New Guy w/ a lot of Questions

[Eric]

Hi. My name is Eric and I am new to the site, although I?ve been monitoring it for 4 or 5 days now. Dr. Raissi at Cedars-Sinai, suggested I check it out.

I?m a 42 year-old commercial real estate broker/investor and I have always led a very active lifestyle, both socially and professionally. So it hit me pretty hard when I found that I had heart problems this past December. My follow-up tests 6 months later (two weeks ago) confirmed that I have a bicuspid aortic valve and an enlarged aortic root of 4.7cm. I?m 6?4?, 200 lbs and may be ?Marfanoid?, although I don?t have enough symptoms for anyone to have diagnosed me as having Marfan Syndrome.

I play beach volleyball, free-dive, spear-fish, swim, lift weights (now lightly) have trekked the Himalayas twice and traveled through ? and photographed - more than 50 countries. I noticed that there are several other very physically active folks on the site and I have been encouraged by your triumphs. Every thread I?ve read has been enlightening. So far I?ve learned a lot and am looking forward to learning more as I travel through this process.

Last week, after Dr. Raissi told me he recommended I do the surgery relatively soon, I started my research. My root and ascending aorta must be replaced for sure. My bicuspid looks good right now but the doc tells me that until he gets in there and sees it for himself, he will not know if he will replace it. So my research has included the various surgical procedures for the root, sinuses and ascending aorta as well as for the valve. I don?t know if I?m a candidate for the Ross Procedure or the David Valve procedure but I?m looking into everything. One way or another I want to complete my research ASAP and get the surgery over with so I can move on with my life.

There are so many opinions out there, as this site seems to reflect. If I need a valve my surgeon recommends a bovine, which he said should last me 15 years, give or take a few. Another surgeon who I met with gave the bovine only 5-7 years in me and recommended I go with a mechanical. I?ve also heard people talk about the pig valve. How long have they been lasting? The study periods for those should be longer then the bovine, right?

Also, my professional life is very busy. How long did you wait to go back to work? My doc tells me 6 weeks! I have an assistant who can handle most things, but that seems like a long time.

I?ve also heard that people often have back pain after the surgery. True? Where?lower or upper (I had back surgery ? herniated and ruptured disk).

How about aftercare? A girlfriend has offered to move in for the time, my mother wants me to go to her place, buddies (and their wives) have offered to come over?How long do you need someone to help care you? I?ve already read all the threads about sex (first thing I read! , so I?m current there.

I?ll stop there for now. I appreciate you taking the time to read this and I look forward to your responses.

 

[coryp]

Hi. My name is Eric and I am new to the site, although I?ve been monitoring it for 4 or 5 days now. Dr. Raissi at Cedars-Sinai, suggested I check it out.

I?m a 42 year-old commercial real estate broker/investor and I have always led a very active lifestyle, both socially and professionally. So it hit me pretty hard when I found that I had heart problems this past December. My follow-up tests 6 months later (two weeks ago) confirmed that I have a bicuspid aortic valve and an enlarged aortic root of 4.7cm. I?m 6?4?, 200 lbs and may be ?Marfanoid?, although I don?t have enough symptoms for anyone to have diagnosed me as having Marfan Syndrome.

I play beach volleyball, free-dive, spear-fish, swim, lift weights (now lightly) have trekked the Himalayas twice and traveled through ? and photographed - more than 50 countries. I noticed that there are several other very physically active folks on the site and I have been encouraged by your triumphs. Every thread I?ve read has been enlightening. So far I?ve learned a lot and am looking forward to learning more as I travel through this process.

Last week, after Dr. Raissi told me he recommended I do the surgery relatively soon, I started my research. My root and ascending aorta must be replaced for sure. My bicuspid looks good right now but the doc tells me that until he gets in there and sees it for himself, he will not know if he will replace it. So my research has included the various surgical procedures for the root, sinuses and ascending aorta as well as for the valve. I don?t know if I?m a candidate for the Ross Procedure or the David Valve procedure but I?m looking into everything. One way or another I want to complete my research ASAP and get the surgery over with so I can move on with my life.

