Opinions on tissue vs mechanical aortic valves

[neil]

hi.i had tissue valve,my personnal choice,i know il need a reop down the line but am cool with that,was scared silly before the op but to be honest wasnt nearly as bad as i thought,which is a good job considering i will need another in 10 15 20 yrs,my motto live for now for tomorrow never comes,theres one thing for sure whichever you pick is sure better than the one you got,....neil

 

[olefin]

My first and foremost consideration is keeping you from having more surgeries down the road. This surgery, one time around, is enough for anyone. This is my opinion and it usually stirs a big bee hive up, so I'll just leave it right here.

I'm with Ross here.

I hope I never have to go through that 20 days again.

Several months before I had AVR I had a severe bleeding duodenum ulcer. The surgeon had much concern about me using a mechanical valve and being on warfarin. But he still recommended mechanical since I was 55.

Wish you the very best

 

[Karlynn]

Question regarding Coumadin, I take nexium daily because of acid reflux which caused 3 ulcers that are actually in my throat, not my stomach. If I stay on the nexium everything is good & I have zero issues.

They aren't bleeding ulcers so there shouldn't be any issues there. Does anyone know for sure if Coumadin & nexium can co-exist? Obviously I will ask my surgeon & he is well aware of this issue of mine.

Nexium is esomeprazole magnesium.

I didn't find it on Al's interractions.

I take Prilosec (omeprazole) I don't know what the difference is in the 2, but I have no interactions with omeprazole and Al's site reports none.

But, yes - it's best to check it with your surgeon.

 

[Cozycat]

Mechanical for me too!

Mechanical for me too!

My first and foremost consideration is keeping you from having more surgeries down the road.
I so agree with all of you going with mechanical. I'm 67 and am still going to go with mechanical on my 2/13 surgery. Every surgery is hard on you, more scar tissue forms, etc. etc., plus there is no guarantee that you won't have other health problems to contend with at a more advance age so I'll take mechanical. My grandson told me I would then be a cyborg!

Cozycat

 

[Jkm7]

My first and foremost consideration is keeping you from having more surgeries down the road. I believe that should be everyones prime consideration, but many disagree with me. I'll never get over how people subject themselves to repeated surgeries to avoid ACT. It's just not logical in my mind. This surgery, one time around, is enough for anyone. This is my opinion and it usually stirs a big bee hive up, so I'll just leave it right here.

Ross... Of course, you are right and the conversation will continue to go round and round but sometimes it's good to remember that decisions as to which valve also involve other considerations such as the ticking.

My valve replacement was my second OHS in four years and I am willing to risk a third to avoid BOTH ACT and ticking. For someone to brush me off and say, "Oh, it's nothing. You'd get used to it." Does not work for ME. I could not risk it. My adversion/reaction to a ticking clock is so extreme it is something I could not take a chance on. I don't mind it mildly.... I have to run away quickly. What in the world would I do if I 'got a loud valve'? My very excellent Mass General surgeon (may he rest in peace) told me there is no way he could predict who would tick loudly and who would not.

He had very petite, ultra thin ladies who barely sounded a tick and huge, barrel chested extra large men who ticked loudly. He considered my comment about that being a consideration for me to be valid.

Combine the attempt to avoid ACT and ticking and I am soo sooooo soooooo happy I chose bovine tissue.

 

[Lynlw]

I find it interesting that the origonal question was "Bottom line: Is there anyone else out there that chose a tissue valve over mechanical at my age? " and this seems to have gotten side tracked. Hopefully She was able to make a decision she feels at peace with today.

 

[Lisa in Katy]

I find it interesting that the origonal question was "Bottom line: Is there anyone else out there that chose a tissue valve over mechanical at my age? " and this seems to have gotten side tracked. Hopefully She was able to make a decision she feels at peace with today.

Yes, but her topic is "Opinions on tissue vs mechanical aortic valves" so maybe she wanted some of both?

 

[abbanabba]

My first and foremost consideration is keeping you from having more surgeries down the road. I believe that should be everyones prime consideration, but many disagree with me. I'll never get over how people subject themselves to repeated surgeries to avoid ACT. It's just not logical in my mind. This surgery, one time around, is enough for anyone.

From what I remember, you had a very difficult time after surgery and I'm not at all surprised you wouldn't want to go throught that again... but then given the horrific time you've just been through with your teeth because of medical professionals who didn't understand ACT, it doesn't seem to be that much better - in my very humble opinion (of course, we all know you're just a masochistic glutton for punishement ).

I guess it goes to show none of us can predict what is around the corner, so while we certainly need to consider the future, we also have to make the best of today. When my cardios were telling me they were putting off my PVR because the sooner they replaced the valve, the sooner I would require surgery again, it wasn't until I pointed out that while they were worrying about what might happen 15 years down the track, I was losing out on my life NOW and IF I was still around in 15 years, I'd deal with it then... that they seemed to "get" it.

But - it's still wonderful that we can all share our experiences and thoughts here, even if they do differ If it helps someone make a better informed decision - whatever that may be - then that's a great thing.


