Question for those who have had both Tissue and Mechanical

[Elgato]

I know a few you have had experience with both mechanical and tissue valves.

Could you please share your experience and feelings about each?

Do they feel the same? Do you feel the same? Noise? Pressure? Headaches? Pounding?

Does one feel more like a natural valve?

Anything else you can think of that was different?

Still trying to make a decision and every little bit helps.

Thank You

 

[ski girl]

I had a tissue valve for 10.5 months before I got endocarditis and bacteria started to eat it. Now I have mech. You can't *feel* your valves so neither felt natural or not. The only difference is the ticking noise the mech comes with, and taking warfarin which is the farthest thing from a big deal. (there are lots of threads about how warfarin doesn't have anything like the impact on people's lives that we had been told to expect so I won't go into that here)

Both will keep you alive and for those with symptoms pre-op, dramatically improve the quality of life. If you get a tissue valve when you have more than 15 years of life to go, you're just about guaranteed to need a re-do op. Mechs will last a lifetime unless you get some crazy complication like endocarditis.

As others have said - it's a difficult choice because both tissue and mech are excellent choices, and both are a million times better than a crap native valve!

 

[pellicle]

Hi

Do they feel the same? Do you feel the same? Noise? Pressure? Headaches? Pounding?

no .. of course not. I have never even heard anyone ever say a mechanical feels the same. Do you get used to it? Well mostly yes.

Headaches is a new one on me.

From what I have gathered the more scar tissue (you know, from successive operaitons) the more a mechanical valve will end up thumping more (better conduction)

Does one feel more like a natural valve?

my Tissue valve was somone elses aortic valve (a homograft) ... apart from the nifty scar it felt as good as new, better really as my original valve was bicuspid ;-)

Still trying to make a decision and every little bit helps.

ok ... well if so, then may I ask how old are you? Its not on your Bio. Please tell me why you are even considering a mechanical valve? I mean all your posts are so apprehensive about that choice. It seems to me you are one who the anxious type. I don't see the advantage in a mechanical if you are so anxious about it.

I would have thought that someone who is of the type to say "so, what should I have Doc" ... "Oh, ok well you just fit that then and I'll move on" - would be more suited to a mechanical.

There is no doubt you will have to accept changes in your life if you take a mechanical valve. You'll need to manage your warfarin (another change) and you'll need to adapt to the changes in your bodys sounds.

I feel (from your writings) that you would have difficulty with that .. no?

If you get a Tissue prosthesis you'll have (in all likelyhood) at least 7 (probably more) good years where you'll only need to go to yearly checkups. After that they'll be looking at signs of stenosis or signs of valve structural failure. But day to day you'll be able to forget about it.

With a mechanical its on your mind for a few instants every day. My phone alarm goes off to remind me to take my warfarin, I measure it weekly. The valve itself doesn't bother me, but now I'm conscious of my heart and my health every day. Personally I actually think that's a good thing anyway.

To me, that's the bottom line ... hope that helps your thinking process.

Best Wishes

 

[pellicle]

and both are a million times better than a crap native valve!

Assuming being alive is only a million times better than being dead...

 

[ChicagoMammy]

I had a tissue valve for 7.5 years. I had it and another valve replaced with mechanical valves 2.5 weeks ago. So far the only difference is the clicking. I notice it but it doesn't bother me. I've been on Coumadin for life for three years (runs of a-fib) anyway so this time around choosing mechanical valves seemed like a no brainer. Although I'm having trouble getting my INR levels settled at the moment over the 8 years I've been on and off it (on for the last three) it's been a non-issue.

 

[Mentu]

My valve is a bio-prosthetic but my Uncle Bob had both. He started out for the first 10 years with a St Jude mechanical. He said he never felt any difference with it other than he could hear it tick at night when everything was still and quiet. He didn't find using coumadin at all difficult and it made little change in his life. When his mechanical valve failed due to tissue growth, he received a porcine valve along with several arterial stents. He said that the second heart surgery was no big deal since he new what to expect and looked forward to being healthy again. Being biological, there was no need for anticoagulation with the 2nd valve so it was discontinued a couple of months after the AVR. Uncle Bob said that while taking coumadin and doing blood checks was never a big deal, he did like the freedom he felt with his porcine valve and found it to be completely silent. He lived 16 years with his porcine valve before his death from COPD which had nothing to do with his use or choice of heart valves but, rather, too many years of smoking which destroyed his lungs and arteries.

Larry

 

[DebbyA]

I never hear my mechanical valve. The surgeon said there's no way to predict who will hear it and who won't.