There are so many opinions out there, as this site seems to reflect. If I need a valve my surgeon recommends a bovine, which he said should last me 15 years, give or take a few. Another surgeon who I met with gave the bovine only 5-7 years in me and recommended I go with a mechanical. I?ve also heard people talk about the pig valve. How long have they been lasting? The study periods for those should be longer then the bovine, right?

Also, my professional life is very busy. How long did you wait to go back to work? My doc tells me 6 weeks! I have an assistant who can handle most things, but that seems like a long time.

I?ve also heard that people often have back pain after the surgery. True? Where?lower or upper (I had back surgery ? herniated and ruptured disk).

How about aftercare? A girlfriend has offered to move in for the time, my mother wants me to go to her place, buddies (and their wives) have offered to come over?How long do you need someone to help care you? I?ve already read all the threads about sex (first thing I read! , so I?m current there.

I?ll stop there for now. I appreciate you taking the time to read this and I look forward to your responses.

Eric,

Nice to have you on board. I recently had this surgery with Dr Raissi and live in Los Angeles as well. We are very similar in many respects (age, activity levels etc etc), with the exception that I am much shorter (5'10) and definatley am not a candidate for Marfans. You are with the right surgeon!! I agree with your perspective and wanted the same thing (getting it over and done sooner than later). I had a Bovine valve put in which is endorsed by Dr Raissi, in fact the Edwards Carpentier Magna 3000fx (what I have) has the longest tested life (18-20 yrs in 90%), the piggy valve (Medtronics freestyle) has had some great success but the test data does not go beyond 12yrs or so.

If you work from a desk for the most part you should feel comfortable (remember everyone is different) to start back aro 3 weeks or so. If you have to drive all over town this will probably take 4-5 weeks in my opinion. 6 weeks is the general rule of thumb (but who follows rules???!).

BACK PAIN??MY BIGGEST PAIN. For me it was the upper area and shoulders (at least 4 solid weeks), my tri's were sore as well. Massages help a little but it just has to go away on it's own.

After care: I would have to say 3-4 weeks (it is nice having someone cooking and getting you stuff) is a solid timeframe, while I was up and around in 10-14 days trying to cook dinners and clean up a little I did not always want to do it so on came my wife. I think that pushing myself to not be useless helped to improve the speed of my overall recovery (I am now 7 weeks post op).
Regards,

Cory

P.S- If you have any additional questions please post or PM me.

 

[Karlynn]

Welcome Eric! I'm a mech valver, so am not to up on the specific types of tissue valves and longevity. We have some members that do have a lot of knowledge on that and I'm sure will be by shortly to answer those questions. I will say that tissue valves last a shorter time in younger people because their hearts are stronger and more active than someone in their 60's. I would think that would also apply to someone like yourself, who is very physically fit and has a strong heart muscle because of it. My husband is a swimmer and a runner. His resting heart rate is about 45 and because of his activities, my guess is that a tissue would not give him 15 years at his age of 46. However, this is just a guess and I'd be interested to see what our resident tissue experts say on that.

If Free Diving involves jumping out of planes - I would say that a tissue valve would probably be the way to go for you, if you intend to continue doing it. Difficult landings could present a problem if you were on Coumadin. Your other activities, while active, would not represent as much of an issue with Coumadin. As you mentioned, we have some pretty active people here.

As far as having someone around you. The standard recommendation is 2 weeks. Definately the first week home. It's also good to have someone with you as much as possible at the hospital. Hospital personnel tend to be busy and overworked and it's good to have someone there to question what is going on (even something like - now what are you putting in the IV and how much, and what is that for?) when you are not awake or alert enough to do it yourself.

