Howdy - AVR coming up!

[DJ-Rae09]

Hi Guys,

42 yo male based in Sydney, Australia - I have BAV with aortic aneurysm which was picked up 12 years ago. My recent yearly echo showed a drop in ejection fraction (50-55%) and larger LV systolic at 6.6cm. My aortic valve has been leaking severely for the past few years with no symptoms. My blood pressure around 120s/70s.

Cardio has now requested valve replacement within the next month. I've meet the surgeon and going for the mechanical valve (SJM) based on my age although I'm a bit concerned about Warfarin to be honest, I do like my wine and craft beer

My aortic root needs replacement too with the sleeve.

Anyway, just wanted to introduce myself and say it's been great the information I've found on here from other members nervous about the upcoming surgery and recovery but that's just natural right?!

Cheers,
Tim.

 

[Chuck C]

Welcome to the forum!

going for the mechanical valve (SJM) based on my age although I'm a bit concerned about Warfarin to be honest, I do like my wine and craft beer

The guidelines certainly call for a mechanical valve at your age, to avoid multiple reoperations. I made the same decision at age 53. Like you, I went with a SJM valve and, like you, my aortic root and part of my my ascending aorta replaced with a dacron sleeve. They call our procedure a Bentall Procedure.

Regarding your enjoyment of wine and craft beer. That is fine, because you should be able to drink wine and craft beer on warfarin. It is a myth that you can't do so. Just don't drink so much that you fall down and hit your head. There are several threads on the forum which discuss life on warfarin, including drinking. Just about everyone here who has been on warfarin a long time will tell you that you can drink alcohol. Just be smart about it. I would strongly recommend self-testing and see how your INR responds to a couple of drinks before drinking more. But personally, I have found that my INR does not move from a couple of drinks and only moves a little after several drinks, but still stays in a safe range. As we say here, know thyself. Which means, know how your INR responds to alcohol, and other things, and the feedback from self-testing will help you understand this.

The good news is that because you are getting your aneurysm repaired at the same time, you will likely be one and done. Most reoperations for those with mechanical valves are due to aneurysm.

And don't let anyone tell you that you can't have an active life on warfarin. I trained Brazilian Jiu Jitsu for almost 4 hours today and finished the final class grappling with a black belt for 7 minutes. You can have a very active life on warfarin and enjoy wine and beer - just be smart about it.

Yes, it is natural to feel nervous about the upcoming procedure. Just know that going into surgery this procedure is one with a very high success rate, especially at your young age. Your chances for a successful operation and recovery are excellent. You'll do just fine and then come back and tell us all about it once you are on the other side.

Good luck with your upcoming procedure and please feel free to ask any questions that you might have.

 

[DJ-Rae09]

Hi Chuck,

Thanks for the reply and information, much appreciated

Yes, getting the Bentall Procedure which I just found out the name (my surgeon didn't mention the name) after a quick google, thanks!

I was also concerned about staying within the correct INR range which is about 2-3? I'm guessing it will take time getting used to the testing and what might increase or drop my INR based on diet/drinking a couple of glasses of wine etc? Does exercise or working out at the gym change INR? ....Reading posts here going out of range doesn't seem like such a big deal?

Does your SJM have a click on it? I'm thinking it might be off putting to start then will get used to it over time.

Yes will update here on the outcome of my surgery and hopefully speedy recovery

Cheers,
Tim.

 

[pellicle]

Ozzie Ozzie Ozzie ... Oi Oi Oi

welcome aboard.

Chuck has touched on the main points but just to say:

Anyway, just wanted to introduce myself and say it's been great the information I've found on here from other members nervous about the upcoming surgery and recovery but that's just natural right?!

yep, its natural ... but just ease back and let it happen ... I like to think of it as an experience that few get.

I'm a bit concerned about Warfarin to be honest, I do like my wine and craft beer

don't be

Best Wishes

 

[Brinntache]

I was in the same place as you, but strangely enough I was not nervous. I think it was because I'd spent so long waiting for the operation and the symptoms were coming on heavy that I was able to accept the surgery as the only sensible course of action. As for the warfarin lifestyle it's not so bad. I drink more than I probably should but strangely enough I'm in the best shape of my life a year after surgery. I have taken my rehab very seriously and exercise every single day. In fact, I did the first headstand of my life two days ago. The only thing I notice about warfarin is that my balance still seems off.
Theme song

 

[JWalters]

Hi Tim, I was in almost your exact shoes 4 1/2 years ago. I'll mention that with sufficient education and convincing yourself you are doing the right thing with the best possible providers, it will alleviate your nerves. At least for me, I was calmed by that. Only thing I would have done differently is shave my own chest and inner arm area (to avoid IV tape annoyance)

Warfarin is a non-issue for me. I have 0-5 drinks a week and my INR is very stable. As some others can explain better than me, the important thing is to stay above the minimum range INR. Exercise has zero effect on INR for me.

