Making a decision on a valve

[lbecker]

I am in the process of trying to decide to go with a mechanical or tissue
for my mitral valve that I will need to have replaced probably in the next
6 to 7 months. The drs. are saying to go with a mechanical due to my age
(51) yet I am on my third trial of warfarin and my bld. just doesn't thin
except on high doses and then I have other side effects. I'm leaning toward
a tissue due to not wanting the stress this causes me and will probably
get worse if I'm not thinning and I have a mechanical valve inside me! Any
words of wisdom. Have appreciated reading this site.

 

[westie]

go mechanical

go mechanical

surely mechanical is the way for you to go; a tissue valve would leave you exposed to another 2 or 3 open heart operations during your lifetime. unless you are a masochist, that is not the way to go.

other member will address your warfarin concerns with more authority, but be assured it does not "thin" your blood and personally, i am unaware of any side effects. maybe you do need a higher dose to attain the desired inr of 3 to 4 but as far as i know there are no health issues from high warfarin doseages.

my personal choice was the on-x valve and 9 months post op i am leading a totally normal life - full stop

 

[Ross]

Your still young enough yet that I think if I were you, I'd go mechanical. In the end, it's your choice, but mechanical gives you the best chance at never having to do this again.

As far as your INR: By far, the largest problem we see is the people managing you have no clue what they're really doing. The correct dose of Coumadin is that which keeps you in the prescribed range, whether it be 2mg a day or 20mg a day or more. There aren't any side effects that I've found personally, but could you elaborate on yours. Perhaps we can figure out what's going on. How is your diet? Any other meds? Can you please get as detailed as possible?

 

[Fran]

You're not much older than I am (46 on Jan 10!) and I suggest the Onx valve. You will be on less Coumadin due to the "curvier" design of the valve's insides, you can read up on it at their website. It washes itself, with the idea of "no clogs!"

My Coumadin levels were weird last year, but after reading here, I'm wondering about the staff at the clinic where I went - it was consistently perfect with one nurse at one location, then I had to transfer to a clinic as she went to nurse prac school. From there on, it was pretty much all over the place, even though I was faithfully following directives.

The Onx valve also means you could be okay for Plavix and aspirin. That's an OFF LABEL usage that my surgeon endorses. I did that up until late November.

Keep asking good questions.

The repeat surgery to replace a tissue valve could be as risky as dealing with your Coumadin. It's 6 of one, half dozen of the other, isn't it? Keep going, understand that it will go as it's meant to (what I keep telling myself!).

Stay safe and sane.

 

[skeptic49]

I'll be 60 soon and probably going to be opting for an ON-X. I'd rather deal with ACT than a re-operation. I'm sure that if I have any problems staying in range Ross will bark at me and I'll get it right.

Best wishes,

Jim

 

[Ross]

I'll be 60 soon and probably going to be opting for an ON-X. I'd rather deal with ACT than a re-operation. I'm sure that if I have any problems staying in range Ross will bark at me and I'll get it right.

Best wishes,

Jim

It's not rocket science but God knows, some people sure would like you to think it is and simply don't know what they're doing. We see it every single day in here.

 

[neil]

hiya............think like most people on here there will say look into all the pros and cons of both then make a personnal choice, as thats what it is a personnal choice, and whatever choice you do make it will be a better valve than the one you got now,, i had a tissue valve this year and am only 52,and i am very very pleased with my choice, but i wouldnt try to sway you either way,am sure when you have looked at everthing you will make the right decision for you,

 

[Montrealer]

I got a mechanical valve due to the fact that I`m only 50. Coumadin was never a factor for me but that being said I had idiots in the beginning. Since I`ve joined a private clinic my INR has been a steady 3.0-3.5. And yes I drink alcohol and eat green vegetables. Did I mention I drink alcohol?.........

 

[skeptic49]

And yes I drink alcohol and eat green vegetables. Did I mention I drink alcohol?.........

Are you buying? I'm drinking, then

Jim

 

[Jkm7]

This was my second OHS (first was four years ago - not valve) and I opted for bovine tissue valve. For me it was the right choice and I am very, very happy that was my decision. I am a little older than you but not That much.