Recovery time is very individual. However, regardless of what you have done, it takes a long time. Anesthesia effects the body for several weeks. Even if you feel wonderful, there are certain things that just shouldn't be done for X-amount of time due to the fact that healing takes it's own time. Your doctor will give you those instructions and they should be followed to the letter. As far as going back to work, I'm guessing you could probably have your foot in the door within a month. Your active past-times is another story. And as far as the sex - we have members who have confessed that area started up again while in the hospital.

I don't recall a lot of back pain - but I was 32 at the time of my replacement and youth has it's advantages. I do know others have had that issue, so they can chime in on this subject.

Welcome again - and let us know when you get your date.

 

[geebee]

Welcome Eric.

You look very fit and healthy in your Avatar so I will definitely believe you lead an active life. I would agree with those who say go tissue. I think your lifestyle would be a problem were you on Coumadin. Despite the dangers of mutliple surgeries, all your various activites require some safety from the possibility of increased bleeding.

That being said, I would definitely plan on a mechanical when you need surgery down the road. Although there are members who have had more than 2 surgeries, each one gets progressively more dangerous.

You should plan on being out of work for 6 weeks. That way things will be covered. You may find you can return after 4 but you need to plan for the unknown.

I did not have problems with back pain. My biggest problem was getting up and down out of bed. If I knew then what I know now, I would have had a recliner but I did not. Be sure and get a recliner if you do not have one.

You should have someone with you the first 2 weeks at least. You will probably be most comfortable in your own place but only you can say for sure on that one. Choose the place that is most quiet (and the one closet to the beach ).

I wish you well. I used to live in LA and Cedars-Sinai is defintely the place to go.

 

[Sherry]

Welcome to our site, Eric. I'm so glad to hear that a surgeon recommended us. (Word's really getting about this cool place. ) Anyway, as you've probably browsed the forums already, you have no doubt seen the valve choice threads, which always bring a diversity of opinions. I had a mechanical mitral valve put in at the age of 33 after the surgeon realized he couldn't repair it. No choice in the matter, but my opinion is that I personally am glad I don't have to face resurgery for awhile. Gina and several others can attest to the difficulties of reops. I've gotten used to coumadin and have found it not to be the big bad thing that we are sometimes lead to believe by the medical community.

As for some of your questions, I had upper back pain and still have it to some degree, but believe that perhaps there are other issues - severe reflux, arthritis, etc. I'm seeking care for both right now.

As for the coumadin, well, if you're going to continue to freedive, I'm not sure mechanical is for you (as Karlynn already mentioned).

As for having family help: yes, you'll need someone for a few weeks or so to drive you to appointments and such. Any help you're offered, you should take.

Working? Well, I had an effusion after my surgery, so my recovery was a little longer, but since I am a teacher, I had it done in June and then didn't go back until late September. That's a little long, I'll admit. You could probably go back in six weeks, but I believe we've had members who have gone back in less than that.

Best of luck to you, Eric, and please keep us informed as to your progress.

 

[MarkU]

Hi Eric,
Welcome. I also have a mechanical valve and am on Coumadin. I was 47 when I had my surgery four years ago and went the mechanical route on the recommendation of my surgeon to minimize the probability of additional future surgeries (no guarantees though...).
From my experience, Coumadin is a minor inconvenience.
I was able to schedule my surgery over the Christmas holidays: My wife was able to be with me the first couple of weeks at home, and then my college age daughter tended to me for a third week. After that I was pretty self-sufficient.
I went back to work after four weeks and worked half days for a week or two.
I was back at the gym doing light workouts after about two months, but didn't really feel 100% physically for about nine months. Don't remember any specific problems with back pain.
Been doing triathlons for the past 1-1/2 years, so guess I'm doing okay...
Mark

 

[William]

Hi Eric, If you don't have a reclining chair, get or borrow one. After my replacement, that was where I wanted to be. There's something about the alignment of the body in the chair that feels good. Will

 

[CCRN]

On cows, pigs, caretakers, and work

On cows, pigs, caretakers, and work

Quote from Coryp:"I had a Bovine valve put in which is endorsed by Dr Raissi, in fact the Edwards Carpentier Magna 3000fx (what I have) has the longest tested life (18-20 yrs in 90%), the piggy valve (Medtronics freestyle) has had some great success but the test data does not go beyond 12yrs or so."

