Mechanical Valve or Tissue Valve ?

[pellicle]

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

thats funny ... this isn't consumerism ... but then you probably don't grasp why iPhones aren't used in probes by NASA either

 

[dick0236]

Call it whatever fancy pants name you want.

Welcome to the forum Hevishot........I see you are a true expert......and "retired".....so you should be in your 60s or 70s (your use of a very old phrase "fancy pants" kinda dates you) and I agree that a tissue valve would be a good choice....for you. However, if you where in your 20s and you don't want to spend a lot of time on an operating table in the future,...I'd go mechanical.

BTW, I see the new tissue "wonder valve" has been LAB tested to last 1 billion cycles......my mechanical has already been FIELD tested for over TWO billion cycles......with no end in site.

Hevishot.......As General Patton(I'm sure you remember him) once said....."Oh God, how I love a good fight".....so bring it on....One old man against another old man.

 

[cldlhd]

I'm 47 so not sure if I qualify as an old man, I think my son would say yes, and I still have my bav so maybe I can't argue/ bicker on this thread?

 

[cldlhd]

Here's another old phrase for you. "Put your money where your mouth is". I contend 20 years from now the tissue valve will be the go to valve regardless of age. Whatever you want to wager is ok with me. Make it easy on yourself. We will put the money in an escrow account. Any takers?

Not really sure why you're taking the aggressive tone with me but I'm not sure how we would work out the logistics of that bet. I don't think the question is whether it will be the go-to valve or not the question was which one would last longer in a younger patient.

 

[dick0236]

Here's another old phrase for you. "Put your money where your mouth is". I contend 20 years from now the tissue valve will be the go to valve regardless of age. Whatever you want to wager is ok with me. Make it easy on yourself. We will put the money in an escrow account. Any takers?

That would be a stupid bet on my part.....as in twenty years I will, most certainly, be looking UP at the grass "cause I don't realistictly expect to live to 101.....although with my old mechanical.....who knows......like my cardio told me.....Those old Starr-Edwards valves where built like Shermon Tanks (another old hunk of metal from General Pattons war)".

 

[neil]

always saddens me when a serious question always nearly turns into an all out slagging match, shame really, I don't agree with hevishot at all but hes entitled to his opinion like everyone else,

 

[Tojomiami]

Hey Shah,
There is no right or wrong answer. Whatever you choose is right for you. My advice is get all of the information you can and make an informed choice. Read through the posts in this forum. If you have the time and opportunity, get second opinions from other medical specialists in this field. Here we can just tell you our own experiences. Myself I had my first OHS in 1999 for a BAV. I opted for a tissue valve, a homograft, and did great for about 12 years. I was a super active guy, summited Mount Rainier 4 times, and did ice climbing, rock climbing, mountain biking in the Rockies. I was 49 at the time and did not want to be on warfarin. Plus I thought when my valve finally wore out, medical technology would have advanced to the point that my next valve would be some sort of tissue valve made of my own cells that would not require anticoagulation therapy. That was what research was investigating back then. Well my graft began failing around 2012-13, and now I can't climb a flight of stairs without getting somewhat winded. I am scheduled for my second AVR soon, and this time I am going with a mechanical valve, hopefully so I won't have to do this again. Yes, the valves are better than 17 years ago now, but I still have the same choice as I did back in 1999. Even with my tissue valve, I was still instructed to take an aspirin a day, and now I am on two other heart medications to help treat my failing valve. With warfarin, I will need to add another med and be very responsible, and take it every day and monitor myself. But I am ready for that now. So best of luck on your choice. Just remember, there is no right or wrong answer here, Just research it, get second opinions, then decide.

 

[Superman]

I received my first mechanical valve in 1990. Due to an aortic aneurysm, I had to have a second open heart in 2009. I only mention that to point out that a mechanical valve is no guarantee against a reoperation. That being said, the archaic piece of plastic was still in perfect working condition after 19 years. I'm still only 44 (over 26 years on warfarin). I can safely say that I do not regret staying with a mechanical valve. I hope to never have another open heart if I can avoid it. Mechanical gave me the best chance of that. Medication is a small price to pay. I've had 7 years on this valve/graft and hope to get another 40 plus out of it.

 

[Agian]

A very emotive topic, which is totally understandable.

Lots of research out there.

 

[cldlhd]

I would say the right answer depends on your priorities. If the main thing is you want your best chance at avoiding warfarin and the idea of multiple OHS's doesn't bother you as much then go tissue. If having the best chance at avoiding future surgeries is more important go mechanical.

