Mechanical Valve or Tissue Valve ?

[shah4u]

Hey there,
I am Shah 27 years old diagnosed with BAV and will undergo surgery soon and what I am really confused is about the selection of the Valve. I wanna go ahead with Tissue Valve since it doesnt require much of anticoagulant but all the docs I have been seeing says they can only last for about 8-15 years max and given my age they dont wanna take the risk, so they are recommending mechanical Valve but that will require a lifelong medication. So arent there any tissue valve that can go on for 20-25 yrs ? Coz second surgery post 20-25 yrs would mean a lot different given the technological advancement of Medical Science. I dont wanna live on coumadin or warfarin for rest of my life.

 

[Ryanvs]

Hi Shah,

I'm 31 and I had my valve replaced in April 2016, so I faced a similar decision less than a year ago.

At the end of the day, you have to do what you feel is best for you and you have to be comfortable with it. If you want a tissue valve go for it, but consider;

Warfarin management is reasonably easy. I still eat 'leafy greens', I still drink alcohol. I just factor it in. Looking back, most of the grief I experienced managing my INR was caused in part by my local GP and online literature that over complicated things. I learnt more from this forum.

no tissue valve that I know of that will last 25 years (that I know off).

Finally, do you really want to be opperated on again in 8-15 years. Then likely again after that valve wears, assuming you choose tissue again. By that stage you'll be around 50-60 years old. Just in time for a third opperation.

Trust me when I tell you that open heart surgery isnt fun. Its tough. Physically. Emotionally. Mentally.

I chose a mech. Valve as it gave me the best chance of living my life without being opened up again. Its not a guarantee, but a tissue valve guarantees more surgeries on the horizon.

What does your surgeon recommend?

 

[Agian]

Hey there,
I am Shah 27 years old diagnosed with BAV and will undergo surgery soon and what I am really confused is about the selection of the Valve. I wanna go ahead with Tissue Valve since it doesnt require much of anticoagulant but all the docs I have been seeing says they can only last for about 8-15 years max and given my age they dont wanna take the risk, so they are recommending mechanical Valve but that will require a lifelong medication. So arent there any tissue valve that can go on for 20-25 yrs ? Coz second surgery post 20-25 yrs would mean a lot different given the technological advancement of Medical Science. I dont wanna live on coumadin or warfarin for rest of my life.

Shah, I understand why young people are spooked by the idea of taking 'lifelong medication'. Totally get it... You mean forever?! The reality is that as we get older the majority of us will be started on something. I think the advice you have been given is correct. 20-25 years? Unlikely in a 27 year-old.

I didn't want to live on warfarin for the rest of my life either, or blood pressure tablets, or anti reflux meds, or .... You get the idea.
Certainly didn't want open heart surgery either. Oh well, we can't have everything. Weigh up the risks and benefits. I've gone mechanical.

 

[shah4u]

Hey Ryan,
I have consulting quite a few docs for second opinion and everyone says mech, Valve except my probable surgeon who is somewhat comfortable with tissue valve and has even suggested Trifecta Tissue Valve which have been lab tested for over a billion pump equivalent to 25 years but then i am little skeptical about it after reading so online regarding tissue valve and finally I came here somehow and have seen how real life patients who have gone through the same can advice better.

 

[Agian]

Hey Ryan,
I have consulting quite a few docs for second opinion and everyone says mech, Valve except my probable surgeon who is somewhat comfortable with tissue valve and has even suggested Trifecta Tissue Valve which have been lab tested for over a billion pump equivalent to 25 years but then i am little skeptical about it after reading so online regarding tissue valve and finally I came here somehow and have seen how real life patients who have gone through the same can advice better.

The testing doesn't take into account calcification. Btw, I'm a real life patient.

Ryan, ditto.

 

[Ryanvs]

I understand why this would be appealing, Shah. Unfortunately nothing is guaranteed. My internet provider says I can get download speeds of up to 50mbs... i get 11.

How soon are they looking to opperate?