I am just curious as to where this information about the "18-20 yrs in 90%" longest tested life info was obtained. The Edwards Carpentier Magna 3000fx valve was only approved for human implantation last year and Dr. Cosgrove at CCF did the first replacement using it on a human subject, at least as far as I can find, last year. So, wouldn't that mean the piggy would be about 11 years ahead of the cow in this case?

Take the person you feel most comfortable, who drives and is able to help up on the offer of moving in with you. If possible, It would be best if you didn't drive for at least 6-8 weeks. It actually takes about 12 weeks to be sure your sternum has healed enough. If you were to take any significant impact by an air bag or steering wheel before that you could very well be in a "pickle" to say the least. (Meaning a rewiring of your sternum or far worse......bleeding, etc.) I would highly suggest having someone on hand 24 hours a day for the first week out of the hospital. After that it depends on how you feel and what you need to do. My job won't let me back with a restriction (Can't lift over 20 lbs) so I have to wait until I pass the 12 week time frame. Hope this helps.

 

[OldManEmu]

Eric welcome on board.
I was similar age to you (41 last year at the time of surgery) and was scheduled for a Ross Procedure and it had to be aborted because my health deteriorated in the week before surgery, so I was left with a choice of Mechanical or Porcine valve I decided on a porcine after being told the expected life of the valve was 10-15 years in someone my age.
I had no complications with surgery and felt at a push I could have gone back to work after a month.
For the first 3 weeks after surgery I got quite tied in the afternoons and would have to take a nap for an hour.
The first 3 weeks after surgery I also found it quite painful to lift more than 2 kilograms, so obviously things like grocery shopping and clothes washing are a problem if someone can't do it for you.
All day to day things I was able to do after leaving hospital.
I had no pain in the upper back however I was sore in the extreme lower back area (just above the buttocks) for about 3 months post surgery.
The doctor told me not to drive for 6 weeks post operation which I didn't.

 

[coryp]

Quote from Coryp:"I had a Bovine valve put in which is endorsed by Dr Raissi, in fact the Edwards Carpentier Magna 3000fx (what I have) has the longest tested life (18-20 yrs in 90%), the piggy valve (Medtronics freestyle) has had some great success but the test data does not go beyond 12yrs or so."

I am just curious as to where this information about the "18-20 yrs in 90%" longest tested life info was obtained. The Edwards Carpentier Magna 3000fx valve was only approved for human implantation last year and Dr. Cosgrove at CCF did the first replacement using it on a human subject, at least as far as I can find, last year. So, wouldn't that mean the piggy would be about 11 years ahead of the cow in this case?

Take the person you feel most comfortable, who drives and is able to help up on the offer of moving in with you. If possible, It would be best if you didn't drive for at least 6-8 weeks. It actually takes about 12 weeks to be sure your sternum has healed enough. If you were to take any significant impact by an air bag or steering wheel before that you could very well be in a "pickle" to say the least. (Meaning a rewiring of your sternum or far worse......bleeding, etc.) I would highly suggest having someone on hand 24 hours a day for the first week out of the hospital. After that it depends on how you feel and what you need to do. My job won't let me back with a restriction (Can't lift over 20 lbs) so I have to wait until I pass the 12 week time frame. Hope this helps.

I am refering to the Edwards Carfpentier valve itself. You can visit the website and see all the related data. The FX VERSION (with anti calcification treatement) can only extend the life of the valve (this was not built into there test data). The test data was also conducted on most person above 55. Bob (Tobogotwo) has posted all the related data on this site multiple times, if you are not successful with your search please review some of his past posts.

 

[Eric]

Thank you...

Thank you...

