Mechanical vs Tissue - need help deciding

[Superman]

Bottom line is, nobody has a great choice. It’s the lesser of two evils regardless of who you are.

For me, having had open heart surgery twice (once for valve, once for aneurysm), I know first hand what it’s like. Having lived with a mechanical valve and warfarin for 31 years now ( and I’m still in my 40’s); I also know first hand what that’s like.

Given the choice - I take living without more open heart surgeries. If I can minimize that, a little ticking and taking a pill is a small price to pay.

Recovering wasn’t fun when I had just turned 18. It was even worse when I was 36. As I approach 50, I can’t imagine a third. They already had trouble with the second OHS due to scar tissue. Took far longer to saw through the bone. I was in the OR for close to eight hours and on the machine for quite a bit of that time.

Of course anyone who could pick a tissue valve that would last the rest of their lives would do it. Nobody is suggesting otherwise. When I was 17 back in 1990, that wasn’t even close to an option (I actually turned 18 in the hospital two days after my first surgery). Even if I could know I’d need an aneurysm repair 19 years later, tissue valves in 1990 as a teenager weren’t going to last very long. The aneurysm likely would have been my third. What was available in tissue valves 2009? I’d easily be looking at a fourth in the next couple years. With another 30 years plus normal life expectancy? So a fifth later?

I love me some ticking and warfarin!

Consider as well @pellicle, who was around the age I am now for his third open heart. Totally get why he went mechanical after a repair and a homograft. Three’s enough I’m sure.

You’re a rookie who’s likely at an age (66?) where a tissue valve will get you pretty close to a quality of life vs quantity debate that makes sense. But that’s a different decision than many are faced with. Your view on this appears to be rather myopic.

 

[le19555]

To anyone trying to decide what type of valve to get, just make sure you look at all the pros and cons of every valve then make your decision. Don’t ever look through the lense of rose colored glasses but remember that once the surgery is done you must live with your choice. I think many of us come here seeking validation for the choice we have made or going to make but the bottom line is that none of us had a choice as to whether to have surgery or not. So every choice was a better choice than the alternative. Tissue valves on average do not last as long as mechanical valves but they have other pros. It does not mean you are going to die when the valve wears out, be it 30 years or 10 years from your implantation. Mechanical valves also can malfunction, can be noisey and require a lifetime of blood thinners but you will probably never need another surgery. I am 66 and was convinced I was going mechanical but knowing me I could not have stayed sane hearing a valve ticking inside me. Others are built in such a way that they do t hear the noise or it doesn’t bother them. Either option will extend your life potentially for a very long time even if you require another surgery or tavr down the road. Lastly all of us will die one day and the important thing is that we live each day to the fullest. Your opinions matter as do mine. Don’t allow anyone to attempt to silence you.

 

[pellicle]

Three’s enough I’m sure.

indeed, and having had some experience in what scar tissue is like (in animals) knew what he meant when he said "surgeons will not be lining up behind you for your 4th"

I had a wife to consider too, and I didn't want to make her live with knowing it would happen again in my later years.

 

[pellicle]

To anyone trying to decide what type of valve to get, just make sure you look at all the pros and cons of every valve then make your decision.

well said ... look it in the mouth and check all its teeth.

Don’t ever look through the lense of rose colored glasses but remember that once the surgery is done you must live with your choice.

exactly!

Don’t allow anyone to attempt to silence you.

nobody here ever has ... but you still haven't mentioned your age.

 

[Superman]

indeed, and having had some experience in what scar tissue is like (in animals) knew what he meant when he said "surgeons will not be lining up behind you for your 4th"

I had a wife to consider too, and I didn't want to make her live with knowing it would happen again in my later years.

Wife and four young kids when I had my second. I remember my wife telling me about how hard the kids took it watching their dad go through that. Would not want to do that to them again. They’re older now (and there are five of them) - but just the same. And how much that left to my wife to manage the house during that time.

