Mechanical or Tissue valve

[hochinag]

Dear Freinds,

I am going to have my valve replacement surgery in Dec 2011. Still very confused whether I should go for Tissue valve or mechanical valve ??

I have never taken Warfarin and please anyone who is taking warfarin , let me know how is life after taking warferin everyday. What are the restrictions in food, life style etc. What are the complications ?

Regards,

Hochi

 

[OldManEmu]

Hochi
Welcome, are you in Melbourne Australia?

 

[normofthenorth]

I went with tissue (at 65), but I was on daily warfarin for the first 3 months post-op. I didn't bother fighting for home testing (which generally makes it easier and better), but it still was no big deal. My cardiologist thought I was crazy to go downhill skiing while I was on ACT, but I did ski a week at Whistler. I was fine and had lots of fun, though I avoided big falls -- unlike some trips. I had one or two mystery bruises (little black-and-blue marks) but no nosebleeds or any other abnormal bleeding.

I'm back to competitive volleyball now, diving onto the floor and bumping into teammates etc., and I wouldn't do that on ACT. But except for bruising high-impact sports, it really was no big deal. My only dietary concession to ACT was trying to "smooth out" my consumption of salad and other high-Vit-K foods.

I'm not saying I wasn't happy when the 3 months was up and I got the OK to stop (and I stopped the Metoprolol Beta-blocker at the same time, which ALSO cheered me up!). But as "crosses ti bear" go, ACT was a pretty small one.

 

[hochinag]

Yes I am. Can u suggest which procedure is better please.

 

[hochinag]

So I guess my main question is what are the limitations if I go for mechanical and taking warfarin, is that a big issue ?? Also since you went for tissue, how long in average the tissue valve lasts for ?

 

[OldManEmu]

Hochi
The longevity of a tissue valve is dependent on the age you are when it is implanted.
The younger a patient is the quicker it deteriorates, this is due to younger patients having a more active physiology.
Most of the stats quoted regarding valve longevity by manufactures for tissue valves are in patients >65 years.
I have never been on Warfarin so can't comment on its day to day regime.
Warfarin is not just used for hear valve patients it is used for a number of other medical conditions, of which the majority of patients on it are elderly.
Warfarin however is one of the drugs in the leading group as far as hospital admissions from complications associated to its usage.
Medicare only covers lab testing of INR levels associated to Warfarin monitoring.
Home monitoring of Warfarin is not covered by Medicare in Australia so if you want to go this route it is at your own expense, I add this as many US members refer to home monitoring.
Being new, one thing you may not be aware of is many people can hear the mechanical valve each time it operates, some find the noise comforting or tune out others find it extremely annoying.
There is no perfect valve choice it gets down to what are the negatives you feel you can best live with.

 

[Cooker]

Welcome ... I was 50 when I had my AVR and chose mechanical and warfarin. I test once a month and have had no issues with the drug (almost 6 years). I eat what I want when I want. I know some people seem to have trouble stabilizing their INR but not me. I am not an extreme sport kind of guy:rolleyes2: but I am fairly active (work, golf). If I had been older I would have gone tissue valve but I wanted to avoid a second open heart surgery if at all possible.

Good luck in your choice and surgery!

 

[hochinag]

Hi Cooker,

Good to hear u r doing great. Which company's mechanical valve u put in ? Did u have much say or u just left it the Doc to decide ? And secondly how long it took u to recover.

Regards,
Hochi

 

[hochinag]

Hi Oldmanemu,

Thanks for your advice. What sort of operation u had ? what is ur view about On-X Life valve ?

Regards,

Hochi

 

[Cooker]

Hi Cooker,

Good to hear u r doing great. Which company's mechanical valve u put in ? Did u have much say or u just left it the Doc to decide ? And secondly how long it took u to recover.

Regards,
Hochi

I have the St Jude Master Series and I just left it up to the surgeon. I had surgery on 2-21-2006 and back at work 4-1-2006. Everyone is different. I really think it depends on whether you are a glass half full or half empty kind of person. It takes time but I believe attitude as a lot to do with how fast we are back in the saddle.

Oh, and I want to say with all honesty that the pain was nothing like I expected.:thumbup:

 

[Phil]

Hi,

There is a response entitled Famous Tobagatwo Writing on Valve Selection (two up from your post). I read it this morning and thought it terrific. I see you are from Melbourne, so am I.

Good luck with your decision and surgery.


Phil.

 

[Lynlw]

Hi hochinag, I'm sorry if you mentioned it and i didn't see it, but would you mind sharing your age? Valve choice is one area that your age could play a roll in what kind of valve they normally reccomend. For example many/most surgeons reccomend tissue valves for patients 60 and up and mech valves 60 and less, altho that tends to be sliding down in alot of centers to like 50 and up reccomend tissue as it looks more and more like the chances of getting a tissue valve that you get now could be replaced by cath by the time it wears out.
Of course nothing is set in stone and many people older prefer to get a mechnical valve and yunger tissue valve, but age is a good place to start the decision making

 

[OldManEmu]

Hochi
If you click on my name and view my profile, the tab "about me" lists the details of surgery. You will need to click on this "about me" tab as it isnt the default one displayed.

