Natascha Heard
Member
You brought it to a point 
thank you:Wink:
thank you:Wink:
mechanical or tissue valve
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MrBig
Member
A couple things. If you choose mechanical don't assume you will not need a reop in the future. The fact is 1 in 4 or 25% of mechanical valves will have to be replaced at some point in time. The reop rate for tissue valves is 3 in 4 or 75%. Also someone suggested you listen to your cardio and surgeons recommendations. When I had mine replaced my cardio suggested tissue and my surgeon suggested mechanical. So you see the experts don't even know what to do. It is all up to you. I went with my gut. Trust your gut feeling and go with it.
almost_hectic
Well-known member
MrBig;n869091 said:
I know there are some instances where a mech valve would be replaced, but Ive never read a statistic as large as what you've stated. Do you know where the info comes from?
does seem high for mech replacement, but as mr big said don't assume you wont need another op with mech, also good advice with listening to the experts,
almost_hectic
Well-known member
neil;n869093 said:
no, and i can't assume i won't be killed in a car crash either. but its an entirely different premise to knowingly chose one option which is proven will only last a particular time frame even in a best case scenario, or choosing an alternate option thats intended to last you a lifetime
almost_hectic;n869096 said:
I agree......this is a surgery I'd want to put behind me and never do again.....if at all possible.
almost_hectic
Well-known member
dick0236;n869097 said:
I love reading that your valve has been clicking along for nearly half a century!
agree but if mech was so far more positive why is tissue used and recommened just as much, why do so many people choose tissue above mech , why because some just don't want to be on anti coags, why do many cardio and surgeons disagree on whats best?, because imo there is no one clear winner, some don't want re ops some don't want anti coags, I totally see that some don't want a re op and frankly in a perfect world who would, but a lot of people don't want to be on anti coags, that's the call each and every one of us has to make, there is only the correct answer to ourselves, as I have said before time and time again whatever you choose is the best for you, but maybe not the best for someone else, I really wise I hadn't to make the choice between a re op and anti coags, it isn't easy but one we all have to make,
almost_hectic
Well-known member
neil;n869099 said:
No i was only stating my opinion on that one aspect only. There are different considerations for each and every patients' situation and lifestyle. And of course there is always the argument that surgeons like repeat business, but lets hope thats not the case.
pellicle
Professional Dingbat, Guru and Merkintologist
Hi
agreed ... a point I usually make myself when discussing this.
well leaving aside for a moment the accuracy of this (and I'd love to see a reference) lets look at things a bit more than just one dimensional view.
This also means that 75% of mechanical valves will never be replaced.
In contrast the only reason that the reoperation rate of tissue valves is not 100% is that you die before it needs reoperation.
This is an important point if you are younger and may not die in 15 years.
I always say that for a person over 60 on their first operation ever that its really flip a coin material, but if you are under 40 then you are most certainly setting yourself up for serial redo operations and harm to yourself. Which is not prudent.
Next, lets look at why some of those mechanical valves are replaced. There are essentially two reasons:
Now, lets look at point 1 ... there are two reasons for blockage:
Before we move away from that (and partially why I often condone tissue for some people) is that thrombosis formation is directly caused by patient non compliance with their warfarin therapy. Non compliance not in a one off, but for weeks and weeks and weeks ... yes people ARE that stupid.
So if you are of the type to take your anticoagulation therapy seriously then your risks of a thrombosis blockage are essentially nil.
So looking at the above again I'd say (even assuming your 25% figure is correct) we could probably drop that conservatively by half. If your young and smart and active then really all of the actual evidence suggests a mechanical ...
agreed ... and indeed it is well known that there are not enough trials to shove it in peoples faces that this or that is an immutable fact. However there are always fringe cases so just because that one size fits all does not mean it will fit you. There is a strong propensity in people in the medical industry to have a favourite and stick with it ... saves them having to do a lot of thinking for each case.
Let me quote from the following publication:
this dearth of fully scientific trials is why there is still "opinion" on the matter. Well that and because of individual variation and circumstances.
Now, please, take a note all those names on that paper ... these aren't just your local cadios mate, these are the top names in the business ... these are the names your local cardio looks to for knowledge.
