I’m in the system!

[Standardvelocity]

I met with the surgeon on Thursday he says it’s time to operate to change aortic valve and ascending aortic artery, no definite date yet the scheduling department will call me in a couple of weeks, this is starting to get real!
I was leaning towards a mechanical valve, doc says he will do either kind I’m 63yrs. He explained the pros and cons of both types along with the TAVI procedure to repair a bio valve if needed down the road. I asked about being a candidate for the TAVI, Doc said what eliminates a lot of people is the distance between the aortic valve and the coronary arteries,(too close together) In my case with a synthetic artery there is enough space between built in to do a TAVI procedure. Now I am rethinking the valve choice there is still time to change my mind a couple of times.

 

[Protimenow]

I can't and won't tell you what to do.

If I was 63 again, and in good health, I'd probably go with a mechanical -- assuming you would live longer than a bovine or porcine valve would last (otoh, if I expected to outlive a bio valve, the mechanical is a fair choice).

The TAVI is a minimally invasive procedure, so it's a lot less strain on the system. An issue with TAVI is that if they have to go back in, the valve gets smaller and smaller. BUT, if I had a TAVI, I'm not sure if I would live long enough to have more than one or two re-TAVIs.

So - my personal choice, if I had one, is of little help to you. Perhaps others will have some useful input.

(Doctors I've encountered recommended bio valves for people your age -- but they didn't have TAVI as an alternative yet).

 

[dick0236]

The rule of thumb is ages 60-70 the choice is either mechanical or tissue so you can choose whichever makes you the most comfortable. Good luck and Godspeed on your upcoming surgery.

 

[Survived03]

Standardvelocity, I chose a bio this past May and the distance between the valve and coronary arteries was one of the factors I weighed heavily. That and the size of valve that would fit.

An Interesting article I read while researching this topic was one where the surgeons would insert a type of “L” shaped stent into the coronary artery to allow clearance away from valve. If I interpreted the publication correctly. Pretty wild idea and not prevalently utilized.

Good luck to you! Keep us posted on your journey.

 

[3mm]

Please consider yourself, rather than a generic 63 year old human. How active are you, because that affects the lifespan of a bioprosthetic valve. How organized are you, because that affects how well you will manage use of warfarin. I'm glad to see you discussed your candidacy for TAVI down the road. But if you need a TAVI in 10 years at age 73, what is your plan when the TAVI wears out?

I'm 65, and I got a mechanical (On-X) valve 6 weeks ago. When I had my first discussion about my health history with a surgery team nurse, she asked me about my lifestyle. Among other things, I told her that I train some combination of walking, biking, martial arts, and resistance training for over 1 hour each day. She suggested that I consider a mechanical valve because of my active lifestyle; she worried that I might wear out a bioprosthetic valve in less than 10 years. For me, this mechanical valve is the right choice. For some other 65 year old, a bioprosthetic may be right.

I pray everything goes well for you!
mTm

 

[pellicle]

The rule of thumb is ages 60-70 the choice is either mechanical or tissue so you can choose whichever makes you the most comfortable

agreed, I too see no compelling case either way. However I will add to add to @Standardvelocity 's case of examination that one may indeed end up needing warfarin (or Xeralto, or ....) at a later date for many and varied reasons.

My opinion tends towards the view that the actual situation in your life and where you live about managing Anti Coagulation Therapy (ACT) is a big factor. If you can't easily do it yourself (due to administrative constraints) then the low hanging fruit of "better outcomes" is to go towards a bio-prosthesis.

I think its well phrased in the Journal: http://circ.ahajournals.org/content/119/7/1034.full

Despite the marked improvements in prosthetic valve design and surgical procedures over the past decades, valve replacement does not provide a definitive cure to the patient. Instead, native valve disease is traded for “prosthetic valve disease​

As you (@Standardvelocity) have said; expect you to back and forth between the choices a few times as you ruminate on it and explore both how you feel and the evidence.

Best Wishes

 

[Standardvelocity]

Please consider yourself, rather than a generic 63 year old human. How active are you, because that affects the lifespan of a bioprosthetic valve. How organized are you, because that affects how well you will manage use of warfarin. I'm glad to see you discussed your candidacy for TAVI down the road. But if you need a TAVI in 10 years at age 73, what is your plan when the TAVI wears out?