 

[Bina]

Hello and welcome. Just wanted to say that I have put you on the VR calendar for Dec. 14
Let me know if the date changes.
Best wishes

 

[enkaynj]

Hochi,
I got a BAV - tissue- valve. I was 50 when I got it. My surgeon recommended it because tissue valves have come a long way and can last 15-20 years before replacement. Plus new techniques are around the corner to re-valve without another open heart surgery.
The best part is that neither dietary retrictions nor cumidin treatments are needed.
Ultimately it boils down to your educated opinion. Good luck in making the right choice for you.

 

[scott.eitman]

This is the toughest question for each of us. My old school self wants to tell you to go with Mechanical and that Coumadin is not that bad...and it really isn't. However, with the new advancements in Valve surgery on the horizon, I would have much more trouble making a decision today than I did in June last year. Most likely, if you go with a bioprostetic, your second surgery may very well not be OHS. It most likely will be performed through a catheterization. However, there is no guarantee.

 

[LeakyUK]

I have been on Warfarin for 6 months - my observations

1) INR Tested weekly to 4 weekly. Dose between 4.5 and 6 each day, prescribed by surgery & taken consistently - same dose each day.

2) I take several other Meds so make up a weeks supply in a pillbox - minimal hassle

3) No problems with minor cuts, but definately bruise easily - bruises are not painful, but not pretty either. Injections (Dental and flue ***)
create soreness for longer.

4) I need to repeat a minor medical investigation - last time it took an hour, next time I am told I will need 5 days of Heparin & a couple
of days in Hospital due to bleeding risk.

5) Valve has become progressively quieter - ticking not an issue.

I still think I made the right decision for me - with a tissue valve I would be permenantly worrying about a re-do.

 

[haggis basher]

HI Hochi.
I had AVR (tissue) on 12th August 2011. I am 71 age, and a very keen long distance runner.
I saw my heart cardiologist yesterday, and asked him many of your questions.
He said that the valve would last 13 - 15 years, and with the advance in tech, my next one would be through the groin and not chest! I stopped warfarin yesterday, but I have to take half an asprin each day.(no tests)
I am back into running again, and glad to have a tissue valve. I would suggest that any keen athlete 'might' prefer the tissue one - no complications with bleeding.
Good luck on which one you decide on.
brian

 

[yotphix]

Hi hochinag, I'm sorry if you mentioned it and i didn't see it, but would you mind sharing your age? Valve choice is one area that your age could play a roll in what kind of valve they normally reccomend. For example many/most surgeons reccomend tissue valves for patients 60 and up and mech valves 60 and less, altho that tends to be sliding down in alot of centers to like 50 and up reccomend tissue as it looks more and more like the chances of getting a tissue valve that you get now could be replaced by cath by the time it wears out.

I hear this quite a bit these days, and I really wonder whether this is an idea that is being seriously discussed? Has anyone ever had a transcather (ie sapiens etc.) valve installed inside an existing prosthetic tissue valve? What effective open area remained? We are already operating at significantly diminished open areas because the architecture of our valve needs to fit where there were only leaflets before. Also, imagine the clotting risk associated with stacking prosthetics, one inside the next.

I would love to be shown to be wrong, and if anyone knows of any actual studies or trials being done, where valves are being installed through catheters inside of existing prosthetics, I would love to read them. Please provide a link, or at least point me in the direction. Otherwise, please tell us where this information is coming from. It really sounds like a fantasy.

Paul

 

[Lynlw]

I hear this quite a bit these days, and I really wonder whether this is an idea that is being seriously discussed? Has anyone ever had a transcather (ie sapiens etc.) valve installed inside an existing prosthetic tissue valve? What effective open area remained? We are already operating at significantly diminished open areas because the architecture of our valve needs to fit where there were only leaflets before. Also, imagine the clotting risk associated with stacking prosthetics, one inside the next.

I would love to be shown to be wrong, and if anyone knows of any actual studies or trials being done, where valves are being installed through catheters inside of existing prosthetics, I would love to read them. Please provide a link, or at least point me in the direction. Otherwise, please tell us where this information is coming from. It really sounds like a fantasy.

Paul

Actualy, almost any surgeon or cardiologist you speak to, especially in the larger centers, or centers taking part in the various trials will say the chances of getting a tissue you get replaced NOW will be able to be replaced by cath are very high. There are tons of articles, but the Melody pulmonary valve is ONLY used inside previos tissue valves/conduits. these are manily used in children and young adults who are very active, they have been approved in the US about a year and did trials probably about 5 years ago and have been used in the UK and Europe about a decade or more. They do not need coumadin. They also have placed newer Melody valves inside older melody valves already with no decline in function. http://www.medtronic.com/melody/home.html

The Edwards Sapien was pretty much designed to be able to fit inside their tissue valves. I'm sure the fact for the most part Perimount valves usually have larger opening than other valves of the same size helps, when you place a valve inside it, but the leaflets are pretty thin and the new valves squish them against the walls so dont take up that much space especially since the leaflets are sewn right onto the stents and dont use the bigger sewing rings/cuffs traditional valves need. Which is why right now, when they replace the native valve, there is usually a larger opening than if the person had a traditionl valve sewn in.

I the US they have done a couple valve in valves, but they have done alot in Europe and the UK since they were approved a while ago there. I cant read this whole article, but the part i can read talks about TAVI inside older valves http://www.medscape.com/viewarticle/737012_14
if you search pubmed for sapien, corevalve, tavi you should find lots articles here is 1 small one with valve in valve http://www.ncbi.nlm.nih.gov/pubmed/22066367
[/url] but im sure some will still say it is fantasy