In all of the trials and all of the follow ups I challenge you to find one which goes for longer than 15 years. 15 years may sound like a long time to the average AVR patient (and that average age is dropping btw) but for those of use who weren't 60 years old on our first surgery 15 years doesn't seem long.
Further I challenge you to find a single case of anyone getting 30 years on a tissue valve without a redo ... you will find that quite a bit with mechanicals, especially with younger patients.
How old are you? Is that shaping your views? Are you considering younger people in your answers?
The bottom line is that when choosing a valve YOU need to be your own best advocate .. cos really they will just do what they want ... its way too late when you've committed to find "oh, **** ... I didn't know that" ... that's what fools do.
The goal should be to be informed ... not just belch out cliches which are barely understood. Its important also to consider who you're talking to and due your due dilligence in helping them inform themselves relative to their needs (not yours).
To those making the choice (not those who have already chosen) I say: think critically, ask questions, read between the lines ... inform yourself ... this is not like rooting for your footy team.
MrBig;n869091 said:
agreed ... a point I usually make myself when discussing this.
well leaving aside for a moment the accuracy of this (and I'd love to see a reference) lets look at things a bit more than just one dimensional view.
This also means that 75% of mechanical valves will never be replaced.
In contrast the only reason that the reoperation rate of tissue valves is not 100% is that you die before it needs reoperation.
This is an important point if you are younger and may not die in 15 years.
I always say that for a person over 60 on their first operation ever that its really flip a coin material, but if you are under 40 then you are most certainly setting yourself up for serial redo operations and harm to yourself. Which is not prudent.
Next, lets look at why some of those mechanical valves are replaced. There are essentially two reasons:
- the valve becomes blocked
- you develop an aneurysm and need reoperation
Now, lets look at point 1 ... there are two reasons for blockage:
- thrombosis formation obstruction
- pannus formation obstruction
Before we move away from that (and partially why I often condone tissue for some people) is that thrombosis formation is directly caused by patient non compliance with their warfarin therapy. Non compliance not in a one off, but for weeks and weeks and weeks ... yes people ARE that stupid.
So if you are of the type to take your anticoagulation therapy seriously then your risks of a thrombosis blockage are essentially nil.
So looking at the above again I'd say (even assuming your 25% figure is correct) we could probably drop that conservatively by half. If your young and smart and active then really all of the actual evidence suggests a mechanical ...
agreed ... and indeed it is well known that there are not enough trials to shove it in peoples faces that this or that is an immutable fact. However there are always fringe cases so just because that one size fits all does not mean it will fit you. There is a strong propensity in people in the medical industry to have a favourite and stick with it ... saves them having to do a lot of thinking for each case.
Let me quote from the following publication:
this dearth of fully scientific trials is why there is still "opinion" on the matter. Well that and because of individual variation and circumstances.
Now, please, take a note all those names on that paper ... these aren't just your local cadios mate, these are the top names in the business ... these are the names your local cardio looks to for knowledge.
In all of the trials and all of the follow ups I challenge you to find one which goes for longer than 15 years. 15 years may sound like a long time to the average AVR patient (and that average age is dropping btw) but for those of use who weren't 60 years old on our first surgery 15 years doesn't seem long.
Further I challenge you to find a single case of anyone getting 30 years on a tissue valve without a redo ... you will find that quite a bit with mechanicals, especially with younger patients.
How old are you? Is that shaping your views? Are you considering younger people in your answers?
The bottom line is that when choosing a valve YOU need to be your own best advocate .. cos really they will just do what they want ... its way too late when you've committed to find "oh, **** ... I didn't know that" ... that's what fools do.
The goal should be to be informed ... not just belch out cliches which are barely understood. Its important also to consider who you're talking to and due your due dilligence in helping them inform themselves relative to their needs (not yours).
To those making the choice (not those who have already chosen) I say: think critically, ask questions, read between the lines ... inform yourself ... this is not like rooting for your footy team.
