated case as my surgeon put it. Luckily what happened to me, doesn't happen to many, so don't spend time fretting about "what might happen".

One thing is certain.....if you need this surgery, get it done. Whether you decide to go with tissue or mechanical....make your choice and then be at peace with your decision and go on to live your life in better health.

Best of luck to you!

 

[bdryer]

Pem

The #1 reason for a MHV to fail is pannus or scar tissue encroaching into the annuls of a MHV. Read njean's comments above mine. Since you are contemplating a MHV, know this: I did exhaustive research on MHV's and chose the On-X hands down over the ATS. I even called and spoke with the MFG of my 3 narrowed choices being St Jude, ATS and On-X. Neither St Jude or ATS has incorporated pannus protection in their design. On-X was THE ONLY valve, period to have pannus protection engineered into the design. The ATS rep was almost flabbergasted I would pose the question. St Jude gave me a line of BS that the pivot guards hold back the pannus. Yea right, if pannus is encroaching and contacting the pivot guards, be prepared for a reop as the leaflets WILL eventually jamb.

On-X and ATS are almost identical but On-X has pannus protection. Hence my choice and that is why I fought to have an On-X implanted in a city where the valve was non-existent. Now it is and I was the first to be implanted! Do your research and satisfy yourself.

If you chose a tissue valve then good on you. Stand firm and go fwd. Me I'm an airplane techy so hands down a mechanical valve won the battle, plus I'm not big on going through the degradation and resulting symptoms from another deteriorating tissue valve. I love my sports and an On-X AV will hopefully see me to my last days without suffering from another failing AV.

ACT is not new and it is not as limiting as you might think. ACT management did not stand still but has progressed and continues to do so.
Good luck

 

[normofthenorth]

Pem, it's a fine decision, and I don't want to second-guess or undermine it in any way, . . . BUT: If you made the decision largely because (as you wrote) "I'm 41, so 41+15+15+15 get's me to 70", I think you might want to check your math pre-op!

 

[Jkm7]

My first OHS was not valve related but my second surgery four years later was.
I opted for bovine valve and I cannot say how grateful I am I made that choice. I had already experienced one OHS so had a very clear knowledge of what to expect and FOR ME, a tissue valve was the clear cut choice.

Only you know what is best for you but the more I learn about the status of OHS, the fact they are now doing percutaneous replacements which are so much less traumatic balanced with all I have learned re: coumadin and the risks involved in bridging for medical procedures, the attention required to testing and consistency in diet and life style..... The risk of having possibly gotten a loudly ticking valve, I know I made MY right choice. Absolutely everyone is different and it is a very hard decision.

I wish you the very best in making your decision as well as in your surgery and hope a bump free recovery for you.
Let us know what you decide and we'll wait to hear you're doing well after your surgery.

 

[neil]

mainframe bit harsh about tissue love in? am really sorry you only had 7 yrs and a rough 2nd op,but id like to think that is not the case for most people, i think what people try to get across to newbies well i cert do is whichever you pick be positive about it,sorry if it comes across as a love in,

 

[Duffey]

Pem, glad you've made your decision.
Not that it matters now, but I have often wondered if people who started with mechanical valves, and then needed a re-op for whatever reason, wished they had gone with a tissue the first time around.

 

[bdryer]

Hi gang

Hey Duffey, I think it is human nature to second guess a decision which flunked. We have all read of tissue folks who have had their valve fail prematurely. On the other hand we have read about MHV's bombing out. Some stay firm to the original choice of valve type while others switch the composition. At least we have a choice of technologies.

Dr Paul Fedak, [he's the guy who invented the Kryptonite glue for fusing the sternum] and I had e-mail correspondence regarding bring the On-X to my home city, as On-X was my choice and we needed to get the part on the shelves and medical staff trained prior to my surgery. He sent me a link to "ValveXchange". He said this is the future. Unfortunately we of the present older generation will not see it as the technology is in it's infancy. I have mentioned this technology on many past posts. Regardless if you have had a tissue or MHV implanted, perhaps you are in the waiting room, but are interested in the future, I encourage you to check the ValveXchange technology out. It's very cool and has some great animation.

Although I was corresponding with Dr Fedak, Dr Kidd did the deed. Could not be happier!

 

[Luana]

mainframe bit harsh about tissue love in? am really sorry you only had 7 yrs and a rough 2nd op,but id like to think that is not the case for most people, i think what people try to get across to newbies well i cert do is whichever you pick be positive about it,sorry if it comes across as a love in,

I guess you don't remember what he went through? Yes, it wasn't typical, but there's no guarantee that something like what he went through will not happen to anyone with an additional surgery.

All I can say about a mechanical valve is that ACT is no big deal at all. It's been the least troublesome thing of my whole post surgery experience.

 

[pem]

Pem

The #1 reason for a MHV to fail is pannus or scar tissue encroaching into the annuls of a MHV. Read njean's comments above mine. Since you are contemplating a MHV, know this: I did exhaustive research on MHV's and chose the On-X hands down over the ATS. I even called and spoke with the MFG of my 3 narrowed choices being St Jude, ATS and On-X. Neither St Jude or ATS has incorporated pannus protection in their design. On-X was THE ONLY valve, period to have pannus protection engineered into the design. The ATS rep was almost flabbergasted I would pose the question. St Jude gave me a line of BS that the pivot guards hold back the pannus. Yea right, if pannus is encroaching and contacting the pivot guards, be prepared for a reop as the leaflets WILL eventually jamb.

On-X and ATS are almost identical but On-X has pannus protection. Hence my choice and that is why I fought to have an On-X implanted in a city where the valve was non-existent. Now it is and I was the first to be implanted! Do your research and satisfy yourself.

If you chose a tissue valve then good on you. Stand firm and go fwd. Me I'm an airplane techy so hands down a mechanical valve won the battle, plus I'm not big on going through the degradation and resulting symptoms from another deteriorating tissue valve. I love my sports and an On-X AV will hopefully see me to my last days without suffering from another failing AV.

ACT is not new and it is not as limiting as you might think. ACT management did not stand still but has progressed and continues to do so.
Good luck

Very interesting! Thanks. I'll be talking with the ACT rep on Monday and pose the question about protection from pannus growth.

How do you find the clicking of the On-X? Do you notice it?

Thanks again!
pem

 

[pem]

Pem, it's a fine decision, and I don't want to second-guess or undermine it in any way, . . . BUT: If you made the decision largely because (as you wrote) "I'm 41, so 41+15+15+15 get's me to 70", I think you might want to check your math pre-op!

Arithmetic was never my strong suit

I don't think it alters my decision though.