CarolM
Well-known member
Thanks everyone! Will keep you posted, I'm sure!
Mechanical vs tissue
- Thread starter CarolM
- Start date
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carverelli
Member
My surgeon is a year younger than me and he said that he woud have a tissue valve done were it him. I eventually chose the on-x mechanical valve. At 45, the possibility of 2 more surgeries in my lifetime helped me in my decision. So far( 4weeks post-op) the warfarin hasnt been an issue as much as the noisy valve "click" I have in ears. On the upside its easy to take my pulse as i count the "clicks",
Another factor in my decision was the cost. I have excellent insurance as long as I'm working. If I were laid off for 3-5 months there is a good chance my coverage would have stopped. With my luck that would about the time a tissue valve would start failing. At 100k + the cost could break me financially.
Eventually, i want to get my own monitor/testing kit so i can check my INR at home.
At 45, my choice was a littler easier to make than your choice at 57. Either choice at this point is much better than no choice at all. I will add that my surgeon said he expepcted 75% of valve replacements in 15 years will most likely be via trans-catheter. The current method is pretty crude and it carries with it a high risk of stroke, but over time it will be refined and eventually that method would be the norm.
Another factor in my decision was the cost. I have excellent insurance as long as I'm working. If I were laid off for 3-5 months there is a good chance my coverage would have stopped. With my luck that would about the time a tissue valve would start failing. At 100k + the cost could break me financially.
Eventually, i want to get my own monitor/testing kit so i can check my INR at home.
At 45, my choice was a littler easier to make than your choice at 57. Either choice at this point is much better than no choice at all. I will add that my surgeon said he expepcted 75% of valve replacements in 15 years will most likely be via trans-catheter. The current method is pretty crude and it carries with it a high risk of stroke, but over time it will be refined and eventually that method would be the norm.
tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick tick .... what was the subject again? ... oh, I get along fine with my valve and warfarin:biggrin2:
CarolM
Well-known member
Good to know
A sense of humor is helpful in all this!
My surgeon had no qualms at all about recommending a mechanical valve for me, and I'm very grateful he did. I was leaning toward a tissue valve and he said I would probably have another 2, possibly 3 surgeries if I chose tissue. That was the deal-breaker for me. Even before surgery, I had a good idea I wouldn't want more. After surgery, I knew I would not want another one and was indeed thankful for the mechanical valve.
I would not put any stock whatsoever it getting a tissue valve now and thinking a future valve(s) can be done with a trans-catheter procedure. There is no way of knowing if you'll be a candidate for one, or, if indeed they will be commonplace in the next 10-15 years. I'd put stock in the here-and-now way over what might be in the future, but that's just me.
I would not put any stock whatsoever it getting a tissue valve now and thinking a future valve(s) can be done with a trans-catheter procedure. There is no way of knowing if you'll be a candidate for one, or, if indeed they will be commonplace in the next 10-15 years. I'd put stock in the here-and-now way over what might be in the future, but that's just me.
I was 47 when I got my ON-X. I would make the same decision today. There have been NO DIET CHANGES. I just eat more consistently (greens every day in about the same amount).
I home test my INR about every 10 days. I might test more often if I suspect any INR drift due to diet/medication. Easy Peasy. I travel every week and don't even need take my meter with me. Once you get a stablized INR it really is not a big deal to manage.
You do need to be a "good" pill taker. Take the coumadin consistently every day. I use a monthly pill box manager to make sure I don't forget a dose or double dose by mistake.
In fact, I think taking daily coumadin reminds me to be consistent with how I care for myself . . .not a bad thing.
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you do know if you get a bovine you cant go passed a field without having an urge to chew the grass? like me the kids take me truffling,:biggrin2:
CarolM
Well-known member
Hey, I can always use a little fiber in my diet!
CarolM
Well-known member
Appreciate your thoughts. We all make our own best call I guess, and hope and pray it is the right one for us. Time will tell!
And I hope we're all around to continue the debate in 15 years...