See what your saying hectic, Don't think the surgeons would do that mate lol, but agree totally with you on everybody has different considerations, Oh for life to be simple eh
Natascha Heard
Member
oh yeah:Smile:so true I have 4 more weeks till surgery and still dont know which one to get:Scared:
well nat whichever you choose will be the right decision for you ok, have another talk with your cardio and surgeon after all these are the experts who have dealt with hundreds if not thousands of cases, good luck
Natascha Heard;n869104 said:
I was hesitant until the night before my surgery debating which one to choose. I settled on mechanical ONLY BECAUSE OF MY AGE...I was 57 then and wasn't sure what my circumstances/health would be at 67 or 77 at time of replacement if I chose tissue.
This is a tough time, but it will come to you. Keep imagining yourself and your life after surgery. Either choice will be right.
I'll try to help thinking with you, if you like, by repeating what had been mentioned before about taking pills:
Do You feel ok with taking a pill for the rest of your life and deal with adjusting the dose depending on your food/drink intake, etc?! Again, this is not a big deal, but personally this caused me anxiety at start. I resolved that by having alarms to remind me to take the pill on time. Now, this is a simple habit. I'm comfortable now with adjusting my dose. I'm not the type who regularly eats greens, salads or same food every day! My food varies depending on my mood! Now, when I binge on my spinach or other greens or enjoy a glass of wine or Mojito, I'd reduce my dose that evening. Also, I always carry some pills in my handbag just in case we decide to spend the night outside home.
Today, I'm reducing my dosage in preparation for my dental implant procedure on Monday--My oral surgeon wants my INR at its lowest range.
I'm not encouraging nor discouraging you from either choice. That's my personal experience.
Good luck.
Last edited:
pellicle
Professional Dingbat, Guru and Merkintologist
Natascha Heard
I think Eva makes a good point here:
Recently OzChrissy who is on warfarin for issues not related to mechanical valve choice was feeling highly anxious about being on warfarin. After talking through things with her she has become a lot more comfortable with the position simply because she now knows things and feels more in control.
There is much mysterious "negative feeling" which is ill defined out there on warfarin and that can shape your thinking ... as Eva says, by talking through these things and asking questions and getting answers you can perhaps come to a position where you know how you feel and doubts are removed. One way or the other.
That is, at the end of the day, why we are here ... to help each other understand. This says "scientist" but to me it should be everyones goal
Best Wishes
I think Eva makes a good point here:
Eva;n869121 said:
Recently OzChrissy who is on warfarin for issues not related to mechanical valve choice was feeling highly anxious about being on warfarin. After talking through things with her she has become a lot more comfortable with the position simply because she now knows things and feels more in control.
There is much mysterious "negative feeling" which is ill defined out there on warfarin and that can shape your thinking ... as Eva says, by talking through these things and asking questions and getting answers you can perhaps come to a position where you know how you feel and doubts are removed. One way or the other.
That is, at the end of the day, why we are here ... to help each other understand. This says "scientist" but to me it should be everyones goal
Best Wishes
OzChrissy
Member
Natasha, I notice that you mention that you can always get a new way of insertion in the future if you need it. Well I have just had the latest new method of insertion, trans catheter Mitral Valve Replacement and I am on WARFARIN. The casing they use to attach the valve to the heart, over the existing Mitral Valve is the same principle as a stent. The actual valve is bovine or pig tissue used and is in the middle of the stent. Now I am not a medical person, but with these new less invasive procedures, I cannot work out how they would be able to insert a new valve without some type of metal to anchor it to the opening. They cannot stitch as no ability to do that, I suppose they could come up with some sort of supa glue, but then again, would we trust it.
I had no option with my valve, I was not given the opportunity to decide if I wanted it for life or a short period of time. I have been in the prescribed life time expectancy legitimately twice before, first with my original diagnosis of Cardiomyopathy in 1999 and again in 2012 with Cancer. I have nearly reached the 5 year 15% survival rate for Oesophageal Cancer and modern breakthroughs of Heart research has taken away my original heart diagnosis. To say it does not play a part in your psyche is rubbish from my own personal perspective. I was a bit more practiced with this approach with my Cancer, after living with my original heart diagnosis, but it is still there in the back of my mind. Every time I go for a checkup or CT Scan for the Cancer now, I still feel the anxiety as to what they may find. I do not live in this state all the time, but it is very hard, and I think not natural or normal, to not experience some form of anxiety when you have been given a time frame. Ok we could all walk outside and be hit by a bus, but we haven't been told that it will happen in 7-10 years though.
