Mechanical valve conduit info

[markp66]

Email I got from Christian D Etz MD on the bentall procedure. I posted a study on this a few days ago and thought id get in touch with him and ask him some questions. All pretty standard info but just shows the importance of maintaining INR, especially first year post op-

Mechanical conduits virtually last forever!* Assuming you had surgery for a stenotic bicuspid aortic valve, your mild LV hypertrophy should resolve within the next couple of months after surgery.* Ventricular remodelling occurs with the new aortic valve maintaining a low pressure gradient reducing LV work load.

Thromboembolic complications and bleedings comprise up to 75% of all complications after mechanical heart valve implantation (including bentalls) and predominantly occur in the first year after surgery.* This being said, be sure to maintain*your INR perfectly within the range for your specific valve. it likely is the most important predictor of event free survival within the first year postop. *Thereafter your risk of thrombembolic complications is likely to diminish. we do not yet know why, though.

On the long run you might want to look out for updates of the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines for your specific valve prosthesis ? however, an INR between 2- and 3 should be perfectly fine.

 

[Sarah_Louise]

I had a mechanical Aortic valve put it when i was 13, it only lasted four years if that! Then it started thowing off clots to nearly every place in my body, causing me to have strokes, and blocking blood supply to my limbs leaving me needing emergancy embolectomy's! I can honestly say during the four years i was on anti-coagulants (tried 3 different ones) i never ever had a stable INR range!!! It was aimed at 2.5-3.5, and never got there, it was either too high at 8.0 or to low at 1.0!! but ended up getting a tissue valve put in the end as the risk of clots was too high, it's been in since april but has now got regurgation already!! So can see why they say mechanical ones last longer!! Just my body didn't like it or the anti-coagulation (that i still need cause if the strokes-can't win lol) xxxxx

 

[markp66]

Sarah, sounds like you have had some bad luck especially with warfarin. I have no didea why they couldn't get your INR stable. Did they give you a reason? Mine has been 2.5 for the past 5 weeks post surgery and I, hoping it will stay like this! What a shame your tissue valve has regurgation already. What hospital did you have yours ops done? If you need it replaced will you have to go mechanical again? Sounds like you have had lots of surgeries already and I'm guessing you don't want many more! A mechanical valve should last forever, sounds like you needed it replaced due to thrombosis on the valve. Was your anticoagulation well managed by your gp? If some people have very low INRs doctors can give way too much warfarin and then next time they check it's far too high. Getting INR stable is about gradually and slowly adjusting the warfarin levels. People can have a major increase in INR with an extra 1mg per day.
Good luck with everything. Hope the regurgation isn't too bad and you can at least keep the valve in for a few more years.

 

[Sarah_Louise]

My body just couldn't tollerate any anti-caogulants, i've tried 3 different ones! I had them done in a specialist GUCH centre here in the UK (Freeman up in Newcastle) i'm not sure what they'll do? especially as i've been told this tissue valve could possibly only last 5 years max! But i can' afford to have a mechanical valve in and risk my loosing my limbs/life cause of anti-coagulants. I'm waiting to go in for number 6 anytime now but this time i'll have my pulmonary valve changed, and my conduit pipe stretched and stented. No my anti-coagulanta dosing and testing where all monitored by the top heamatologist in the North East! And he said in all his career (semi retired so he's been there a while) he's never seen anyone act to anti-coagulants like i have! I fought with warfarin for about 2 years, had a 6th month spell on phenidione which never worked, and now i'm on heparin injections as there running out of options for me, to the point of me possible going to be one of the first in the UK on dabigatran used for the heart!! (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a610024.html)
Really hope you manage to keep a stable INR level
Sarah xxxxxxxx