I'm 65, and I got a mechanical (On-X) valve 6 weeks ago. When I had my first discussion about my health history with a surgery team nurse, she asked me about my lifestyle. Among other things, I told her that I train some combination of walking, biking, martial arts, and resistance training for over 1 hour each day. She suggested that I consider a mechanical valve because of my active lifestyle; she worried that I might wear out a bioprosthetic valve in less than 10 years. For me, this mechanical valve is the right choice. For some other 65 year old, a bioprosthetic may be right.

I pray everything goes well for you!
mTm

I am a rancher so fairly active, most days on the move at least 4-5hrs more during calving season and haying.
I am fairly organized and confident I could manage warfarin. For almost 1yr after my initial heart episode I was prescribed a blood thinner which allowed bruising at the slightest bump or pressure, I believe they work on two different principle.

 

[pellicle]

am fairly organized and confident I could manage warfarin.

If you use my sheet and a pill box I'm 100% confident you can

 

[Beach77]

I was 64 (turned 65 in the hospital) and wanted a TAVR. After talking to a few doctors and researching, I chose a mechanical aorta. (On-X). I had a few weeks to decide what I wanted too. It's tough! I was changing my mind daily and even a couple of times a day! LOL I'm sure I drove my husband crazy! It's not an easy decision! Once I decided, the stress was gone.

The TAVR doctor said, the data shows they are good for 10 years but after that there's not much data. if needed to replace it, the valve in valve was new and very hopeful but not guaranteed. They also said I was on the younger side for a TAVR, they seem to stress that a few times. That made me smile too! I decided I didn't want to go through another surgery in 10 or so years, if needed and how strong/healthy would I be then.

In a few weeks, it'll be 3 years since my surgery and I'm very happy with my decision! I've had a few challenges but most of the time, I don't think about it.

Praying for you as you decide what's best for you!

 

[pellicle]

I didn't want to go through another surgery in 10 or so years, if needed and how strong/healthy would I be then.

its perhaps my own mental problem, but I always wonder if in 15 years time access to medical services will be as good as it is now. All that has to happen is a world war to stuff that up for us all for another 20 years or so.

 

[LondonAndy]

its perhaps my own mental problem, but I always wonder if in 15 years time access to medical services will be as good as it is now. All that has to happen is a world war to stuff that up for us all for another 20 years or so.

That is a good point. We tend to assume that medical knowledge will be forever improving, consequently giving better treatment options and indeed better preventative measures. But that assumes society continues to be stable. I am generally an optimistic person, but I am increasingly alarmed at the threats we face. Whether it be the war in Ukraine, which I see as having far wider implications if the Ukrainians lose to Russia aggression; the seemingly impossible situation in Israel/Gaza; the incredible level of debt most Western governments have run up as politicians try to deliver the services we don't really want to pay for; increased lawlessness with massive shoplifting sprees seemingly considered acceptable now, and the general lack of respect for our institutions, some of whom have brough it on themselves.

Or maybe I am just getting old.

 

[pellicle]

Or maybe I am just getting old.

we are all getting old my friend ...

There are more threats than just wars:
https://www.rand.org/pubs/research_reports/RRA2307-1.html
https://en.wikipedia.org/wiki/Pensions_crisis

 

[user 15848]

I was 64 (turned 65 in the hospital) and wanted a TAVR. After talking to a few doctors and researching, I chose a mechanical aorta. (On-X). I had a few weeks to decide what I wanted too. It's tough! I was changing my mind daily and even a couple of times a day! LOL I'm sure I drove my husband crazy! It's not an easy decision! Once I decided, the stress was gone.

The TAVR doctor said, the data shows they are good for 10 years but after that there's not much data. if needed to replace it, the valve in valve was new and very hopeful but not guaranteed. They also said I was on the younger side for a TAVR, they seem to stress that a few times. That made me smile too! I decided I didn't want to go through another surgery in 10 or so years, if needed and how strong/healthy would I be then.