As for the Warfarin, with the help of the brilliant, understanding, caring Chris (Pellicle) I am now so much more at ease with my INR results. Knowledge is golden and I have learned so much from him and I am finally getting my head in the right space. I am much more confident and it has really made a difference to my existence. So what if I have to have weekly tests, and I know you over in the US can do home testing, so I really don't see the issue NOW. I did before and if anyone had suggested there was a way I could have avoided Warfarin, then I would have embraced it with open arms. After learning about Warfarin and charting and taking personal control of my own health in this manner, I feel much more relaxed and easy with all this.
What is more prominent and an issue now for me is the life of the Valve. I was not aware and didn't even give it a thought, how long it will last. This is far more relevant to me personally, than taking Warfarin. I am 12 months in with my valve, and I intend to have a lot years more with it. In your case, you have many more years than me, why take something that will only give you a few years, (in the big scheme of things) over the chance of a valve that would last you a lifetime. To me the choice is easy, but then, that is just me.
Thinking of you as you face this issue, I was given no choice, but I am sure I would have gone for longevity.
I had no option with my valve, I was not given the opportunity to decide if I wanted it for life or a short period of time. I have been in the prescribed life time expectancy legitimately twice before, first with my original diagnosis of Cardiomyopathy in 1999 and again in 2012 with Cancer. I have nearly reached the 5 year 15% survival rate for Oesophageal Cancer and modern breakthroughs of Heart research has taken away my original heart diagnosis. To say it does not play a part in your psyche is rubbish from my own personal perspective. I was a bit more practiced with this approach with my Cancer, after living with my original heart diagnosis, but it is still there in the back of my mind. Every time I go for a checkup or CT Scan for the Cancer now, I still feel the anxiety as to what they may find. I do not live in this state all the time, but it is very hard, and I think not natural or normal, to not experience some form of anxiety when you have been given a time frame. Ok we could all walk outside and be hit by a bus, but we haven't been told that it will happen in 7-10 years though.
As for the Warfarin, with the help of the brilliant, understanding, caring Chris (Pellicle) I am now so much more at ease with my INR results. Knowledge is golden and I have learned so much from him and I am finally getting my head in the right space. I am much more confident and it has really made a difference to my existence. So what if I have to have weekly tests, and I know you over in the US can do home testing, so I really don't see the issue NOW. I did before and if anyone had suggested there was a way I could have avoided Warfarin, then I would have embraced it with open arms. After learning about Warfarin and charting and taking personal control of my own health in this manner, I feel much more relaxed and easy with all this.
What is more prominent and an issue now for me is the life of the Valve. I was not aware and didn't even give it a thought, how long it will last. This is far more relevant to me personally, than taking Warfarin. I am 12 months in with my valve, and I intend to have a lot years more with it. In your case, you have many more years than me, why take something that will only give you a few years, (in the big scheme of things) over the chance of a valve that would last you a lifetime. To me the choice is easy, but then, that is just me.
Thinking of you as you face this issue, I was given no choice, but I am sure I would have gone for longevity.
Natascha Heard
Member
Thank you so much everybody Im so glad I joined that forum it is amazing to have all of you telling your storys it helps sooooooo much Im so thankful!!!!! OZ chrissy thank you so much I wish you and everybody else just the best !!!!!
Natascha Heard
Member
Hi Im back had my tissue valve on october 28th with a triple aortic arch repair....Sugery went perfect everything looks great but the first 4 days were hard on me....Thanks everybody
Natascha Heard
Member
Hi Im back had my tissue valve on october 28th with a triple aortic arch repair....Sugery went perfect everything looks great but the first 4 days were hard on me....Thanks everybody
hi nat glad to hear your doing ok, what valve did you get piggy or moo, what made you go tissue?