My Mass General Surgeon and my cardio were supportive of my decision and both earnestly believe in the near future, valve replacement will be done percutaneously. Of course, we cannot count on that. There is no wrong choice. The right choice for you is the one that you choose.

 

[Marguerite53]

I was 52 when I chose my bovine tissue valve. I had no other medical conditions, threats or problems. I am not afraid of a second surgery, nor do I dwell on the prospect of it. Many people who get mechanical valves need a second surgery for whatever bad luck reason (as do many with tissue valves). I don't really think you can plan for the future that way. I think one needs to choose for now.

My surgeon was my exact age and he said he would choose the valve I chose. That was very reassuring for me, but I still would have gone tissue regardless. I think many of us have gut instincts about this very very very difficult choice, and we go with our gut.

It seems like your gut told you mechanical and so you are trying the coumadin. If you are emotionally sold on the mechanical, then please consult the many threads here devoted to coumadin management to ease your concerns about adjusting to it.

Otherwise, consider your day to day life, what you want it to look like, and re-evaluate your choices.

It is a very difficult choice, but remember, however you choose, you will be given renewed life. LIFE. That is the best choice you are making!!!

Hang in there. Ask as much as you can of us. We're here to help.

Best wishes.

Marguerite

 

[Karlynn]

I'm interested in what your INR's and doses have been on your warfarin trial. Most of the warfarin problems we find here are due to mismanagement because for some odd reason in the US warfarin management hasn't caught up to the 21st century.

Don't worry about the amount you have to take to stay in range - there is no difference in risk between myself (who takes 10/day) and someone who takes 5/day.

I am also interest in what your issues are on the higher doses. Warfarin - for most people has very few side effects. I have none and have been on it for 17 years.

At 51, the odds are good that you will need at least one more replacement. Unfortunately we can't "try out" open heart surgery like we can try out warfarin. Just as, with proper management, most people do fine on warfarin, most people do well with surgery. But as there are a few who don't do well with warfarin, there are also a few who have bad surgery experiences. Get out your crystal ball.

If you can give us detailed info on your warfarin trial, we may be able to help you ferret out what the issues are.

But someone already said - no choice is a bad choice. The bad choice we be to not have the replacement.

 

[Ross]

Get out your crystal ball.

Ballie Ballie on the table who's the fairest maiden to label?

 

[dlangton]

choices...

choices...

At the age of 56 I went with porcine (pig) tissue, but only after a lot of research and also finding a surgeon who said that's what he'd do. Other doctors gave me the old standard advice to get a mechanical valve because tissue lasts only 5 years, but that is outdated information. It's unnervingly common to find medicos that don't keep up-to-date with developments in their own field. Technology has advanced considerably and some of the current batch of tissue valves are expected to last up to 25 years and more, though not enough time has passed for reliable data. After frantically looking at all sides and weighing the pros and cons I pushed the reset button and realized that I'd be more at ease with organic material similar to what I'm made of.

Anyone on this list will tell you that he or she chose right for him/herself. When you're off the slab, you're committed. I strongly believe I chose the right option, even though my first choice was ON-X since it is alleged to combine virtues of both, but On-X was not available then, except for that surgeon in LA. I guess it has been approved elsewhere in the US, so in your shoes I'd consider it. Another consideration: you want a surgeon who is experienced sewing in the valve you choose.

Yet another thing to consider is that you will be on drugs no matter what you do. With tissue valves you take aspirin as a blood thinner, not coumadin. Depending on other cardiac numbers (like BP), you might need to be on a beta blocker (metoprolol), or losartin sodium, or a water pill like Hctz. Or you can go the new-age self-healing route and live on fresh air and sunshine in northern Scandinavia or Alaska. Some people have issues with some of these meds.

 

[vprnet]

Welcome Ibecker,

I'm 54 and went through much of what you are given the time to think about the options and the tradoffs involved.

I just completed BAVR surgery on December 19 and went with the ON-X to avoid re-op, and for its possible broader therapudic options now under study and the hope that it may be a more forgiving mechanical solution.

My INR has ben stuborn also but the doc's seem to feel confident I will be eventualy brought into range.

