Mechanical valves in elderly patients

[tobagotwo]

If he's already required to take warfarin for something else, then it may make some sense to continue with a new mechanical valve (I would also look to the On-X). There is a slightly greater risk of an uncontrolled brain or GI bleed with the dosage needed for a valve (heightened because of age and because he is prone to it), but it's not a lot. A downside would be that if he were to need another surgery for a different aneurysm, the warfarin would be a complicating factor. He would also be unable to have a catheter-placed valve if needed later, but it would be highly unlikely that a mechanical valve would ever need replacement anyway.

Otherwise, a tissue valve should last a very long time at his age, and if needed, he would be able to have a percutaneous valve placed later, should it wear out on him.

There will likely be at least two antiplatelet therapy drugs (including Pradaxa) in the US for AFib in 2011 (maybe three, as there are two more in trials or presentation). However, the expense is much greater than Coumadin, so there may be some reluctance by insurance companies to cover any of them for a while.

Best wishes,

 

[lcwhitney]

Trust your own instincts My own pulmonic valve ( the lowest pressure valve) lasted less than three months! I barely recovered from my initial surgery before a routine stress test destroyed the valve my doctors thought would last me forever.
Two years after my first surgery my pulmonic tissue valve was replaced with a mechanical valve but, I suffered a disabling stroke during that surgery.

Lettitia

 

[sue943]

If I needed a re-operation now at 63 I would opt for tissue so at 81 I wouldn't hesitate to have tissue.

 

[olefin]

I'm almost 76, if I needed another valve it would probably be a tissue. If I was 10 years younger it would definitely be another mechanical.

Hillary, welcome to the forum. Wishing your husband the very best.

 

[Protimenow]

Pradaxa, I've been told by a meter manufacturer, will cost about $8 a day. I, too, am not sure about an antidote for overdosing.

Compared to the cost of generic warfarin (about a dime or two a DAY), and the ability of most people (either with advice of doctors or anticoagulation clinics, or from dosing charts) to manage their INRs, the question of which medication to take seems to be a no brainer.

Returning to the original topic of this thread -- it sounds like the doctors are on top of things. I have no opinion about tissue versus mechanical.

Good luck with whatever decision you make.