Risk of reoperation with tissue valve vs. warfarin

[Bryan B]

Isn't it a fact that after a tissue valve that Warafin has to be used for at least 3 months and possibly forever depending on the situation?

This is not a fact. Generally, if you don't have any problems with a-fib after a tissue implant they will send you home on aspirin therapy only. Some surgeons may prescribe the short course of Coumadin as a precaution, but I think that would only be if there were mitigating factors. I had a Ross Procedure and I'm only taking EC aspirin 325mg daily.

But I do agree, once you make your choice and have the surgery...don't look back, and enjoy your new lease on life!

 

[ddarsch]

Two time porcine

Two time porcine

I have had two mitral valve repalcements, the first in Nov, 1991, the most recent in Sept, 2003.

I was of course very worried before both procedures, and in both cases the worry was for not. Last September, I went in on Tuesday and was out of the hospital before the weekend was over.

I know that I will face a third surgery, but Ireally enjoy my life without the worries of coumaden

Regards, Dave Darsch

 

[Karlynn]

"I have said this before and I still feel that there needs to be studies done on the effects of repeat major trauma to the body and what permanent effects there are. That is the information that is needed to make this above study complete."

I agree with Nancy. I was 32 when my St. Jude mechanical was installed. I wasn't given a choice. I was just told that at 32 the risk of Coumadin vs repeat surgeries was a better risk. And this was the cardiothoracic surgeon who told me this. And he was a pretty heavy hitter, surgically speaking. Now that was 12 and a half years ago and tissue valves have gotten better.

I have to admit that I've been a teensy bit sensitive to the threads on coumadin vs. repeat surgeries, because there seem to be many choosig tissue valves at young ages in order to avoid Coumadin. I get a bit confused as to why people fear Coumadin more than they fear additional surgery. Has our Plastic Surgery society made surgery seem less scary - because so many people are doing it for cosmetic reasons, so it would seem it can't be too dangerous? I know that's a stretch, but it does make me wonder. The anesthesia alone carries risks, for even the most minor of surgeries.

By the way Al, I've been on Coumadin for 12.5 years and never had a nose bleed. Do I get an award????? (Now I should probably walk around with a box of Kleenex because I mentioned that.)

Valve choice is a personal one, with many factors weighing in. Correct information is vital to making that choice.

 

[Raverlaw]

Karlynn,

I'm with you one hundred percent.

Even though I'm new to warfarin, it hasn't had any significant impact on my life at all. I'm determined to make my dosage fit my lifestyle, rather than the other way around.

And major surgery is not something one should choose to face unless they have to. Yes, mine went well and I recovered quickly; but I liken it to playing chicken with an oncoming train - just because the train missed you the first time doesn't mean you should do it again.

I fully support everyone here who have made their choices for their own individual reasons. I'm just kind of tired of hearing of the "horrors" of being on warfarin.

Hey, if little Madison can do it, so could we all...

 

[Bryan B]

My post was not meant to stir up the Coumadin debate (again... ), just to correct a misassumption made by someone. It's important that anyone who may be researching valve choices get accurate information.

 

[tobagotwo]

Bryan's right, Brian. I was never on Coumadin before or after my surgery. I had a 30-day supply of Plavix, to help lower the chance of clots, but three weeks out, when I called to ask if I should have it refilled, the surgical group said, "Nope. In fact, you can just throw the rest out."

Most tissue implantees never receive warfarin as an adjunct to the surgery, although they may be on it (or go on it) for other things. It is not unusual for a three-month course of Coumadin to be used after tissue valve surgery for someone who is showing a lot of atrial fibrillation, however. If the afib goes away, which it usually does, the warfarin ceases.

I am on one 81mg aspirin daily, although I am taking two a day right now because this bottle is enterically coated. My cardiologist didn't bring it up - I asked if I should start it again, because I used to take one a day before the surgery. He said I could if I wanted to. And I take Atenolol, which is a beta blocker. That's it.

Bryan's also right about this not being a "which is better" thread. As I posted much earlier in this thread - resurgery: yin; warfarin: yang. The basic reasons for tissue vs. mechanical choice have not changed. All that has been attested to is that the patient's odds (our odds) seem to be about equal for either choice.

Individual needs lead each of us to a conclusion that we feel is best for ourselves, and that, I believe, is as it should be.

Best wishes,

 

[Karlynn]

Bryan's also right about this not being a "which is better" thread. As I posted much earlier in this thread - resurgery: yin; warfarin: yang. The basic reasons for tissue vs. mechanical choice have not changed. All that has been attested to is that the patient's odds (our odds) seem to be about equal for either choice.

Individual needs lead each of us to a conclusion that we feel is best for ourselves, and that, I believe, is as it should be.

Best wishes,

It would seem that the study Al posted basically says just that. It is a very individual choice. My life in the last 12 years wouldn't have given me time for another OHS. I figured my number would have come up right as my children were graduating from high school. My family is pretty much raised now, as far as the hands on, driving around like a city bus driver-sporting events cheer leader-cook-and-bottle-washer time. My role has switched much more from the physical to the mental aspect of parenting. If I were given the decision today, at 45, I'd have to be honest and say it would be an agonizing choice. But not because of my fear of Coumadin (which I don't fear), but because of the reason we "clickers" are on Coumadin to begin with - clotting.