 

[shah4u]

Thanks for some very important suggestion that will long way in helping me guys. Further can you guys suggest if i go with mech valve which valve should i be considering and how am i to manage it after operation.

 

[pellicle]

Hi

Thanks for some very important suggestion that will long way in helping me guys. Further can you guys suggest if i go with mech valve which valve should i be considering and how am i to manage it after operation.

to the best of my knowledge there is no significant difference between any of the top 3 mechanical valves. I consider it a bit like fuel, Shell or Mobil or BP will each tell you their brand is better, but the reality is that they are all very very close.

So the St Jude has a good track record, the ATS / Medtronic (Medtronic bought ATS) has a similar record and the On-X while it does not have the same amount of installations and time in the field ("runs on the board") is a good device too.

In terms of managing yourself after surgery there really is only this to do over the long term:

1. take your warfarin
2. test your INR
3. adjust your dose if needed

I would expect that the hospital will get you on a relatively stable INR (which is simply the term that is used to determine what is the right level of "blood medicine" you need) and from there you just maintain that.

I've written some blog posts that can help and I'm happy to help you as soon as you're ready to keep you even and teach you the ropes as I've learned them.

Aside from that there isn't much else. You can miss a pill here and there and to honest that's not a big issue. Self testing isn't expensive and is really quite similar to what diabetics have to do with their blood sugar measurements.

I don't know if I've put links to my blog posts which talk about INR self management, but here are the important ones:

Introduction to the topic
An Example
my Current INR data
and a post about finding a dose that isn't too high, isn't too low and is just right (which I call the Goldilocks dose)

The only bit of the equation I don't know at the moment is if you're male or female and if you are female, if you want to have children ...

Best Wishs

 

[dick0236]

.......... which valve should i be considering and how am i to manage it after operation.

I'd go with the one my surgeon is most comfortable with. They will all be very similar post surgery. Other than using common sense I personally don't think a replacement valve requires special handling. I just take my pill, test routinely and try not to run with scissors.........everything else is "fair game".

I've noticed I am on the computer a lot lately.......but it's bitterly cold here and golf or fishing is "out of the question".......and the computer is my only release to keep from going stir crazy. I guess I could go back to work.......not!!

 

[Superman]

I'd go with the one my surgeon is most comfortable with.

I don't agree here. I'd go with the one I'm most comfortable with, and if your surgeon isn't okay with it - find a new one. If your surgeon only does tissue valves, and you wouldn't be able to sleep at night knowing you may have a repeat in 10 - 15 years - it's time for a second opinion. If your surgeon only does mechanical, and you know yourself well enough to know that managing a required daily medication is something you can't get comfortable with - it's time for a second opinion.

 

[EasterRat]

It's a thin line between educating and advocating for yourself and accepting that you are not a cardiac surgeon (not to mention team) with what, 20+ years of education, access to literature and experience. We all tread the line differently. I try to take out the emotional thoughts like being upset that I have this condition at all etc...

 

[dick0236]

Whoops, I assumed, from Shah4u post that he was asking about which "mechanical " to choose.

 

[Paleowoman]

It's the patient's choice, obviously with advice from cardiologist and cardiac surgeon, as to whether they go with tissue or mechanical, but if they have strong feelings about either regardless of the advice, then it is ultimately their, the patient's choice. The make of valve, on the other hand, is surely something a patient cannot know which is best for them, unless they happen to be a cardiac surgeon themselves.

 

[cldlhd]

I'd go with the one my surgeon is most comfortable with. They will all be very similar post surgery. Other than using common sense I personally don't think a replacement valve requires special handling. I just take my pill, test routinely and try not to run with scissors.........everything else is "fair game".

I've noticed I am on the computer a lot lately.......but it's bitterly cold here and golf or fishing is "out of the question".......and the computer is my only release to keep from going stir crazy. I guess I could go back to work.......not!!

Thanks for that Dick. I'm out working and it's around 15 degrees.

 

[pellicle]

Dick

Whoops, I assumed, from Shah4u post that he was asking about which "mechanical " to choose.

no whoopsi .. if anyone bothered to read the few words written it was pretty clear they were asking which mechanical

Thanks for some very important suggestion that will long way in helping me guys. Further can you guys suggest if i go with mech valve which valve should i be considering and how am i to manage it after operation.

but so many people here are all too worried that someone may choose a mechanical against their team ... they're pretty quick to shove it down throats "its the patients choice" until some patient seems inclined to choose a mechanical ...

sheesh its not like the patient might an actual adult who can make what they want of the advice given ... and not feel that a gun has been placed to their head.

 

[pellicle]

It's the patient's choice, obviously

exactly so if they ask..