Mechanical vs Tissue - need help deciding

[Chuck C]

I wish I had discovered this forum when I had time to consider options. I already had my surgery this past June (2021) but I am posting this only to emphasize how valuable this forum is. It has been interesting reading about experiences and reasons behind choices made.

I have been fortunate to be reasonably healthy and strong. Something serious like open heart surgery was new to me. It all came fast. After about 2 months of symptoms which were not eliminated with normal adjustments I saw a doctor. It was either physical or more disciplinary (lack of proper rest). Symptoms pointed to a heart condition. After an initial echocardiogram I was immediately referred to a cardiologist and told a valve replacement was inevitable and within a couple months.

As the options were described the dangers of Coumadin stood out as the greatest threat. How naive. I had yet to go through open heart surgery but that was not the concern at that time. My biggest concern was being able to arrange and manage everything on my own from beginning to end. Up to the final moments before I was knocked out I never got nervous about the surgery. Getting through the surgery was nothing if I could get that far.

You would think I would opt for the one time shot through the mechanical valve option. Maybe my situation is so unique it is not useful to hear. My big concern was not the surgery itself or even the recovery from it. It was managing everything on my own. At that time I perceived a life on blood thinners as a life ever at risk of stroke so I chose the biological valve and consequently to have at least two open heart surgeries in my lifetime (I was 62 at the time of the surgery). I would accept the surgeries but I was not considering the logistics.

Having experienced the surgery, (more specifically the recovery in the hospital), I would not make the same choice. My experiences in the hospital were some of the worst things I had experienced in my life. It was the people and the environment. The good could not counter the negative. Far from healing it was a toxic environment and my needing to be sparkling clear before I could be released, given my solitary lifestyle, made me an inconvenience to some nurses. The experience was so miserable I would rather live susceptible to a stroke than go through the hospital process again. I look forward to truly minimally invasive advancements.

Thank you for sharing your story and your thoughts on valve choice Michael. I'm sorry that your hospital experience was not a good one. Like Crooser and Keithl, I had a very good experience in the hospital. I had my procedure at UCLA.

If you feel comfortable sharing, it would be good to know the name of the clinic and any specifics that you were unhappy about. You might also consider writing a letter to the hospital administrator about your experience. There is no certainty that they will pay attention to your concerns, but without feedback it is unlikely that things will change.

I appreciate you being honest about how you feel about valve choice. At 53, I felt that the mechanical valve was the right choice for me. I still feel that I made the right decision, but at the same time, the thought has crossed my mind that the surgery and recovery went so well that if I had to do this again it would not be that big of a deal. Although, each time they go back in does carry a little more risk due to scar tissue and the fact that one is older.

At 62, the guidelines indicate that either tissue or mechanical valve are reasonable choices. I tend to agree. If I was 62 and it was my first surgery, I can't say for certain, but I very well might have chosen tissue. There are pros and cons of either decision. The best thing to do now is to not look back and just live the best life that you can, enjoying every moment of the precious time we have here.

As others have suggested, I would definitely plan ahead to have my next surgery at a top rated facility. I am fortunate in that I live just 2 hours from one of the top ranked clinics in the nation. It is a big enough deal that it is worth travelling if your local area does not offer top rated institutions.

For now, the best course of action is to live a healthy lifestyle. There was one study which showed that having uncontrolled blood pressure, excessive weight and insulin resistance led to quicker SVD (structural valve deterioration) for prosthetic tissue valves. So, taking steps to stay in the ideal zone in these categories would be one positive step you could take to increase the likelihood that your valve will last longer, which would mean regular exercise and healthy eating- basically the things that keep us in general good health anyway. This will also help you go into your next procedure in the best condition possible. Hopefully that day will be many many years away.

 

[pellicle]

Hi

(I was 62 at the time of the surgery).

well soon enough your experience will be in the rear view mirror, and to my mind you have not made any sort of bad choice in the valve you've chosen (been given?). Were you 42 I would respond differently.

I'd expect you to get another 12 or so years from that new valve making you 74 (or older) and even then its entirely possible you won't need another OHS.

Best Wishes

 

[tom in MO]

I wish I had discovered this forum when I had time to consider options. I already had my surgery this past June (2021) but I am posting this only to emphasize how valuable this forum is. It has been interesting reading about experiences and reasons behind choices made.