Now 8 weeks post-surgery, my INR is still not in range--maybe this week.

 

[Elgato]

Hi



no .. of course not. I have never even heard anyone ever say a mechanical feels the same. Do you get used to it? Well mostly yes.

Headaches is a new one on me.

From what I have gathered the more scar tissue (you know, from successive operaitons) the more a mechanical valve will end up thumping more (better conduction)



my Tissue valve was somone elses aortic valve (a homograft) ... apart from the nifty scar it felt as good as new, better really as my original valve was bicuspid ;-)




ok ... well if so, then may I ask how old are you? Its not on your Bio. Please tell me why you are even considering a mechanical valve? I mean all your posts are so apprehensive about that choice. It seems to me you are one who the anxious type. I don't see the advantage in a mechanical if you are so anxious about it.

.

I would have thought that someone who is of the type to say "so, what should I have Doc" ... "Oh, ok well you just fit that then and I'll move on" - would be more suited to a mechanical.

There is no doubt you will have to accept changes in your life if you take a mechanical valve. You'll need to manage your warfarin (another change) and you'll need to adapt to the changes in your bodys sounds.


If you get a Tissue prosthesis you'll have (in all likelyhood) at least 7 (probably more) good years where you'll only need to go to yearly checkups. After that they'll be looking at signs of stenosis or signs of valve structural failure. But day to day you'll be able to forget about it.

With a mechanical its on your mind for a few instants every day. My phone alarm goes off to remind me to take my warfarin, I measure it weekly. The valve itself doesn't bother me, but now I'm conscious of my heart and my health every day. Personally I actually think that's a good thing anyway.

To me, that's the bottom line ... hope that helps your thinking process.


Thanks again.

Best Wishes

Headache may be the wrong term. I have seen migraine and silent migraine mentioned.

Will be 60 in July. This age seems to make me borderline either direction. I am "anxious" about both, just trying to get as much info as possible

I feel (from your writings) that you would have difficulty with that .. no? I do not know. Just getting as much input as possible.

It looks like the lower INR ranges have been approved for use in Europe with the On-X. That seems to make it more attractive but I am not sure how much is hype.

Thanks again

 

[pellicle]

Hi

Will be 60 in July. This age seems to make me borderline either direction. I am "anxious" about both, just trying to get as much info as possible

yeah, I would tend to agree with that ...

I feel (from your writings) that you would have difficulty with that .. no? I do not know. Just getting as much input as possible.

well my purpose in replying was to throw as manydifferent ideas into the mix, not to make judgements. Understanding the background of the asker steers the sort of responces I give. If someone is anxious then why suggest something that you know will irritate them?

I was thinking about your question earlier today and thought I may offer another tangent. However as you mention your age it may be pointless. With that in mind : if you have a mechanical it is a probability you will need no further surgery, the same is not true with a tissue valve. However if you are considerinng a tissue valve and willing to accept that it will fail in time (less issue for you perhaps) then if the mechanical becomes obstructed (requiring a redo) that would give you the opportunity for replacing that with a tissue valve at that point. For then you will know how you feel about a mechanical.

Hope that is worth something... Best Wishes

 

[Superbob]

It IS a tough decision, with many factors to consider, pros and cons of each choice. In this forum on February 1, 2005 -- two weeks before my aortic valve/root replacement at age 63 -- I tried to describe the dilemma this way:

*********************************************************************************

"It would help so much in making this momentous decision if we had a crystal ball, wouldn't it?

"If I get a tissue valve, it will last (or won't) 15 to 20 years. I won't live any longer than that (or I will) and so that will take care of me fine. Or I will be around at 80 and subject to a VR for the tissue but medical technology will be so advanced by then, it won't require invasive surgery (or it will). If I get a tissue valve, won't have to have coumadin more than 3 months, which is the norm (or I'll be the exception and have to have it longer).

"If I get a mechanical valve, regulation of the thinners won't be a problem (or it will be a pain), and the mix will never get out of whack (or it will, and cause clots or bleeding). The ticking sound won't bother me, even though I am a light sleeper (or it will drive me crackers). The mechanical valve will last forever (or I'll have some sort of accident, and it won't after all). I won't ever be far from a clinic and so will be able to keep the coumadin nicely regulated (or I'll be far away from one, in Timbuktu or somewhere, and too klutzy to do the self-regulating).

"I want to go for quality of life. No, I want to go for quantity of life.

"I am not trying to be flippant. You have given me a lot to think about. I am going to call my surgeon's office tomorrow morning and see if I can get one more session with him to discuss more fully the options. He mentioned a stentless bioprosthesis that does the Bentall in one seamless piece, as I understand it. (But I don't understand, really.)