BTW, I did not pre-op test for warfarin, but I did for Plavix and aspirin becasue I was interested in this valve.

http://www.onxlti.com/onxlti-hv-proact.html
http://www.onxlti.com/onxlti-hvm-clinical-trial.html

Best wishes

PS. I am not a medical professional or a doctor. My comments in this forum are my own opinion and are not intended to be given as medical or professional advise or a recommendation of any valve choice. Decisions that affect your health and wellbeing are ultimately yours and your doctors. vprnet

 

[Eva]

I was worried, like you, about the warfarin/coumadin and it was another stress that I wanted to avoid. But in real, it is not a big deal nor a stress at all. My surgeon told me I could go either mechanical or tissue at my age (57), but I opted the mechanical to avoid another possible surgery with the tissue valve. Also, it is good to know that some patients with tissue valves end up taking aniticoagulant for some reason. The final decision is yours after you discuss the pros and cons of each.

Good luck

 

[lbecker]

More info on lbecker

More info on lbecker

Thanks for all the input. Here is a little more info about my case and
specifically the INR issue. I had a closed commissuotomy (blew my
valve open with a balloon) 12 years ago. I was on warfarin prior to that
but did not feel the need to continue on it for long term. I have been taking
ASA ever since then. As I have gotten older they are concern about me
stroking so have wanted me on warfarin, that is why I have been put
on it again. The previous 2 times I did not feel well and my bld. work
showed that my cholesterol level was very high, I went off the warfarin
and it went down significantly. Well I am back on Warfarin taking 42.5mg
a week and just did bld work and again cholesterol very high compared to
bld work done right before I started it. My diet has not changed.
My INR was 1.5 a week ago, and the highest it has ever been is 1.9., about
a month ago. I know that there is not suppose to be a connection between
the 2 but sure seems there is with me. Ran into my Dr. today and he
said you need to work at being like everyone else, ha! By the way I continue
to be on ASA 81mg. times 2 everyday plus the warfarin. I have occasional
atrial fib. and of course do not know if that will clear up with surgery
or not.

 

[westie]

surely not!

surely not!

The previous 2 times I did not feel well and my bld. work
showed that my cholesterol level was very high, I went off the warfarin
and it went down significantly. Well I am back on Warfarin taking 42.5mg
a week and just did bld work and again cholesterol very high compared to
bld work done right before I started it. My diet has not changed.
My INR was 1.5 a week ago, and the highest it has ever been is 1.9., about
a month ago.

i have never heard about a connection between warfarin and cholesterol and i am sure i would have read about such connection on this site over the last 2 years if it existed.

my guess is the association you report is purely coincidental

 

[Ross]

Thanks for all the input. Here is a little more info about my case and
specifically the INR issue. I had a closed commissuotomy (blew my
valve open with a balloon) 12 years ago. I was on warfarin prior to that
but did not feel the need to continue on it for long term. I have been taking
ASA ever since then. As I have gotten older they are concern about me
stroking so have wanted me on warfarin, that is why I have been put
on it again. The previous 2 times I did not feel well and my bld. work
showed that my cholesterol level was very high, I went off the warfarin
and it went down significantly. Well I am back on Warfarin taking 42.5mg
a week and just did bld work and again cholesterol very high compared to
bld work done right before I started it. My diet has not changed.
My INR was 1.5 a week ago, and the highest it has ever been is 1.9., about
a month ago. I know that there is not suppose to be a connection between
the 2 but sure seems there is with me. Ran into my Dr. today and he
said you need to work at being like everyone else, ha! By the way I continue
to be on ASA 81mg. times 2 everyday plus the warfarin. I have occasional
atrial fib. and of course do not know if that will clear up with surgery
or not.

That's a new one on me! First time for everything I suppose. Would be nice if we were all the same and didn't have different chemical make ups, but alas, we are not. I'm going to have to study this one to see how many others may be going through the same thing. I was just thinking, maybe there is something to this because my on cholesterol level is sky high and for no apparent reason.

Would you happen to have any renal impairment? I'm grasping at straws here, but you might well be on to something that I never thought about.

 

[Karlynn]

Are they increasing your dose with the low INR's? The only way to raise a low INR is to increase your dose. Warfarin is not like a drug that you set your dose level and it stays there for the time you are on the drug. Very few people on warfarin take the same dose continually.

The cholesterol issue is a new one to me too. Let's get Al Lodwick on this one. Just trying to be different, aren't you.