Is resurgery that bad if one chooses a tissue valve?

[Arnold Ziffel]

Hi Im new here in fact this is my first post. I am going in for an AVR in 2 weeks, so here I am deciding on valve types (hence the Arnold Ziffel name for you folks who use to watch Green Acres). I have been through the echo, cardiac cath, and met with the surgeon so here I am.

I am a 52yo male, in good shape with no problems other than being a type 2 diabetic for 6 years now (controlled)and just found out that I need an AVR. My cardio-vascular system is in good condition other than the valve. I have no plaque build up, no blockages, the arteries are all good and no heart muscle damage and have always had normal bp and never more than been 20 lbs overweight. So for these reasons all my dr's are saying this is going to be a piece of cake.

I heard both sides of the valve issue and to be honest I am considering a tissue valve because I really dont want to make a large lifestyle change, for the simple reason is I love riding motorcycles and in my business I tend to get some deep cuts and bruises occasionally. I take medication for my diabetes and get blood tests bimonthly now, the thought of having to change my entire lifestyle and become a slave to bloodwork, more pills (my goal is to get off the pills or get to one a day), so I dont want to be reminded every day that I have to be careful not to "bump" into anything, so to speak.

Having been around medical professionals in the cardiac field for the last 20 something years, I have a basic understanding of what heart disease does to people, my ex wife was a CCU nurse and took care of open heart patients, I cant believe the advancements made in technology.

Everything I read about valve replacements, the bottom line is it is the patients choice. So I know that the decision is mine, but I am being told the surgery although has its risks, the fatality rate is about 1% or less.
Now they are only going to make a 2-3" incision, and Im told it takes about 2 weeks for the valve to heal and about 6-8 weeks for the sturnem to heal.

I have the utmost confidence in technology so if I needed to go in in 10-15 years I will still be young enough to successfully go through another surgery. (The Dr said there are tissue valves out there going on 20-25 years, but they cant claim they will last that long but....). I just read a post here that a Dr in UK has performed a valve replacement by going through an artery without opening the chest. Would like to hear some positive feedback from anyone.
Thanks to everyone for listening.
Arny

 

[Phyllis]

Welcome, Arny. Advances in AVR (including doing replacements by cathetar) are something that we are all hoping for, but there are no guarantees. Re: being in good shape for a redo in 10-15 years, I can only tell you that Dick had his first AVR at 70, was in good physical shape going in and had a model surgery and recuperation. They are talking about 20 years for the Edwards Magna that he has, but again, no guarantees. At your age, you really have to weigh the choices and consequences between mechanical and tissue and then make your own choice. Once you've made it, don't look back, but just enjoy your new valve and your new good health.
Read the threads in valve choice, do your research and then decide with confidence. Again, welcome and please pose any questions that occur on your road to surgery. Let us know the date and we will add you to the calendar!

 

[Cooker]

View attachment 4529Welcome Arnold...lots of good information here. I like the name

Cooker

 

[Kate]

Hi Arny!
I had a bovine valve put in last September at the Cleveland Clinic (so, I guess you can call be Bessie! ). I went biological because, like you, I decided the risks of reoperation were more acceptable to me than the risks / inconveniences associated with long-term Coumadin usage.

The bare facts as you have stated them roughly correspond to what I was told about this surgery (1% risk for the first surgery and roughly double that for the second, 2 weeks for scar to heal, 6-8 weeks for sternum to heal) but, although I'm very happy with the choice I made, I think it only fair to warn you that this surgery is extremely invasive and takes a long time to fully recover from. I was able to go back to work at 6 weeks, but did not regain my full stamina for about 10 months - and that was at age 38. In addition, you are likely to have a period of declining energy prior to when your reop occurs.

I'm not trying to talk you out of going biological - as I said above, I'm happy with my choice and would definitely make the same again. However, I think it is important for you to know as you make your decision that this is a long healing process. If you decide to go biological, I was told that people planning on an eventual second surgery should go to the most experienced surgeon available for their first to help minimize scar tissue and other negative events that could cause complications when the time comes to redo. Happily, there are some world-class heart hospitals in CA, so that shouldn't be a problem for you. Best of luck! Kate

 

[Nancy]

Welcome to the site. I think you should thoroughly discuss your diabetes with the surgeon and cardiologist. In the future it may have a bearing on additional heart surgeries, even though now you are in good control.

 

[geebee]

I just wanted to welcome you since there is so much good information on this site about valve choices.

Having been through multiple surgeries, I can tell you that reops are not easy despite statistics. It gets harder each time and there are things that can occur that make reops downright dangerous like scar tissue that has to be cleared to access the heart.

However, one nevers knows in advance how their body will react to surgery. You simply need to be comfortable with gambling that your body will be okay if you decide on multiple surgeries.

I am a prime example of "you never know". I have survived 3 OHS but was not given a great chance of making it through my third and I almost died during the second. Again, I am still here so I don't know whether that helps or not.

I lead a very active lifestyle on coumadin but many people find it to be a problem. Again, an individual issue and one that may not be predictable in advance.

A good quote used on this website is, "The only bad decision is no decision".

