A few answers from my surgeon in response to my many questions. Please speak to your cardiologist/ surgeon before taking any of these points on board.
Tissue or mech valve?
As your tissue valve failed in the first 4 years the only sensible option is a mech valve. This should last the rest of your life...
What about catheter AVR? If I get another tissue valve the next could be done via catheter
Although promising, especially for older patients there is absolutely no point in gambling with technology as tissue valves do not have an exact lifespan and differ from each individual. People have done this in the past (even in the late 90s) and the gamble hasn't paid off. Mech valves have great results overall.
What type of mechanical valve-
All new mech valves do a great job and are almost identical, some clearly have better marketing campaigns than others.. However, all surgeons have their preference and it would be unwise to get a surgeon to use a valve that he hasn't used before (although most surgeons could fit any valve).
How long do mech valves last?
200+ years
What is my life expectancy after op?
In theory back to normal life expectancy once successfully replaced with possibility of another op down the road (leaking around stitches etc) although this would be rare. All mech valves used today will last 200+ years. A reop would not be much risker than this op especially in 20 years time.
Clicking noise
Different for each person. Yes you may be able to hear your valve although this may get quieter with time. Try not to worry about it, if anything it gives reassurance that all is working.
Seriously?!
Yes, there is no reason why not, especially if there is minimum damage to your heart.
There can be complications after any surgery (as with any surgery) but if all goes as planned you should go back to a normal life and live until you are very old. However, patients with any AVR need to take much more care of infections which can cause valve damage leading to another replacement. Seeing a dentist least least very 9 months in essential.
But what about various internet stats about life expectancy after valve ops?
Dont look at these sites. Completely false numbers especially for todays standards. Based on very small number of patients from many years ago, most of whom who are over 65. Surgical technique has also greatly improved over the last few decades. Remember that Valve surgery has only been around for the last 50+ years so there is minimum evidence in any study.
Risk of death during op
For a 27 year old who is healthy/ fit- 2-4%+/-
Why would I potentially need my aorta replaced as well as the valve-
So we can put a larger valve in which gives better results.
What about warfarin?
Not a huge problem if monitored correctly. Easier than you would believe after reading articles on the internet. Many, many people have no problem with warfarin. Younger children and older patients find it hard to find their suitable INR at first. Risk of stroke/ bleed much lower with home monitoring. Clearly warfarin isn't ideal but at the end of the day it is preventing stroke risk. Without it would be catastrophic. Manage warfarin correctly and limit all the noted problems.
Do certain valves need less warfarin?
No. All latest generation of bi leaflet valves, including on x valves should be within standard INR range for bi leaflet mech valves. Lot's of ongoing research still needed. Tissue valves on the other hand rarely need Warfarin (it does happen however...)
How do I obtain a home monitor kit?
Either buy one or wait and receive through the NHS (around 4-6 months)
Diet restrictions with Warfarin?
If you keep your diet consistent it doesn't really matter what you eat as long as vitamin k foods are kept to a moderate level. By no means stop eating anything and everything with vitamin k! Check the list of foods/ supplements that are unsafe.
Alcohol with warfarin
No more than 2-3 units of alcohol per day. If anything keep consistent on a weekly basis. consistency is key. By no means do you have to give alcohol up.
Preparing for your op
See your dentist first and foremost. If you need any teeth removing etc get this done asap as we can't operate for 6 weeks post dental work. It is still good practice to take antibiotics after any dental procedure even though recommendations have been slightly changed in recent years. Keep fit, eat well and be positive. Keep very fit and mentally positive.
Recovery time?
Up to 2 weeks in hospital post surgery (normally less), 3 months on average for the sternum to fully heal. Therefore no heavy lifting in this period.
When can I travel after the op? Travel insurance.
Try and wait at least 6 months before getting on a plane. Travel insurance will be harder/ much more expensive after any OHS. However, it is available. INR levels need to be monitored before you go away. A good idea to bring home testing kit with you. Drinking whilst flying isn't a good idea as cabin pressures alter effect of alcohol on warfarin. Heat can also impact on the effect of warfarin.
When do I need my surgery
Don't hang around too long. Waiting will only damage the heart which could be irreversible. Once diagnosed with severe valve stenosis there is absolutely no point waiting even in asymptomatic patients.
Anything else?
Stop worrying and reading false articles on the web. It will only make things worse. Try to relax and don't worry about things you have no control of. Leave that to us!