And with my insurance troubles lately regarding my home testing supplies I'm wondering if that wouldn't be the best reason to go tissue!

 

[Debrinha GT]

still haven't decided!

still haven't decided!

Hello everybody, when I went to see my cardio a few weeks ago and told him that I may want to get a mechanical valve this time he said that it's to be discussed with the surgeon when the time comes which put an end to the subject. Although I've come close to making my choice, the more I hear about both types, the more confused I get so, I guess I'll follow my doctor's advice and leave it for the time being. I'll still keep my eyes open for information and hope that by the time my fourth surgery comes, there will be something promissing out there for me. By the way, I'd like to thank you Bob for the help you've given me and I hope that whenever you come across something you think might be useful for me, you'll let me know. I have my ups and downs, but I'm trying to lead my life as normally as I can and so far I've managed. I'll probably feel awful when faced with the surgery again but all I can do for now is pray that it's still some time away and knowing I can always count on you lot to give me support along the way makes a big difference! Thank you so much!

 

[Lorraine]

Interesting Study Al,

All I can say is I would prefer personally not to have another surgery unless it is in my cards so to speak. Only God knows!

I rather be on Coumadin. I stay fairly stable and only once in a while have gone too low or too high with my INR. Of course I do panic! I've had several surgergies in my life and all I've had is complications with each one. Even OHS I wouldn't stop bleeding for quite a while.

 

[RWS]

Choice

Choice

I am going to give my two cents worth concerning life on warfarin. Maybe the bum wrap is before good patient education and med management. The new bi leaflet valves do not require the higher INR range. I really think home testing is the answer to self control. I home test once a week, and have learned how to control my range. If I was a year away from VR and having a hard time with valve choice issues because of warfarin why not start taking warfarin and see how you respond etc? No doc would go for it but I don?t think it?s that whacky of an idea. OK, maybe a little.
I know being a clicker I?m not immune to another surgery but at least it?s not already on the calendar. Maybe if my post op experiences were different I would not be so one sided on this issue of planned re-op. One week of tachycardia, two weeks of severe skip beats, one month in and out of a-fib, one TIA and several visual grey curtain events. Throw in re-hab, sternum and shoulder issues etc.. and now 15 or so years older lets do it all again. Hey, not that tissue valves are the right choice for some of us, they are, but I hate to see someone make a choice solely on the warfarin issue only. I guess it?s all about the pros and cons of choice. For me it?s about warfarin vs. re-op. When you get right down to it, is not that the issue? Yes, I have nose bleeds and nasty yellow bruises from time to time and will probably deal with other anticoagulation issues over the years to come. What?s funny is given a choice (I was not, emergency surgery) I still wonder what I would have done faced with the all this information to digest. Live Long and Prosper????????..

 

[ALCapshaw2]

To my mind, the biggest Down Side to Coumadin is having to go OFF anti-coagulation for Invasive Procedures (such as Upper Endoscopy, Colonoscopy, ) and any OTHER type of Surgery that may be needed as we get older.

There have been reports of STROKES following otherwise successful tests and procedures which is pretty scary.

Bottom Line: Coumadin limits our choices in testing for and treating other medical issues.

I'm due for a colonoscopy but so far have not been willing to go through the OFF / ON Coumadin Cycle to have the test. Swelling following a bad leg bruise was an irritation. There are definitely times I wish I had received the Bovine Pericardial Tissue Valve I requested. 15 years from now I may have a different perspective. We'll see.

'AL'

 

[della_anne]

Valves

Valves

I will share with you my experience and opinion on porcine vs. mechanical valves. I have had both types of valves. 1st the porcine and then the mechanical. When I needed to have my valve replaced, my parents had the choice of the porcine and mechanical valve. They chose the porcine valve. After about a year of having a porcine valve, it was calcifying and needed to be replaced. I was still pretty young and growing, so the doc decided to go with the mechanical valve. To this day I still have my mechanical valve. I am on Coumadin and go for INR testing. Its not really that much of a inconvienience for me being on Coumadin. I would take Coumadin over another surgery any day. Yeah I have to go for monthly blood test, occasional brusing, and excessive bleeding when I cut my leg when shaving, but really I'm not dying, I'm not in any pain, I can function normally, that's what counts.

 

[ticktock]

Tissue verses

Tissue verses

Al
You may already know my opinion on the subject you mentioned, as I am pretty vocal about it. NO reoperations!! Trust me! They only get more difficult, more complications, more r i s k. Hands down, I would take the inconvenience of Coumadin (26 years now) over a 2, 3rd AND 4th surgery!

Just an opinion, you understand.

mindy

 

[Birky]

coumadin

coumadin

I agree with Al on testing or any other surgeries. When I had the wires removed last fall I had to be off 5 days prior to surgery. I was a nervous wreck. The day after the surgery I was in bed all day with a terrifice headache. Scared me......Kept thinking that I kicked up a clot. I have been going to a local orthopedic for my hand and if anything has to be done with this, I will go where my Cardiologist is located 60 miles away. I am waiting now to see if I can go get a 2nd opinion since this is Workers Compensation. I just had my INR done and I was a little thin. My arms look like they have been in a fight.I personally don't think that are local mds know much about coumadin therapy.