Best of luck to you.

 

[Karlynn]

52 is kind of the gray area of valve choice. One can make some excellent arguments for any type of replacement. Kate gives advice that I was going to, until her post, that recovery, in general takes a lot longer than the time it takes for your sternum to heal.

I would also echo Nancy's suggestion that you seriously discuss the issues of Type II diabetis with your doctor and surgeon. My Dad was a Type II diabetic and had OHS for bypass surgery. He got an infection in his sternum and due to the lack of blood supply from his diabetis, antibiotics couldnot get to the sight of the infection. They ended up having to remove his sternum and some ribs. He was in the hospital for 2 months.

I realize that this is really a worst case scenario, and I don't mean to scare you when you are already scared about the valve surgery to begin with. But I did feel that this is something you should know about. My Dad's Type II was felt to be pretty controlled. At the time of his surgery he had no other diabetis-associated health problems that would have given the physicians a clue that he may have trouble. I should also let you know that he was on insulin shots and not the pills, so he was testing daily. It sounds like you take pills.

 

[hensylee]

Hey, Arnold. I can't help you on your question, but I want to welcome you to VR and to ask you how are things down on the farm.

 

[tobagotwo]

Everyone recovers differently from the surgery.

For some, the recovery just seems to start immediately, and continue unabated. For others, it's filled with setbacks and disappointments. Sometimes, recovery time has to do with how early the surgery intervenes. But there are some people whose bodies just take grave offense to the intrusion, and it takes them a long time to recover.

For most, it's successful and not unduly difficult in the recovery. Most women rate childbirth as being worse. It's to be remembered that the average valve patient is in the 60s-to-70s age range, where recuperation may be more difficult (Dick aside, Phyllis ).

Unfortunately, there doesn't seem to be a way to tell who is going to be whom - and in this game, you have to choose before you get to find out.


There are percutaneously installed valves out there (installed via catheters, not unlike those used for catheter angiograms). However, at this time, the valve apertures (openings) are smaller in size than the valve you would receive in a normal operation, increasing the pressure gradient at the vavle and the work your heart has to do to pump it. There is also no track record yet for how long they'll last. These are great for saving the lives of people who might not survive a surgery, but not optimal for an otherwise healthy individual. Eventually, they may be an equivalent option, or even a preferred one. But certainly not yet or soon.


I agree with Nancy regarding where your diabetes may fit into the picture for the next operation (such as if it affected your kidneys or wound healing). But I also wonder about day-to-day issues of Coumadin use from a quality of life perspective. At some point, there is usually constant blood testing required for diabetes, and there is some less frequent blood testing required for Coumadin. One question is how (or whether) Coumadin interact with circulatory problems (such as brittle capillaries and bruising that can accompany diabetes) with all this testing (when warfarin, too can cause bleeding and bruising), or with kidney problems that can be associated with diabetes over time.

Diabetics are at higher risk for blood clots and atrial fibrillation, and may wind up on Coumadin anyway, eventually. You might look to blogs or diabetic sites that have postings by warfarin/insulin patients for information on this. Standard medical sites almost never refer to the life adjustments that real people have to make to live with the medications they are prescribed.

Coumadin (sodium warfarin) itself does not affect blood sugar, but there are a few oral diabetes medications that it can affect by making the tablets more potent than normal. Users should be able to adjust dosage to that, but they should be aware of it beforehand.


I chose a tissue valve at 52. I feel much as you do about not wanting to be a patient all the time, having to go to labs and wait, having to be treated special for some dentistry and physical tests, like colonoscopy, etc. I am content with my choice, and would still choose tissue if I had it to do over again. (And will choose tissue again when I'm around 70, having this one replaced, unless unfortunate circumstances no longer allow it.)

However, each person needs to choose a valve that suits him or her, both in personality and personal physical circumstances. It's not easy. You may change your mind several times before you finally decide. No one here will think more or less of you for your choice either way.

Best wishes,

 

[Karlynn]

Most women rate childbirth as being worse.

I don't know that you can compare the 2. I've had 2 births and 1 valve replacement and I can tell you it took me a lot longer to recover from the valve replacement than it did giving birth. (And one of my births was with a messed up valve.) The pain was more intense with childbirth, and maybe that's what you're referring to. But that lasted less than a day. I was reeling from the pain of unexpected coughs and sneezes a month after my VR. But much like childbirth, the "end product" gives you such joy that one tends to forget the pain. With valve replacement, one is so happy to have a new lease on life, unless you've had a difficult recovery, you forget eventually.

 

[Jay F]

Hello

Hello

Good luck to you and I hope your inner voice speaks to you loud and clear. I am 44 years old and had a medtronic mosaic ultra porcine tissue valve installed 23 days ago. The surgeon at NYU medical center in NYC Stephen Colvin is the pioneer there of minimally invasive surgery. He basically made a 6-7" horizontal incision 3 or 4 inches above my right nipple to access the heart. No Stenotomy. Dr colvin travels around the world and teaches. I believe he may be the inventor of this style. My reasons for choosing tissue is the same as everyone elses but I also have alot of faith in modern medical technology and believe that first, my new valve will be good for 20 years, second, by the time I am 64 valve choice will be an easier desicion and re-surgery will be streamlined even more. By the way, I am walking 4 miles, playing drums 90 - 120 min and goin back to work in 4 more days. Once again, I am a little over 3 weeks post OP!!! Be well, any other questions please dont hesitate.