A : )

 

[klynnc]

Wow! Thanks so much for all the input. I had a talk with my surgeon again today and I have decided on tissue for sure. He decided on the bovine part for me, which was fine.
I really appreciate everyone's opinions and suggestions. Hopefully I won't even need the replacement and he can do a successful repair.
Just to answer the question many of you aske about the TIA's. They are pretty sure they are coming from the heart. I have some strange thing that shows up on the echoes that no cardiologist, even with a TEE can figure out exactly what it is. It has been suggested that it could be 1) an old endocarditis that I never knew I had and resolved after a dose of antibiotics (sounds pretty unbelievable, but told that it can happen), but there appears to be some vegetation that could be breaking off and going to the brain or 2) A subartic membrane with some growth on it getting into the blood stream (although I think thet pretty much ruled out subartic memb) 3) a benign heart tumor that just needs to be removed 4) and this was the last epiphany that Dr Thomas came to - one of the 2 leaves on the valve had a fenestration and it tore through causing a piece to flap around and small pieces break off and get into the blood, to the brain causing small TIA's which for me caused blind spots 2 times and blurred vision a few times. I think I got all of that right. They say the only way they will know for sure is once they open me up and actually see it. At this point, I'm kind of curious as so many doctors seem a bit baffled by it.
So, assuming this is the cause of the TIA's then they don't expect that I should have to be on coumadin anymore.
I'll keep everyone posted. My surgery is tomorrow and have to be there at 5:15am so better get some shut eye.

 

[abbanabba]

All the best!!


A : )

 

[Superbob]

Just catching up with this thread, and just realized your surgery is tomorrow morning --- just wanted to say I am glad you have reached a valve decision you are comfortable with. Sending you my best wishes and prayers.

 

[Eva]

Will be thinking of you tomorrow. Good luck

 

[Jkm7]

Best wishes for successful surgery and a bump free, fast recovery. We'll be anxious to hear you are doing well as soon as you are able.

Godspeed.....

 

[Karlynn]

Just in case you're seeing these... we look forward to your good report of a successful surgery.

 

[ticktock]

My first and foremost consideration is keeping you from having more surgeries down the road. I believe that should be everyones prime consideration, but many disagree with me. I'll never get over how people subject themselves to repeated surgeries to avoid ACT. It's just not logical in my mind. This surgery, one time around, is enough for anyone. This is my opinion and it usually stirs a big bee hive up, so I'll just leave it right here.

Ross, I couldn't agree with you more. I well know what repeat surgeries do and none of it is good. You will eventually suffer some collateral damage, it happens and any surgeon worth their salt will tell you that.

I have been on Coumadin now for 31 years. I don't feel as though I have missed one darn thing because of it. Yes, I home test once a week and I take a pill. I would take that any day over cognitive dysfunction, loss of memory, left sided weakness, a paralyzed left vocal chord and left sided paradoxically paralyzed diaphram. Yep. Put me in the titanium line any day and pass the pills.

 

[mikeb85]

If there were a guarantee that a mechanical valve meant no future OHS I would consider it but, they dont offer that option! I am going with the tissue because ACT just is NOT apealing to me. Also there is no guarantee you wont need ACT with tissue valves so it is 6 of one and 1/2 dozen of the other. I agree with Neil Live for Today!
Mikeb

 

[neil]

mike thats what i thought,,but there is no guarantee that with a mech you wont need ohs surgery in the furture,as having a tissue wont mean you wont finnish up on act,and looking at all the threads a lot seem to be about act and the problems it can bring,saying that i can see totally why someone would go with mech,hey we all gotta make our choices and it aint easy,just cheeses me off when people think that we are mad or stupid to want tissue,i say good luck to everbody regardless what you choose,ps my local rugby team won at the weekend yippeeeeeeeeeeeeeeeeee

 

[tobagotwo]

Some thoughts...

If there's calcification with the stenosis or regurgitation (and there very often is), that can definitely cause TIAs. This is mostly from tiny pieces of apatite crust breaking off and traveling through the bloodstream to the affected points. Episodes of that type of TIA should dissipate after surgery.

The use of coumadin (warfarin) is not such a simple decision, any more than creating the liability of certain reoperation should be.

As pointed out by abbanabba, coumadin can affect other health issues you have or may contract, or create difficulties with the treatments for them (not just getting teeth pulled).

It can increase the risks of subsequent operations of any type, and certainly complicates many otherwise routine medical and dental procedures, such as colonoscopy and root canal. Even bridging is not without its risks.

A small percentage of people have bad reactions (called adverse events) with coumadin, and it's not really a drug you want to go without, once you've got your valve. In some people (again, a small percentage), it seems to be very difficult to control dosage. In some instances, it can make users prone to other issues, such as Purple Toe Syndrome.

If you have a history of severe gastric issues involving stomach or intestinal bleeding, or any other continuing or recurring bleeding disorder, you should ask your doctor to consider this when determining whether you should be given a type of valve that requires ACT (Anti-Coagulation Therapy).

It's a drug that can have very desirable benefits, including reducing the risk of stroke for people with AFib or previous strokes, and allowing the reliable use of a usually permanent valve type that would otherwise be a stroke risk itself. The great majority of people adjust to it fairly well to extraordinarily well. But like all drugs, it's not without its drawbacks, and it's not universally well-tolerated among patients.

Best wishes,

 

[neil]

tobagotoo.........very good post,well put,you have my vote lol............