Tissue or mech valve?
As your tissue valve failed in the first 4 years the only sensible option is a mech valve. This should last the rest of your life...
What about catheter AVR? If I get another tissue valve the next could be done via catheter
Although promising, especially for older patients there is absolutely no point in gambling with technology as tissue valves do not have an exact lifespan and differ from each individual. People have done this in the past (even in the late 90s) and the gamble hasn't paid off. Mech valves have great results overall.
What type of mechanical valve-
All new mech valves do a great job and are almost identical, some clearly have better marketing campaigns than others.. However, all surgeons have their preference and it would be unwise to get a surgeon to use a valve that he hasn't used before (although most surgeons could fit any valve).
How long do mech valves last?
200+ years
What is my life expectancy after op?
In theory back to normal life expectancy once successfully replaced with possibility of another op down the road (leaking around stitches etc) although this would be rare. All mech valves used today will last 200+ years. A reop would not be much risker than this op especially in 20 years time.
Clicking noise
Different for each person. Yes you may be able to hear your valve although this may get quieter with time. Try not to worry about it, if anything it gives reassurance that all is working.
Seriously?!
Yes, there is no reason why not, especially if there is minimum damage to your heart.
There can be complications after any surgery (as with any surgery) but if all goes as planned you should go back to a normal life and live until you are very old. However, patients with any AVR need to take much more care of infections which can cause valve damage leading to another replacement. Seeing a dentist least least very 9 months in essential.
But what about various internet stats about life expectancy after valve ops?
Dont look at these sites. Completely false numbers especially for todays standards. Based on very small number of patients from many years ago, most of whom who are over 65. Surgical technique has also greatly improved over the last few decades. Remember that Valve surgery has only been around for the last 50+ years so there is minimum evidence in any study.
Risk of death during op
For a 27 year old who is healthy/ fit- 2-4%+/-
Why would I potentially need my aorta replaced as well as the valve-
So we can put a larger valve in which gives better results.
What about warfarin?
Not a huge problem if monitored correctly. Easier than you would believe after reading articles on the internet. Many, many people have no problem with warfarin. Younger children and older patients find it hard to find their suitable INR at first. Risk of stroke/ bleed much lower with home monitoring. Clearly warfarin isn't ideal but at the end of the day it is preventing stroke risk. Without it would be catastrophic. Manage warfarin correctly and limit all the noted problems.
Do certain valves need less warfarin?
No. All latest generation of bi leaflet valves, including on x valves should be within standard INR range for bi leaflet mech valves. Lot's of ongoing research still needed. Tissue valves on the other hand rarely need Warfarin (it does happen however...)
How do I obtain a home monitor kit?
Either buy one or wait and receive through the NHS (around 4-6 months)
Diet restrictions with Warfarin?
If you keep your diet consistent it doesn't really matter what you eat as long as vitamin k foods are kept to a moderate level. By no means stop eating anything and everything with vitamin k! Check the list of foods/ supplements that are unsafe.
Alcohol with warfarin
No more than 2-3 units of alcohol per day. If anything keep consistent on a weekly basis. consistency is key. By no means do you have to give alcohol up.
Preparing for your op
See your dentist first and foremost. If you need any teeth removing etc get this done asap as we can't operate for 6 weeks post dental work. It is still good practice to take antibiotics after any dental procedure even though recommendations have been slightly changed in recent years. Keep fit, eat well and be positive. Keep very fit and mentally positive.
Recovery time?
Up to 2 weeks in hospital post surgery (normally less), 3 months on average for the sternum to fully heal. Therefore no heavy lifting in this period.
When can I travel after the op? Travel insurance.
Try and wait at least 6 months before getting on a plane. Travel insurance will be harder/ much more expensive after any OHS. However, it is available. INR levels need to be monitored before you go away. A good idea to bring home testing kit with you. Drinking whilst flying isn't a good idea as cabin pressures alter effect of alcohol on warfarin. Heat can also impact on the effect of warfarin.
When do I need my surgery
Don't hang around too long. Waiting will only damage the heart which could be irreversible. Once diagnosed with severe valve stenosis there is absolutely no point waiting even in asymptomatic patients.
Anything else?
Stop worrying and reading false articles on the web. It will only make things worse. Try to relax and don't worry about things you have no control of. Leave that to us!
