Mechanical vs Tissue - need help deciding

[pellicle]

Thanks Pellicle. This in- vivo study is from December 2018 (5 months ago) on trileaflet mechanical valves.

yes, I'm sorry I didn't find anything more recent. I recall that Dr Didier Loulmet was working on a trileaflet mechanical and that there was also a plastic one (touted as low priced) being evaluated too ... sorry to be unclear. Hopefully Warrick will chip in his 2c worth too ;-)

 

[pellicle]

Thanks Pellicle. This in- vivo study is from December 2018 (5 months ago) on trileaflet mechanical valves.

I thought I'd share this little vignette

https://americanhistory.si.edu/collections/search/object/nmah_1726264

This trileaflet valve which looks similar to a natural human heart valve was developed by Charles Hufnagel, MD. It is coated in hepacone, silicone rubber impregnated with heparin, and is a size 5 with a diameter of 33mm. Hufnagel believed the trileaflet design would prove to be superior to the ball and cage heart valve because it provided better dynamics. The base of the valve was designed to fit the shape of the aorta when implanted. The leaflets or cusps were made of polypropylene and coated with silicone rubber at high pressure. A 1975 study of patients who had received this prostheses determined that the Hufnagel trileaflet valve was not durable enough to withstand constant blood flow. In a majority of cases, patients died due to prosthetic degeneration or thrombosis.​

so glad we test stuff better now...

 

[Warrick]

I know I read that the last lot of animal trials (sheep for 3 months) for the Furtiva valve had gone well but I remember there was further testing that had not- I think it was further lab testing on flows with blood related media that had shown thrombosis was occuring in some parts that had not shown up previously, they shut down the website last year after that but I see its back up so progress must have been made

I recall reading Didye was tied up with the Foldax valve also but I have been unable to find where I read that so I may have my wires crossed..unsure.

 

[Warrick]

So that other post by zelic is for a 3 leaflet mechanical but it isn’t the Furtiva valve from what I read.
The lastest from back in Feb from Furtiva is here in the press release that they have the capital to start human trials, the rest is in french which I haven’t read since school...
https://www.novostia.com/news
Looks promising but then theres a few new valves that do lately, I’d guess 5-10 yrs before something gets to mainstream maybe.

 

[ottagal]

so glad we test stuff better now...

You can say that again!

 

[MethodAir]

As stated in another thread, 1.5 mg warfarin daily keeps my INR at 2.5. The ticking is always there, but only noticeable if you listen for it. That's not always a bad thing, you can test your heart rate, see if your heart rhythm is regular etc.

 

[pellicle]

As stated in another thread, 1.5 mg warfarin daily keeps my INR at 2.5.

not sure if I've seen this before (or simply forgotten it) but WoW ... man that's fascinating. I wonder if you've had problems with clinics being freaked by that.

Thanks for reposting this

 

[Nusb22]

I had an ON-x valve installed, a year ago (okay minus three weeks) had no issues with a ticking, and no issues with warfarin. My surgeon mentioned they've made improvements over the years.

 

[MethodAir]

not sure if I've seen this before (or simply forgotten it) but WoW ... man that's fascinating. I wonder if you've had problems with clinics being freaked by that.

Thanks for reposting this

Regular self-testing keeps me out of the clinics.

 

[pellicle]

Regular self-testing keeps me out of the clinics.

Ahmen to that Brother (or Sister ...

)

 

[Agian]

Today, anyone who challenged such a narrative might be considered a fascist.

 

[W. Carter]

I'm going on 5 years with Carbomedics Carboseal. Replacing ascending aortic and valve. Hardly ever notice any ticking anymore and test every 6 weeks for INR at VA Hospital unless it is off. If it is off they will schedule me every 2 weeks until back to normal. I have an ultrasound every two years. I am happy with it and no replacing.

 

[Art O Ceitinn]

I have a St Jude and had a few major bleeds. When I had hip replacement I bleed internally for 5 or 6 days and received multiple blood transfusion and cried tears of joy when I left the hospital after14 days. The pain from the bleed was by far worse than my heart surgery.
I can never hear the silence TIC TIC TIC
But my St jude is 12 years old and still keeping me alive.
It is a tough choice we all have to make.

 

[Art O Ceitinn]

My hip

 

[Duffey]

I have a St Jude and had a few major bleeds. When I had hip replacement I bleed internally for 5 or 6 days and received multiple blood transfusion and cried tears of joy when I left the hospital after14 days. The pain from the bleed was by far worse than my heart surgery.
I can never hear the silence TIC TIC TIC
But my St jude is 12 years old and still keeping me alive.
It is a tough choice we all have to make.

Sorry to read of your experience. As you mention, valve choice is a difficult decision and none of us know what other health issues we may encounter in the years ahead. That’s why I suggest that new valve recipients give it some time before recommending one or another. Circumstances change, and what seemed like a logical choice one day can turn into a “why in the world did I choose this,” the next whether it is mechanical or tissue.

 

[MKM]

Hi



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

This is so loaded with information. Thanks for all of it. And for including the link to the youtube video of Mechanical vs Bioprosthetic Aortic Valve discussion with Mayo Clinic doctor.

 

[Warrick]

Looks like Furtiva human trials are finally happening-
https://heartvalvesociety.org/meeting/abstracts/2021/A2.cgi

 

[oo0My_Valve0oo]

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.

 

[Keithl]

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.

Sorry your recovery was so bad. Where did you have surgery? My recovery was actually pretty much a pleasant surprise as I was expecting much worse. My hospital experience was very good, but I flew to Cleveland Clinic as I was not going to risk this to the local hospitals in GA, none of them get a score over 55 in the US New and Health Report scores, while Cleveland got 100.

As far as valve decision, at 62 tissue valve is common choice. At 58 I was encouraged to do tissue, but opted for mechanical as I wanted one and done, even though the odds would be they could do TAVR if I needed another in the future. I was too nervous about worrying how long the tissue valve would last. I had a good friend that had a mechanical valve 20 years ago so chatting with him and finding this forum I was fine with Coumadin. It is a hassle at times, and while is was very ocd about taking my INR for 2 years lately it is not unusual for me to skip a week as my INR has been very stable.

The good news is the worst is behind you and enjoy you new lease on life.

 

[Croooser]

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.

To echo Keith's question - where did you have the surgery performed? Maybe next time you might try a different clinic?

When I consulted with my Central Florida cardiologist about travelling to the CC, he felt very strongly that it is not just about the surgeon but the facilities, the rest of the staff and how ell refined the procedures and processes are.

Which valve did you get? I am71, not 62. But my surgeon indicated that it is very possible that I might get 15-20 years from my Inspiris Resilia. Not guaranteed, but possible. At that point I should be a candidate for a TAVR.