 

[le19555]

Also it is not factual that the newer valves or even the older tissue valves will begin to decline at 10 years. The Edward’s Resillia Inspiris has a projected lifespan of 25-30 years. You may doubt that but that’s what the reputable company that manufactured the valve states. Also many many people have 15 plus years with the old pig valve. The valve I chose was the former as I loved the idea of a tissue valve with really good longevity expectations.

 

[le19555]

I have a wife too and she was dead against a mechanical valve because of the reasons I already stated.

 

[le19555]

I’m glad we had this discussion may you all have long, healthy and fulfilling lives. God bless.

 

[pellicle]

I have a wife too and she was dead against a mechanical valve because of the reasons I already stated.

apparently I missed you had posted your age, so as I said earlier:

As I keep saying "parameters" matter. As you have no information in your bio one has to guess, but if you were born in 1955 then I'd hazzard that you would be well served by a tissue, which when it goes into SVD may be a candidate for TAVR ... I would check the table posted earlier about the candidates suitable for that.

so much for koomby-ya brother

 

[pellicle]

I’m glad we had this discussion may you all have long, healthy and fulfilling lives. God bless.

you too

 

[pellicle]

Also it is not factual that the newer valves or even the older tissue valves will begin to decline at 10 years.

some evidence to the contrary was provided (but I guess you didn't read that)

The Edward’s Resillia Inspiris has a projected lifespan of 25-30 years. You may doubt that but that’s what the reputable company that manufactured the valve states. Also many many people have 15 plus years with the old pig valve. The valve I chose was the former as I loved the idea of a tissue valve with really good longevity expectations.

even more a reasonable choice now that I know your age.

Were you 48 and your wife younger than that, and had you already had two operations I suspect you may have seen things my way.

But as I already suggested, you probably can't see outside your situation and assume everyone is facing your decisions.

Best wishes

 

[le19555]

Bottom line is, nobody has a great choice. It’s the lesser of two evils regardless of who you are.

For me, having had open heart surgery twice (once for valve, once for aneurysm), I know first hand what it’s like. Having lived with a mechanical valve and warfarin for 31 years now ( and I’m still in my 40’s); I also know first hand what that’s like.

Given the choice - I take living without more open heart surgeries. If I can minimize that, a little ticking and taking a pill is a small price to pay.

Recovering wasn’t fun when I had just turned 18. It was even worse when I was 36. As I approach 50, I can’t imagine a third. They already had trouble with the second OHS due to scar tissue. Took far longer to saw through the bone. I was in the OR for close to eight hours and on the machine for quite a bit of that time.

Of course anyone who could pick a tissue valve that would last the rest of their lives would do it. Nobody is suggesting otherwise. When I was 17 back in 1990, that wasn’t even close to an option (I actually turned 18 in the hospital two days after my first surgery). Even if I could know I’d need an aneurysm repair 19 years later, tissue valves in 1990 as a teenager weren’t going to last very long. The aneurysm likely would have been my third. What was available in tissue valves 2009? I’d easily be looking at a fourth in the next couple years. With another 30 years plus normal life expectancy? So a fifth later?

I love me some ticking and warfarin!

Consider as well @pellicle, who was around the age I am now for his third open heart. Totally get why he went mechanical after a repair and a homograft. Three’s enough I’m sure.

You’re a rookie who’s likely at an age (66?) where a tissue valve will get you pretty close to a quality of life vs quantity debate that makes sense. But that’s a different decision than many are faced with. Your view on this appears to be rather myopic.

Bottom line is, nobody has a great choice. It’s the lesser of two evils regardless of who you are.

For me, having had open heart surgery twice (once for valve, once for aneurysm), I know first hand what it’s like. Having lived with a mechanical valve and warfarin for 31 years now ( and I’m still in my 40’s); I also know first hand what that’s like.

Given the choice - I take living without more open heart surgeries. If I can minimize that, a little ticking and taking a pill is a small price to pay.

Recovering wasn’t fun when I had just turned 18. It was even worse when I was 36. As I approach 50, I can’t imagine a third. They already had trouble with the second OHS due to scar tissue. Took far longer to saw through the bone. I was in the OR for close to eight hours and on the machine for quite a bit of that time.

