Have I got this right or did I miss something?

[Mentu]

Well, I meet with my surgeon in two weeks. As a starting point, I'm a 59 year old guy who would like to be a hell of a lot more active than I can manage right now. Since I was last on my bike (Hotter'n Hell Hundred, Wichita Falls, TX - 2006), I've gained weight and to no great surprise am feeling a little worse each week. I think this decision about valves might be a little easier if I felt better. It's sort of like having something unpleasant behind you breathing over your shoulder.

At any rate, I'm leaning towards a bio-prosthetic. There is certainly the likelihood of valve degeneration but my Cardio (and some of you) thinks that by that time it may well be possible to fix these things without full-blown OHS. Even if that is not the case, surgical techniques and equipment should improve. It seems that it really is still a crap shoot whichever way you go.

Only after I began to talk with my family about my AVS did anyone mention that one of my Uncles had the same problem. So I called up Uncle Bob and asked if he had had an AVR "Oh, yah" he said "Twice!". It turns out that he was implanted with a St Jude in 1984 and did more or less ok on anticoagulant until 2000 when his symptoms returned. A heart cath revealed that a fungus had covered his valve and degraded its performance. In his second AVR the mechanical was removed and was replaced with a porcine valve. Nine years later, (Age 74) he has other health problems but his valve is working well.

My Uncles' tale just goes to show that, indeed, there are no certainties. The statistics are interesting and even reassuring but statistics cannot guarantee the experience of the individual.

 

[dick0236]

My Uncles' tale just goes to show that, indeed, there are no certainties. The statistics are interesting and even reassuring but statistics cannot guarantee the experience of the individual.

You have it right. Do your homework and make your decision. Either choice will probably improve your quality of life.

If I had to do it today, at 73, I probably would choose a "tissue " type valve. However, I am very happy that at age 31 I got my mechanical valve, which doctors tell me, will most likely last my lifetime. At your age, statistics indicate you can go either way.

 

[Karlynn]

At 59 I think you're at that age where the choice is up for grabs. As Dick said - pick the one that makes you feel more comfortable when you think about it.

Your other family members may want to get screened, as it appears there MAY be a genetic connection.

Best Wishes!

 

[netmiff]

Whatever you choose is the right valve for you. It is a hard deceision, though. BUT, don't listen to all the horror stories about warfarin, 90% of them just ain't true!

I agree with Karlynn, especially if either of your native valves are bicuspid, to get other family members checked out.

 

[Bina]

If some of these newer bovine valves are going for +/- 20 years in the more mature age
group, then if I need another one, that's what I would hope to choose.
For the record, I have absolutely no problem with my Coumadin meds.

 

[ALCapshaw2]

The Bovine Pericardial Tissue Valves have a record approaching 90% "Freedom from Explant" at 20 years in older patients. Carpentier-Edwards seems to be the Big Supplier in this type but there are others. IMO, this would be my 'preferred choice' for someone who wants durability and only needs 'moderate' performance (performance is somewhat limited by a higher gradient that other valves).

The "Improved" Porcine Tissue Valves are hoping to match that 20 year record but haven't been around long enough to know and we see a number of "Early Failures" for various reasons. The Porcine Valves have the Lowest Gradient which is always of interest to athletic types who want the most performance / endurance from their heart.

 

[Ross]

I'd have to say at your age, tissue would be my choice.