Mechanical vs tissue

[CarolM]

Hello all,

I am meeting with my surgeon on Tuesday for aortic valve replacement. I would like to come to a decision on which type of valve.
I'm 57, and my local cardiologist is firm that mechanical is the way to go. I just hate the thought of Coumadin and blood testing for the rest of my life.

Are the diet changes and blood testing a huge impact on your lives? Should I just be glad this problem was caught in time and deal with it?

I have spent WAY too many hours on the Internet reading pros and cons....the real answer I need is first-hand experiences from people like you.

Thanks in advance

Carol

 

[dick0236]

Hello all,

I just hate the thought of Coumadin and blood testing for the rest of my life.

Are the diet changes and blood testing a huge impact on your lives? Carol

Warfarin(Coumadin) management is not difficult. I have never allowed the drug to really change my diet....I eat what I enjoy, but I am more aware of hi vit K foods now, and try to eat a balance diet that always includes some amount of greenish vegetables....mostly 'cause I enjoy them. Testing no longer is a problem, since most of us use the "finger stick" method and many self-test at home.

Normally, a mechanical valve at age 57 would be the only valve operation needed over your lifetime. My bigger concern regarding mechanical or tissue would be another surgery in my "senior" years. I am 76, healthy and active....but I WOULD NOT look forward to going thru this surgery again at my age.

Read all you can and make the decision that is the lessor of the two evils....for you. Be careful of some of the stuff you read on the internet......especially about warfarin(Coumadin). A lot of that stuff is written by people who have no, or limited, experience with the drug.

 

[CarolM]

Thank you. It is definitely a very big factor just doing this once in my lifetime (as you have fortunately). How nice that you have positive comments, and a great outlook on life!

All good advice. We will see...

 

[Freddie]

Diet changes? Were we to change our diet? No one ever told me that.
Like Dick, I eat what I want when I want and more aware of hi vit K foods, I still eat them, just not as much in one sitting.

Here's the thing, for myself after surgery and being on warfarin I was to go to the lab every week until I was within my range, for me I think it took about 6 weeks. Then it was every two weeks, which is what I'm still doing.

Does it impact your life? Well maybe depends on how you look at it. If it's like spilled milk, you'll deal with it just like any other appointment.

BTW Hi & Welcome

 

[Lynlw]

Hi, Carol, Have yu read the threads in this valve choice forums? Pretty much whichever valve anyone ends up with they are happy, which is a good thing, but alot of people have shared their thoughts and experiencees in those threads. I would probaby wait until you do talk to your surgeon and see what they reccomend, sometimes surgeons are more up to date on valves an choices than Cardiologist who usually the majority of the patients they take care of are elderly who had bypasses not that many valve patients.

FWIW I'd alo ask the surgeon what they think they chancces of getting a tissue valve IF you chose one now, beng replaced in the cath lab (percutaneous valve replacement) when they time comes, they are already doing them today, so there is a good chance you could possibly end up not needing another surgery or Anticoagulants..

BTW Im curious where are you having our surgery, you live pretty close to us.

 

[CarolM]

Appreciate the welcome and the input, Freddie. If I don't have to entirely omit certain foods I like, it would be a big plus. You make it sound doable.

Another "check mark" on the mechanical list, I guess.

 

[CarolM]

Hi Lyn,

Yes, I have read many of those threads. I'm not sure if it makes it easier or harder since people DO mostly seem happy with their choice.

True, my surgeon will surely guide the decision...I just want to be as informed as I can possibly be before my appointment.

Looks like surgery will be University of Pennsylvania. It's just over the bridge from us in Southern NJ. How about your son?

 

[Lynlw]

Hi Lyn,

Yes, I have read many of those threads. I'm not sure if it makes it easier or harder since people DO mostly seem happy with their choice.

True, my surgeon will surely guide the decision...I just want to be as informed as I can possibly be before my appointment.

Looks like surgery will be University of Pennsylvania. It's just over the bridge from us in Southern NJ. How about your son?

He's doing well, knock on wood, hes had most of his heart surgeries at CHOP right next door, but most of his docs are on staff at both hospitals. Penn has been very involved with the Aortic percutaneous valves trials and since the Sapien was approved for the highest risk patients have been doing them, so it should be interesting what they have to suggest
Good Luck..oh Justin fav part is all the good food trucks right out side
I meant to add we live in stratford

 

[karla]

I am quite happy with my mechanical valve and being on warfarin has not been a big deal for me. The most recent recommendations are to just be consistent with your intake of vitamin k. I eat a spinach salad or have a healthy portion of broccoli every day. My INRs have been right on the money for several months and knowing that my chances of needing another OHS are less than they would be had I chosen a tissue valve makes me a happy girl. I self dose and that has been easy to do. A mechanical valve was the right choice for me at 53 years old but whatever choice you make will be the right one for you. As I have read here, the only bad choice is not having the surgery. Good luck!

 

[CarolM]

That sounds much more reasonable--I thought I'd have to almost never eat greens/vitamin K again. Thanks for the info, Karla.

