porcine vs. bovine? any thoughts helpful

[kate22]

am scheduling mitral valve surgery - hopefully repair, but surgeon said only 50/50 chance of that so next would be choice of valve. If I go with a tissue valve, which one to choose - my surgeon's preference is porcine - a friend with similar surgery a month ago- his surgeon recommended bovine. Has anyone out there a real preference for one or the other? Everything I've read seems to indicate porcine closest to humans, but I see from some threads that many here have had bovine - why was that? Any thoughts would be helpful, thanks!

 

[ski girl]

The tissue used is so heavily processed and treated that it doesn't matter. Go with your surgeon's preference! I have a mechanical valve, that's not close to humans at ALL and it seems to be working fine.

 

[Jkm7]

My surgeon at Mass General Hospital implanted my bovine valve. So far, everything is going fine for me.
Good luck for yours. Hopefully you will have a successful surgery and easy recovery.

 

[kfay]

I have a porcine valve, I honestly don't believe there is going to be a tremendous difference between the two, probably more just surgeon and hospital preference.

 

[epstns]

As the others have said, it is probably more important to know which valve your surgeon has more experience with. In my case it was no contest. We chose the bovine valve because my surgeon was a member of the design team for this valve and had already implanted thousands of them. His familiarity was important in getting a good outcome.

 

[kate22]

hi ski girl - thanks for your input, can I ask why you chose the mechanical over tissue? I know my tissue valve will only last 8-10 years, and that is worrisome as I may need at least 2 more surgeries based on my age -- but I thought while I'm still young and an avid gardener and traveller, I would try and stay off the coumadin, and then at my second surgery go with the mechanical. So glad it's working fine for you - when was your surgery? Take it you must be very active yourself - "ski"?

 

[ski girl]

Hi Kate - I didn't really choose a mechanical . . . I had my first AVR in 2010 and got a tissue valve (bovine cos that's what my surgeon preferred) and then 11 months later I got a severe case of endocarditis with some damage to the heart. My surgeon said no way was I getting another tissue valve as that would require re-op later in my life and he was going to be retired by then - and he was the only one in the country who he would trust to do that as it would be very tricky!! I was in no position to argue . . . .

Coumadin won't affect your gardening or travelling, and if you've been led to believe you will be a fragile little flower on it, that's rubbish. I'm a competitive ocean paddler and have been crunched on the head by a flying surfski (that's the 'ski'!) in a shore break - almost knocked me out but I didn't bleed internally. I also ride mountain bikes very badly and I crash every ride, I've given myself some good cuts and bruises and again, no issues. I was under the impression I'd have to wrap myself in cotton wool on coumadin but that cotton wool has been peeled off layer by layer and now I do everything I want to do!

So if you're choosing a tissue valve and guaranteed re-op because you're afraid of the impact coumadin will have on gardening and travelling, maybe give that a bit of a re-think . . . .

 

[pellicle]

Hi kate22

I agree with everything ski girl has said below and wish to re-iterate it

So if you're choosing a tissue valve and guaranteed re-op because you're afraid of the impact coumadin will have on gardening and travelling, maybe give that a bit of a re-think . . . .

Further please read this post of mine and ask yourself again if you really have a sound basis for warfarin fear

http://www.valvereplacement.org/for...nd-feelings-(some-may-find-images-disturbing)

Don't choose a second operation unless its really unavoidable.

Also like ski girl I am a bit active myself.

 

[kate22]

thanks ski girl and pellicle. Am not totally adverse to the coumadin, more the cost - my pharmacist told my husband it could cost up to $2,000/mo if injections necessary and we have no pharmacy coverage. Also, one of the reasons for my surgeon recommending the tissue valve was that hopefully transarterial valve surgery will be perfected by then, and OHS not necessary in future. Whether that's available in 10 years time when my first tissue would wear out is a crapshoot. This is such a hard decision to make, I am making myself crazy going back and forth between the two. As I do more research I find more pros and cons for both, and no totally definitive answer. I see a lot of people posting that no answer/decision is right or wrong, you just have to decide which is best for yourself in your circumstances, and I haven't reached that point yet where I can say absolutely that I know one or the other is the right choice for me. Thanks so much for both of you responding, all your feedback was most helpful

 

[pellicle]

thanks ski girl and pellicle. Am not totally adverse to the coumadin, more the cost - my pharmacist told my husband it could cost up to $2,000/mo )

Unheard of. I would have thought $30 a month to be nearer

PS just checked online , prices in the USA were about $20 for 30 5mg tablets, $17 for 2mg tablets. You'll find your dose varies on your metabolism and will likely settle between 4mg and 9mg daily (note: it won't vary that much that is the upper and lower limits I would anticipate you needing).

Self testing is about as straight forward as what diabetics do and a tester not expensive. Certainly a months worth of what you mentioned would set you up for having a tester and a years supply of strips and medicine.

