Hi Maggie
its a vexing decision and there are no "clear cut" or answers. Its always just generalisations in a bank of fog.
I think the thing I am most worried about is the maze procedure because if this does not work my heart will have even more ablation scarring and I will still suffer from a-fib.
I fully understand that and I say that from the position of having a good (life long) friend who made the catheters for a company that supplied the cardiologists. When he started doing that was 1986 and he left that after a few years because of what he saw as the cowboy approach of interventional cardiology.
I looked at the data recently again when I got tachycardia about may last year. I was disturbed by the readings and fervently hoped I would respond well to medication (metoprolol tartrate) and not need to take it further. This has so far turned out to be the case for me (phew).
Now this point I'll circle back to.
I also have been reading posts about some of you who have had the bovine replaced with new mechanical valves. Is there an advantage to the new mechanical over bovine, and don’t you have to be on blood thinners with them.
The advantage of the new mechanical valves over the old ones is that they are less thrombogenic; meaning that they are less likely to cause clots within your blood stream. This is best visualised by comparing the technology. The top row is right to left organised of the old ball and cage types to the new bileaflet type
A lot of work has gone into the design in terms of fluid mechanics and understanding the pressure jets which occur as the valve opens and closes. Think of putting your thumb over an open hose when watering the garden. Water is glugging out the half inch hose mouth and as you close it off (to move to the next place) then a brief spray occurs. That's a pressure jet.
This damages blood platelets which in turn leads to the triggering of clots inside the blood stream.
Accordingly there are many many cases of people who "get away with" poor "anticoagulation management" (what is wrongly called blood thinners)) and have no problems.
This is an improvement worth understanding.
I would underscore what Tommyboy has said here
However, if its likely that you will be on anticoagulants for the rest of your life anyways as a result of the Afib, then it is really worth thinking hard about the mechanical valve option, since reoperation would be pretty unlikely. Perhaps this is something worth discussing with your doctors.
I would underscore that if you follow patients who have bioprosthesis valves long enough you'll find that in their later years they find themselves on anticoagulations. This can be for a number of reasons including
- the valve causes thrombosis events due to some degradation of the valve.
- the onset of some arrhythmia (such as afib or tachycardia)
This is even mentioned here from time to time by people who report in their reply something like "I'm on warfarin now because of _____" and you can see from their bio that they have a bioprosthesis.
Back in May last year I developed a sporadic tachy cardia which went from sporadic to one day just set in at 140bpm and stayed there.
Firstly I credit my mechanical valve with finding this early because I am of course always able to be aware of (or tune out to) my heart rate. I call it my biofeedback indicator. I was also not worried about this because I knew that already being on exactly the treatment to prevent events like this causing a stroke (warfarin) I was wearing a seatbelt and had air bags.
I frequently wonder if I'd been on a tissue valve with no anticoagulation therapy if I'd have had a stroke before I finally went to hospital with the 140pbm unrelenting onset.
I remain engaged with life and just at the moment have been up my tree pruning it with a chainsaw...
and cutting the logs up and putting them into a trailer to take to the dump.
Having said that I'll say that at 66 you are very likely to get a good 10 years out of a modern bioprosthetic valve (say, a Resilia) and may get 20 years out of the valve before it becomes critical.
This is of course where you need to get "actuarial" examine your health and examine your family history and "estimate" how long you can reasonably expect to live on that assessment. If 90 comes up then I'd suggest that it would be very detrimental to your health as an 88 year old to need another intervention.
We can't predict the future, but we can look at what "knowns" exist as being a hazard and clear them from our path.
Lastly I'll say that 90% of the issues surrounding a mechanical valve are
anticoagulation management related. With proper attentiont to anticoagulation almost anything can be managed. Myself I'm very glad I got mine in at 48 years of age and being who I am (both genetically and educationally) have learned how to manage my INR better than any clinic ever could. Its a method I also teach to those who are starting their journey, but its a method that requires a bit of consistency and accurate documentation to support. Its not onerous but then I find the for some people and personality types anything to do with being regular is too much to ask.
I encourage you to discuss the above points clearly and openly with your cardio. I wish you well in your deliberations.
HTH