I have been fortunate to be reasonably healthy and strong. Something serious like open heart surgery was new to me. It all came fast. After about 2 months of symptoms which were not eliminated with normal adjustments I saw a doctor. It was either physical or more disciplinary (lack of proper rest). Symptoms pointed to a heart condition. After an initial echocardiogram I was immediately referred to a cardiologist and told a valve replacement was inevitable and within a couple months.

As the options were described the dangers of Coumadin stood out as the greatest threat. How naive. I had yet to go through open heart surgery but that was not the concern at that time. My biggest concern was being able to arrange and manage everything on my own from beginning to end. Up to the final moments before I was knocked out I never got nervous about the surgery. Getting through the surgery was nothing if I could get that far.

You would think I would opt for the one time shot through the mechanical valve option. Maybe my situation is so unique it is not useful to hear. My big concern was not the surgery itself or even the recovery from it. It was managing everything on my own. At that time I perceived a life on blood thinners as a life ever at risk of stroke so I chose the biological valve and consequently to have at least two open heart surgeries in my lifetime (I was 62 at the time of the surgery). I would accept the surgeries but I was not considering the logistics.

Having experienced the surgery, (more specifically the recovery in the hospital), I would not make the same choice. My experiences in the hospital were some of the worst things I had experienced in my life. It was the people and the environment. The good could not counter the negative. Far from healing it was a toxic environment and my needing to be sparkling clear before I could be released, given my solitary lifestyle, made me an inconvenience to some nurses. The experience was so miserable I would rather live susceptible to a stroke than go through the hospital process again. I look forward to truly minimally invasive advancements.

I've had 5 surgeries over 26 years at an excellent hospital and know what you mean. Every one had its problems. The OHS strangely was the best, most likely due to the assembly line approach. Hospitals are full of disease by nature thus avoidance is just being prudent. That's why I chose mechanical...to limit the surgical risk, my time in the hospital and not miss again 6-10 weeks of life with a few months of recovery.

Take heart, your tissue valve could last 20+ years and you could die at the hands of a jealous husband at age 82

 

[David W]

Do the reading, watch the videos, speak to others (Including your GP) and go with your gutt feeling. I am an active outdoors person and
went with the tissue valve. Feeling great!

 

[Redone]

Hello All! I'm new here a personal trainer. After being offered the Ross Procedure I have decided against it and am going with a tissue valve. I am very active, a former figure competitor, hike 4k's in New Hampshire and do a lot of resistance training. Valve choice is a confusing process in my opinion. I haven't had the surgery yet, but am completely dreading it! I don't like taking time away from my clients, working out (also not a huge fan of cardio other than hiking). I probably should have put this comment under another thread, but I hope someday advancements in this procedure will go far beyond the TAVR! It seems like we should be way ahead now. My biggest fear is the healing of the Sternotomy and possibly having future limitations to getting back in shape i.e. pull ups, bench press, tricep extensions, etc.

 

[Keithl]

Here are 6 months and 18 months. I had a full crack and mechanical and aortic graft. If you take care of your chest during the first 12 weeks it is like nothing happened.

I was told to baby it for 6 weeks, no driving even. I made sure not do anything that would put pressure on my check. At the end of 6 weeks you are about 80%+ healed and the remaining healing is over the following 6 weeks. Other than a faint hint of the scar remaining I am 100% or more than I was before. Dont; worry about it, just take care of your chest and then it is like it never happened.

 

[Michael O]

Hello All! I'm new here a personal trainer. After being offered the Ross Procedure I have decided against it and am going with a tissue valve. I am very active, a former figure competitor, hike 4k's in New Hampshire and do a lot of resistance training. Valve choice is a confusing process in my opinion. I haven't had the surgery yet, but am completely dreading it! I don't like taking time away from my clients, working out (also not a huge fan of cardio other than hiking). I probably should have put this comment under another thread, but I hope someday advancements in this procedure will go far beyond the TAVR! It seems like we should be way ahead now. My biggest fear is the healing of the Sternotomy and possibly having future limitations to getting back in shape i.e. pull ups, bench press, tricep extensions, etc.