 

[Agian]

I understand why this would be appealing, Shah. Unfortunately nothing is guaranteed. My internet provider says I can get download speeds of up to 50mbs... i get 11.

How soon are they looking to opperate?

Hmm, 11 is pretty slow. The NBN was a waste of money. I only recently found out there are 3 levels of NBN speed.

Shah, my advice is go mechanical. But that's just me.

 

[Ryanvs]

Hmm, 11 is pretty slow. The NBN was a waste of money. I only recently found out there are 3 levels of NBN speed.

Shah, my advice is go mechanical. But that's just me.

You're telling me! It's terrible. On ADSL I was 5mb, so it's a slight improvement.

 

[pellicle]

I have consulting quite a few docs for second opinion and everyone says mech,

if you are an otherwise healthy male (female brings the question of pregnancy) with no other issues (not diabetic, not prone to bowel bleeds .... aka sickly) then I would join that chorus of "mechanical"

Valve except my probable surgeon who is somewhat comfortable with tissue valve and has even suggested Trifecta Tissue Valve

two things (maybe three)

Sugeons get sick and tired of seeing harm come to people who are essentially idiots with management of their Warfarin therapy ... if you're a dope who is not going to take their health seriously then I'd side with the surgeon. If you are able to pull your act together and monitor your coagulation levels and take your pills as directed (indeed as YOU yourself direct) then mechanical is the only way to have any chance of avoiding repeat surgeries.

When you have a valve replacement you swap out "heart valve disease" for "posthetic valve disease" ... there are two fundamental types of prosthetic valve disease.

1. tissue prosthetic disease
2. mechanical prosthetic disease

1) is managed by redo surgery (and some AC therapy if it starts causing clots or you get afib from the surgery)
2) is managed by AC therapy

you are directly involved in 2) but uninvolved in 1) ... meaning you exchange being managed for managing yourself.

Redo surgery is repeat business for surgeons (if not your surgeon, one of his cohort)

which have been lab tested for over a billion pump equivalent to 25 years but then i am little skeptical about it after reading so online regarding tissue valve and finally I came here somehow and have seen how real life patients who have gone through the same can advice better.

exactly ... not subject to a 25year immersion in a blood filled with chemicals and an immune system bent on destroying it.

If you are under 40 I'll put my money down that you won't get 25 years. 15 would be lucky 12 common and less if you're unlucky. At your age it would be more like 9 years or less.

Every year we hear the same thing from tissue valve makers "this new years model is new and improved and you'll get longer life" ... so far every study shows the last iterations "new improved formula" gave scant improvement ... every year the "believers" say well, that's the old stuff, we need studies on the new stuff.

guess what ... the more things change, the more they stay the same.

Now TAVI is being hailed as the answer ... but again the consumers avoid the facts: they don't last as long as a regular (gosh because they're designed for those who are too ill to be operated on) and valve-in-valve can only be done once (maybe twice) before another regular surgery will be needed.

 

[pellicle]

Hmm, 11 is pretty slow. The NBN was a waste of money. I only recently found out there are 3 levels of NBN speed.

I've had my money on Fiber to node and LTE / WiMax since the get go ... fiber to door is a ponzi scheme. But what would I know? I've just had decades of experience in IT and worked as an electronics tech in wireless comms (competing and winning against hard wired) data transfer for years.

 

[pellicle]

shah4u

Shah, I understand why young people are spooked by the idea of taking 'lifelong medication'. Totally get it... You mean forever?! The reality is that as we get older the majority of us will be started on something.

what he said!

in spades

 

[Agian]

I've had my money on Fiber to node and LTE / WiMax since the get go ... fiber to door is a ponzi scheme. But what would I know? I've just had decades of experience in IT and worked as an electronics tech in wireless comms (competing and winning against hard wired) data transfer for years.

I have no idea what you just said.

