I've crossed the line into severe and need to make a decision

[newarrior]

C

Chuck C, i agree with your leaning to a mechanical valve at your age and activity level. The Choice of Bio vs Mech valve, was a tough decision for me in 2010 at 56 years of age.
So my bio valve is just shy of 11 years old today and there was some hope in 2010 that the St-Jude bio could possibly do 20+ years. It was also thought in 2010 that TAV, might be the option for a redo, if redo required. A recent CT scan has provided info that TAV now seems a higher risk option for me. Surgeon will justify OHS vs TAV in our meeting this coming week.
it also seems that TAVR is more expensive than OHS (surprise to me) and that TAV is not commonly done at my hospital for patients under 70.

Correct even in Asia TAVI/TAVR more costly, higher change of stroke, can have some activity limitations (though I don't see this in Mick Jagger) etc etc..Age is a factor as well..70 or at least 65 is a good cut off range

 

[Brinntache]

C
Correct even in Asia TAVI/TAVR more costly, higher change of stroke, can have some activity limitations (though I don't see this in Mick Jagger) etc etc..Age is a factor as well..70 or at least 65 is a good cut off range

That is very interesting. I'm 50, about to get AVR. One cardiologist suggested that bio at 50 was an option, with a TAVI at 65 and 80. If TAVI is bad at those ages, then I would be signing up for another OHS. One is enough. Mechanical it is. (yes, I have done lots of research into my decision. This just supports it.)

 

[Chuck C]

Day 17 of recovery: The different meanings of "Wow"!

INR was 2.8 this morning. It is great to be within my target range and I expect to keep it controlled from here going forward.

The word "Wow!"

"wow" can be very good or very bad.

During my valve surgery journey I first encountered the expression "wow!" during my June 2019 echo. After looking at my aortic valve, the tech exclaimed "Wow! your aortic valve has a lot of calcification."

This is not the kind of ""wow" that you want to hear.

However, today, during the follow up visit to my surgeon's office, I would hear this word again, in a different context.

When the nurse practitioner, who works for my surgeon, had me lift my shirt to show her the incision, the first word that came out of her mouth was "Wow!"

Me: "What do you mean by wow?

NP: " I mean that you are healing amazing. I have seen thousands of incisions post surgery and I can't remember ever seeing one that is healing as well as yours. Wow!"

I'm certainly happy to take "wow" in that context!

I also met with my cardiologist today. They did an echo on the day of my release from the hospital. My cardiologist gave me the results today: AVA 2.0; Mean pressure gradient 9.0. Although he did not use the term "wow", he indicated that those are very good numbers and given that I have a mechanical valve, likely to stay about where they are in the long run. Really glad that I chose mechanical.

 

[gpr100rs]

Great to hear Chuck. Figured once your INR settled down, you'd be all set! I go to Cleveland Clinic Tues., 4-13, for AVR, ascending aortic aneurysm graft and CABG. I'm 63 and leaning towards the Edwards Resilia, figuring I can get a TAVI in 15 yrs or so, at 78, which then shd last me to the end of the line. I haven't ruled out a mechanical, though CC surgeon is recommending the biological valve. Continued success with your recovery.

 

[Unicusp]

Day 17 of recovery: The different meanings of "Wow"!

When the nurse practitioner, who works for my surgeon, had me lift my shirt to show her the incision, the first word that came out of her mouth was "Wow!"

Really glad that I chose mechanical.

Excellent news and progress Chuck.

I agree with the nurse. Funny that my scar from the heart lung machine input or output on my upper right chest looks like your scar. But mine is horizontal and thru muscle not just bone. That one hurt more than the big one. And I'm at week 7 already today.

I haven't had an echo since surgery but will get one next week. I'm curious to hear and see the results and current status.

I totally agree with the mechanical valve decision as well.

