Mechanical vs Tissue - need help deciding

[Holley650]

I'm a 48 year old male; 6'-3" height and 275lb.

I have AVR in my very near future, and need to decide my path forward : Mechanical (On-X) valve or Tissue valve.

I'm very nervous about the prospect of hearing something tick in my chest for the rest of my life.

Is there anyone out there that can shed some light on the noise concern - and perhaps share their experience?

Any feedback / recommendations greatly appreciated


Holley650

(because I feel like I'm having a carburetor serviced on a V-8 engine)

 

[Eva]

Hi Holley650, welcome aboard!

You’ll find MANY previous threads here about valve choice and many different opinions!
My thoughts are that your cardio and your surgeon (if you trust them) will be the best to advise which valve is best for you, as they know your heart’s condition and your overall heath better!
To answer your question about clicking, also some members hear it, others don’t.
I personally have two St. Judes mechanical valves that I very rarely hear! And when I do, it’s comforting not bothersome!

Good luck.

 

[Duffey]

I'm a 48 year old male; 6'-3" height and 275lb.

I have AVR in my very near future, and need to decide my path forward : Mechanical (On-X) valve or Tissue valve.

I'm very nervous about the prospect of hearing something tick in my chest for the rest of my life.

Is there anyone out there that can shed some light on the noise concern - and perhaps share their experience?

Any feedback / recommendations greatly appreciated


Holley650

(because I feel like I'm having a carburetor serviced on a V-8 engine)

Many, many threads on the forum about valve choice and reflect the views and experiences of Vr.com members, but as Eva points out, your cardiologist and surgeon know more about your particular case than any of us. Hopefully you can review and read threads, discuss your options with the surgeon, and then make your decision on valve choice. Whatever choice you make, it will be 100 % right for you. Good luck and best wishes.

 

[pellicle]

Hi

I'm a 48 year old male; 6'-3" height and 275lb.

I have AVR in my very near future, and need to decide my path forward : Mechanical (On-X) valve or Tissue valve.

Any feedback / recommendations greatly appreciated

my thoughts are well described here
https://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
The issue of sound is (like anticoagulants) over blown and in the main more a personal / anatomy / how scar tissue grows issue.

There is less difference between the bileaflet (St Jude, On-X, ATS ...) than you may think.

best wishes

 

[LondonAndy]

I was 49yo when I had my AVR and went with mechanical. For me ticking is only noticeable when I listen for it. I suspect that us beefier guys insulate it a bit.

For me, my primary concern was to minimise the risk of another OHS when in my 60s and weaker. But recently I have read threads here pointing out that being on a blood thinner can cause problems taking some pain killers etc for arthritis, so perhaps not a clear cut decision but I am very happy with mechanical.

 

[pellicle]

.... But recently I have read threads here pointing out that being on a blood thinner can cause problems taking some pain killers etc for arthritis, so perhaps not a clear cut decision ...

agreed, I don't think it is, its always a risk. Equally its always also possible that even when choosing a tissue prosthesis you may end up needing warfarin too ... indeed there is also some evidence that warfarin as you age can also be a good prophylactic in lowering your (natural) tendency to be more prone to a stroke as you age.

Always other angles.

PS, I misread what you said at first and thought you said:

 

[Patrick7651]

I had my AV replacement 2 years ago at 49. I chose a mechanical valve on the basis that I did not want to endure another surgery or possibly two. That along with the accompanied degradation in health leading up to a tissue replacement and subsequent rehab. That being said I can hear my ticking and is both comforting and at times a somber reminder. Taking warfarin is a pain but it is what it is. I have had a few instances where the warfarin has come back to haunt me with treatment for other issues. It does limit my use of my old standbys to treat pain/inflammation but I have dealt with it. To me it still beats the prospect of surgery and rehab at least two more times.

 

[marvsehn]

I have to agree with Patrick. I got my St Jude mechanical 2 1/2 years ago and it is great. I labored to decide what type of valve. Went into surgery thinking bio valve and came out with a mechanical because of size and space. Boy was I happy. As it turns out after the fact (surgery) the most important factor for me was to NEVER go through open hear surgery again. Prior to surgery warfarin was an issue for me but turns out not to be so bad. I do weekly testing and quite easily stay in my 2-3 range. I do miss being able to use anti inflammatory meds. I have a knee issue and some arthritis but Tylenol works ok. I am 68 and plan to live to 100. I consulted two surgeons (Cleveland Clinic and Duke), both were about the patient having significant input on what type of valve. However, when I had surgery at Duke the surgeon made the final decision during surgery. We talked about the options and had a joint plan before going to surgery. I do hear mine a bit at night, in bed, but no one else does, it is not bothersome to me.

 

[zelic]

I agree with the above. Had to make my choice last year at 57 with BAV. Was going with mechanical to lessen any risk of another surgery. Figured at my age tissue valve could last 8-13 years and hoping to live into my 80s might be a total of three procedures. Downside is being on coumadin as I am very active- but planning on getting a home INR monitor and doing the best with it. At last minute I decided to check to see if I had a genetic variant that would increase my sensitivity to coumadin. (known genetic factors include variants in the VKORC1, CYP2C9, CYP4F2 genes, and the rs12777823 variant in the CYP2C gene cluster on chromosome 10). I asked my cardiologist and cardiac surgeon and they both said they do not routinely check as it is very rare ( seen in Asian and eastern European communities) and if one has it they just adjust the dose. I decided to check anyway and found out I did have this variant in the homozygous form - 2 copies of the defective gene. With that I looked up the very few articles available and found that even when the INR is in rage there is a 2+ fold incidence of high-risk bleeding events when having just one of these variant genes. In light of that I went with the tissue valve ( Edwards Resilia Inspiris). Lucky for me as I was on coumadin for 3+ months after my procedure and developed a pericardial effusion that was mostly blood that needed to be surgically removed. Most likely this was due to a mild pericarditis after the surgery which led to small amount of bleeding over time that in the end became a liter of fluid around my heart. Now recovered from the procedure and doing well hoping to get as long as possible with my current tissue valve. Hope this helps -

 

[JWalters]

Echo the comments above about Mechanical Valve. The clicking is present but not a big deal in any way. Also have had zero issues/side effects with warfarin. I've had my On-X 23mm aortic valve since Nov 2017. Mechanical valve is a no-brainer for someone on the younger side and/or active, IMO.

