please help!

[nadav]

Hello to everyone out there!
I am a 27 years old married woman,no kids.
I have mitral valve prolapse with severe regurgitation and in about 2 weeks i am supposed to get my mitral valve repaired or if they can't fix it eventually replace it.Well, now i am left with an important decision to make and i don't know what to do: i have to choose between a tissue valve and a mechanical valve.I'd like to have kids in the near future but if a get a mechanical valve i'll have to be on blood thinners and the surgeon said it would make my pregnancy risky and there could be complications for me as well. Therefore on
the other side ,if i decide to go with a tissue valve it would only last 10-15 years or even less and i would have to go through another surgery to replace it and who wants to do it again?
I am really depressed ,scared of making the wrong choice,not only for my life but also for a future family plan.Any advice? So please if there is anyone out there who is or has been in my same situation,i would really appreciate an advice.Thank you in advance.

 

[Nancy]

Welcome to the site. You'll find lots of answers here. There is another member here with the exact same questions. Here's a link to the thread.

http://valvereplacement.com/forums/showthread.php?t=12982

Pay particular attention to the post from tobagotwo. He spells it out in the best way possible.

It boils down to a very personal decision. And it's one of the hardest decisions one could make.

 

[Curtsmum]

Hi Nadav, just wanted to say hello and welcome, i really wont be much help to you. I would say tissue would be best if you want to have children, but i could be wrong, i have no expirence of this what so ever. Hope somebody will come along to help you soon. Best of luck with your decition, sorry i couldn't be of more help to you. Paula x

 

[PJmomrunner]

Hi Nadav: I know you are freaking out right now, but if you spend some time perusing this website you will find that you can have a normal, healthy, happy life after valve replacement. (Personally, I'm banking on it!!! ) The following link is a part of a website run by VR.com member, Allodwick. You may find it very useful in making your decision.

http://www.warfarinfo.com/pregnancy.htm

Best of luck to you.

 

[Christina L]

Hi,

Hi,

You sound panicked and rightly so. I would guess that they will be able to repair your valve, but since you want children, if I were YOU (which I am not) I would choose the tissue valve.

I had my mitral valve repair done two years ago at the age of 44 - way past childbearing years, but most everyone (EXCEPT my cardiologist here in Colorado) recommended I get the tissue valve if my valve needed to be replaced. That is what I was going to do - get the bovine mitral valve.

It is such a tough decision - the more heart surgeries you have, the mortality risk becomes greater, but the risks of longterm Coumadin are not small either.

If children are an issue, I would go with the thought of having a child - if that is something you don't want to miss out on in this life, then get the tissue valve.

BUT good luck! I feel for you - it is a tough decision, although I pretty much knew I wanted the tissue and didn't have to think about it too much. I did not want to be on Coumadin just yet!

Christina L

 

[geebee]

There have been some who have gone through pregnancies on coumadin but it is very high rish.

My thoughts are, if you intend to have children, you go with a tissue this time if you need a replacement. You could then have your children and get a mechanical when the tissue valve needs replacement. You should then be set for life.

Best of luck and welcome to the VR.com family.

 

[Karlynn]

Welcome! I had my mitral valve replaced at the age of 32 with a St. Jude mechanical. The difference between you and I is that I had 2 children already. If I was presented with valve surgery prior to having children, AND if I definately knew that I wanted to absolutely have my own bio-kids, I would have chosen tissue.

If you are an otherwise healthy woman, I would think that bearing children with a tissue valve would be more desireable than going the very tough, very risky way of trying to do it while on Coumadin. While Coumadin is a very "livable" medication and will allow you to lead a normal life - pregnancy is one of the things that throws up a red flag.

You may want to check with your surgeon to see if he feels that he will give you the go ahead to get pregnant with a repaired valve. Depending on the valve and the experience of the surgeon doing repairs, some repairs don't last long. Others last a long long time.

The down side of going with a tissue valve in order to have children, is that you will have young kid/s when you need another surgery. OHS is not a cake walk and recovery time is tough with young kids (I do have experience with that.)

You are faced with some hard decisions and I wish you well with them.