Similar situation - I'm an active person who just never could bring myself to do lots of treadmill/running/bicycle type cardio, but effectively did it as part of my regular activities. A tissue valve replacement and other repairs were done 8/9/21. I've had knee, hip and 2 very bad shoulder injuries and I know very well how I heal. At about 6 weeks out, I can tell you that the single biggest thing you can do to speed your recovery is to slow your recovery.

Other people on the boards can testify, but until you've lived through it, you won't get a sense for how much your body will self-regulate your efforts to force it back to it's pre-surgery activity level. At this point, I'm convinced that getting back to pre-surgery lifting/activity levels is very possible within a year IF you take your time. If one of your clients got into a car accident, you'd tell them to pay attention to how their body will splint itself around to protect the injured part and expect that your body will generate back, hip, neck, shoulder pain as it tries to protect that damaged sternum. Be ok with that. Do your stretches, take your time. NH is beautiful, hiking will be great cardio and a great way to re-condition your body symmetrically. (IMO, unless you're VERY careful, the tendency is for most resistance exercise is that you favor your strong side. ) Even if your BP 1RM is half what it used to be...you're above ground. Get clear on what's important. Dead guys can't train.

Lastly, re: dreading the procedure - it's important to separate the urgency of the procedure with the difficulty of the procedure. Yep, it's a massively invasive/disruptive thing, but thousands of them are done every year, and depending on the hospital, they've seen and solved every variation that can come up. OHS at a good facility is a solved problem. If you're basically in good shape going in, and it sounds like it, the one thing you can do to aid your recovery is take your time.

Good luck, and let us know how things are going.

 

[Redone]

Here are 6 months and 18 months. I had a full crack and mechanical and aortic graft. If you take care of your chest during the first 12 weeks it is like nothing happened.

I was told to baby it for 6 weeks, no driving even. I made sure not do anything that would put pressure on my check. At the end of 6 weeks you are about 80%+ healed and the remaining healing is over the following 6 weeks. Other than a faint hint of the scar remaining I am 100% or more than I was before. Dont; worry about it, just take care of your chest and then it is like it never happened.

View attachment 888118View attachment 888119

Thank you for sharing your experience! It helps to know healing went well while you protected your chest, took time for recovery and now looking like nothing happened! It's always nice to hear those positive experiences!

 

[Redone]

Similar situation - I'm an active person who just never could bring myself to do lots of treadmill/running/bicycle type cardio, but effectively did it as part of my regular activities. A tissue valve replacement and other repairs were done 8/9/21. I've had knee, hip and 2 very bad shoulder injuries and I know very well how I heal. At about 6 weeks out, I can tell you that the single biggest thing you can do to speed your recovery is to slow your recovery.

Other people on the boards can testify, but until you've lived through it, you won't get a sense for how much your body will self-regulate your efforts to force it back to it's pre-surgery activity level. At this point, I'm convinced that getting back to pre-surgery lifting/activity levels is very possible within a year IF you take your time. If one of your clients got into a car accident, you'd tell them to pay attention to how their body will splint itself around to protect the injured part and expect that your body will generate back, hip, neck, shoulder pain as it tries to protect that damaged sternum. Be ok with that. Do your stretches, take your time. NH is beautiful, hiking will be great cardio and a great way to re-condition your body symmetrically. (IMO, unless you're VERY careful, the tendency is for most resistance exercise is that you favor your strong side. ) Even if your BP 1RM is half what it used to be...you're above ground. Get clear on what's important. Dead guys can't train.

Lastly, re: dreading the procedure - it's important to separate the urgency of the procedure with the difficulty of the procedure. Yep, it's a massively invasive/disruptive thing, but thousands of them are done every year, and depending on the hospital, they've seen and solved every variation that can come up. OHS at a good facility is a solved problem. If you're basically in good shape going in, and it sounds like it, the one thing you can do to aid your recovery is take your time.

Good luck, and let us know how things are going.

Thank you for sharing this Michael! I have had other injuries as well including the possibility of future hip replacement. Even though I consider myself an athlete I don't train with as heavy resistance as I used to. As you know once the foundation is built, it takes a bit less to maintain. I am a bit concerned about losing it all, but I'd much rather lose a lot of muscle mass than die. It's very difficult as you know to experience very few symptoms, being very fit and then having this procedure weighing on you. I've heard about patients experiencing pain in other areas of the body as a result of OHS and it's discouraging honestly. In fact, I've had to stop reading posts on various social media platforms because so many people simply want to complain about the horrible aspects of OHS. I'm going in expecting the worst and praying my low expectations end up better than I anticipated. Mentally sitting still, feeling like and 80 year old and struggling to get back to me will be one of my greatest battles. I'm going to put up a fight though!