Thank you for your responses and welcoming me to the site. The valve issue seems to be a hot one and everybody seems to have different experiences with coumadin. At 42 years of age and with a bicuspid, if I need a valve now chances are I will need another surgery during my lifetime ? regardless of whether I go with a mech, like Karlynn, Sherry and Mark or a bovine or porcine like Cory and OldManEmu. If I am convinced the bovine would only last 5-7 years (as one doc told me), I would go with a mech. On the other hand if I?m convinced it would last 10-15 years (as other docs have said) I would opt for the bovine and hope for further advancements in this realm during that time period. Perhaps then as Geebee suggested, with no further advancements, I opt then for the mech. But I'm still undecided. Has the bovine valve been proven to better than the pig valves? How long are the piggy valves lasting?

By the way Karlynn, I free dive in the ocean, not from an airplane. I generally do it while spearfishing, so no hard landing there. Also thanks for the heads up about the member who never skipped a beat with his sex life. That?s encouraging?I hope I get the same physical therapist

Mark, your story in encouraging. I hope to bounce back as fast as you did. Will, thanks for the idea of the reclining chair. Sounds like a must, although I have a large couch with lots of pillows that may be a substitute for a recliner?

CCRN, I understand your challenge of the 18-20 years and I question it as well. It?s somewhat subjective because there is no hard long-term data. That?s why I asked about the piggy data above. It's a big decision.

OldManEmu, I am going to ask my doc about the Ross Procedure.

Thanks for sharing with me your suggestions and experiences. I am new to this whole thing and any bit of information helps.

 

[coryp]

Quote from Coryp:"I had a Bovine valve put in which is endorsed by Dr Raissi, in fact the Edwards Carpentier Magna 3000fx (what I have) has the longest tested life (18-20 yrs in 90%), the piggy valve (Medtronics freestyle) has had some great success but the test data does not go beyond 12yrs or so."

I am just curious as to where this information about the "18-20 yrs in 90%" longest tested life info was obtained. The Edwards Carpentier Magna 3000fx valve was only approved for human implantation last year and Dr. Cosgrove at CCF did the first replacement using it on a human subject, at least as far as I can find, last year. So, wouldn't that mean the piggy would be about 11 years ahead of the cow in this case?

Take the person you feel most comfortable, who drives and is able to help up on the offer of moving in with you. If possible, It would be best if you didn't drive for at least 6-8 weeks. It actually takes about 12 weeks to be sure your sternum has healed enough. If you were to take any significant impact by an air bag or steering wheel before that you could very well be in a "pickle" to say the least. (Meaning a rewiring of your sternum or far worse......bleeding, etc.) I would highly suggest having someone on hand 24 hours a day for the first week out of the hospital. After that it depends on how you feel and what you need to do. My job won't let me back with a restriction (Can't lift over 20 lbs) so I have to wait until I pass the 12 week time frame. Hope this helps.

View this link

http://www.edwards.com/Products/HeartValves/PERIMOUNTAorticCommunique.htm

For additional info.

This is on the inferior original bovine valve and not the improved magna 3000fx) difference being anti calcification treatments.

I will provide additional data shortly

 

[LLJ]

Hey Eric: Welcome! I can't tell you how excited I was when I found this site full of active people who survived and thrived after OHS. It is scary. It is uncomfortable. It is unknown territory for most. I highly reccomend someone staying with you for at least 2 weeks. My surgeon told me the younger people he operatd on with more muscle mass and tone generally had more back and shoulder pain. Since I had lifted weights for 20 years and did duathlons I can assure you he was right. My upper back was quite painful. As a physical therapist, I can tell you GENTLE massage can help,but time is the healer.
I'm on board with the recliner; it is hard getting in and out of bed from a flat postion after your chest has been opened. I had friends and family stay with me the first 2-3 weeks because believe it or not I couldn't even pull the sheets around to make my bed (thank goodness my kids are 12 and 10 and somewhat self sufficient) and forget lifting gallon milk jugs!
My advice: don't be a hero with the pain meds. I resisted them and finally gave in and took them and it made a huge difference in those first couple weeks. Also: take your time with getting to work. You won't believe how tired you are and how good a nap is.
Mostly, let those who care about you help you. One thing you will learn is just how many people care and how lucky you are to have them. Take the favors and one day you may be lucky enough to give some back.
Lastly, talk to the surgeon and cardiologist. Whatever valve choice you make will be the right one. Make sure you like and trust your cardiologist if he will be following you long term. He/She is as important as your surgeon.
Please let us know how you are doing along the way.
Laura (LLJ)