Of course anyone who could pick a tissue valve that would last the rest of their lives would do it. Nobody is suggesting otherwise. When I was 17 back in 1990, that wasn’t even close to an option (I actually turned 18 in the hospital two days after my first surgery). Even if I could know I’d need an aneurysm repair 19 years later, tissue valves in 1990 as a teenager weren’t going to last very long. The aneurysm likely would have been my third. What was available in tissue valves 2009? I’d easily be looking at a fourth in the next couple years. With another 30 years plus normal life expectancy? So a fifth later?

I love me some ticking and warfarin!

Consider as well @pellicle, who was around the age I am now for his third open heart. Totally get why he went mechanical after a repair and a homograft. Three’s enough I’m sure.

You’re a rookie who’s likely at an age (66?) where a tissue valve will get you pretty close to a quality of life vs quantity debate that makes sense. But that’s a different decision than many are faced with. Your view on this appears to be rather myopic.

Remember that the ticking noise may not be an issue for you but I’ve read comments from people who said the mechanical valve had ruined their social life because of the noise. Again let’s present ALL of the information not just one’s opinion.

 

[Superman]

Remember that the ticking noise may not be an issue for you but I’ve read comments from people who said the mechanical valve had ruined their social life because of the noise. Again let’s present ALL of the information not just one’s opinion.

We all just share our own experiences here. And my experiences are fact as I experienced them. Pretty much all of my life experience is post mechanical valve / ticking. I started ticking in high school. Perhaps I’m a bit ignorant, I can’t fathom how that would possibly ruin a social life. I would suggest counseling. Sounds like more issues than a ticking valve.

 

[Warrick]

Getting a bit heated there peoples...
I've posted on here several times the worst part of the whole valve thing to me is the ticking and I would quite happily take warfarin for ever if it meant a tissue valve that lasted forever.
I've yet to read of an actual minacious side effect of warfarin itself, I mean there's the bleeding issues and the clot issues but as we all know if it is managed correctly(and it is NOT that hard to DIY), its a pretty benign medication and does what it says on the tin.
I have read many "bad" warfarin management stories on other sites (and tried to help where I could) and when you get down to the guts of it simply its poor management, even severely fluctuating INRs seem to come down to some of the ridiculous dosing methods like huge differences in doses each day.
My father had a mechanical implanted in 1984 that never missed a beat until his death from cancer earlier this year, and he went that whole time with monthly blood draws and a below average level of management without incidence. I know he didn't dwell on the sound but he did obsess his hair was going to all fall out for a bit there.....

I am pretty sure most if not all mech valvers if they had a choice would chose a quiet valve, but then there are those lucky enough not to hear it... oh and then of course there have been the tissue valvers on here complaining they can hear their tissue valve... so even tissue is NOT guaranteed to be silent.... and then there's the risk of having afib after OHS not matter what contraption they put in there..

The Edwards valve is definitely a cool option now and I sincerely hope it lives up to expectations, I bet back in 1984 they were wanking on how long mechanicals last blah blah and what do you know they were bang on!!!
My moneys still on the biopolymer valves like Foldax clearing the field.

 

[Warrick]

Funny how the OP hasn't been on here since June 2019... I wonder what they chose....

 

[Michael O]

I've yet to read of an actual minacious side effect of warfarin itself,

There's some significant data indicating that specific SSRI's, SNRI's and some hormonal contraceptives don't play nice with warfarin. (I can post links, but honestly, 30 seconds of googling will get you there.) These can be absolute dealbreakers for some patients.

No matter how much we say it here on the boards, warfarin management isn't easy, for a number of reasons. Estimates for 5 year schedule adherence for VKAs range from 40-60%. There's reasons for that. Warfarin dosage compliance is *straightforward*, but not *easy*, and definitely not trivial. (There is also the matter of the number of patients who have high VKA adherence, but low INR range compliance. (I have my own theories about this, but no matter.)) To be fair, Warrick, these are not mendacious side effects, just cautionary tales.

