Mechanical Valve or Tissue Valve ?

[Bodhisattva]

If you do go tissue, the good news is that you will get a second chance. And really, who knows what options will be there in 10 - 20 years time? You will likely have bought yourself 10 - 20 years without dealing with warfarin.

This is so true! Who knows? Totally agree with how the longer one can wait before having surgery, the better in terms of waiting for other options to ripen in time. But once the referral to the surgeon happens, time is of the essence. The native valve must be jettisoned asap for the sake of the heart. So we are stuck playing the cards as they are laid right now. The future can't be held in the hand.

 

[ashadds]

This is so true! Who knows? Totally agree with how the longer one can wait before having surgery, the better in terms of waiting for other options to ripen in time. But once the referral to the surgeon happens, time is of the essence. The native valve must be jettisoned asap for the sake of the heart. So we are stuck playing the cards as they are laid right now. The future can't be held in the hand.

wisdom ! My doctor says that they wait till my risk of death from the valve increases beyond the risk of death from surgery !

 

[pellicle]

...the thing is who do you listen to? the people who are the experts and do it all the time? or people on a forum? ,

its entirely possible he's already asked a Dr and a Surgeon and has come here to ask people who have experience and have been through the situation he is facing to ask for information to assist his decision making.

That's why people come to the forum, mostly they've already been to a Doctor first

 

[pellicle]

... wisdom ! My doctor says that they wait ...

its a reasonable stance and (as you know) similar to the path which I happened upon. I had a homograft placed and that got me 20 years. It is true that I was on the extreme edge of stats and that 20 years was uncommonly long for duration in my age group. However as has been observed here don't let the heart detoriate too long ... it takes longer to recover.

None the less deferring to a tissue prosthetic does delay your need to consider warfarin therapy. That indeed may be simply "a good thing"

Most of your fears about warfarin are simply untrue, the things you are afraid of are the worst case of the worst TV soap drama, but one can not dismiss that the Texas Chainsaw Massacre is possible (if not probable)

BUT as was raised a few posts back on this thread the surgeon will be concerned with your ability to manage your AC therapy properly. So (and this is something only you can answer) how likely are you to be a good manager of that?

If you doubt yourself then the concerns of the surgeons about possible harm from AC therapy are justified. If you are not a responsible and stable personality and play fast and loose with this stuff you may get hurt. None of us can answer that question for you.

Mistakes happen often, I myself have missed a dose here and there ... I take that seriously. EVEN STILL I am 93% in range ... which puts me in a very safe position. Managing warfarin is not like managing "nitro glycerine " ... it won't kill you with the slightest error ... it takes repeated attempts to get harm. But if you were get carried away and go wild for a week you (not taking your warfarin) its likely you may well have a stroke.

All the questions you ask and ask again are basically answered with this: its safe if you're responsible and careful , but if you aren't then its not safe.


only you can answer that question.

As I've mentioned before, you should ask your surgeon (I mean this seriously) if you are in a risk group for aneurysm. If you are then its entirely likely you will need a reoperation in the future (as I did, as superman did) in which case you may as well pick a tissue now and answer the question next time

Best Wishes

 

[dick0236]

.........One of my doctor surgeons told me, when pushing for tissue, doctors are mostly worried that the patient won't maintain the warfarin treatment after they get the mechanical valve. Maybe the doctor thinks the patient isn't suited to warfarin treatment, they are the type that will forget to take their daily dose or will blow off the INR testing. Because if you get a mechanical valve, you have to do the warfarin part like a habit. You have to do it regularly without fail........

..........So maybe your doctors are looking at you and thinking, right now at this stage in his life, this patient is not a good candidate for warfarin therapy. We don't get the feeling he will be able to keep it going. If he is unable to keep up with the warfarin therapy, he will be at high risk for a stroke. We would prefer to give him a tissue valve even if this means he has to have another open heart surgery sooner or later. Because the risk of stroke from not doing the warfarin properly is higher than the risk of dying during the second surgery. Something like that? Maybe ask them?

!

