Heart Talk Update

[Marie-62]

On September 25, I have to be at Buffalo General Hospital to finish up with the pre-up testing. Then after words I will meet up with my surgen if I have any more questions. This is getting real

 

[Marie-62]

I am 64 going with tissue valve. When and if the Valve goes, I will have the Tar that would go uo your groin to put the new valve in. They are doing it already here at Buffalo Vassular hospital. Friend father just had it done, he is in his mid eighty's, doing great

 

[pellicle]

...He wants to move forward with the surgery and I need to make a decision on a mechanical or tissue aortic valve. I really don't want to be on blood thinners the rest of my life and also don't want to have another surgery in 10-15 years.

well that's it in a nutshell really ... if I may observe that firstly the benefits of having a mechanical to avoid a certain reop are perhaps reduced depending on your current age (there is nothing to guide me in that area of your bio).

Next almost all of us here are doing well on AC therapy (and its not blood thinners because it does not actually thin your blood ... that's just a term designed to make it seem bad or dumb it down for those who can't grasp things). There are a few specific exceptions which I daresay you are not one of.

Almost all of us on AC therapy have the same beginnings: we didn't know what it was going to be like (some feared it) but after a year or so on it we wonder what the hell all the fuss was about.

I'd say universally we'd say (myself included) I'd rather remember to take a pill every day than have a reop and be forever in the waiting room waiting for the new valve to fail (because we know its when not if).

Some thoughts on my blog where I undertake analysis of some medical papers:
http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html

and a very useful talk by a senior surgeon from the Mayo


take your time and read / watch that set carefully ... treat it as if this is a decision which will have major life outcomes for you (not a washing machine purchase)

 

[pellicle]

oh, and Markj , important questions which may drive a reop independent of valve is Aneurysm potential in your future. Are you a Bicuspit Aortic Valve patient ? If you are this will increase the chances of an aneurysm in your future (depending on the age you are now which as I mentioned I don't know)

 

[Superman]

I am 64 going with tissue valve. When and if the Valve goes, I will have the Tar that would go uo your groin to put the new valve in. They are doing it already here at Buffalo Vassular hospital. Friend father just had it done, he is in his mid eighty's, doing great

They are doing TAVR’s in the elderly that aren’t likely to need another surgery and would have a hard time surviving open heart in their mid 80’s. I have not seen anything about them doing valve in valve TAVR’s. Especially in younger patients. Nothing wrong with going tissue, but I would have the mindset that a re-op is what I’m accepting if I outlive the valve. Bonus if they figure it out by then, sure. But in really young patients, how many valves do they expect to stack on top of each other?

Mark, your age and the number of likely reops would have an impact on my thoughts as well.

I’m 45 and going on 28 years on ACT. Hoping for another 45. I’ve managed okay so far.

 

[user 16827]

pellicle great vid , not seen that before

going back 8yr since my valve surgery at that point i wasn't really given the tissue option by my surgeon
i knew very little about it all either and was happy to be led by his opinion.

a blessing in disguise looking back because it's a difficult choice



i took control of my AC therapy 2 years ago and i'm happy with the choice we made to go mechanical.
The warfarin isn't an issue if managed correctly and i'm a very active outdoors person

( chainsawing logs getting ready for winter today )



knowing another surgery isn't in the future suits my mentality ......

 

[Marie-62]

I just don't get it What ever valve we get, it is a done deal. If it tissue or mechanic. mechanic can go bad to.
juzj give us support.

 

[Superman]

I just don't get it What ever valve we get, it is a done deal. If it tissue or mechanic. mechanic can go bad to.
juzj give us support.

Doesn’t support include clarifying misconceptions and making sure people have accurate information?

It’s really hard to just let some claims go unchecked when people are basing decisions on those claims. For example, “Mechanical valves can go bad too.” While I suppose there is a very slight possibility of valve failure in a mechanical valve, it’s more accurate to say that going mechanical is no guarantee against re-op. The reasons, however, are seldom due to a failure of the devise. Pannus growth (scar tissue), aneurysm, or needing another valve (mitral, for example) are the most likely culprits. But second surgery with a mechanical is borderline never because the valve wore out.

Likewise, when there is new data available, it’s very helpful to source it. For example, if your friend had already had a tissue valve installed via open heart surgery, it would be amazing to know they did a TAVR inside a tissue valve. I, for one, had not heard they were there yet. I had a friend who was made those same promises by a surgeon 10 years ago. He was in his 30’s and went tissue.

 

[honeybunny]

Marie, you have my support. I'll be 64 in a few days so we're pretty much in the same boat. I got my tissue valve at 61, and my cardio told me point blank I would have TAVR the next time around. (I'm not entirely convinced but he is!)

Sending positive energy your way.

Hugs,
Michele

 

[pellicle]

Hi Marie

I just don't get it What ever valve we get, it is a done deal. If it tissue or mechanic. mechanic can go bad to.
juzj give us support.

and when you've asked for it I too have given it: http://www.valvereplacement.org/foru...932#post884932

This forum (and indeed any given thread) may contain questions asked by others, should we not give it to them too? As Superman put it well some people need informing. We all need / want support in our own ways, some want just their "hand held" others want information to make choices.

One thing I've noticed is that the same thing which causes "buyers remorse" is at work when people hear their opinions are questioned. I think its kind of like a pride sting.

There is no "one truth" but there are clearly differences which can not be ignored and are not wrong. There will not be a cardiac expert who disagrees with the following: "in a patient who is young a mechanical valve may require a reoperation during their life, with a tissue valve reoperation is a certainty"

So you are (I'm guessing) 62, and I'm quite sure I've said to you that for you choosing a tissue prosthetic will not be a bad choice at all, especially given this is your first OHS.

I recommend you read the following article with care
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696738/

Looking at table 3 we see that for a younger person (36 - 50 years old) 68% avoided reoperation at 10 years, and by 15 years that had shrunk to 48%

So for a younger person (less than 50) is just (in my view) unethical to sign them up on rainbow promises which don't fit the facts.

From the summary of that:

For patients aged 70 or older, it is clear that a biological valve should be recommended; likewise, a biological valve should be recommended for patients aged 65 to 70 whose life expectancy is reduced by comorbidity. For patients under age 65, a mechanical valve is to be preferred, at least in the mitral position. If a patient in this age group is averse to anticoagulation, it is proper to implant a bioprosthesis as long as the patient has been fully informed about the long-term implications, because reoperation, if it should become necessary, can be performed with an acceptably low risk.

Lastly its often with some sadness that I read the primary reason for a person avoiding a mechanical valve is the fear of warfarin, only to find that they need to be on warfarin a few years later. It must feel pretty frustrating, and I guess that people cover that up in all manner of ways.

Let me say lastly that for your at your age it is not by any stretch of the the imagination a bad choice to pick any valve you want.

Best Wishes

 

[carolinemc]

Marie-62 Please do not sweat it a lot. Just put your mind on something else. The real deal decision will come and you will go with your heart and being informed. You are very proactive and informed and you will made a great decision. Hang in there. You are watched over by all of us here. Hugs for today.