Ozaki or Mechanic on-x ?

[francy.pam]

Hello
I am happy to have known this forum. Thanks to anyone who will write me.
I am 48 years old and have two children young enough not to understand what is a bicuspid aortic valve with severe moderate stenosis.
The intervention will be carried out in the coming months. A surgeon asked me to do a contrast CT scan to check for enlarged aorta. I’m waiting to get it done and decide how soon to operate.
I spoke with the two cardiac surgeons in Italy who routinely practice the Ozaki technique.
One of the two recommends the Ozaki for the quality of life that I would have for a while, the other the on-x mechanical valve to avoid further interventions.

Looking to the future with the Ozaki, I would repair the valve and approximately after 10/15 years I could do a TAVR with valve replacement (which is less invasive than an open heart operation), but it will last about 10 years. At that point I should hope that in the meantime they have found a less invasive solution for an additional operation (for my age at that time).
I know that the guidelines recommend mechanics, but I would like to have at least 10 years of life when not sick (hopefully more).
I have great difficulty in accepting the idea of a mechanical valve because it would condemn me to continuous anxiety for:
- risk of injury (even if statistically significant injuries are few)
- impossibility of treatment in various parts of the world (for lack of antidote) I love to travel,
- forgetting to take the pill,
- blood test once a month.

For these reasons I am oriented towards an Ozaki technique but if they open and find it is not feasible (because I had pericarditis in the past without knowing it) then I must have already chosen a second option.
And I am very much torn because at that point it would make more sense to put the mechanics.

Please tell me what is your experience? Thank you.

 

[dornole]

I am an age 57 woman and I just had a mitral mechanical valve installed in October. I decided to have a mechanical valve because I didn’t want to have multiple open heart surgeries. In my case my surgeon also said “anyone who says this can be repaired is lying to you” and that a tissue valve might only last me 2-3 years because I have rheumatic heart disease. So easy decision.

Repeat OHS is something to avoid if you can. Trust me it’s not a good time and there’s no guarantee your repair will last 10-15 years especially given your young age. Also no guarantee that you’d qualify for TAVR. And then you’re hoping for a breakthrough after that?. . . Each surgery also creates internal scars and raises the complexity and risks. There’s a good reason mechanical is recommended for younger patients.

Second issue is your worries that a mechanical valve will somehow make you an invalid. I’m only 5 months out from surgery and I’m not a sickly person. . I’m a person who takes a couple of pills and gets regular blood tests to monitor my INR. I do everything I did prior to surgery. There’s no difference except my heart works better now. I am not sure what you’re talking about a lack of antidote?

I travel. I use a pill box and reminders on my phone to make sure I take my pills. I am not worried about injuries. I mean I wouldn’t juggle chain saws, but I wouldnt do that anyway. I hike, camp, sail, swim, kayak etc. I lead a normal healthy life indistinguishable from most people my age.

If you travel a lot you can get a home setup to easily test your own INR wherever you are.

Ask away for questions. It’s natural to worry but you want to be really sure you’re making a logical decision if you’re going against cardiology guidelines agreed on by experts all over the world.

 

[francy.pam]

Non sono sicuro di cosa tu stia parlando, mancanza di antidoto?

Thank you so much for sharing your experience.
By antitodo, I mean the solution that the hospital can provide for blood clotting in case of serious injury.
I was told by the surgeon that for ex On-x mechanical valve has an antitodo that hospitals have in case of serious injuries.
I like to travel in countries such as Mexico, the Maldives, the Caribbean, Africa (I would like to go on a safari in Kenya)
and the fact that I might get hurt and may not be able to save me in hospital paralyzes me with fear.

 

[pellicle]

My vote would be mechanical and my leaning would be towards St Jude or ATS

I was told by the surgeon that for ex On-x mechanical valve has an antitodo that hospitals have in case of serious injuries.

this is misleading and seems consistent with no evidence based bias in parts of the world towards On-X ... the antidote you mention for reversal is simply Vitamin K and this works on every mechanical valve.

Vitamin K is the standard and has been widely used for about 30 years

https://pmc.ncbi.nlm.nih.gov/articles/PMC6334060/

The On-X is not special and its claims of lower INR have been shown to be unsafe. Given standard levels of anticoagulation then every mechanical valve is pretty much on a level playing field.

I like to travel in countries such as Mexico, the Maldives, the Caribbean, Africa (I would like to go on a safari in Kenya)
and the fact that I might get hurt and may not be able to save me in hospital paralyzes me with fear.

this is true of every human who travels and travel as you get older (valve or no valve) gets risky. Stay with facts and statistics not troubled exaggerations.

Whatever valve you get the key point is to learn a little bit about your anticoagulation therapy (first point: its not blood thinning despite what people may say) and manage your INR to be between 2.0 ~ 3.0 for optimal effectiveness of the Aortic position and 2.5 ~ 3.5 for the Mitral

Best Wishes