 

[pellicle]

PPS
Just checked Amazon and a coaguchek XS with test strips is about $1100

http://www.amazon.com/CoaguChek-System-Plus-Strips-Lancets/dp/B0052U2SVM

Flea bay
http://www.ebay.com/itm/150995924926


There are cheaper online buys for strips too. Have a look on YouTube for some Roche training videos on the XS
After you've done it a few times the 5 minute videos will seem more complex than it really is.

Change pharmacist, he obviously loves your wallet too much

 

[Debbrn]

I have a tissue valve because I had my pulmonary valve replaced. I have a bovine valve because that was my surgeon's preference. It was my 4th heart surgery. They are hoping that when this one needs to be replaced they will be able to do it in the cath lab.

Debbie

 

[virginian777]

Same here debbrn

 

[ski girl]

One thing I think we all have to consider when planning on successive valve surgeries being done by the catheter method is the testing required by the government in order for that to happen. Currently the cath method is only available to old crumblies who wouldn't survive OHS (someone feel free to jump in and correct me if I'm talking out of my proverbial).

I don't know if this method is even being tested for valve replacements on healthy people who would easily come through OHS, and I *really* don't know if anyone is testing it for use in valve re-replacements. I remember the cath method being discussed with me as a future option in the 80's - but it's still not an option available to us.

So if you go tissue valve on the assumption that your next surgery will be by cath, it's worth doing some research on what the availability of cath valve replacement for otherwise healthy people is likely to be!

 

[epstns]

From what I understant, they are still working on trans-catheter valve replacement for healthy patients. If you are a younger patient, I would be concerned if your cardio says that your next valve could be implanted via catheter, since tissue valves deteriorate faster in younger patients and a tissue valve might need to be replaced in less than 10 years. For us "seniors" over 60 or so, our tissue valves are projected to have longer lifespans (mine was quoted as 15-20 years possible), so there may be more time for the labs to work on the trans-catheter valves before we need another replacement.

All we can do is make educated decisions. We cannot know the future, and I don't think I would want to know it. . .

 

[Rachel]

I have a tissue valve, I'm 47 and I am fully aware and prepared for another OHS to replace the one I have in the future -- if I'm still here --

I know that my surgeon said that by the time I need another one, trans-catheter might be available -- might be. I'm not counting on it - but if it happens, great.

I think I've got it now....there are no guarantees in anything really - period.

And the only thing that I can say is not any different than what everyone else says (because it's the very best advice) - everyone is different - you have to live with the choice you make, don't make a choice of valve based on what someone else said or experienced. It's just all about you and what you think you can or cannot live with.

Good luck, any choice you make is going to be a good one, you can't lose here.

Rachel

 

[Jkm7]

deleted

duplicate

 

[Jkm7]

Unheard of. I would have thought $30 a month to be nearer

PS just checked online , prices in the USA were about $20 for 30 5mg tablets, $17 for 2mg tablets. You'll find your dose varies on your metabolism and will likely settle between 4mg and 9mg daily (note: it won't vary that much that is the upper and lower limits I would anticipate you needing).

Self testing is about as straight forward as what diabetics do and a tester not expensive. Certainly a months worth of what you mentioned would set you up for having a tester and a years supply of strips and medicine.

In response to the high cost quoted:

I suspect the high cost was a suggestion as to lovenox injections at times bridging of coumadin is needed or when INR is too low, the lovenox injections twice a day would keep the patient safe until they could get back into their range. Lovenox is very costly though there is now a generic.

 

[Superman]

Cost may vary for warfarin. Warfarin is available generic. Some places have $4 list for perscriptions that it falls into. Lovenox is now generic for bridging. Self testing can be more expensive than going to a lab once a month without insurance. In 22 years of being on warfarin, I've had to bridge with Lovenox twice. Strips can be $10 each, a lab draw is $17 where I'm at. $1,100 up front cost for a machine would take 157 tests to make up the costs. 3 years if testing weekly, 13 years if monthly.

I don't know what your age is, but you mention being younger and a husband. If children are in your plans, then mechanical is out of the question as warfarin is very bad in pregnancy.

Mitral valve is not under as much pressure as the aortic valve (which seems to be what most posters here have). You could get more life in the Mitral position out of a tissue valve. Still likely for future re-ops though. I certainly wouldn't base a decision on trans-cath replacements becoming available though.

 

[ElectLive]

Mitral valve is not under as much pressure as the aortic valve (which seems to be what most posters here have). You could get more life in the Mitral position out of a tissue valve. Still likely for future re-ops though. I certainly wouldn't base a decision on trans-cath replacements becoming available though.

Historically, tissue valves actually deteriorate faster in the mitral position than they do the aortic. To further the point about trans-catheter replacement, though, it is much much further behind than the state of things in the aortic position. In fact, I think there has only been 1 or 2 ever performed worldwide in the mitral position to date, so obviously no full scale clinical studies, etc.