mechanical or biological?

[Jimmyk]

I'm currently on a cardiac surgery ward ready to have my aortic valve replaced this Monday.
I just spoke with the surgeon. I'm completely lost.
I'm a 52 year old man in otherwise good health.
he asked me if I would prefer a mechanical or biological replacement.
I'm aware of the blood thinners to take with the mechanical valves.
CAn I please get some feedback on what are the thoughts of members of the forum?

Thanks everyone

 

[Jimmyk]

I'm leaning towards the mechanical..
but this is a whole new ballgame for me.

 

[jcgtok17]

Jimmy,
I had my surgery on May 1st hence 7 weeks post op. I went with a tissue value, the Trifecta GT (28mm) which has bovine tissue. I am 50 hence had the same decision as you re: 25 year mechanical versus 8-12 year tissue valve(s). St. Jude do not yet have enough data yet but believe the latest bioprosthetic will have a longer life (10-15 possible?).

https://www.sjmglobal.com/en-int/pr...2a04194f:cadddb93-fcc4-47f2-8ceb-fd88f01ca17f


I was keen on the fact that I would not need to take Warfarin post recovery. The fact that both Japan and Canada cover TAVI procedures was also a factor in my decision as signing up for 2 more OHS is a daunting thing! The recovery time from the trans catheter operation is much shorter. Hope this helps! Prayers with you for Monday. JCG

 

[dick0236]

When I had the surgery only mechanical valves where available so I never had to go thru the "it's your choice" routine, but I have been very satisfied with my mechanical valve. Warfarin is not a probllem......but it does require adherence to a simple regimen......"take the pill and test routinely". In my opinion the real advantage of the mechanical valve is that it lasts much longer than tissue valves.....and staying off an operating table is a big deal for me......especially now that I am entering an age group, 80+, where a major surgery is a BIG deal.

Medical advances are always improving and no one really knows "what and when" new advances in valve design, surgical procedures or new drugs will change all we know today; All you can do is make the choice that seems right for you at your time in life.

 

[epstns]

Jimmy - I was a bit older than you at time of surgery (I was 63). The conventional "wisdom" has always been "Mechanical valves for most younger patients (except women planning on having children), tissue valves for older patients." The quandary has been the definitions of "younger" or "older."

When I had my surgery, the Cleveland Clinic (often thought of as the leader in US heart valve surgery) was using tissue valves in the majority of their patients as young as mid-50's. At that time their valve of choice was the Edwards Lifesciences 3rd-generation bovine pericardial valve. The manufacturer's tests lead them to project a useful valve lifespan of "up to 20 years." I have not yet heard of any large numbers of valve failures among that cohort - but I have had this valve for only 6 1/2years.

Given that you are "just" 50, again using the conventional wisdom, many would suggest that you opt for the mechanical valve. I do not think that you could "go wrong" in doing this. If you now opt for a tissue valve, that just about guarantees that you will need at least one re-operation. (You DO plan to live past 65-70, don't you?) Yes, you could assume that if you need a re-operation you may be able to have it done via catheter (TAVR), but so far that is just a "maybe." No guarantees. If you opt now for a mechanical valve, odds are that you will never need to have it replaced again. Yes, you would need anticoagulation therapy, but that is what you would trade for the need for another operation when you're older.

It is, as they say, "your choice." Personally, I feel that the "conventional wisdom" still holds true and that the odds are in favor of the mechanical valve patient. Bear in mind, though, that this is just an opinion. I am not a medical professional. Heck, I am not even a mechanical valve patient. Just another guy who went through the same decision process years ago.

 

[Freddie]

I was 47 when I had OHS, did I have a choice in valves......maybe yes but my surgeon made the decision for me saying, "I don't think you'd want to go through this type of surgery again". I now have a mechanical for 10 yrs. Yes taking warfarin is a learning curve and like Steve said 'that's the trade off'. Good Luck

 

[Nocturne]

My advice to you is to have a coronary CT scan done. If you have a very unusual amount of coronary artery calcium (CAC), then you might lean more towards a tissue valve because there is some evidence that Warfarin accelerates coronary arterial calcification. If you don't have much CAC for your age, I'd personally go mechanical. Just my personal opinion based on what I have learned (I've hopefully got years before I have to decide myself).

 

[neil]

theres no wrong choice, I got a tissue over 9 years ago and its still honking away, didn't want to be on warfarin, for everybody who says tissue somebody will say mech, its your choice, don't measure using somebody elses ruler , pick for you,

 

[LondonAndy]

I was almost 49 years old when I had to make my choice Jimmy, and that was almost three years ago now. I went for mechanical, on the same thought process as Dick - this open heart surgery malarky is a big deal, and I don't really want to have to do it again at an older age when I will be less able to cope with it, leaving aside the issues of surgeons having to go through scar tissue from round 1. I use a hand held coaguchek machine to test my blood once a week, to help keep an eye on Warfarin level, and adjust my own dose if needed but have the support of an anti-coagulation clinic if I need it (I am in the UK).

I am happy with my choice, and would not change it. There is a possibility that you will end up on Warfarin with a bio valve anyway - my mother has. Having said that, my Cardiologist said that advances in tissue valve design are changing the game a bit, and the age-point at which a genuine choice between the two (mechanical or tissue) is lowering. There are many threads here on exactly your topic, and you will find others far more detailed than me in their reasoning for their choice. But as Neil says, there is no wrong choice.