For sure the carbon valves click, but it is such an insignificant issue, don't even waste time worrying about it.

 

[Chuck C]

I was also concerned about staying within the correct INR range which is about 2-3?

Yes, that is my range and the range that is most often given for the SJM. Your cardiologist will set your range for you or possibly defer to the coumadin clinic. Mine was 2.5-3.5 for the first few monts, because I had a couple bouts of afib during my recovery in the hospital. If a person has afib in addition to a mechanical valve generally the INR is set a little higher. Once it was shown that my heart had been in normal sinus rhythm for a few months, my INR target was moved down to the standard 2.0-3.0. I know that there is at least one member here who has a target of 2.0-2.5.

I'm guessing it will take time getting used to the testing

For me the testing was pretty easy to adapt to. There is not much to it and @pellicle has at least one instructional video on it, which you may find helpul. I also have found it easy to stay in my range, which I am in probably 90-95% of the time.

Does exercise or working out at the gym change INR?

It seems to lower my INR a little when I start doing more cardio work. Others have reported similar findings, although it generally is not a big move. One member reported that her INR went down a little when she had an extra hard day of cardio exercise. Her solution was to drink an extra large glass of wine that night, which tended to mover her INR up a little. Apparently the two cancelled each other out, lol.

Reading posts here going out of range doesn't seem like such a big deal?

It is not a big deal, especially if you home test and promptly make adjustments to your warfarin dose. Since I test weekly, on the rare occasions I go out of range, it will be like 3.1 or 3.2. That is not a big dieal at all. The important thing is to not spend too much time out of range, which is especially important when you are below the low end of your range.

Does your SJM have a click on it? I'm thinking it might be off putting to start then will get used to it over time.

Yes and yes. Mine does, but I am fortunate that mine is very hard to hear. I am in a quiet room right now and I can't even hear it. However, if I take a deep breath, I can hear a couple of beats. For me, it sounds like a thumping. The only other people who can hear mine are those who put their head on my chest. Some report that sound is louder for them. The vast majority report that they get used to it over time and don't even notice it.

 

[PAN]

Her solution was to drink an extra large glass of wine that night, which tended to mover her INR up a little. Apparently the two cancelled each other out, lol

This sounds perfect

 

[DJ-Rae09]

Ozzie Ozzie Ozzie ... Oi Oi Oi

welcome aboard.

Chuck has touched on the main points but just to say:



yep, its natural ... but just ease back and let it happen ... I like to think of it as an experience that few get.



don't be

Best Wishes

Yep Aussie indeed Where in AUS are you from?

 

[DJ-Rae09]

I was in the same place as you, but strangely enough I was not nervous. I think it was because I'd spent so long waiting for the operation and the symptoms were coming on heavy that I was able to accept the surgery as the only sensible course of action. As for the warfarin lifestyle it's not so bad. I drink more than I probably should but strangely enough I'm in the best shape of my life a year after surgery. I have taken my rehab very seriously and exercise every single day. In fact, I did the first headstand of my life two days ago. The only thing I notice about warfarin is that my balance still seems off.
Theme song

Thanks for the reply!

Yeah, I've been waiting for this operation at some point too. BAV was picked up 12 years ago. I'm OK now with the operation but I'm guessing the week/days before the anxiety levels might ramp up a tad!

Good to know about your exercise and health! I currently exercise and train at the Gym. My hope is getting back to that ASAP.

Cheers

 

[DJ-Rae09]

Hi Tim, I was in almost your exact shoes 4 1/2 years ago. I'll mention that with sufficient education and convincing yourself you are doing the right thing with the best possible providers, it will alleviate your nerves. At least for me, I was calmed by that. Only thing I would have done differently is shave my own chest and inner arm area (to avoid IV tape annoyance)

Warfarin is a non-issue for me. I have 0-5 drinks a week and my INR is very stable. As some others can explain better than me, the important thing is to stay above the minimum range INR. Exercise has zero effect on INR for me.

For sure the carbon valves click, but it is such an insignificant issue, don't even waste time worrying about it.

Thanks for the reply and information!