This is true! I have, over the years, had opportunities to talk candidly, since I have "survived" warfarin so long, with my docs. Patient knowledge is the key. I had my one, and only, problem with warfarin only seven years post surgery and when I was only 38. Partly that was not my fault since managing warfarin was still in the "dark ages" and the dos and don'ts where not easily come by. I suffered a stroke that was primarily due to my mismanagement of the drug.......I learned, REAL FAST, after that experience and have had zero, zip, nada problems since. I have counseled people that if you can't follow a simple regimen don't go on warfarin........and that advice is also true for a lot of drugs on the market......even asparin will kill you if mismanaged.

I visit with heart surgery patients in a local hospital. Those getting valves are normally pretty old and the majority are getting tissue. That makes sense to me as they are unlikely to outlive them and they probably won't have to fool with ACT at their age. Interestingly, two patients in their twenties have received tissue valves in the past several months. Both had their valves replaced after heart infections due to "dirty needle drug use" and I was surprised at the choice of tissue valves for them. Perhaps the above argument that the patients are unlikely to maintain an anti-coagulant regimen was the reason the docs put in tissue.

 

[Superman]

Both had their valves replaced after heart infections due to "dirty needle drug use" and I was surprised at the choice of tissue valves for them. Perhaps the above argument that the patients are unlikely to maintain an anti-coagulant regimen was the reason the docs put in tissue.

I'll go out on a limb and suggest that they aren't likely to outlive their valve choice either.

 

[neil]

some really good points made, imo picking is sooooooooooo hard, and it is so personnel, lets be honest here all of us would drather not be in this position we can all agree on that. But we have to make that choice, as ive said before there is no wrong choice,just that some don't want a re-op and who can blame them, some of us don't want to be on warfarin,but its so personnel and can alter from person to person, we are all right in our choices because that choice is for us,

 

[Ryanvs]

You have some really solid advice here, but at the end of the day it is your call. My 2 cents:
* Managing warfarin/INR really is pretty straightforward and not nearly as bad as what medical professionals make it out to be. However as mentioned above, if you don't think you can or are capable of managing this then a tissue valve may be the way to go.

* If you do choose a mech. valve (and as such will be on Warfarin) I would look at self testing. I started late last year and test weekly. My dosage is manage by myself and at present I take 6.5mg a day and my INR typically fluctuates between 2.2-2.8. Perhaps another thing to note is the costs associated with self testing - In Australia the device is around $500 - $600 new plus an annual cost of around $250 for the purchase of test strips. Would your financial position allow for this? Of course, you can always still get your INR checked at a clinic however.

* Finally - If you do choose a tissue valve, I wouldn't do so expecting 20 years out of it. Perhaps aim for 10 or so with anything more being a bonus. Choosing it solely on the expectation it will last 20 years may just lead to disappointment.

 

[Agian]

The chances of a clot are the same for a tissue valve as they are for someone with a mechanical valve, who is on Warfarin. That's what the literature says.

I'm on Warfarin and Plavix and have low platelets. I haven't woken up in a pool of blood, yet. Just mowed the lawn. Cuts, scrapes, you name it.

INR in range: 100%

Ask your surgeon how many patients he has with 20 year-old tissue valves.

2nd and 3rd ohs? No big deal, if you're the surgeon.

27 years old huh? Don't believe the hype.

 

[neil]

imo if I was young I would lean towards mech, It doesn't freak me out if and when I need another op, but needing more would maybe sway me, the newer tissue valves atm seem to be doing very well of course we wont find out how well for a few years, mines 9yrs and doing fine, speaking to others of around the same time it does seem in general that they are lasting longer, we have to choose the valve for us and what we think is best, no wrong choice imo,

 

[Mike1959]

The chances of a clot are the same for a tissue valve as they are for someone with a mechanical valve, who is on Warfarin. That's what the literature says.

I'm on Warfarin and Plavix and have low platelets. I haven't woken up in a pool of blood, yet. Just mowed the lawn. Cuts, scrapes, you name it.

INR in range: 100%

Ask your surgeon how many patients he has with 20 year-old tissue valves.

2nd and 3rd ohs? No big deal, if you're the surgeon.