 

[dick0236]

I anticipated. Mentally sitting still, feeling like and 80 year old and struggling to get back to me will be one of my greatest battles. I'm going to put up a fight though!

Hi Redone and welcome to a POSITIVE THINKING forum. OHS is not an end of the world experience. If you are like most you will come thru it OK and will be back to living YOUR life in a short time.

PS: At 80 I was still playing golf and going to a gym on a regular basis several times a week.......now at almost 86 I am slowing down and no longer clean the leaves out of my gutters.....when you reach my age you no longer bounce when you fall. It's hell to get old.......but it does beat the alternative

 

[Redone]

Hi Redone and welcome to a POSITIVE THINKING forum. OHS is not an end of the world experience. If you are like most you will come thru it OK and will be back to living YOUR life in a short time.

PS: At 80 I was still playing golf and going to a gym on a regular basis several times a week.......now at almost 86 I am slowing down and no longer clean the leaves out of my gutters.....when you reach my age you no longer bounce when you fall. It's hell to get old.......but it does beat the alternative

 

[Redone]

Hi Dick,

I hope I didn't offend as it wasn't my intention. I don't consider this a positive thinking forum as much as a place to be free to share how we feel, our experience, etc. I require OHS for a Bicuspid Aortic Valve, Aortic Aneurysm and Anomalous Coronary Artery. I was born with these issues and I don't know how you feel at 86 (my dad is 85 and still exercises), but this is difficult in my opinion no matter what your age. At 54 it's hard to go from few symptoms, extremely athletic, hiking every weekend to being concerned about all the uncertainty of OHS, choosing heart valves and hoping they last so OHS doesn't need to be repeated. I have a lot of faith things will go well.

 

[dick0236]

Hi Dick,

I hope I didn't offend as it wasn't my intention............... At 54 it's hard to go from few symptoms, extremely athletic, hiking every weekend to being concerned about all the uncertainty of OHS, choosing heart valves and hoping they last so OHS doesn't need to be repeated. I have a lot of faith things will go well.

No offense taken. OHS is a BIG deal regardless of age.....but especially so if you are young.....been there, done that. Read thru the many stories on this forum and hopefully, that will put your fears into their proper perspective.

 

[tom in MO]

Hello All! I'm new here a personal trainer. After being offered the Ross Procedure I have decided against it and am going with a tissue valve. I am very active, a former figure competitor, hike 4k's in New Hampshire and do a lot of resistance training. Valve choice is a confusing process in my opinion. I haven't had the surgery yet, but am completely dreading it! I don't like taking time away from my clients, working out (also not a huge fan of cardio other than hiking). I probably should have put this comment under another thread, but I hope someday advancements in this procedure will go far beyond the TAVR! It seems like we should be way ahead now. My biggest fear is the healing of the Sternotomy and possibly having future limitations to getting back in shape i.e. pull ups, bench press, tricep extensions, etc.

It sounds like you made your choice but want affirmation it is correct. Both paths, mechanical and tissue are paths to life. There is not a wrong choice.

My surgeon and cardio told me to choose valve type based upon current technology. Do not make your choice based upon hope for the future to bring different technology. Even now, TAVR is not for all patients who need a replacement for their worn out tissue valve. TAVR is by the very nature of the technique a smaller valve.

At age 55 with a tissue valve, you will have valve deterioration that will result in a reoperation. When this happens depends upon things out of your control and beyond the ken of modern medicine. Modern medicine will tell you when it's needed through routine surveillance, but modern medicine can only about 1-2 years into the future.

You're worried about your sternum. It will be as strong or stronger than before. It takes about 6 months to fully heal if you are into heavy weight lifting or hard manual labor. Some doctors limit driving, others don't see the risk of an airbag deployment as very high and it happens even if you are a passenger. I could drive as soon as I was off narcotic painkillers, about 2 weeks after discharge.