 

[cgv]

cgv

cgv

For more info on the porcine valves try the medtronics website.
http://www.medtronic.com/cardsurgery/products/mosaic_index.html

I am 58 and very active; didn't want to mess with coumadin so I went with a Medtronics stentless porcine valve. My surgery was on May 27, in Denver. I did a lot of research prior to my decision. I chose the Medtronics since it was stentless and had the latest calcification treatment. The stentless valves require a little more surgery time and skill but more closely approximates the original valve. My doctor said he would have to use a larger size stented valve to get the same hemodynamic performance of a stentless valve. The question of fit then came into play, so I decided on the stentless.

As far as valve life goes, I think they are probably similiar. Neither manufacturer has long term data with the calcification treatment. The websites provide helpful info, but recognize that it is biased - they want you to use their product.

The assumption I used for my decision was that the tissue valve would last 15-20 years and assuming I stay active and in good shape, I will have another successful surgery, maybe with improved techniques and valves. I feel that in the next 15 years of my life, I will be more active and likely take more risks (injury wise) than I will after that period. My doctor said 85% of people my age opt for a mechanical valve. I just don't fall into the same lifestyle or physical condition as them so I made the choice I felt was right for me. Only time will tell it it was the right choice.

One final thought - there are no guarantees in life so make the choice that you are most comfortable with for you, not what others or the majority etc. do. I just found out today that my neighbor (39 years old) was killed in a car accident on his way home from work. A car going in the opposite direction was rear-ended and crossed the median hitting my neighbor head-on. Had he been a few seconds earlier or later he would likely still be alive. I also have a friend from the Winter Park Ski Patrol who is working as a park ranger and has been missing since Friday in Rocky Mt. National Park. They have had hundreds of people searching plus helicopters but no luck so far. I still hold out hope that he will be found alive. My point is that you just never know what the future has in store so live every day to the fullest and make the best decision you can with the information you have.

 

[Eric]

Thanks for the link, Cory. I wish they had studies of people our age or younger. Most of the patients in the study were in their 60s and 70s so the bovine is expected to last longer in them.

Laura, thanks for the input. Did you (William as well) sleep in the recliner or just use it to rest in? I plan on being sore after the surgery although I?ll start stretching now! Must be the position they put you in. I value your recommendation of talking to my cardio and surgeon. Unfortunately, the surgeon is on vacation for a week and my cardiologist is away for 3 weeks. I may get a second opinion from a doc at the Cleveland Clinic where a friend of mine had valve replacement surgery.

CVG, great thoughts. Regarding making the right decision for yourself and making the most of what you have TODAY, since I had been diagnosed with heart disease 7 months ago, that?s the way I?ve tended to think. I'm sorry to hear about your neighbor and I hope they find your friend. There seems to be no clear right/wrong decision to the valve issue. I?ll decide what I?ll decide and live with my decision. I have other issues to consider as well, such as what procedure the doc should use to replace my aortic root, ascending aorta and maybe my sinuses.

I?ll keep you informed?

 

[ALCapshaw2]

My understanding is that STANDARD Porcine Valves have the shortest durability numbers (8 to 12 years). My (bypass) surgeon told me he will NOT implant a standard porcine valve for this reason.

