Made my choice

[TitanEddie]

I have decided on at tissue valve. Based on the decision chart my surgeon showed me an am just below the point where a tissue valve makes sense. I am 50 years old with no other issues other than a bicuspid or possibly diseased valve. I know about the on-x and lower warfarin and possibly no warfarin but decided on the tissue valve anyway. I love to be active. i have put off a lot of stuff until my kids were grown and now they are so I want to get my skydiving license, travel , scuba dive, and other things. So I don't want to worry about bleeding out or dealing with a substandard doctor not use to dealing with someone that may have a bleeding issue. There is a lot of good in a mechanical valve and maybe when I am sixty and have done what I want and have grand children I may opt for a mechanical. For now I am willing to go through this again to do the things I have always wanted to do without worry. Not looking to influence anyone else, just the research I have done and the recommendation from my surgeon led to my decision. Make your decision on your own research and talk to your surgeon(s). In no way am I looking to influence anyone, just offering my insight.

 

[pellicle]

Hi Eddie

glad you made a choice and are happy with it.

I was reading your list and noticed:

... so I want to.. scuba dive

I had my PADI licence refused because I'd had OHS (it was a homograft valve, but it matters not valve type only that you've had OHS, which can lead to adhesions between lung and inner thoracic cavity. This can lead some Drs to refuse a dive medical without you then having a series of CAT scans so as to clear you. I disagreed with the Dr, but it was pointless. It will likely be case by case.

I was surprised and disappointed by this when it occurred to me (years ago) so I thought you'd like the pre-warning on that one...

Adhesions between the lung and thoracic cavity would have your lung ripped and you would never make the surface ... this is not related to warfarin.

If you need a redo valve at 60 then the redo should probably be tissue, for its when you're younger that you stand to benefit from a mechanical (younger active people calcify tissue valves faster than older people do).

 

[TitanEddie]

That would absolutely suck. Wanted to do it forever. Oh, well if it can't be done I'll find something else.

 

[Dodger Fan]

If you need a redo valve at 60 then the redo should probably be tissue, for its when you're younger that you stand to benefit from a mechanical (younger active people calcify tissue valves faster than older people do).

Tissue valves eventually fail due to calcification. I knew that they are typically recommended for older people. I didn't know how they failed. I learn something new every time I go on this site.

 

[pellicle]

Hi

Tissue valves eventually fail due to calcification. I knew that they are typically recommended for older people. I didn't know how they failed. I learn something new every time I go on this site.

yeah ... something else (should you or other any other lurker readers be curious about):

Calcification is more rapid and aggressive in the young;
the rate of failure of bioprostheses is approximately
10% in 10 years in elderly recipients, but is nearly uniform
in less than 4 years in most adolescent and preadolescent children.
Although the relationship is well established, the mechanisms accounting
for the effect of age are uncertain.

ref http://www.med.upenn.edu/cstr/docume...orSurg2005.pdf


each decade the makers try new stuff to prevent this and each decade the numbers stay more or less the same. There are members who have posted here who have had their valves calcify to dysfunction in less than 3 years. The younger / more active you are the more you should avoid tissue valves (barring other medical conditions which would select against mechanical).

A much older study gives these rates:

The freedom from deterioration for patients less than 20 years of age is significantly less than that for other age groups.
The freedom from deterioration increased by decades;
The greatest freedom was noted in patients 70 to 80 years old and 80 years old or older.

The freedom from deterioration at 10 years for patients :
- less than 30 years of age is 26.8 ± 17.2%;
- 30 to 59 years, 77.4 ± 3.0%;
- and 60 years and older, 83.1 ± 4.2%.

not sure how much its improved ...

a later paper says a little more about why native valves don't suffer from calcification:

Native heart valves (typified by the aortic valve) are cellular and layered, with regional specializations of the extracellular matrix (ECM). These elements facilitate marked repetitive changes in shape and dimension throughout the cardiac cycle, effective stress transfer to the adjacent aortic wall, and ongoing repair of injury incurred during normal function. Although GLUT bioprostheses mimic natural aortic valve structure (a) their cells are nonviable and thereby incapable of normal turnover or remodeling ECM proteins; (b) their cuspal microstructure is locked into a configuration which is at best characteristic of one phase of the cardiac cycle (usually diastole); and (c) their mechanical properties are markedly different from those of natural aortic valve cusps.

onsequently, tissue valves suffer a high rate of progressive and age-dependent structural valve deterioration resulting in stenosis or regurgitation (>50% of PAV overall fail within 10–15 years; the failure rate is nearly 100% in 5 years in those <35 years old but only 10% in 10 years in those >65).