27 years old huh? Don't believe the hype.

I find your comments Agian very negative indeed.

what you should be saying is that whilst tissue valves are unlikely to last 20 years, both options are terrific and life savers, and both have pro's and con's and down to personal choice based on latest information.


I just wish everyone could be more open minded and supportive of both options and each other.

lets all act as a unified supportive group!! Wouldn't that be nice :Smile:

 

[pellicle]

I just got off the phone after speaking for over 2 hours to a very nice and intelligent young man who was highly confused by all the issues. He had seen 3 surgeons (more iirc and you count the cardiologists) and got differing opinions. He was confused and simply didn't understand many of the things which some of us may take for granted as knowledge.

He found that learning more actual experiences about warfarin management helped him ... each person needs to learn something to help them.

So when he gets told "there are not wrong choices" it was worse than no comfort - it confounded and confused him further.

Sometimes what people need here is actual engagement with them and their specific cases in an honest and meaningful way, not just the recitation of "there are no bad choices" and "speak to a Doctor" ... no comfort or support at all. Indeed it just makes things worse. If there genuinely are no wrong choices then what is wrong with helping settle someones mind with saying "I think X is better than Y for you"

I mean if there are no wrong choices and you have something more than tea-leaves to back up your opinion?

I'd call 2 hours on the phone listening and guiding support ... wouldn't you Mike?

I'd call open minded making a recommendation of something other than what you chose for yourself ... wouldn't you?

PS: and for the record, what was negative about Agian s comments? They seemed simple statements of fact to me. Does it need some sugar on top?

 

[cldlhd]

First of all I think the Palestinians and the Jews are going to agree on the settlements before this issue is resolved. I agree if the valve needs replacing either is better than nothing. However, and I think Mike said this in a way, it depends on what the patients priorities are. A mechanical isn't a guarantee they won't need a reop but it does make it a lot less likely than with a tissue. Is there an aneurysm? If not is there some enlargement of the root or ascending that makes it pretty likely?
Seems simple in a way - with a mechanical the trade-off for PROBABLY not needing a reop due to the valve is warfarin so it makes sense to research the reality of being on warfarin as much as you reasonably can. Which would include talking to people actually on it. I can hear some anti warfarin people saying something along the lines of "well you won't be able to talk to the people who bled out because they're dead" . Same could be said to those who say a reop wasn't a big deal, well there are certainly some people who didn't make it through the reop who would disagree.
I think a lot of people get defensive because they feel like a big decision they made is being questioned or attacked but it's about helping someone who hasn't made the decision yet make the one that's best for them. Everyone is different but when I came out here going on 3 years ago I was freaked out by my diagnosis and I was given comfort by emotional support from people AND knowledge learned which helped me make a decision.

 

[dick0236]

I just wish everyone could be more open minded and supportive of both options and each other.

"open mindedness" does not include "turning a blind eye" when docs are telling a 27 year old man that "he suggests a mech valve but the patient is advised NOT to engage in riding a bike afterwords". See post #113. What young man (27) would not be dismayed to learn that he won't be able to live a normal life after having a needed surgery?? Riding a bike is a NO NO??......gimme a break! I learned, soon after joining this forum, of the misinformation concerning the "evils of warfarin".......and it often is MISINFORMATION........ frankly, I think it is a copout by many physicians who have little idea on ACT management......I've had a few docs like that......fortunately many younger docs are better equipped to deal with ACT than the "old guys" who practiced medicine as an "art" that only they knew.

BTW, riding a bike is one of the more sedate activities I have done.......without giving my anti-coagulation a second thought.

 

[Duffey]

If I were 27, I'd go mechanical. I'd probably go mechanical at age 40. As it is, I was 52 when I had replacement and I went tissue. I will celebrate my 12th year with the this valve in about five months. I had an echo last month and the cardiologist said the valve still looked "stone cold perfect". Her words. But I was almost twice shah4u's age when I made my choice.