 

[savysmommy]

Hello, and welcome!
I was in a similar situation as you not long ago. I had my aortic valve replaced 3 months ago. I chose a tissue valve. Even though I already have one small child, I didnt want to rule out having another child of my own just yet. I wanted to make sure I at least have the option to have another child if I wanted to later down the road.

The decision was still very hard. I waited until the last possible moment to make my decision and I am very happy with it.

Good luck to you,
Shannon

 

[twinmaker]

Welcome to the family! I went through a somewhat similar experience when I was younger. I had my first open heart surgery at age 22. It was a mitral commissurotomy. They went in and cut away scar tissue that was closing off the valve. We didn't have any children at the time. Between that first surgery in 1974 and my valve replacement (with a mechanical) in 1981, we had our children. Our daughter was born in 1976 and our twin boys were born in 1978. Our children were ages 5 and 3 when I had my second surgery. I didn't have to make a decision the first time because the surgeon was very confident that the valve wouldn't need to be replaced at that time. But if I had to choose back then, I would have chosen a tissue valve the first time around. Even in the situation that I was in, I knew there would be a second surgery. It was just a matter of "when" not "if". I wanted children very badly. Before my first OHS, we lost another set of twins. I was in the middle of my sixth month when they were born and they were just too small to make it. Less than a year after they died, I had my first OHS. Anyway, my pregnancies with our daughter and our second set of twins were pretty much uneventful as far as problems. I had some A-fib with the twins so I couldn't do much housework the last couple of months...but that was fine with me! I didn't even need C-sections with either of the pregnancies. I know everyone has to make their own decisions concerning these things but just wanted to let you know about my situation in case it helps you any. If you have any questions, I'll be glad to try and answer them. Linda

 

[Christian]

My wife is 32 and is having mitral valve repair or replacement in roughly five weeks. We recently had our first baby and would like another, and that tilted the scales towards the tissue valve (Carpentier Edwards Bovine). Our doctors agreed that it was a reasonable choice.

Hopefully she'll get a repair and the whole issue will be mooted.

 

[tobagotwo]

The repair would be the best outcome, and I hope it works out that way for you.

Having a successful pregnancy on Coumadin is not impossible, but is highly inadvisable.

If you want to have children, the tissue valve is far and away the safest choice, and that route has been followed by many. However, it will mean a resurgery down the line. At that time, you could switch to a mechanical valve if you wish.

You pretty much wind up having to make a choice at this point. There is a website for this specific issue, which may have more information but I don't remember the URL. Someone here will likely provide it.

Best wishes,

 

[nadav]

choice

choice

First of all ,
i'd like to thank you all for the support and advices you have given me. I thought a lot about the valve selection and after discussing it with my husband i decided i should go with the tissue valve.As for now, i can only hope (and pray)that my surgeon will be able to repair my mitral valve like he said but if he can't at least i know what it's best for me and for my future kids. What is the difference between the bovine and the pig valve?I have read that the bovine tissue valve lasts longer,why is that?
Do all the surgeons have this choice for patient going tissue?
Well, thank you again.I'll keep you posted on the date of my surgery.

 

[George]

In comparing a porcine or pig valve to a bovine or cow's pericardium valve my surgeon said: Think of a porcine valve as a ballet slipper. Then think of a bovine valve as a work boot. That is the difference in durability, according to him. The pig valve has served many of us well over the years. I just received a bovine valve 3 weeks ago today. I am 50. The Dr. mentioned that by the time I need a replacement, robotic surgery may be at the point where we don't need a sternotomy to get a new valve. I'm very pleased & confident with the choice of a tissue valve.

 

[tobagotwo]

In historical studies, the bovine valve - in the aortic position - lasts about five years longer than the procine valves. However, there are new anticalcification treatments and preservation techniques being used for both types that may change that picture over time. We just don't know. As the valves have not changed structurally from their forebears, I would still put my money on the results of the historical studies.

In the mitral position, tissues valves don't tend to last as long as they do in the aortic position. The bovine valve still outlasts the porcine valves, but the difference is smaller.