And I hope we're all around to continue the debate in 15 years...
kfay
Well-known member
Carol, I'm so glad you have made the best choice for you! No one other than you has to live with the choice you make (okay, maybe your family), so the reasons they chose the valve they did and the ones you had for making your choice are not going to be the same. Be content with your choice and get ready for a full, healthy life after your surgery.
Kim
CarolM
Well-known member
Thank you, Kim. I do need support for my decision! It's one I didn't make lightly, and I am hopeful that it is the correct one.
I'm scheduled for the 11th, and my nerves are starting to fray!
Carol
I'm scheduled for the 11th, and my nerves are starting to fray!
Carol
Hi Carol,
I want to wish you well. Your decision for moo-cow valve is what you felt was right for you and you alone. I too went through the tissue valve/mechanical valve tug of war in my head. I finally decided for reasons of my very own that a cow valve would serve me proud. I am well aware that I likely will need a replacement some years down the road. But this little heifer has been working hard and keeping me alive for the last four years and so far my cardiologist says that she is working like a champ. So keep us posted and like Neil said, you will have a huge urge to chew some sweet green grass every once in a while (hahaha). I will keep you in my prayers.
I want to wish you well. Your decision for moo-cow valve is what you felt was right for you and you alone. I too went through the tissue valve/mechanical valve tug of war in my head. I finally decided for reasons of my very own that a cow valve would serve me proud. I am well aware that I likely will need a replacement some years down the road. But this little heifer has been working hard and keeping me alive for the last four years and so far my cardiologist says that she is working like a champ. So keep us posted and like Neil said, you will have a huge urge to chew some sweet green grass every once in a while (hahaha). I will keep you in my prayers.
Rachel
Well-known member
Hi Carol,
Just want you to know that I'll be thinking of you on the 11th!
I also have a "Moo-Cow" valve and very happy with it!
Rachel
Just want you to know that I'll be thinking of you on the 11th!
I also have a "Moo-Cow" valve and very happy with it!
Rachel
CarolM
Well-known member
Thanks very much, Chris. I am happy that your decision has been so good for you!
As Oct. 11th gets closer, I am feeling more anxious. A pep talk is exactly what I need right now.
Carol
As Oct. 11th gets closer, I am feeling more anxious. A pep talk is exactly what I need right now.
Carol
CarolM
Well-known member
Thanks, Rachel! I appreciate your kind thoughts.
Carol
Carol
carolinemc
Well-known member
You have come to the right place. There are many of us that are on coumadin/warafin and the others have tissue/bovine valves. On the diet front, if you are already eating healthy foods, stick with it. You are strong to come here. There are people who answer from experience of many years of being the patient, or a loved one who is a patient. I hope you have a speedy recovery. Hugs for today.
ramjet
Well-known member
Hi Carol,
There are some other considerations and not just tissue vs mechanical....
If you have coronary artery diesase (eg one or more of your coronary arteriesa re narrowed), you may need a coronary artery bypass graft (CABG)... some cadiologists do this at the time of valve replacement, depending on how advanced the coronary artery disease is.
I suspect all is ok with you, firstly being female (as the female hormones confer some protection during your early years, and also because you don't mention it as a problem, but just worth thinking about)
Let me explain further. If you have say, moderate coronary artery disease, the surgeon may advise that when you have the valve replaced you also have an "early" (preemtive if you loke) CABG procedure at the same time. If this is done, then it is advisable in some circumstances to have a long lasting medcahnical valve, because depending on how they do the CABG and what vessels are involved, the CABG can make redo valve operations more difficult or risky.
So, if a CABG is also a possibility, it may be best to have a mechanical valve and avoid, hopefully, having another operation.
Typically they will do a coronary artery angiogram to have a good look at your coronary vessels at some stage before a valve operation.
They do this because they need to stop your heart for the valve repalcement procedure as you will know, but they need to fill your cononary vessels with a solution to help keep your heart alive while it is very cold and stopped. If you have a partically blocked coronary artery, it can make the valve surgery more challenging, or you can suffer some more side effects, and hence doing a coronary artery bypass at the same time while your chest is open can be a good option.