When choices are hard, that usually means both paths have merit and there is no inherently wrong path.

 

[pekster11]

Hi Dick,

I hope I didn't offend as it wasn't my intention. I don't consider this a positive thinking forum as much as a place to be free to share how we feel, our experience, etc. I require OHS for a Bicuspid Aortic Valve, Aortic Aneurysm and Anomalous Coronary Artery. I was born with these issues and I don't know how you feel at 86 (my dad is 85 and still exercises), but this is difficult in my opinion no matter what your age. At 54 it's hard to go from few symptoms, extremely athletic, hiking every weekend to being concerned about all the uncertainty of OHS, choosing heart valves and hoping they last so OHS doesn't need to be repeated. I have a lot of faith things will go well.

before my surgery in April i was very active..I actually ran 10km 2 days before the operation.
now 5 months after, i am back to running 10km...

if you are in good shape before surgery your body should be able to cope and heal remarkably quickly

 

[Redone]

No offense taken. OHS is a BIG deal regardless of age.....but especially so if you are young.....been there, done that. Read thru the many stories on this forum and hopefully, that will put your fears into their proper perspective.

Thank you! I definitely will read the stories. When did you have your first OHS?

 

[Redone]

It sounds like you made your choice but want affirmation it is correct. Both paths, mechanical and tissue are paths to life. There is not a wrong choice.

My surgeon and cardio told me to choose valve type based upon current technology. Do not make your choice based upon hope for the future to bring different technology. Even now, TAVR is not for all patients who need a replacement for their worn out tissue valve. TAVR is by the very nature of the technique a smaller valve.

At age 55 with a tissue valve, you will have valve deterioration that will result in a reoperation. When this happens depends upon things out of your control and beyond the ken of modern medicine. Modern medicine will tell you when it's needed through routine surveillance, but modern medicine can only about 1-2 years into the future.

You're worried about your sternum. It will be as strong or stronger than before. It takes about 6 months to fully heal if you are into heavy weight lifting or hard manual labor. Some doctors limit driving, others don't see the risk of an airbag deployment as very high and it happens even if you are a passenger. I could drive as soon as I was off narcotic painkillers, about 2 weeks after discharge.

When choices are hard, that usually means both paths have merit and there is no inherently wrong path.

Hi Tom,

Thank you for your response. I feel pretty good about my decision going with a tissue valve. It was either tissue or Ross for me. I couldn't wrap my head around the Ross Procedure though. It seemed crazy to mess with a valve that was in good condition to repair the Aorta.

I hope the Sternum fuses and I plan to do whatever it takes to ease back into weight training. We do a lot of hiking as well so hopefully that will be a possibility by summer with a planned surgery of October 26.

I agree there are hard choices because of the good viable options.

 

[Superman]

Hi Tom,

Thank you for your response. I feel pretty good about my decision going with a tissue valve. It was either tissue or Ross for me. I couldn't wrap my head around the Ross Procedure though. It seemed crazy to mess with a valve that was in good condition to repair the Aorta.

I hope the Sternum fuses and I plan to do whatever it takes to ease back into weight training. We do a lot of hiking as well so hopefully that will be a possibility by summer with a planned surgery of October 26.

I agree there are hard choices because of the good viable options.

My most recent surgery was in Mid October 2009. We were in Disney World by Spring Break and had a great time. Don’t know if I was 100%, but we weren’t limited and I rode all the rides the kids did.

 

[dick0236]

........... When did you have your first OHS?

I've only had one OHS......in 1967 when my mechanical valve was implanted......and it's still clickin'.

 

[pellicle]

Hi and welcome

... Valve choice is a confusing process in my opinion.

that it is, put some time into it and read around here and don't feel like you need to make a decision in seconds.

I haven't had the surgery yet, but am completely dreading it!

its a bump in the road but within a few months you'll be back to normal and wondering why you were so concerned

My biggest fear is the healing of the Sternotomy and possibly having future limitations to getting back in shape i.e. pull ups, bench press, tricep extensions, etc.

the bone heals pretty well as long as you follow the guidance of not lifting things during the healing process. Its a thin and flexible bone, and forms a keystone role, so just let it happen and take your time.

I've had 3 (spaced out by some years) and mine's doing fine. I'd rather not have a 4th.