Between the valves, the difference is that the porcine valves are actual valves taken from pigs and treated with preservatives. The bovine valve is a manufactured valve, sewn together from preserved cow pericardium, the tough tissue that surrounds a cow's heart.

Both are excellent valves.

Best wishes,

 

[Arc_Weld]

Difficult Choices

Difficult Choices

Nadav:
Welcome to community.

I just found out two weeks ago that I need an aortic valve.
I?ve known for a year that my aortic valve was leaking.
.. recently.. it got worse.

I?ve looked at hundreds of documents in the last few weeks.
Here a few web sites that I found very informative.

http://cardiacsurgery.ctsnetbooks.org/?ck=nck

The following link has a good history of heart valves.
Cedars Sinai Medical Center - Types & History of Valves
http://www.csmc.edu/pdf/Heart_Valves.pdf

both tissue and mechanical have pros and cons.
Bob - "tobagotwo" has posted some really wonderful
information on pros & cons.
http://www.valvereplacement.com/forums/member.php?u=1099

 

[samiam]

Bovine vs. porcine

Bovine vs. porcine

Greetings!

My doctor didn't even consider the porcine option. He is very enthusiastic on the new bovine valves and said they are predicted to last an average of 25 years. By that time, as GEORGE wrote, imagine where heart surgery will be.

Good Luck!

 

[RCB]

Two Points

Two Points

Greetings!

My doctor didn't even consider the porcine option. He is very enthusiastic on the new bovine valves and said they are predicted to last an average of 25 years. By that time, as GEORGE wrote, imagine where heart surgery will be.

Good Luck!

1. "said they are predicted to last an average of 25 years"
Can you ask your doctor for a source for that statement and does it say for
which valve position and what age of pt. I have never seen that kind of
data or prediction even by our resident valve guru, TobagoTwo(Bob H. would you care to comment on"an AVERAGE of 25 years"?)

2. As far as the blanket statement:
"By that time, as GEORGE wrote, imagine where heart surgery will be"

Are you familiar with the law of "Diminishing Marginal Gains"? The valve
technology curve started over 60 years ago and started leveling off 10 years ago. Tissue engineered valve were promised 25 years ago to be in use 10 years ago. Your about the same age as I am- remember back 40 years ago all the predictions that were made for the year 2000- Most except for computer advances fail far short.

 

[Ross]

Shoot me for saying it, but advances in technique of surgery maybe, but I highly doubt your going to see anything drastic anymore. There is only so much that can be done to the human heart and I do believe they've done just about all of it.

 

[tobagotwo]

The current history is that 90% of the bovine valves are still in place after 18 years, and 80% after 20 years in the aortic position. That suggests the life cycle curve starts accellerating at about that point, and that 50% would probably show up somewhere between 21 and 22 years.

The expectation is that the new anticalcification treatments and less damaging preservation techniques now used will advance the longevity of the valves by another five years, as the current major reason for the valve's decline is calcification.

I share the belief that the valve will last longer, and that five years is a fair estimate, considering the statistics already available from the valve, and realizing that the physical structure of the valve is unchanged. Again, this is in the aortic position, rather than the mitral. If average is defined as 50%, I suppose a 25-year average could result from these upgrades.

Of course, then you would probably like to know up front which 50% you'd be in...

However, the 25-year figure is a considered estimate, not a fact. As things go in life, it is not impossible that one of the new treatments could cause an issue that actually winds up degrading the average life of the product over time. We'll be more certain in 16-18 years. There's no testing laboratory like the human body.

Stats is stats, marketing is marketing, and heaven help us all when they meet (as they often do these days). There is nothing wrong with deciding to accept an apparently reasonable estimation as a working premise, as long as you keep in mind that it is not a promise or an absolute, only a logical extrapolation presented as a basis for your decision.

There's always a brief, astringent whiff of Hobsen's Choice in the air when selecting a valve.

Best wishes,

 

[RCB]

Here we go!

Here we go!

What's this- the new math:


If "average" means 50%, I suppose a 25-year average could happen from it. Of course, then you would probably like to know up front which 50% you'd be in...

Under what rule of math does 50 % = average.

Do I have to give the formula for statistical average?