Not only is everyones' valve procedure a little different, eg some have a dilated aortic root others have an oblong shaped aorta, and this can also impact on valve choice, but also the state of the coronary vessels can dictate to a certaion procedure whatshould be done, and sometimes its all these other issues that can als impact on the choice of valve....not just the warfarin question.
Also, be aware that some newer drugs are in the testing phase that may (or may not) replace warfarin in the forseeable future, which can make the whole warfarin issue and testing and diet stuff hopefullly fade away.
Also, if you have a tissue valve, and need a redo 5, 10, 15 or 20 years (its unpredicable unfortunately), you may need a CABG then and hence the whole idea of a percutaneous valve repalcement may not be an option anyway, as they will need to opne your chest to do the CABG.
And also, to use an analogy: If I need to paint the hallway, I like to open the front door, have some room to swing the paint brush and roller and paint the hallway. I don't paint the hallway by using a long thin paint brush and paint it by looking through the letterbox at the front gate.
The same issue with heart surgery. There is a lot to be said actually about opening the chest and actually seeing what you do, and cutting out the old valve (or old repalcement valve), and stitching in a new one neatly and checking for leaks and spraying some biological glue around to plug any leaks and then restarting the heart, and then getting out. So the whole percutaneous valve approach is really quite tricky, and honestly, whilst its a option for someone who may die from having open heart surgery, eg a ninety year old with other medical issues ...it may not be the best approach for 60 or 70 year old who is still quite fit and well...so I am not sure I would choose or plan on having a percutaneous valve replacement unless it was the only option due to the poor state of my health.......sooooo, after all that, its not just about warfarin, but sometimes the surgeons and cardiologists have some other reasons for recommending a particular valve and procedure, and some of them are not so good at openly explaining all these reasons....and they don't openly say to the patient : "I wish you would choose this procedure because I'm not quite as good at doing it that way or I have little experience with that valve".... or whatever....
I said, "Doctor, if you were in my place, honestly, what would you choose?"...
So, in summary....
1. Warfarin may be replaced by a better alternative in the forseeable future, and even if it isn't, for many people its not a big issue. I had it for only three months and it was ok, INR was ok, and it didn't change my diet etc.
2. Percutaneous valve repalcement, at this stage, is not really the best way to replace a valve in otherwise healthy people...its a backup procedure where open heart surgery has increased risks.
3. If you may have coronary vessels that need attention, and if you have a CABG then it can sometimes make a redo operation tricky, so a mechanical valve may be a better chice if you also have a CABG
4. It not just about a decision to avoid warfarin...sometimes there are size, shape and surgeon experience issues related to particular valves....
I had a tissue valve, and whilst my coronary vessels are ok they are not pefect, and when I have a redo valve operation I will almost certainly have a CABG at that time, so it was considered best that I had a tissue valve now, avoid a decade or more of warfarin, and when I have open heart surgery in 10 to 15 years ZI'll almost certainly need a CABG ...and at that time I will most likely get a mechanical valve...as I'll be 60 - 65 years of age by then...and then hopefully will not need another operation...
You need to be comfortable with your choice, but you also need to be guided carefully by your surgeon, and ask him/her direct questions...what would you do, etc etc
There are some other considerations and not just tissue vs mechanical....
If you have coronary artery diesase (eg one or more of your coronary arteriesa re narrowed), you may need a coronary artery bypass graft (CABG)... some cadiologists do this at the time of valve replacement, depending on how advanced the coronary artery disease is.
I suspect all is ok with you, firstly being female (as the female hormones confer some protection during your early years, and also because you don't mention it as a problem, but just worth thinking about)
Let me explain further. If you have say, moderate coronary artery disease, the surgeon may advise that when you have the valve replaced you also have an "early" (preemtive if you loke) CABG procedure at the same time. If this is done, then it is advisable in some circumstances to have a long lasting medcahnical valve, because depending on how they do the CABG and what vessels are involved, the CABG can make redo valve operations more difficult or risky.
