Great Feedback! Thanks all for your input! A couple of additional questions

[mcarmical]

Thank you all for the replies to my first thread! A few additional questions. I believe I am leaning towards a mechanical valve. Question is, which manufacturer does everyone have, and are there some that are better than others? INR......... what does it measure and how often must you test? I have a fairly good idea that it is a measure of the Warfarin however I could use some clarification. Any side effects from the Warfarin as it relates to the chills? My body currently runs pretty warm. Larry from Tulsa suggested having a surgeon's input on the timing of the surgury. I know that I have an enlarged heart from the extra work. Any other stories of damage that could have been avoided if the timing of the cardiologist was better? I am scheduled for a stress echo with a chemical inducement. Anyone else gone thru this procedure? Lastly, what should I look for as I shop for a surgeon?

47 YR Old Male, Current Stenosis 1.0 and closing, 36 gradient resting 63 peak.

Thanks again all!

 

[catfan]

My husbands stenosis is less than 0.8, no symptoms or heart damage yet. 3 years ago it was 1.2. We are doing surgery in a week or two as soon as we get a date from the surgeon. He is 44 now. Going with mechanical due to his age. INR is what they use measure how much coumadin(warfarin) you need to take. If you have INR done at doctors office you check it once a month if it is in the desired range. they will check it more often if it is not and adjust your coumadin accordingly. I don't know anything about home testing your INR. We will use the doctors office. Don't know about side affects of coumadin(warfarin) as regards to chills. My friend has been on it for 10 years and doesn't complain of anything.

 

[ALCapshaw2]

The Big Four Mechanical Valve Manufacturers in the USA are ATS, Carbomedics, On-X, and St. Jude.
All 4 were designed at least in part by Jack BoKros, Ph.D., who is credited with the discovery / development of the Pyrolytic Carbon material used in the Leaflets of the (more modern) Bi-Leaflet Mechanical Valves. Do a Search for "Bokros" on VR to find links to his background. See the Valve Selection Forum for Lots of information on the different Valve options.

As an Engineer, I am highly impressed with the latest technology offered by the On-X Valves
(see www.heartvalvechoice.com and www.onxvalves.com).
St. Jude has the longest track record (30 years and counting for the Master's Series Valves) - see www.sjm.com

INR stands for International Normalized Ratio which is the latest measurement techique for characterizing Clotting Time.
It can be determined from a blood sample by Vein Draw or one of the newer 'finger stick' testers in use by many Coumadin Clinics, Doctor's Offices, and even Home Testers. See the Anti-Coagulation Forum for LOTS of information on anticoagulation measurement and management.

Look for a Surgeon who does a fair number of Aortic Valve Replacements (over 100 / year would be a good number... the Top Valve Surgeons perform 200 to 400 per year). Note that not all Surgeons offer ALL of the Valve Choices so Surgeon Selection can be tantamount to Valve Selection so you need to screen Surgeons if you have a particular valve preference. The Valve Manufacturers can probably help you find Surgeons who use their valves.

'AL Capshaw'

 

[Freddie]

In regards of testing: ideally once a week after surgery until you are steady in your therapeutic range, from there every 2 weeks (which is what most of us still do), some members here do test once a month.

Basically warfarin depletes the clotting agent (vit. K) in your blood, you don't want clots if you have a mechanical valve. Someone will be around to clarify this more clearly for you (too late in the evening for me.....sorry)

 

[dick0236]

First, welcome to the site....it can answer a lot of your questiones and concerns.

I have a mechanical valve, but my valve is no longer in production as technology has moved on.

In a nutshell, INR(international normalized ratio) is a measure of the time it takes for blood to clot while taking warfarin(anti-coagulant). The additional time to clot is only a few seconds longer than in a non-anticoagulated person....but that is all that is needed to prevent clotting. It is one of the little things I have never tried to fully understand, but I know my range is 2.5-3.5 and I try to stay within (or close) to my range by measuring my INR about every two weeks (home test) and adjusting warfarin as needed (usually very infrequently). There are some on here that will provide a better technical definition.

I have been on Warfarin continously, for over 43 years with no known side effects. I have never had a problem with chills(warfarin is an anti-coagulant....it is NOT a blood THINNER). However, I do have a caution about taking the pill. Take it as prescribed and test routinely.

At the time of my surgery, my gradient over the Aortic valve was 122 and my heart had slightly enlarged. After surgery, things apparently went back to close(?) to normal. I have had few problems since the AVR.

 

[nngbwh]

I have a St Jude mechanical valve. If my INR is stable I test once a month at a coumadin clinic.