Tissue heart valves: Current challenges and future research perspectives - ResearchGate. Available from: http://www.researchgate.net/publicat...h_perspectives [accessed May 20, 2015].

also explains why native valves damaged by rheumatic or scarlet fever do calcify ...

 

[knotguilty]

Good luck Titaneddie. I think it feels better once you've made a decision. I think you have made a good one based on your concerns.

 

[epstns]

Well . . . I'll let you know if anything happens. My tissue valve (implanted at age 63) seems to be chugging along fine so far, 4 years post op. If we're all still here when I hit 80, I promise to post back and let you know if the original bovine valve is still around.

Seriously, Eddie, you have done the right first step - chosen to do something about the valve issue. Whichever choice any of us makes is the best choice for each of us. I'm glad you were able to come to a decision on your own. So many folks agonize over it, and so many second-guess themselves after the op. You'll do fine, and life will return to being good. The rest of us know that from experience - right, pellicle?

 

[jhc1]

TitanEddie- your thinking was like mine almost 2 years ago. the latest literature I found had no contraindications to scuba with a tissue valve. My cardio was also OK with it. Mech valve and warfarin were disqualifiers. now that you've made the choice, sit back and "enjoy" the ride! best of luck

joe

 

[Duffey]

It's good that you're happy with your choice. I made the same decision at the age of 53, and that was almost 10 years ago. So far, so good.

 

[pellicle]

Steve

.. The rest of us know that from experience - right, pellicle?

get that tongue outta your cheek before the wind changes and you get stuck with that silly grin

Indeed Eddie as one who has had a hurdle or two post op, life does indeed get back to "normal" I can't say what normal is, but that's actually a good thing because if normal is unchanging then that's a rut ... and I don't want to be stuck in a rut.

The same can be said for many of the hurdles that life throws at us, keep plugging along (no plan needed, perhaps even possible) and you will emerge no matter how dark and long the tunnel is. Always these things change us, and we are not exactly who we saw ourselves as being before the event. We discover more of who we are during and after it.

Life changes and grows us (forces us to grow), that's all good, because I wouldn't want to be who I was at 10 years old forever anyway....

Steve: I recommend an Australian movie to you. Its called Bliss. If you can't get it there let me know and I'll post you a DVD
http://www.imdb.com/title/tt0088821/

Harry Joy is my icon of success

 

[pellicle]

Hi

...I found had no contraindications to scuba with a tissue valve.

I wish the doctor who did my dive medical had seen it that way. I went free diving on that trip (had already been doing that every now and then before) and went down to great depths to prove my point to the wanker. He didn't understand physics (most don't) and didn't see my point about lung deflation on a gulp of 1ATM.

These days I have other terrestial activites to undertake ... like a moose hunt next year in Finland.

 

[TitanEddie]

The same can be said for many of the hurdles that life throws at us, keep plugging along (no plan needed, perhaps even possible) and you will emerge no matter how dark and long the tunnel is. Always these things change us, and we are not exactly who we saw ourselves as being before the event. We discover more of who we are during and after it.

I have had my share of challenges and they have shaped me into who I am just as this one will help shape me into who I will be. I know on the other side of this I will be stronger and will not take life for granted anymore. This has really made stop and take a look at my life, which I know now was a good thing.

 

[Agian]

You guys say the most amazing things. Truly inspirational. I still don't fully understand why having a valve replaced has such a profound effect of people's lives. For some reason I find it a little unsettling. On the one hand we're told it's routine and yet people talk about facing their mortality, and the like.

Could it be this happens with all major operations, or is it something to do with the thought of someone holding your heart in their hands? Is it cultural? There are so many metaphors related to the heart. We associate this organ with life itself.

 

[skeptic49]

I've been a certified scuba diver for 35 years. I questioned my surgeon about returning to diving post-op before he did my OHS. He said: "no restrictions." I have read accounts of others who have returned to diving post OHS.

 

[Superbob]

TitanEddie, just wanted to say congrats on doing the research and making the choice you believe to be best. Like Steve, I had my tissue valve (along with a replacement aortic root) put in at age 63, and I am still ticking along with an active life at 73. Have an echo scheduled next month to check on how it's doing. Wishing you the best for an excellent surgical outcome and a long run with your valve of choice.

 

[pellicle]

I've been a certified scuba diver for 35 years. I questioned my surgeon about returning to diving post-op before he did my OHS. He said: "no restrictions." I have read accounts of others who have returned to diving post OHS.

you know, that's what I would have thought ... that's logical. So I guess that I got a dickhead doctor here in Queensland back in 1997 and if there had been alternatives easily available (and if I had been older and wiser perhaps) I could have sought altrenative opinions. (somehow this is reminding me of the opinions I read here about warfarin from GP's)

Thanks for clearing that up skeptic ... I've not persued it again as after that I started travelling and didn't make it back home for 10 years (and there was really little scuba opportunity were I was at).