 

[Jimmyk]

Thanks everyone for your input. The mechanical valve will be my choice.
The surgery is set for Monday 6/26.
This will be the biggest challenge of my life.

Once again, thank you very much.

Jimmy

 

[pellicle]

Hi Jimmy

This will be the biggest challenge of my life.

I suspect from your attitude that like many who take a challenge you will emerge both stronger and wiser ... do stop by when you've had it done and feel free to ask any questions about the "thinners" (which I call AC therapy for Anti Coagulation) as thinners contains a few implications which are wrong.

FWIW I've had 3 OHS and my last (and I hope it is my last) was a mechanical. I believe its fair to say that I've been "knocking management of AC therapy for 6" as we colonials say.

Best Wishes for the 26th

 

[Jimmyk]

Pellicle,
I hope that the third one is the last for you as well.
I will definitely be back after the surgery. This forum is great. As far as learning how to take my medication, I'm sure that the Dr's will give me information, but I would prefer to hear first hand from members of the forum.
I actually had the surgeon come into my room about an hour ago and ask me" what's it going to be?" I told him that I have decided on a mechanical valve. He said excellent choice, one mechanical valve coming up!

Hope everyone has a nice day!

 

[Jimmyk]

Pellicle,
I hope that the third one is the last for you as well.
I will definitely be back after the surgery. This forum is great. As far as learning how to take my medication, I'm sure that the Dr's will give me information, but I would prefer to hear first hand from members of the forum.
I actually had the surgeon come into my room about an hour ago and ask me" what's it going to be?" I told him that I have decided on a mechanical valve. He said excellent choice, one mechanical valve coming up!

Hope everyone has a nice day!

 

[Jimmyk]

Sorry,
I'm on the hospital wifi, and it didn't seem like my reply was posting,
if any of the administrators are out there, possibly you can remove the duplicate posts.

 

[Lisa2]

Jimmy, wishing you a successful surgery and looking forward to seeing you on the other side!

 

[mikeccolella]

Hi Jimmy good luck with your surgery. The posting on this site is a bit slow but it auto saves it so it wont get lost.

 

[Seeker]

Hi Jimmy,
I've been lurking on this forum for about 2 years and rarely post so forgive me if this entry rambles.
I'm 16 months AVR post-op. I was 46 when I had my surgery. I was set on a tissue valve because I was afraid of the idea of taking, "blood thinners" and dealing with the ticking for the rest of my life. After months of reading posts by those who've "been there" (thanks Pellicle and dick 0236) and having a side conversation with my anesthesiologist prior to the surgery, I ended up going with a mechanical.

My anesthesiologist shared with me that he has seen a lot of tissues valvers at my age have to re-op at about the 5-7 year mark and if he were in my shoes he'd go mechanical. He was careful to not make a recommendation either way, but nonetheless I thanked him for sharing his opinion. Even after all the reading, conversations with doctors and family, I still wasn't 100 percent sure what to choose. Then I read a post on this forum about how your family is going though this journey with you. With a mechanical valve I could lessen the chance of my wife and children having to go though this ordeal again. I chose to go mechanical not just for me, but for my family.

But to be honest, right up to the surgery date, I still wasn't 100 percent about my choice. You see, I kept chasing certainty in an uncertain situation. As others have said, there is no "right" choice. You just go with what you think is best for you and your circumstances.

Jimmy, I did wake up post surgery hearing the most annoying ticking between my ears. It seemed so loud at the time. I was so pissed about the noise I totally skipped over the fact that I was stiil alive! It took me about 3 months to get used to the ticking. My mind helped my get used to the new noise and these days I really don't notice the ticking unless I stop to think about it.

Taking Warfarin has become so routine I just think of it like taking a daily vitamin. It took me about 3 months of taking Warfarin for my INR to stabilize before I was approved for a CoaguChek home testing machine. I test myself once every 2-3 weeks.

Just remember, slow and go with your recovery. It can be a bumpy journey to recovery but you'll get through it. Oh yeah, watch out for that first cough/sneeze! Hold on to that pillow! See you on the other side Jimmy.

 

[pellicle]

Hi Jimmy,
I've been lurking on this forum for about 2 years and rarely post so forgive me if this entry rambles.

Actually an excellent post and not rambling at all. Filled with exactly the fresh memory experiences that I all to often forget over time(but you have reminded me of)

Jimmy, the words about the pillow are important.

See you on the other side

 

[Jimmyk]

Thanks everyone ,

I'm thinking on the same lines of Seeker.
My wife has been sleeping on a tiny couch in the hospital ,next to me for almost a week now.
I have 3 brothers and a sister. They shouldn't have to go through this again either.
That's another reason for my choice.
The blood thinner medication, will just become part of my routine.

 

[ForeverThankful]

Hi Jimmy! Wishing you the best of luck with your surgery Monday and a speedy recovery!

I had my surgery about a year and a half ago at age 55 and I too opted for a mechanical valve. I didn't want another surgery 15 years down the road when I would be 70.

Home testing really makes managing Warfarin very easy, as you said it's just part of my routine.

I'd also like to mention that I don't hear any ticking at all with my mechanical valve.

And as Seeker said... "Hold on to that Pillow!" I actually managed to avoid sneezing at all for three months after surgery and I coughed very gently but what got me needing that pillow was Laughter! I have a very close friend who I spend a lot of time with and she made me laugh constantly, even in the hospital. Most of the time she wasn't even trying to make me laugh but I just found everything she said to be funny! So keep that pillow handy for Laughter too!