So, if a CABG is also a possibility, it may be best to have a mechanical valve and avoid, hopefully, having another operation.
Typically they will do a coronary artery angiogram to have a good look at your coronary vessels at some stage before a valve operation.
They do this because they need to stop your heart for the valve repalcement procedure as you will know, but they need to fill your cononary vessels with a solution to help keep your heart alive while it is very cold and stopped. If you have a partically blocked coronary artery, it can make the valve surgery more challenging, or you can suffer some more side effects, and hence doing a coronary artery bypass at the same time while your chest is open can be a good option.
Not only is everyones' valve procedure a little different, eg some have a dilated aortic root others have an oblong shaped aorta, and this can also impact on valve choice, but also the state of the coronary vessels can dictate to a certaion procedure whatshould be done, and sometimes its all these other issues that can als impact on the choice of valve....not just the warfarin question.
Also, be aware that some newer drugs are in the testing phase that may (or may not) replace warfarin in the forseeable future, which can make the whole warfarin issue and testing and diet stuff hopefullly fade away.
Also, if you have a tissue valve, and need a redo 5, 10, 15 or 20 years (its unpredicable unfortunately), you may need a CABG then and hence the whole idea of a percutaneous valve repalcement may not be an option anyway, as they will need to opne your chest to do the CABG.
And also, to use an analogy: If I need to paint the hallway, I like to open the front door, have some room to swing the paint brush and roller and paint the hallway. I don't paint the hallway by using a long thin paint brush and paint it by looking through the letterbox at the front gate.
The same issue with heart surgery. There is a lot to be said actually about opening the chest and actually seeing what you do, and cutting out the old valve (or old repalcement valve), and stitching in a new one neatly and checking for leaks and spraying some biological glue around to plug any leaks and then restarting the heart, and then getting out. So the whole percutaneous valve approach is really quite tricky, and honestly, whilst its a option for someone who may die from having open heart surgery, eg a ninety year old with other medical issues ...it may not be the best approach for 60 or 70 year old who is still quite fit and well...so I am not sure I would choose or plan on having a percutaneous valve replacement unless it was the only option due to the poor state of my health.......sooooo, after all that, its not just about warfarin, but sometimes the surgeons and cardiologists have some other reasons for recommending a particular valve and procedure, and some of them are not so good at openly explaining all these reasons....and they don't openly say to the patient : "I wish you would choose this procedure because I'm not quite as good at doing it that way or I have little experience with that valve".... or whatever....
I said, "Doctor, if you were in my place, honestly, what would you choose?"...
So, in summary....
1. Warfarin may be replaced by a better alternative in the forseeable future, and even if it isn't, for many people its not a big issue. I had it for only three months and it was ok, INR was ok, and it didn't change my diet etc.
2. Percutaneous valve repalcement, at this stage, is not really the best way to replace a valve in otherwise healthy people...its a backup procedure where open heart surgery has increased risks.
3. If you may have coronary vessels that need attention, and if you have a CABG then it can sometimes make a redo operation tricky, so a mechanical valve may be a better chice if you also have a CABG
4. It not just about a decision to avoid warfarin...sometimes there are size, shape and surgeon experience issues related to particular valves....
I had a tissue valve, and whilst my coronary vessels are ok they are not pefect, and when I have a redo valve operation I will almost certainly have a CABG at that time, so it was considered best that I had a tissue valve now, avoid a decade or more of warfarin, and when I have open heart surgery in 10 to 15 years ZI'll almost certainly need a CABG ...and at that time I will most likely get a mechanical valve...as I'll be 60 - 65 years of age by then...and then hopefully will not need another operation...
You need to be comfortable with your choice, but you also need to be guided carefully by your surgeon, and ask him/her direct questions...what would you do, etc etc
Hi Carol, I've been thinking of you. Hope to hear from you in the post op forum soon
Jkm7
Well-known member
...........
ramjet
Well-known member
huh?..........