Lastly, if you are a person expecting to face a series of major invasive surgeries, the case for a mechanical valve + anti-coagulants for life is less clear.

I'll never say that warfarin is a bad medicine, but I believe that in general, these boards trivialize the case for bio valves. All respect to everyone who chose either path.

 

[dick0236]

Also it is not factual that the newer valves or even the older tissue valves will begin to decline at 10 years. The Edward’s Resillia Inspiris has a projected lifespan of 25-30 years. You may doubt that but that’s what the reputable company that manufactured the valve states. Also many many people have 15 plus years with the old pig valve. The valve I chose was the former as I loved the idea of a tissue valve with really good longevity expectations.

le 19555.......I do hope you get 25-30 years out of your new Edwards Inspiris tissue valve. I remember when I got my Edwards "ball-in-cage" mechanical valve that the surgeon said the valve was tested to last 50 years.....and it did....and is still going strong. The Edwards Lifesciences Co. (designer of both of our valves) has been a leading innovator in solving heart and related issues since the beginning.

However, your bashing of mechanical valves seems to be an effort of convincing yourself that you made the best decision. You made a good decision to have the problem "fixed". If, or when, you have to have a redo down the road your choices will be different from those of today.......but just as perplexing.

PS: I did offer my story to Edwards for publication in their marketing magazine. Can you believe that they never responded? Must have been something about mechanical valves lasting so long

 

[Warrick]

Thanks @Michael O
Ok but isn't what you are saying regarding the antidepressants and contraceptives being an interaction of rather than a side effect of?

I think or maybe rather muse that maybe a doctor managing multiple patients on warfarin would say warfarin management is not easy but if one of those multiple patients that is hard to manage or keep in range had their own POC device and a bit of knowledge they would do far better staying in range.
I would certainly like to think warfarin compliance is easy given the possible adverse affects of noncompliance, if not people are not getting the right information, there is certainly a herd or blanket way of thinking to management, in NZ the last figure I read was 38,000 people in the country on warfarin, whereas in many other countries the numbers are probably at least double that and that's in one city. But yep people just don't want to know.

 

[Warrick]

And then I bet say with an interaction between warfarin and antidepressants that goes in the basket of warfarin side effects rather than the antidepressant side effects basket.

 

[pellicle]

Hi

There's some significant data indicating that specific SSRI's, SNRI's and some hormonal contraceptives don't play nice with warfarin. (I can post links, but honestly, 30 seconds of googling will get you there.) These can be absolute dealbreakers for some patients.

last I looked a female of the age of childbearing is typically swung away from a mechanical anyway, which would suggest is prudent.

No matter how much we say it here on the boards, warfarin management isn't easy, for a number of reasons. Estimates for 5 year schedule adherence for VKAs range from 40-60%. There's reasons for that.

well those figures are correct and in my view are strongly related to the people and the system. I see far less of that sort of data in studies of anyone doing self testing and self administration.

Indeed this is why I advocate for testing and why I help people who are having trouble.

I have not yet once had a case where anyone I teach to self manage hasn't.

Warfarin dosage compliance is *straightforward*, but not *easy*, and definitely not trivial. (There is also the matter of the number of patients who have high VKA adherence, but low INR range compliance.

my door is open to you if you are having trouble with range compliance.

Lastly, if you are a person expecting to face a series of major invasive surgeries, the case for a mechanical valve + anti-coagulants for life is less clear.

true, but as we've also discussed here that's not impossible and if its the case you know you're going to have these "serious of major invasive surgeries" then you should steer away from warfarin ... call that "contra indicated".

However can you give me some idea of who these people are and just what a "series of major invasive surgeries" is and why given the examples or procedural management I've offered here in the past it would be "less clear" what to do (or even dificult to do).

I'll never say that warfarin is a bad medicine, but I believe that in general, these boards trivialize the case for bio valves. All respect to everyone who chose either path.

I'd be very surprised to see any discussion that trivialised the case, can you find one please?