One thing I've never posted on these threads (tissue or mechanical) but I will today is my own personal wish that posters who are new to either warafin management or new to sporting a nonmechanical valve would consider that two or three years with either type of valve does not make one an expert. It's one thing to offer your reasoning behind your choice, but that's about all.

Regarding Mike1959's post, it reflects what he would like to see on this forum. Hank, VR founder, always says that the forum should be open to all points of view. However, it's probably easier to get along with other members if you don't quote them, then disagree with them in your own post. Using profanity at the end of the post won't endear you to members either. At least not me.

 

[neil]

agree duffy and cldlhd you know its gonna end in everybody having a dig all and sundry, shame really,

 

[pellicle]

Hi

..., it reflects what he would like to see on this forum. Hank, VR founder, always says that the forum should be open to all points of view. However, it's probably easier to get along with other members if you don't quote them, then disagree with them in your own post. Using profanity at the end of the post won't endear you to members either. At least not me.

agreed ... actually I prefer to address the asker and not to engage in fights with other respondents (I admit I'm guilty of breaking my own preferences from time to time ... I am human {despite the rumours}).

I feel that If (fictitious names) Billy asks a question and Bobby answers and then Jimmy answers with a different view there is no need for Bobby and Jimmy to argue it out.

Such simply chases away / scares off the question asker (BIlly)

If anyone seeks clarification on opinions offered to answer Billy then it should be in consideration of their evidence. Don't shoot the messenger.

There is sufficient complexity in things for there to be no simple answers. My own position is well know, however its clear if anyone follows my posts that I do indeed suggest tissue valves to people who are younger if there are reasons (co-morbidities, AC therapy compliance doubts, desires for having children ...). The main thing for all who answer Billy is to answer for Billy's needs ... not to project their own decisions made.

Shalom

(PS: Billy and Bobby are both gender neutral names)

 

[Agian]

I think a lot of people get defensive because they feel like a big decision they made is being questioned or attacked....

Of course, that's a real risk. That's why it's important for us to be objective, empathic and sincere.

 

[ashadds]

One of the few questions that I personally have and asked a lot is ...I am a person with a moderate level of activity which I cherish a lot ( walking , cycling , swimming)....The cardinal interests in my life are travel and trying different foods and cuisine... Is such a thing like world tour and frequent travel even possible with warfarin ?

A critical example is my job is in the US and my home in India and I would travel a lot between home and job . How do I survive ACT when I live 6 months in US and 6 months in India as an example

 

[pellicle]

Hi

One of the few questions that I personally have and asked a lot is ...I am a person with a moderate level of activity which I cherish a lot ( walking , cycling , swimming)....The cardinal interests in my life are travel and trying different foods and cuisine... Is such a thing like world tour and frequent travel even possible with warfarin ?

there is zero problem with that ... I've answered this question here many times. I regularly travel and spend time in different countries. I recently moved from Australia to Finland ... it is a myth that changes in food will make any significant alteration to your INR, and even if it does, because you will have your own tester (discussed below) just like a diabetic you prick your finger and test and then decide on your dose. Unlike a diabetic who does this many times in a day, you'll do it only once a week.

I have even posted this link of a woman who climbed Mt Everest with a mechanical valve and of course on AC

http://www.valvereplacement.org/for...014-veronika-meyer-climbs-mt-everest-post-avr

A critical example is my job is in the US and my home in India and I would travel a lot between home and job . How do I survive ACT when I live 6 months in US and 6 months in India as an example

I move between Australia and Finland. I own a coagucheck XS which is a tool to measure my INR , it is like you are a melodrama specialist "how will I survive ACT" ... as you have seen here all of us on AC don't just "survive" we live normal lives, lives that are 99% uneffected by AC Therapy

I have given you blog posts of instructions and offered personal help to you. I have contacted you and offered to talk to you on the phone. You have not responded.

If you actually want discussion and answers then read your personal messages and contact me by skype or simply read my blog posts that I have put here. (and will now put here again).

http://cjeastwd.blogspot.com/2014/09...ng-my-inr.html

http://cjeastwd.blogspot.com/2015/10...r-example.html

any time you actually want to talk just answer that PM and I'm happy to call you to discuss in person