 

[pellicle]

I have no idea what you just said.

and so can you imagine how well Brandis understands the issues (or any of those morons in Govt ) The major difference is you're honest about it and hes a politician

 

[shah4u]

if you are an otherwise healthy male (female brings the question of pregnancy) with no other issues (not diabetic, not prone to bowel bleeds .... aka sickly) then I would join that chorus of "mechanical"

Thanks for this suggestion and till now I havent had any of it that you mentioned but diabetes is something that runs in my family so I cant quite confirm the same that I wont have it in future and given family history I guess mech makes a lot more sense in order to avoid second operation as much as possible.

 

[cldlhd]

I understand why this would be appealing, Shah. Unfortunately nothing is guaranteed. My internet provider says I can get download speeds of up to 50mbs... i get 11.

How soon are they looking to opperate?

That sucks I get around 220 to 240 down. They ran a lot of fiber to the door around here but I don't have that provider.
I would vote mechanical at your age, I don't need to go through the reasons as they've already been mentioned but ultimately it's your decision but it seems like you're going about it the right way-doing your research. Best of luck with the process.

 

[hevishot]

I would go with tissue. That archaic piece of plastic they call a mechanical valve will be obsolete before your tissue valve wears out. I fully expect the mechanical valves will be on the junk heap in 20 years.

 

[pellicle]

.. That archaic piece of plastic they call a mechanical valve will be obsolete

you mean that piece of high tech pyrolytic carbon?

https://en.wikipedia.org/wiki/Pyrolytic_carbon

http://www.azom.com/article.aspx?ArticleID=1463

quite the material scientist I see (know your stuff well) ... given you know so well how the mechanical valves are made I'd assign that level of knowledge to the rest of your statements.

choose what ever valve you wish to, just make it an informed choice ...

 

[Agian]

I would go with tissue. That archaic piece of plastic they call a mechanical valve will be obsolete before your tissue valve wears out. I fully expect the mechanical valves will be on the junk heap in 20 years.

What a pleasant distraction from the gun debate. Please tell me you're serious.

 

[pellicle]

Thanks for this suggestion and till now I havent had any of it that you mentioned but diabetes is something that runs in my family so I cant quite confirm the same that I wont have it in future and given family history I guess mech makes a lot more sense in order to avoid second operation as much as possible.

at your age, lets assume you get 15 years out of a tissue prosthetic

27 = surgery 1
42 = surgery 2
57 = surgery 3

people have been putting a candle in the window for TAVI for the last 15 years


something to read:

http://cjeastwd.blogspot.com/2014/01...r-choices.html

Also this guy:
http://www.mayoclinic.org/biographie...d/bio-20053174

has this interesting presentation: here

• •Patients’ age is probably the most important factor in recommending tissue or mechanical valve
• •Bioprosthetic valves are ideally suitable for older patients (>70 years) or those who are not likely to outlive the valve (co-morbidities)
• •Mechanical valves should be recommended to younger patients (<60 years)
• •If anticoagulation is a perceivable problem, tissue valves can be used in younger patients but the probability of reoperation is high

as well as some other presentations on the matter (I have them in my dropbox)

https://www.dropbox.com/s/u4oidfr20nwmv4r/14 Schaff 145 mechanical vs bio AATS.pdf?dl=0

and sit down with a cup of tea and take notes on this one:
https://www.dropbox.com/s/7ndy7b1l1r9zq42/cardio-grand-rounds-031910_000102p2003622p7.flv?dl=0


and this paper too (not his) is worth a read Choice of prosthetic heart valve in a developing country



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898620/


Best Wishes

 

[hevishot]

you mean that piece of high tech pyrolytic carbon?

https://en.wikipedia.org/wiki/Pyrolytic_carbon

http://www.azom.com/article.aspx?ArticleID=1463

quite the material scientist I see (know your stuff well) ... given you know so well how the mechanical valves are made I'd assign that level of knowledge to the rest of your statements.

choose what ever valve you wish to, just make it an informed choice ...

Call it whatever fancy pants name you want. The fact is if you want the beta max/4 track of valves go with mechanical. If you want the blu ray of valves go with tissue