The Bovine Pericardial Valves were first used about 18 years ago and data reveals 80 or 90% durability over that time (in mostly OLDER patients - over 60?). This valve is highly regarded at the Cleveland Clinic (#1 rated Heart Hospital), especially by Dr. Cosgrove.

Tissue Valves wear out FASTER in YOUNGER patients but I'm not sure that much data is available to quantify that observation.

Improved tissue valves (with anti-calcification treatments) are a fairly recent innovation that is 'hoped' to extend the lifetime of treated tissue valves. Stentless Porcine valves are touted as lasting longer than standard porcine valves.

Following my AVR (second OHS) I had INTENSE back muscle pains that would come on suddenly. I found that MASSAGE from a vibrating disk massager was FASTER and BETTER at relieving that pain than any pain medication. Gentle stretching helps to (mostly) eliminate that nuisance over time. I highly recommend Cardiac Rehab 6 weeks after surgery if your insurance will cover it. The 'arm cycle' machines really helped loosen up my shoulder / upper arm / upper back muscles. The nurses will monitor your HR and rhythm while you exercise for an hour 3 days a week and provide instruction / recommendations for the different machines. (You will most likely be the most fit person in your class )

For most patients, a recliner is the preferred sleep solution for the first two to four weeks, until the sternum begins to heal and becomes more stable. BTW, most patients only sleep 2 to 3 hours at a time, sometimes for several weeks. NAPS are GREAT !

AT 6 weeks, the sternum is still only healed to about 80%. It typically takes 12 weeks to be fully healed given no complications. You will be restricted to lifting only 5 or 10 lbs for the first several weeks and then GRADUALLY allowed to increase that limit as your sternum heals.

Standard RTW (Return to Work) for NON-physically demanding jobs is 6 to 8 weeks. A FEW (Young and Fit) individuals such as yourself can return earlier to non-physically demanding jobs given no complications. MANY of us (older patients) found that we continued to heal and improve our stamina and exercise tolerance for a YEAR or more, especially after repeated surgeries.

It is helpful to have someone watching your treatment / medications while in the hospital to be sure that you are getting the right medicine and right dose at the right time. It is good to have someone at home to help for at least the first week and preferably the second week as well. After that, you should be able to take care of yourself throughout the day. Someone to prepare your meals and check in on you for another couple of weeks is nice. You will probably be restricted from driving for 6 weeks (to allow the sternum to heal sufficiently) but some doctors relent to MINIMAL daytime driving at 4 weeks, usually to allow you to come in for a check-up.

It is tempting to try to 'push' your recovery, especially for Fit / Macho types. DON'T DO IT! A fall or impact to the chest can set your recovery back by WEEKS and may even require re-cutting your sternum if damaged. SLOW and STEADY wins this race.

Hope this helps.

'AL Capshaw'

 

[Cris N]

Forget trying to sleep in a bed or even a couch with lots of pillows. Go with the recliner - try to find one with an easy operating mechanism. I was in one in the hospital & had to call the nurse just to get out of it - too weak to operate it

 

[OldManEmu]

Eric a Ross Procedure may be an option for you if you do not have Marfan syndrome. Marfan syndrome is not compatible with Ross Procedures.
The following link is to a surgeon?s web site in the USA that specialises in Ross Procedures and appears to explain them reasonably well.
I checked other web sites before my initial decision to go with a Ross and the information and statistics given appear reasonable consistent.
http://ps4ross.com/ross/index.html

I must say that I am a little different to others as I found sleeping in a bed easier than sleeping in a recliner.
I was actually able to sleep all night on coming home from hospital, I do not know if this was just me or because I was so tied from being woken up in hospital for an hour each night to have suspected still active endocarditis treated.

 

[CCRN]

Oh, you good looking guy...

Oh, you good looking guy...

View this link

http://www.edwards.com/Products/HeartValves/PERIMOUNTAorticCommunique.htm

For additional info.

This is on the inferior original bovine valve and not the improved magna 3000fx) difference being anti calcification treatments.