 

[pellicle]

Hi there

.... I still don't fully understand why having a valve replaced has such a profound effect of people's lives. For some reason I find it a little unsettling. On the one hand we're told it's routine and yet people talk about facing their mortality, and the like.

I'll have a go at this.

To me its a confluence of a few streams of change in society which combine to produce what you're observing.

I'm 50, and when I was a kid people just didn't scream and howl and fall at their church congregation with requests for prayers. People were stoic. I don't know if that's because I'm an Australian and many writers here are American or if its to do also with generational change. I suspect that here in Australia we are becoming more like Americans as when I went to hospital for my re-valve in 2011 I was confronted by a howling emotional teenager who was appearing to act like someone going to the gallows. Yet when (as a kid) I was going in for surgery I never once saw anything like that. There were quite a few kids in my ward. Again when I was 28 and went to the same hospital I saw nothing more than calm.

There has been a clear transition in society in my life time from concern about others to a focus on "me". Even social media is about "me" - look what I had for lunch, look what I'm doing ... it reminds me of my friends little girl who always cries out "daddy, look at me". Clearly this is a deep feeling in many people and in my generation we were socialised out of that behavior. Now we are socialised into it.

As a result it seems to me that what people express is less guarded ... so perhaps thats good, perhaps that panics others unnecessarialy. I can't know, I can only ponder.

Next there is th fact that (in my view) most people never even think they will ever die. Aldus Huxley once wrote that :

have never prevented the majority of human beings from behaving as though death were no more than an unfounded rumor.

and so most people proceed on with their lives in the false apprehension that 1) they are in control 2) they have choices 3) they want more and better and more of it every day. That they see other humans in nursing homes and dying seems somehow in the psyche of many to be "what happens to others". Try having chats with kids who are less than 25 and listen to their quite self certain wisdom.

Finally hearing that you are not structurally quite right and it will effect your health is quite a shock (well I write that as if I've ever experienced that, so to be honest I should have written "must be quite a shock") and then submiting yourself to be rendered unconscious and told solemnly there was a small possibility of death must be the icing on the cake for many.

The idea your car could be involved in an accident and you killed seems somehow remote and impossible, yet death by surgery is real because the doctor said so. Curiously people seem quite divorced from the idea that you could die on the way home. It wont' happen to me.

I suspect that being in the right location and it being said with the results of tests before you wrenches people out of "other-isation" and that is part of the shock.

Or I'm way off the mark

Best Wishes

 

[Jkm7]

TitanEddie, I want to join the others in congratulating you on making a very reasoned choice. You clearly have given your choice much thought and seem content with that decision.
My bovine mitral valve is now 6 years old and is taking very good care of me. I've had no problems at all (but certainly don't want to jinx myself).

All best wishes as you move forward toward your surgery.

 

[Jkm7]

TitanEddie, I want to join the others in congratulating you on making a very reasoned choice. You clearly have given your choice much thought and seem content with that decision.
My bovine mitral valve is now 6 years old and is taking very good care of me. I've had no problems at all (but certainly don't want to jinx myself).

All best wishes as you move forward toward your surgery.

 

[epstns]

Back to Agian and pellicle's discussion -- For me, I think it hit me quite a bit before surgery. I had a bicuspid aortic valve with severe stenosis. I was never told so, but I sincerely believe that my father had, and died from, the same condition. My father was one of the stoics that pellicle mentions. Of all the medical issues he had, he never spoke and most certainly never complained. He also, for reasons not known to me, declined any treatment for his heart condition and died from sudden cardiac death on his way to work one morning, at the age of 68. (This was before I was diagnosed.)

Once I received the diagnosis and prognosis that surgery was the only way to have a chance for a normal life span, I thought back to my father and thought something like "Crap. That could have been me, too." At the time of my diagnosis and all, I had a lovely wife and a daughter in her mid-teen years. I had another "Oh, crap!" moment when I thought that I did not want to leave either of them without me (might have been just a bit selfish, but that's my honest feelings). That meant that I had not only my own life to worry about, but the lives of others. That made a "good surgical outcome" supremely more important to me. I agonized over it as surgery approached, and when I came through it all, even with all the speed bumps I hit on the road to recovery, I was so much more grateful and joyful. I guess I could describe it as feeling like a puppy dog when "his people" come home.

I personally realize that we can only control those things about which we are granted choices. That's probably a very small percentage of the things that affect our lives, but the thought of exercising those choices makes it more bearable for us as individuals.