 

[Demonic]

Over here in the UK you get to measure the effectiveness of your rat poison therapy ( ) by how long you have between INR retests. You'll start on a weekly test and then they double the period (2 weeks, 4 weeks etc) if you stay in range. I think that the longest I have got to is 8 weeks. That's probably the longest I'd want to go between tests anyhow.

 

[dick0236]

Over here in the UK you get to measure the effectiveness of your rat poison therapy ( ) by how long you have between INR retests. You'll start on a weekly test and then they double the period (2 weeks, 4 weeks etc) if you stay in range. I think that the longest I have got to is 8 weeks. That's probably the longest I'd want to go between tests anyhow.

Although I have gone three months between tests in the distant past, I really would not recomend a schedule beyond monthly. Although most of us can easily control INR, it is possible to "get out of whack" in a hurry.....been there, done that, and strokes are NO fun.

 

[Bill B]

After reading all I could get my hands on, I did not think there was anywhere near enough published information to make a clear choice among the different valves. The newer ones sound promising but do not have enough experience data to say whether their design features will really pan out to be advantages or have perhaps some unintended effects. I decided to trust the opinion of my surgeon. He had a rather strong preference. I'm a very skeptical person who suspects that most people, even supposed experts, are unjustifiably biased, but he struck me as one of the smartest people I had ever met and one of the most respected in his field. For me to think that I could possibly in a few months of casual study become better informed than he had in 30 years of being involved directly in valve surgery at all levels, was rather ludicrous. So, I went with his preference. That is not to say he doesn't use other valves, depending on the situation. I got a St. Judes. A couple of weeks later he installed a Carbomedics valve in another member here. Anyway, try to find a surgeon you can trust, seek his advice and ask as many questions as you can to him about why he recommends what he does. Most surgeons have preferences. Some instead choose to stay out of the choice-making, regarding it as a "personal" choice you need to make. Still, your surgeon should be your best information source or I would look for another surgeon.

Finding the best surgeon for you is a challenge. For informational purposes only, I went to the best academic center for OHS in our area and arranged an appointment with their most experienced valve surgeon. I was not necessarily intending to have my surgery there. I really just wanted information. My local cardiologist was not planning on sending me there, but was probably going to recommend a local community surgeon and hospital. She said she refers "more complicated" cases to the academic centers. I believe my case turned out to be more complicated than she appreciated, and I am rather glad that I connected with the academic center and surgeon on my own and had my surgery done there. It may have turned out just as well done locally, but I'll never know that for sure. Although AVR has become rather routine surgery, I had a quite a bit of my aortic arch replaced as well, which requited hypothermic total circulatory arrest with retrograde cerebral perfusion. I don't think I'd be comfortable with that except in the most experienced hands.

Bill

 

[Luana]

I totally agree with Bill about trusting the surgeon to select the right valve for you. My surgeon and I had agreed on an On-X valve before surgery; however, it didn't fit right, so I got a St. Jude Regent instead. There are absolutely no regrets on my part; the right tool for the right job.

 

[JeffM]

I'm addressing your "timing" question. I went with a tissue valve and was only on anti-coag therapy for a couple months. My surgeon told me I could have had my valve replaced a couple years earlier. There was a significant amount of enlargement of my left ventricle and left atrium over the two years prior to my AVR surgery. I'm happy to report that as of my 2 year echo, my left ventricle has returned to a normal size and my left atrium has returned to almost normal, albeit at a slower rate. The wall thickness of my left ventricle has also diminished to normal. I couldn't be happier with these results. Hope that bit of info helps you and that you go into your sugery knowing that surgeon and hospital selection are key and that the odds are very much in your favor for a successful surgery and strong recovery.

Thank you all for the replies to my first thread! A few additional questions. I believe I am leaning towards a mechanical valve. Question is, which manufacturer does everyone have, and are there some that are better than others? INR......... what does it measure and how often must you test? I have a fairly good idea that it is a measure of the Warfarin however I could use some clarification. Any side effects from the Warfarin as it relates to the chills? My body currently runs pretty warm. Larry from Tulsa suggested having a surgeon's input on the timing of the surgury. I know that I have an enlarged heart from the extra work. Any other stories of damage that could have been avoided if the timing of the cardiologist was better? I am scheduled for a stress echo with a chemical inducement. Anyone else gone thru this procedure? Lastly, what should I look for as I shop for a surgeon?

47 YR Old Male, Current Stenosis 1.0 and closing, 36 gradient resting 63 peak.

Thanks again all!