I will provide additional data shortly

I know what the data says.......I wanted one of those darn things! I argued and tangled with my surgeon for several weeks. I was told that, even though we don't stock that particular valve, it would be ordered just for me. However, he also pointed out to me that it had been available for implantation for barely a year. He was much more in favor of the previous model but most of the CV surgeons in my group told me they would opt for the stentless valve just due to the fact that it is the closest thing anatomically to a native valve.....in their opinions. AND opinions are like.....well you fill in the dots. There is a rule of thought that that anatomical likeness is one reason their track record has been so good thus far. Much of this is theoretical but so is the mechanical that's ticking away in my chest right now. I don't think that model has been out over 12 to 15 years. Who knows? Give me a break. I was just having some fun hoping I might get some attention from a guy with a cute tissue valve.

 

[tobagotwo]

I am just curious as to where this information about the "18-20 yrs in 90%" longest tested life info was obtained. The Edwards Carpentier Magna 3000fx valve was only approved for human implantation last year and Dr. Cosgrove at CCF did the first replacement using it on a human subject, at least as far as I can find, last year. So, wouldn't that mean the piggy would be about 11 years ahead of the cow in this case?

A good point. However, both figures are assumptive at some level. All the tissue valves have evolved some over time, but are structurally the same, and have thus inherited the usable life statistics of their forebears. While new features, model names and numbers have been added, the FDA has allowed the valves to continue to be produced under their original approvals, as the upgrades were not considered to substantially differentiate themselves from the originals in a way that would create a difference in terms of use, indications, or functionality.

The 90%-at-18/80%-at-20 figures are from published data for the Carpentier-Edwards bovine valves (Edwards Scientific), going back from when they were offered without anticalcification treatments. It is a manufactured valve, made of natural materials (cow pericardium - the tough tissue surrounding the heart). Structurally, the valve has remained almost the same over time, having gained low-pressure preservation treatments, a thinner stent, and anticalcification treatments along the way. Indications are that these improvements should reasonably add to the product's useful lifespan. More recent versions (such as the Magna, aka CEPM) continue to maintain this nature-mimicking structure, but allow for a supraannular mounting, which allows the use of a larger valve size for more bloodflow.

The porcine valves fall into two categories, stented and stentless.

The stentless valves (Freestyle) that have been discussed a lot recently on the site have been offered by Medtronics for just thirteen years, recently receiving anticalcification treatments as well. They have a 94% record at 12 years. However, a similar product, called the Toronto SPV (now marketed by St. Jude Medical) has been available for over fifteen years internationally. It is not treated to reduce calcification (St. Jude is still in trials with their own anticalcification process), and has been described as having 12 - 15 years of useful life. It appears comparable in quality to the Freestyle (after all, it comes from the same natural parts), but does not share any benefit that may be derived from anticalcification treatments. The Freestyle is available in a number of different configurations for various patient requirements, and can also be used when root replacement and other factors beyond the valve itself are involved. Stentless valves are real valves that are still attached to the wall of the pig's original aorta, and are implanted inside the patient's aortic wall, or in place of it, depending on the patient's needs.

A number of companies market stented porcine valves, including St. Jude Medical and Edwards Scientific. However, the premium valve in that category in recent years has been the Medtronics Mosaic, which I understand to have the dubious honor of being the most expensive valve on the market. Being an actual porcine valve attached to a stent (ring) for mounting, it remains structurally as defined by nature. Its forerunner, the Hancock MO valve, reached 15 years at a 90%-95% rate in mixed ages in various studies. "Upgrades" since that time include a thinner, flexible stent, a nondamaging tissue fixative treatment, an anticalcification tissue treatment, and the ability to mount supraannularly with the Mosaic version. Stented valves have a plastic ring which is used for mounting on the aortic wall.

There have been numerous model changes in both valve types in the last five years, and I recently read of the most current Mosaic model being called the Mosaic Ultra (the new moniker is not reflected in the Medtronics website). Again, the natural structure and indications are maintained.

Best wishes,