 

[Chuck C]

Great to hear Chuck. Figured once your INR settled down, you'd be all set! I go to Cleveland Clinic Tues., 4-13, for AVR, ascending aortic aneurysm graft and CABG. I'm 63 and leaning towards the Edwards Resilia, figuring I can get a TAVI in 15 yrs or so, at 78, which then shd last me to the end of the line. I haven't ruled out a mechanical, though CC surgeon is recommending the biological valve. Continued success with your recovery.

Thank you gp100rs and good luck with yours. I believe that under 60 mechanical is a good choice. Over 70 tissue is a good choice, and 60-70 is where going either way is reasonable. I believe that the European guidelines state something to this effect.
Please keep us posted. We tend to have a well read, very knowledgeable segment of the heart valve replacement population on the forum. It is remarkable how many members end up choosing Cleveland Clinic. I believe this is for good reason and that you will be in very good hands.

 

[Unicusp]

Great to hear Chuck. Figured once your INR settled down, you'd be all set! I go to Cleveland Clinic Tues., 4-13, for AVR, ascending aortic aneurysm graft and CABG. I'm 63 and leaning towards the Edwards Resilia, figuring I can get a TAVI in 15 yrs or so, at 78, which then shd last me to the end of the line. I haven't ruled out a mechanical, though CC surgeon is recommending the biological valve. Continued success with your recovery.

Hello - I'll be at the CC on the 15th for follow-up tests. If you're out of ICU, and up for it, I could stop by and say hello.
I can't recall who your surgeon is? Funny that the first recommendation for me was also the Resilia.
I said "No thanks"! Got the On-X with zero regret. I'm close to your age too, hitting 60 this year. Give it some careful thought!

 

[Chuck C]

Funny that my scar from the heart lung machine input or output on my upper right chest looks like your scar.

I'm not clear why I don't have one of those. They must have used a different method to hook me up

I totally agree with the mechanical valve decision as well.

One thing that I believe is really nice about the mechanical is the follow up echos. In theory, they should be very consistent, aside from the small risk of something like pannus. One of the factors is choosing mechanical for me was those native valve echos. Each time the news was never good. "Slight progression" "Moved from moderate/mild to moderate AS", "Moved from moderate AS to moderate/severe AS" and so on. If I went tissue, I wondered when that day would come when I would start that cycle of progressively worse reports again. It did not appeal to me at all. I look forward to some very boring echos in the future.

 

[BillDaThrill]

Great to hear Chuck. Figured once your INR settled down, you'd be all set! I go to Cleveland Clinic Tues., 4-13, for AVR, ascending aortic aneurysm graft and CABG. I'm 63 and leaning towards the Edwards Resilia, figuring I can get a TAVI in 15 yrs or so, at 78, which then shd last me to the end of the line. I haven't ruled out a mechanical, though CC surgeon is recommending the biological valve. Continued success with your recovery.

Wishing you the best gpr100rs!!! Please keep us posted on your recovery. I'm two months behind you, traveling to the CC to get my surgery done by Dr. Svensson.

 

[gpr100rs]

Hello - I'll be at the CC on the 15th for follow-up tests. If you're out of ICU, and up for it, I could stop by and say hello.
I can't recall who your surgeon is? Funny that the first recommendation for me was also the Resilia.
I said "No thanks"! Got the On-X with zero regret. I'm close to your age too, hitting 60 this year. Give it some careful thought!
[/QUOTE]
I sought out Roselli, but he was booked until after June and given my gradients, 82 mean and 129 peak, he said I shouldn't wait. He recommended Dr. Aaron Weiss, who will be the lead, but Roselli will be in the OR for some of the procedure.
When was your procedure? INR has not been an issue? How about the sound? Are you back to normal activity? Was your procedure valve only? I, like most, have given this issue a ton of thought and there is no clear choice at my age, though the surgeons "push" the biologic. Chuck makes a good point about a gradual, multi year decline with the biologic being, like the natural valve decline, a PIA! My bicuspid valve has been followed for 25 yrs and even with my terrible gradients, I'm feeling pretty good. So... I've got 3 days to continue to mull it over. Probably a game time decision!