 

[jenebug]

Hi and welcome. I too am new here. Today makes day 16 with my mechanical valve. It was a gut wrenching decision for me. My surgeon recommended tissue valve for me, saying I would have to make no dietary changes and would not have to take Coumadin. I did a lot of research on my own. Needless to say, my kids were not happy with my initial choice, and the thought of valve failure in 10-12 years scared me. What other health concerns could I have developed by that time? Being 65 now, I sure did not want to go through this surgery farther down the road.
I made my first trip to the INR clinic and blood was thin (which they said is what they wanted). On the next visit, 3 days later, it was thinner still at 5.2. That was last Friday. They cut my Coumadin to 1/2 tab, followed by 2 days of 1 whole tab, then repeat the cycle. Went back today and my level was 3.2- we were all very happy. I am to return again in 1 week, then hopefully every 2 weeks for a month, then start once a month-as long as I stay within range.
I am watching my high K foods, but still eat them a couple times a week. It hasn't been bad for me. I am also taking an 81 mg aspirin daily.
For me, just knowing that this valve has an average life of 20-30 years or longer was what helped me decide. Good luck and God bless.

Surgery for aortic valve replacement Sept. 5, 2012 by Dr. Peter Pluscht at Providence Hospital in Mobile, Al.

 

[Fundy]

Both choices have their good points and their bad.

At 57, there's probably a high probability of at least 15 years from a tissue valve. A very good possibility that 15 years from now that failed valve can be replaced using a transcatheter approach and I'm not sure what anyone could tell you about that valves longetivity. But if ten years could be expected...you would be in your 80's before needing an OHS replacement. and that valve should last the rest of your life.

But then again, a tissue could fail much earlier. For me, a major point in selecting tissue was can I handle going through another OHS. Since I didn't really know what it would be like, I figured I would take my chances and believe that I could. I would have hated anti-coagulation therapy though. I would have hated it bad. It would have been dangerous for me too though, as sometimes I eat nothing for days, sometimes I eat a whole lot.

Taking the pills, trying to eat consistantly, testing the blood, and the risks when out of range; I would really have hated it. But most seem to be OK with it that do get a mechanical.

Its basically which would you hate most, anticoagulation therapy, or another open heart surgery. I don't think anyone, including cardiologists or heart surgeons are qualified to assess that for you. That's an opinion you really need to form for yourself I think.

 

[Bob in Colorado]

Hi Carol. I think your surgeon is giving you a very good recommendation. I've had both tissue and mechanical valves. Note that even tissue valvers may sometimes have to take Coumadin. As for me, like others have said, I eat what I want and adjust my doses to match. I self test at home and it takes just a couple minutes. Easy!

 

[neil]

whichever you pick is gonna be better than what you got now,for me tissue was my choice, did not fancy being on anti coags and the problems that can occur with it, yes you can finish up on anti coags after having a tissue valve but its only a small few that do, bit like people who need re ops after having mech valves, it can happen, make your choice and be happy with it,

 

[hook]

Blood testing is no big deal if you get a home test meter; I do mine every week or two. The diet thing is a myth; eat what you want and your levels will fall in line as you determine you Coumadin dosage. It is my opinion to eat healthy levels of foods with Vit K, as it helps to regulate levels. Staying away from K foods seems to yoyo things.

As far as bleeding, I have not had a nose bleed, gum bleed, or cut shaving that was an issue. I had to give up sword juggling though.

 

[CarolM]

Well, we met with my surgeon yesterday and I'm scheduled for surgery on Oct. 11th! My valve is only 0.6 and a peak gradient of 94, so he thinks sooner rather than later is indicated.
Personally, I'm glad to have a date and stop having my imagination go crazy. Interestingly, he would NOT state a valve preference; simply the facts on both. I have chosen a tissue valve. He believes it will last 12-18 years and it most likely will be replaced transcatheter and won't need OHS again.

Now I will start re-reading the pre-surgery forums more closely!

Carol

 

[neil]

hi carol, so what you going for a mo cow or porky pig? the op isnt as bad as you think, the worst part is the waiting, you will be just fine,

 

[CarolM]

A moo-cow it will be. Thanks for the positive thoughts!

 

[Jkm7]

Hi Carol,
Your surgeon took the same position as many (perhaps most) of our surgeons. They educate us, answer our questions but do not recommend which valve we should get absent some particular circumstance that would indicate one is more apropriate for specific medical reasons.

I chose bovine and am so grateful I made that choice some 4 years ago. That surgery was my second OHS in four years so I certainly knew what to expect in my second surgery seeing I was having the same surgeon, same hospital etc

It is likely you will find, like many of us, the wait for surgery is often the worst part of it.

All best wishes.

 

[Roberta]

Carol,

That is fantastic news that you have made a decision. Choosing between a mechanical and tissue valve was one of the most difficult decisions I have ever had to make. Like you a spent many, many hours on the internet and on this forum before my choice was made. However, once I made it, I made peace with my decision and moved forward. Hope you can do the same. Wishing you all the very best!