 

[pellicle]

Hi

... At last minute I decided to check to see if I had a genetic variant that would increase my sensitivity to coumadin. (known genetic factors include variants in the VKORC1, CYP2C9, CYP4F2 genes, and the rs12777823 variant in the CYP2C gene cluster on chromosome 10).

I just wanted to say that I think you are the only case of this I've ever heard of "in the wild".

With that I looked up the very few articles available and found that even when the INR is in rage there is a 2+ fold incidence of high-risk bleeding events when having just one of these variant genes

interestingly that's the first I've ever heard of that, instead I've just heard about dose control issues. I wonder if the summary of this is that because clinics fail to follow the intention to treat being INR INR and INR (often instead thinking well other patients take 8mg, so biasing their response to a higer dose) that results in those patients having a higher INR on average and thus an expsoure to a higher bleeding risk?

If you still have any of those links or readings I'd be very appreciative of them.

Thanks for sharing that I've got my morning research topic now

 

[ForeverThankful]

I was 55 when I had my AVR and I went with a mechanical valve, St Jude. I didn't want to go through open heart surgery again.

Warfarin has not been a problem. I have a Coaguchek XS meter and test my INR at home. It's very convenient and I'm always in range.

As far as clicking, I haven't heard a clicking sound.

 

[Superman]

I was 17 and wasn’t given a choice. St Jude mechanical it was. Still had a second open heart at 36 due to an aneurysm. Stuck with what I knew and kept my mechanical valve. Shouldn’t have to dig in there again I hope. This fall will mark 29 and 10 years, respectively.

I tick. Rather loud I think. I’m 6’ 4” and around 205 lbs. Could be my Dacron graft creates an echo chamber. I don’t know. It’s a nice conversation piece and I don’t lose any sleep over it.

 

[zelic]

I agree with the above. Had to make my choice last year at 57 with BAV. Was going with mechanical to lessen any risk of another surgery. Figured at my age tissue valve could last 8-13 years and hoping to live into my 80s might be a total of three procedures. Downside is being on coumadin as I am very active- but planning on getting a home INR monitor and doing the best with it. At last minute I decided to check to see if I had a genetic variant that would increase my sensitivity to coumadin. (known genetic factors include variants in the VKORC1, CYP2C9, CYP4F2 genes, and the rs12777823 variant in the CYP2C gene cluster on chromosome 10). I asked my cardiologist and cardiac surgeon and they both said they do not routinely check as it is very rare ( seen in Asian and eastern European communities) and if one has it they just adjust the dose. I decided to check anyway and found out I did have this variant in the homozygous form - 2 copies of the defective gene. With that I looked up the very few articles available and found that even when the INR is in rage there is a 2+ fold incidence of high-risk bleeding events when having just one of these variant genes. In light of that I went with the tissue valve ( Edwards Resilia Inspiris). Lucky for me as I was on coumadin for 3+ months after my procedure and developed a pericardial effusion that was mostly blood that needed to be surgically removed. Most likely this was due to a mild pericarditis after the surgery which led to small amount of bleeding over time that in the end became a liter of fluid around my heart. Now recovered from the procedure and doing well hoping to get as long as possible with my current tissue valve. Hope this helps -

Hi



I just wanted to say that I think you are the only case of this I've ever heard of "in the wild".



interestingly that's the first I've ever heard of that, instead I've just heard about dose control issues. I wonder if the summary of this is that because clinics fail to follow the intention to treat being INR INR and INR (often instead thinking well other patients take 8mg, so biasing their response to a higer dose) that results in those patients having a higher INR on average and thus an expsoure to a higher bleeding risk?

If you still have any of those links or readings I'd be very appreciative of them.

Thanks for sharing that I've got my morning research topic now

I think the INR testing is a very crude way to manage the bleeding risk due to multiple factors inherent in how coumadin works and what the INR test is testing. For most people this is not an issue but for anyone who has one of these variants it can be more of an issue than we know. I will attach a few of the papers on this. ;-0

 

[Classtime Sailer]

If you are outdoorsy active, get a tissue valve and you can avoid blood thinners. I have a porcine valve and hear it when it is quiet and I inhale deeply.

 

[Agian]

I click, therefore I am.

 

[pellicle]

If you are outdoorsy active, get a tissue valve and you can avoid blood thinners.

...but of course face a second or third surgery as a certainty as the trade-off

 

[tom in MO]

I have a mechanical valve. I don't hear it often, but when I do it's not bothersome. Only my daughter's young ears has ever detected it in a public space and that was in a small room in an art museum.

I wouldn't let the sound stop me from getting a mechanical valve. Very few people have a problem with the noise and even fewer don't get used to it. However, if you suffer from a diagnosis of some type of compulsive disorder that would be transferred to the heart valve sound, you may want to discuss it with your doctor as to what they would recommend to mitigate the potential problem.

 

[Duffey]

...but of course face a second or third surgery as a certainty as the trade-off

If you live that long.

 

[pellicle]

If you live that long.

True