 

[DJ-Rae09]

Yes, that is my range and the range that is most often given for the SJM. Your cardiologist will set your range for you or possibly defer to the coumadin clinic. Mine was 2.5-3.5 for the first few monts, because I had a couple bouts of afib during my recovery in the hospital. If a person has afib in addition to a mechanical valve generally the INR is set a little higher. Once it was shown that my heart had been in normal sinus rhythm for a few months, my INR target was moved down to the standard 2.0-3.0. I know that there is at least one member here who has a target of 2.0-2.5.



For me the testing was pretty easy to adapt to. There is not much to it and @pellicle has at least one instructional video on it, which you may find helpul. I also have found it easy to stay in my range, which I am in probably 90-95% of the time.


It seems to lower my INR a little when I start doing more cardio work. Others have reported similar findings, although it generally is not a big move. One member reported that her INR went down a little when she had an extra hard day of cardio exercise. Her solution was to drink an extra large glass of wine that night, which tended to mover her INR up a little. Apparently the two cancelled each other out, lol.



It is not a big deal, especially if you home test and promptly make adjustments to your warfarin dose. Since I test weekly, on the rare occasions I go out of range, it will be like 3.1 or 3.2. That is not a big dieal at all. The important thing is to not spend too much time out of range, which is especially important when you are below the low end of your range.



Yes and yes. Mine does, but I am fortunate that mine is very hard to hear. I am in a quiet room right now and I can't even hear it. However, if I take a deep breath, I can hear a couple of beats. For me, it sounds like a thumping. The only other people who can hear mine are those who put their head on my chest. Some report that sound is louder for them. The vast majority report that they get used to it over time and don't even notice it.

Thanks for the info! And yes I have read @pellicle Wafarin/INR blog, very useful.

Question, were you on any other medication post operation and into your recovery? Apart from Wafarin....

 

[pellicle]

Hi there

Yep Aussie indeed Where in AUS are you from?

well you've just outed yourself as using a phone, which fails to show all the richness of websites (like every mobile version of everything).

I suspect it explains why you haven't responded to my Personal Message either.

I've been in Web development since 1997 and in all that time nobody has got mobile right (well, ok Nokia did a good job back in 2009, but Samsung and apple are just crap at it and everyone else has dropped the ball too)

So I suggest: read your PM

Best Wishes

 

[pellicle]

Question, were you on any other medication post operation and into your recovery? Apart from Wafarin

I wasn't pre operation, but after I was on metoprolol. Then a year later antibiotics...

 

[DJ-Rae09]

I wasn't pre operation, but after I was on metoprolol. Then a year later antibiotics...

Were you on metoprolol for long post op? I'm assuming that's to control HR and potential A-FIB?

I'm currently on a calcium channel blocker and angiotensin receptor blocker. I been on them for 12 years since BAV and mod-sev leaky AV was discovered. I'm not sure If I'll be on them post operation since blood pressure might return to normal range (currently at the high-end of normal). But, will ask my cardio when I see him next week.

Cheers,
Tim.

 

[pellicle]

Were you on metoprolol for long post op?

about 3 months ...

I'm assuming that's to control HR and potential A-FIB?

that's what I understood too...

 

[pellicle]

My aortic root needs replacement too with the sleeve.

just curious if its the root or they are going aways up the Ascending Aortic Artery? I had mine done to the arch.

usually a Bentall goes up more... if you have BAV I'd be asking about that as Ascending Aortic Aneurysm is what drove my 3rd surgery (but the valve wasn't far behind it, so they whipped that out too {however I get the feeling you know my history a bit})

 

[Chuck C]

Question, were you on any other medication post operation and into your recovery? Apart from Wafarin....

Yes. I was on metroprolol for about 3 months to control my blood pressure. This is a beta blocker and it seems almost all are put on a beta blocker after surgery. From my understanding, the purpose is to control blood pressure during the recovery period, so that sutures can heal properly.
I was also on amiodarone. This was because I had two episodes of afid in recovery. Afib is very common after valve surgery. My surgeon indicated that about 40% of patients have at least one episode of afib in recovery. The good news is that for the vast majority it is transitory. I only had to be on amiodarone for about 6 weeks, as I recall.

 

[pellicle]

Afib is very common after valve surgery

even a few years after it too ... its like a surprise gift package

 

[DJ-Rae09]

just curious if its the root or they are going aways up the Ascending Aortic Artery? I had mine done to the arch.

View attachment 888530

usually a Bentall goes up more... if you have BAV I'd be asking about that as Ascending Aortic Aneurysm is what drove my 3rd surgery (but the valve wasn't far behind it, so they whipped that out too {however I get the feeling you know my history a bit})

I have mild aneurysm at the ascending and mild-moderate at the root. So I think its up to the arch. but will check with my surgeon.