 

[sue943]

I am also type II Diabetic, diet controlled. I had my OHS and the surgery and healing were both fine. I am on warfarin now for life.

 

[tobagotwo]

Karlynn,

I wouldn't presume to speak for the women in VR.com, particularly in regard to an entirely feminine experience. This is a statement regarding relative pain that has been made a number of times by women on the site, and has been agreed to by others when it has been brought up. Like any other subjective comparison, it's very unlikely that it would be a universally apt statement.

In any event, I don't mean it to trivialize the impact of open heart surgery on the surg-ee.

Best wishes,

 

[Karlynn]

Karlynn,

This is a statement regarding relative pain that has been made a number of times by women on the site, and has been agreed to by others when it has been brought up.

And that's what I thought you meant. I just didn't think it was clear that it was the pain you were referring to.

I think the pain has also been described as less painful than abdominal surgery. And I'd agree there too. I had my appendix out, and found it much more painful a recovery (although quicker) than my VR recovery. Anytime you have to cut through muscle....

 

[LUVMyBirman]

Surgery was not bad. Did not find the pain awful. Recovery was long and difficult. Would not want another one if I could avoid it!

 

[Magic8Ball]

Another biker facing the same dilema

I've gone the other way being 36 and have chosen mechanical...the main reason was to be around for the kids rather than my own selfish reasons....

Perhaps i'll get back into recreational riding once the kids have left home but while they are dependant i have a responsibility to them first and foremost.

One thing my surgeon said to me was re-ops should be minimal risk but if anyone thinks they can control scar tissue then they are wrong so if you can avoid messing with it then do so.

I'd kinda hoped to keep my bav for 10-15 then go tissue but i guess i'm now just content on being around for a while no-matter how much noise i make....just looking through car mags to get a car that stirs the blood as much as a bike and i'm not having much luck..

 

[lynn]

Here's something I'm wondering about, and maybe it should be in a different thread. When a mechanical fails, do you have symptoms like you would with a tissue letting you know it's going. Or does it just fail and that's the end?????

I will be 47 and I'm torn as to which way to go

 

[tobagotwo]

First off, pyrolytic carbon (mechanical) valves almost never fail. The materials and design are extensively tested, and are such that they should outlive you and several levels of progeny.

From what I have read, in the tiny, percent-of-a-percentage that have failed, the effect has been that it's an immediate crisis, but surprisingly, most often not fatal.

Tissue valves generally degenerate in a similar manner to your original valve when they reach the end of their useful lifespan.

There are many reasons, physical and psychological, to choose a particular valve or valve type. I would personally not consider the possibility of structural failure in a carbon valve to be a worthwhile criterion for decisionmaking. It's simply too remote a circumstance.

Best wishes,

 

[geebee]

Here's something I'm wondering about, and maybe it should be in a different thread. When a mechanical fails, do you have symptoms like you would with a tissue letting you know it's going. Or does it just fail and that's the end?????

I will be 47 and I'm torn as to which way to go

As Bob said, the mechanicals rarely fail unless there is a defect (like the St. Jude Silzone [I think that's the name] or the Bjork-Shiley CC). Even with Bjork-Shiley, many people had symptoms and were able to have the valves replaced with emergency surgery (some were not so lucky). However, if you go with a tried and true mechanical like the St. Jude, it should outlive you.

The problems happen mostly because your body changes. In my case, I produce excess amount of scar tissue that encroached on the Bjork-Shiley I had, causing it to stick. And, yes, there were symptoms (syncope, breathlessness, etc.) when the valve was sticking.

However, my situation is very rare. Tests indicated I had anti-heart antibodies in my system and that was probably causing the scar tissue buildup around the valve.

The reason I went through this explanation is to let you know that I am an exception and don't want members to assume that this happens all the time.

 

[tobagotwo]

Scar tissue can be a problem from the very first operation. It seems to be luck of the draw, based on your genetics. Sometimes, mechanical valves have to be replaced due to scar tissue that interferes with their movement or that blocks blood flow. It's not that common, but there have been threads on the site from valvees with that issue. Of course, that can also happen with a tissue valve.

Just to clarify from above, the fact that a carbon (mechanical) valve can physically outlast you doesn't mean that you will necessarily keep it for a lifetime, or that you will be free of further cardiac surgeries. Scar tissue, invasion of epithelial tissue onto the surface of the valve, disease of surrounding tissue or neighboring valves, aneurysms, aortic root expansion, pericardial restriction/constriction, endocarditis, and a few other things can cause the valve to be replaced or another type of cardiac surgery to be done.

However, a carbon valve definitely minimizes the circumstances in which further surgeries might happen, particularly considering that a tissue valve in a younger person raises the likelihood of cardiac resurgery to a certainty.

Best wishes,