"This is an awfully big decision. Where is Solomon when you need him?

"Thanks for your concern and advice."

**************************************************************

Those were my thoughts nine years ago when I was posting as "BionicBob."

After weighing all the pros and cons, each of us has to make his/her own decision. What's best for one person may not be best for another.

I would just advise that after you have made your decision be at peace with it. It will be a good decision. The only bad decision is to do nothing.

 

[Forrest]

Well stated SuperBob

 

[Gail in Ca]

I got my tissue 25 yrs ago at age 34. That surgeon thought I wanted another baby, but after the surgery and he saw what shape my aorta was in, he then recommended I NOT have another. I was happy with my one girl, no regrets. I totally felt back to normal after getting the tissue valve.
I didn't need warfarin after a couple of months. My heart was functioning well, and I exercised on a step with 2 risers, felt great. It felt natural, except for the scar, I never knew I had a valve replaced.
But, when it began to fail, it went very fast, I was in bad shape, needing emergency surgery, and couldn't get my mitral valve done at that time because I was in such bad shape.
So, now I've had 2 mechanical valves, only because I got BE. Of course, I hear the sound of the mechanical valve. I always have, and this new(5yrs) one is larger and it is louder, and thumps more. I'd say just because of the sound, I know it's not natural, and am constantly reminded that I have had valve replacement surgery. After my last surgery, and I finally had my severely leaking mitral repaired, my heart functions as it did with a tissue.
I have been exercising, walking, gardening, etc, and feel good. I think I used to feel the tissue was more natural, but that was because at that time, my mitral valve was only leaking slightly, and it didn't affect my heart function when I exercised. The more it leaked the worse I felt while exercising, but I used to think it was the mechanical valve. Now that it's been fixed, I can say that I feel the same as I did with tissue.
Neither valve caused headaches, pressure. Maybe the mechanical pounds a bit at times. I do have a large valve inside a larger graft.
If we didn't need a redo with a tissue, of course we'd all get one. But, I don't want a 4th surgery, and so I go with mechanical.
Now, I've had 3 surgeries, so maybe scar tissue is also affecting how the valve sounds, and I've had much scarring the surgeon has had to deal with the last 2 times.
You make your decision on whether you want to go through another surgery. And it could be a lot sooner than you would want. It also could last as long as many surgeons are saying it could. The average, according to someone on this site, is 12 years for a tissue valve. It seems like a long time until you get close, and then you want much, much more time.

 

[Elgato]

SuperBob,

Exactly!

You guys with all the experience are supposed to have all the answers by now. That why we come here.



Met with a second surgeon today. He clearly leaned towards tissue valves even though he would not come right out with a recommendation.

He likes the Edwards Trifecta and Magna Ease for tissue and the On-X for mechanical. He felt there was a lot of hope that the reduced coag trials with the On-X would work out.

Thanks

 

[pellicle]

You guys with all the experience are supposed to have all the answers by now. That why we come here.

my experience is that more knowledge just brings more questions. Certainly some questions are answered, but the knowledge usually brings with it the vision of things from which more questions arise.

He clearly leaned towards tissue valves even though he would not come right out with a recommendation.

and ... well he shouldn't either. His role is to inform you in the least possibly biased way he can. From there it is you who makes the decision.

For me it was simpler ... in the earlier stages I did what I was told was best .... on the last occasion the answer for me was obvious.

Best Wishes

 

[Phil]

Hi,

I've had both - a homograft for almost 11 years and a mechanical for almost 10 months. The homograft served me well, but was a slight pain to deal with when it started heading south - feeling tired, lots of AF and disagreement between cardiologist and surgeon as to when replacement surgery should occur. My mechanical valve is terrific - I had an ablation done at the same time and have had virtually no AF since, my INR is always within range and I like the noise it makes. I usually only hear it at night and find it comforting, not intrusive at all and oddly nice and reassuring. This has surprised me as I'm someone who does not deal well with sounds like dripping taps, etc; and before surgery I worried a lot about how I would deal with the valve noise, but it's been a total non-issue.

Hope this helps.

All the best.


Phil.

 

[extraordinary]

It IS a tough decision, with many factors to consider, pros and cons of each choice. In this forum on February 1, 2005 -- two weeks before my aortic valve/root replacement at age 63 -- I tried to describe the dilemma this way:

*********************************************************************************

"It would help so much in making this momentous decision if we had a crystal ball, wouldn't it?