In a few weeks, it'll be 3 years since my surgery and I'm very happy with my decision! I've had a few challenges but most of the time, I don't think about it.

Praying for you as you decide what's best for you!

Same here, i turned 63 in the hospital; and went through same process; and went with the Mechanical (my surgeon only uses OnX), and it is now 8 years; I did not want to go back to TAVI or OPS again, and also before the OPS met a lady, mother of a doctor, she had her Bio Valve once, and then a TAVI, and that one only lasted 4 years; went for TAVI #2.... and there was no room for more ... ; and "for me" that was a wake up call, WIsh thinking ?, a tissue valve that lasts as long as a Mech, not such a thing, and, a note, I know many , many 60+ people on some kind of anti coagulation therapy due to age/heart strokes, etc issues. So even if you go with a magical ever lasting tissue one, the "pill" is not out of your way as time goes by. Just sharing.

 

[Standardvelocity]

I’ve been flip flopping back and forth, I’m thinking a mechanical now.
Things are moving fast the scheduling department called and told me it maybe 9mo wait for surgery with the surgeon I have been seeing, but if I am willing to go with another surgeon it could happen in 1mo.
I was curious why the difference in wait time between surgeons, seems like the one that I have does some procedures that the other surgeons don’t. Minimally invasive procedures I think.
So I told them the sooner the better getter done! I just need 16 days to get the ranch on auto pilot for a couple months.

 

[Protimenow]

I am a rancher so fairly active, most days on the move at least 4-5hrs more during calving season and haying.
I am fairly organized and confident I could manage warfarin. For almost 1yr after my initial heart episode I was prescribed a blood thinner which allowed bruising at the slightest bump or pressure, I believe they work on two different principle.

You mentioned a 'blood thinner.' Are you referring to Eliquis?

You can't take it AND Warfarin, and the FDA has NOT approved Eliquis for people with mechanical heart valves.

For my money, even IF the FDA approves Eliquis for people with mechanical valves, I'd stick with Warfarin -- it's much less expensive, easy to manage, meters can easily test your INR, and its effects are easy to reverse. (From what I've heard, Eliquis is $8 a day, and Warfarin is, maybe, 50 cents (and often even less)).

 

[3mm]

Regarding one Dr being available sooner than another, I think some dates open up because patients' plans change. For example, August 30th I decided to have surgery at Mayo Clinic. One surgeon, Dr Daly, had openings for Sep 14th and Sep 28th. Otherwise, he was booked up until December. I took the Sep 14th opening.

 

[Standardvelocity]

You mentioned a 'blood thinner.' Are you referring to Eliquis?

clopidogril? Was on it for a while following a heart attack (myocarditis)

 

[LondonAndy]

I don't have any experience of minimally invasive surgery, so what I am about to say may be codswallop. But my instinct is that if a "proper job" needs to be made of a procedure then full-on open heart surgery may be a bigger disruption to living for a bit, but the investment is worth it. People's circumstances differ, of course - I was in the fortunate position of a supportive employer who allowed me generous sick leave, no reduction in pay, and to return to work gradually. Not that there was a choice in my case!

I accept I may well take a different view if that wasn't the case, and of course everyone's health situation and circumstances are different. What do others think?

 

[Standardvelocity]

Some of these procedures are amazing, almost like rebuilding an engine through the exhaust pipe. I’m a hands and eyes on kind of guy.

 

[Protimenow]

Yes, kind of **** rebuilding an engine through the exhaust pipe -- but it's like installing a flow restrictor. Once the flow restrictor starts to clog, another, smaller restrictor is used to repair the first one -- eventually, the actual flow of exhaust gases gets too low, and you need to drop the exhaust, lift the manifold, and do a proper repair. I'm not sure which approach is best in your case --- it's up to you, your doctors, and if you wish, your family to decide.

While the future of cardiac valve technology is unclear, there are no guarantees that new approaches will be developed or FDA approved. I was 41 when I got my mechanical valve - and don't regret it. This was also good timing -- my employer had a generous medical plan (I don't remember paying ANYTHING for the surgery) and I got 8 weeks off. Ten months later, I was out of the job -- if I had waited for the surgery, it may not have happened.