 

[user 15848]

Hello - I'll be at the CC on the 15th for follow-up tests. If you're out of ICU, and up for it, I could stop by and say hello.
I can't recall who your surgeon is? Funny that the first recommendation for me was also the Resilia.
I said "No thanks"! Got the On-X with zero regret. I'm close to your age too, hitting 60 this year. Give it some careful thought!

Yes, i did the same at 63.

 

[gpr100rs]

Yes, i did the same at 63.

jlcsn2015- still happy with the decision to go mechanical? How long since your surgery? Any regrets? Thx

 

[Unicusp]

[/QUOTE]
I sought out Roselli, but he was booked until after June and given my gradients, 82 mean and 129 peak, he said I shouldn't wait. He recommended Dr. Aaron Weiss, who will be the lead, but Roselli will be in the OR for some of the procedure.
When was your procedure? INR has not been an issue? How about the sound? Are you back to normal activity? Was your procedure valve only? I, like most, have given this issue a ton of thought and there is no clear choice at my age, though the surgeons "push" the biologic. Chuck makes a good point about a gradual, multi year decline with the biologic being, like the natural valve decline, a PIA! My bicuspid valve has been followed for 25 yrs and even with my terrible gradients, I'm feeling pretty good. So... I've got 3 days to continue to mull it over. Probably a game time decision!
[/QUOTE]

Long story, try to summarize. Most recent surgery was on Feb. 19th, 7 weeks ago today. Dr. Svensson was my surgeon. I had a severely stenotic and calcified unicuspid aortic valve.

Dr. Svensson also was my surgeon back in June 2013 when he only replaced my enlarged ascending aorta (which was at 5.4cm) with a dacron graft. He did not replace my valve at the time (although extremely rare) because he said it looked good and healthy. I should have pushed for a valve at the time, but did not, and left it up to him as he is the expert.

First surgery was a mini-sternotomy and recent one was a full sternotomy (due to scar tissue). Truth be told, the recent recovery was much better with much less pain and issues. I was off all serious pain killers at end of day 2 after surgery and only on Acetaminophen for maybe 7 days after. Yes, the scars are much worse this time but that's only cosmetic.

They used a different connection method second time to heart lung machine. Normally one in the femoral and one in the aorta, but this time I was connected thru a incision in the upper right chest and femoral upper right thigh. That one was enlarged and protruding for about 4 weeks after.
This method is apparently safer since you are connected before they start to open you up. I'm not sure when they start and stop the machine but time was minimal. Dr. Svensson is very quick and meticulous. He's had lots of practice.

Yes, they have all valve options in-stock in the O.R. and you can change your mind up until being put under.
I agree with Chuck and would not want to be thinking about this issue for the rest of my life.

The Resilia "could" last 15 years, but my surgeon admitted it could also fail in 7 years. No guarantees.

Recovery has gone great. I returned home on a Thursday, 6 days after surgery and was back to work in my home office the following Monday.

Valve sound; I could not hear it at all for the first week I think due to engorged tissue. Once that subsided, yes I can hear it and it does sound different depending on the position you are in, like lying on your side or on your back. Not bad. Does not "tick" but more like just hearing your heartbeat.

I've been walking from 2 to 5 miles every day since the week after surgery. Yesterday's 3 mile walk on the same hilly course was completed faster than right before surgery. And easier with more aerobic capacity.

INR took a few weeks to get dialed in and is fairly simple. I test at Quest labs, and bought my own
Coag-Sense unit and am also going to try one of the services since I've met all my deductibles for 2021.
Warfarin for me, has zero side effects. And as others have said, I dose my diet. No restrictions.