"If I get a tissue valve, it will last (or won't) 15 to 20 years. I won't live any longer than that (or I will) and so that will take care of me fine. Or I will be around at 80 and subject to a VR for the tissue but medical technology will be so advanced by then, it won't require invasive surgery (or it will). If I get a tissue valve, won't have to have coumadin more than 3 months, which is the norm (or I'll be the exception and have to have it longer).

"If I get a mechanical valve, regulation of the thinners won't be a problem (or it will be a pain), and the mix will never get out of whack (or it will, and cause clots or bleeding). The ticking sound won't bother me, even though I am a light sleeper (or it will drive me crackers). The mechanical valve will last forever (or I'll have some sort of accident, and it won't after all). I won't ever be far from a clinic and so will be able to keep the coumadin nicely regulated (or I'll be far away from one, in Timbuktu or somewhere, and too klutzy to do the self-regulating).

"I want to go for quality of life. No, I want to go for quantity of life.

"I am not trying to be flippant. You have given me a lot to think about. I am going to call my surgeon's office tomorrow morning and see if I can get one more session with him to discuss more fully the options. He mentioned a stentless bioprosthesis that does the Bentall in one seamless piece, as I understand it. (But I don't understand, really.)

"This is an awfully big decision. Where is Solomon when you need him?

"Thanks for your concern and advice."

**************************************************************

Those were my thoughts nine years ago when I was posting as "BionicBob."

After weighing all the pros and cons, each of us has to make his/her own decision. What's best for one person may not be best for another.

I would just advise that after you have made your decision be at peace with it. It will be a good decision. The only bad decision is to do nothing.

loool I'm curious what you've ended up choosing?
you know i've just had my valve replaced and still questioning my choice and wish to go back in time and change it !! even though what i've choose is whats makes sense

 

[extraordinary]

It IS a tough decision, with many factors to consider, pros and cons of each choice. In this forum on February 1, 2005 -- two weeks before my aortic valve/root replacement at age 63 -- I tried to describe the dilemma this way:

*********************************************************************************

"It would help so much in making this momentous decision if we had a crystal ball, wouldn't it?

"If I get a tissue valve, it will last (or won't) 15 to 20 years. I won't live any longer than that (or I will) and so that will take care of me fine. Or I will be around at 80 and subject to a VR for the tissue but medical technology will be so advanced by then, it won't require invasive surgery (or it will). If I get a tissue valve, won't have to have coumadin more than 3 months, which is the norm (or I'll be the exception and have to have it longer).

"If I get a mechanical valve, regulation of the thinners won't be a problem (or it will be a pain), and the mix will never get out of whack (or it will, and cause clots or bleeding). The ticking sound won't bother me, even though I am a light sleeper (or it will drive me crackers). The mechanical valve will last forever (or I'll have some sort of accident, and it won't after all). I won't ever be far from a clinic and so will be able to keep the coumadin nicely regulated (or I'll be far away from one, in Timbuktu or somewhere, and too klutzy to do the self-regulating).

"I want to go for quality of life. No, I want to go for quantity of life.

"I am not trying to be flippant. You have given me a lot to think about. I am going to call my surgeon's office tomorrow morning and see if I can get one more session with him to discuss more fully the options. He mentioned a stentless bioprosthesis that does the Bentall in one seamless piece, as I understand it. (But I don't understand, really.)

"This is an awfully big decision. Where is Solomon when you need him?

"Thanks for your concern and advice."

**************************************************************

Those were my thoughts nine years ago when I was posting as "BionicBob."

After weighing all the pros and cons, each of us has to make his/her own decision. What's best for one person may not be best for another.

I would just advise that after you have made your decision be at peace with it. It will be a good decision. The only bad decision is to do nothing.

loool I'm curious what you've ended up choosing?
you know i've just had my valve replaced and still questioning my choice and wish to go back in time and change it !! even though what i've choose is whats makes sense

 

[AZ Don]

I had my valve spared during surgery for my aneurysm, but valve choice is a topic I follow since I had to choose a backup for my 1st surgery and I have a fair chance of having to make the choice again someday. Here is how I net out the choice:

Choice of valve can be (and has been) debated endlessly. You have to decide which you would rather live with: repeat surgery or blood thinners. Most live with either one fine, some have issues. Here is an article on the AHA web site that may be helpful: http://circ.ahajournals.org/content/117/2/253.full. See especially the figure containing a decision tree. Also, there is a good example using a 50 year old man with a 30 year life expectancy, and determining the risks with either choice, tissue or mechanical valve. The net is that in this example the risk of death is slightly higher with the tissue valve and the risk of illness is much higher with the mechanical valve (I think this risk can be mitigated to some extent with self testing).

Don