 

[Flymark]

That is very interesting. I'm 50, about to get AVR. One cardiologist suggested that bio at 50 was an option, with a TAVI at 65 and 80. If TAVI is bad at those ages, then I would be signing up for another OHS. One is enough. Mechanical it is. (yes, I have done lots of research into my decision. This just supports it.)

Hi Brinntache: Similar to what your cardiologist recommended, I'm 52 and a few days ago at CC my cardiologist discussed with me that surgery (AVR only) was probably on the horizon sooner than he initially thought and at the next appointment in five months ordered a repeat stress echo and cardiac MRI with the bells and whistles.

We discussed the possibility of a Ross, which he felt makes a one valve issue a two-valve issue and was probably not best suited for me due to my age. We also touched on repair, which he noted that even a "perfect" repair could result in the need for another OHS in a few years. We also discussed mechanical v. bio., with both of us preferring bio.

The one thing I'm curious about is your cardiologist's comment about a second TAVI for you at 80. My doctor was pretty clear that while my second valve would be TAVI, the third would likely be OHS. I didn't know you could do 2 TAVIs following an OHS.

 

[Chuck C]

Once that subsided, yes I can hear it and it does sound different depending on the position you are in, like lying on your side or on your back. Not bad. Does not "tick" but more like just hearing your heartbeat.

Yes, that is my exact experience. It is not a click, but more like a "thub, thub, thub" - best described as just being able to hear my heart beat if it is quick and I am alone or in a certain position. Also, I always hear it when I take a deep breath.
Like you, I could not hear it for the first week, and this was attributed to inflamed tissue around the heart absorbing the sound.

 

[Unicusp]

Yes, that is my exact experience. It is not a click, but more like a "thub, thub, thub" - best described as just being able to hear my heart beat if it is quick and I am alone or in a certain position. Also, I always hear it when I take a deep breath.
Like you, I could not hear it for the first week, and this was attributed to inflamed tissue around the heart absorbing the sound.

Yep exactly! When I inhale deeply, it produces a deeper louder thub, thub, etc..

 

[pellicle]

Really glad that I chose mechanical.

I anticipate that in 20 years you will also be glad that you chose mechanical

Yes, that is my exact experience. It is not a click, but more like a "thub, thub, thub"

that's how I hear mine. I have heard people call it a click and I know that when I use a sensitive microphone I hear a click in the recording.
A mate when working together on something (different parts of the project) in a quite room turned to me and said "I thought that was a distant car stereo, but its you" and he was hearing a bass type sound.

 

[Chuck C]

Tales from the recovery room.

I thought it would be fun to share some of my experiences in recovery.

Shedding the caveman.

I generally like to keep clean shaven.

On day 6 in recovery I was getting a little tired every time I looked in the mirror of looking like I had regressed down the evolutionary scale. No offence intended for those with facial hair- some wear it very well, but I just don't feel I'm one of those.

So, at 6:45am my night shift nurse, nearing the end of her shift, asked me if there was anything she could get for me: Yes, a razor and some shaving cream, which she was happy to get me.

7am the new nurse comes in. She sees the razor and questions me what this was doing in the room. I told her that I was about to shave.

Nurse: "Oh, you can't shave! You are on warfarin. If you were to cut yourself you could bleed to death." She confiscated the razor.

I didn't argue with her. Just smiled. I had done my homework here on the forums and knew very well that cutting oneself shaving was not a death sentence. When she left, I remembered that I had packed my own razor and went about shaving, as she had not confiscated the shaving cream.

Since then I have shaved 8 times and am happy to report that I have not cut myself, nor have I died. But, I will keep you all posted should I have a life threatening bleed while shaving.

 

[pellicle]

Nurse: "Oh, you can't shave! You are on warfarin. If you were to cut yourself you could bleed to death." She confiscated the razor.

this sort of 5hit is just impossible to weed out of the system ... to those who aren't without support from the experienced imagine what sort of message this sends to the patient and how long that may take to undo?

 

[Meanjellybean]

How they think we shave.. haha