Second AVR valve selection

[Tojomiami]

I am scheduled soon to have my second AVR. My first was done in 1999 using an aortic valve homograft. That was excellent for a long time, but is now failing, and my docs tell me it is time for replacement. I am seriously considering a mechanical valve this time to avoid a third surgery and the pre-surgery loss of energy and exercise tolerance while waiting for that next AVR. Anyone else with experience with this situation? What type of valve have people been choosing in this context for their second AVR? Thanks! We are blessed that our doctors can perform this surgery for us!

 

[jwinter]

I have to agree with your decision so far. I had my first AVR in 2012. They used a mosaic porcine. November 1st I had my second AVR at Mayo and they used a mechanical valve this time. I, like you, did NOT want to keep going through open heart surgery.. Had a few bumps after this one and it confirmed my decision was the right one for me.

Good luck with your surgery.

Welcome to the group!

 

[cldlhd]

I have to agree with your decision so far. I had my first AVR in 2012. They used a mosaic porcine. November 1st I had my second AVR at Mayo and they used a mechanical valve this time. I, like you, did NOT want to keep going through open heart surgery.. Had a few bumps after this one and it confirmed my decision was the right one for me.

Good luck with your surgery.

Welcome to the group!

So you only got 4 years out of it?

 

[George in Denver]

Tojomiami: My situation was identical to that of jwinter. My medtronic mosaic porcine valve (installed November 2013) began leaking almost immediately, and had to be replaced in less than three years (this August). Went to Mayo this time for consultation and ultimately for surgery. They advised me to get the On-X mechanical valve, which I did. Procedure went very well, and am finding the adjustment to warfarin to be uneventful. I wish I had been urged to consider a mechanical valve the first time around--but here in Denver there seems to be a professional bias toward tissue valves. Or more accurately, both of the surgeons I consulted in Denver the first time around argued in favor of a tissue valve, and I was never presented with a balanced assessment of my options. Didn't know then of this forum, and didn't take the initiative to explore options on my own (wanted to believe that the docs knew best). I now realize that heart surgery is like relationships--you have to have one practice round before you know enough to do it right. In my case (recognizing that each case is somewhat unique), I very much wanted to avoid a third and fourth round of OHS; and living with warfarin seemed a small price to pay to decrease substantially the chances that I'll have to go through this again.

Good luck, Tojomiami, as you face this difficult decision.

 

[jwinter]

I had read a post of yours, George, before and noticed how we both had about the same experience. Did we both get a bad mosaic porcine? One cardiologist surgeon suggested the porcine I had was too small? WTH? Another said it could be that as soon as it was put in my body started attacking it. All I know for sure is by the time I got it fixed it was severely stenosed and had a loose suture.

Surgery nurse told me the plan was for a St. Jude but when I read the reports it stated they used an On-X. I don't think the brand name really matters (to me it doesn't anyway)

Taking warfarin and testing to get the right dose has been a little slow for me but am now theraputic.

Oh and yes, I do feel blessed

 

[pellicle]

Hi

I am scheduled soon to have my second AVR. My first was done in 1999 using an aortic valve homograft.
.... I am seriously considering a mechanical valve this time to avoid a third surgery
... What type of valve have people been choosing in this context for their second AVR?

well I have an ATS, but as I've written here before the top 3 (St Jude, On-x, ATS/Medreonic) are all neck and neck and its like picking a new car. Each has minor differences so as to not tread on each others patent toes and to differentiate themselves from each other. I have not seen anything to suggest one is better than another.

Like you I had a homograft that lasted nearly 20 years.

The main thing is after you get your mechanical valve valve to make the biggest difference in your long term health with consistent measurement of your INR , to not get "cocky" that its all running smooth and just do the task of test, write up and decide on action.

I can assist you when you get down that path with some tools if you want that.

Best Wishes

 

[dick0236]

The main thing is after you get your mechanical valve valve to make the biggest difference in your long term health with consistent measurement of your INR , to not get "cocky" that its all running smooth and just do the task of test, write up and decide on action.

I'll echo what Pellicle says. Mechanical valves are designed to "not wear out".....and few, if any, do. Proper INR management is the only "must do" with a mechanical valve......and with a simple 10 minute test and a little common sense, living with a mechanical valve has been, for me, pretty simple.

 

[Tojomiami]

Thanks everyone for those helpful comments. I am motivated to manage my INR, and looking forward to the surgery and getting my energy back. My surgeon recommended the On-X, and what I have read sounds very promising. I loved the homograft, but apparently they don't recommend a repeat homograft, and anyway, don't really want to do another heart surgery in my 70s or 80s. I do some juicing with vegetables like spinach, kale, celery, and carrots, so will have to figure out if I can still do that with warfarin, or figure out how to adjust dosages to allow that. Happy and Healthy New Year everyone!

 

[George in Denver]

Thanks everyone for those helpful comments. I am motivated to manage my INR, and looking forward to the surgery and getting my energy back. My surgeon recommended the On-X, and what I have read sounds very promising. I loved the homograft, but apparently they don't recommend a repeat homograft, and anyway, don't really want to do another heart surgery in my 70s or 80s. I do some juicing with vegetables like spinach, kale, celery, and carrots, so will have to figure out if I can still do that with warfarin, or figure out how to adjust dosages to allow that. Happy and Healthy New Year everyone!

I now realize (now that I have to pay attention to it) that I eat a lot of K, and that's presented no problems at all. Am guessing from my own experience and from all I've read here that you'll be able to maintain whatever level of K you want to, and that you'll learn to dose your diet. For now (since I'm new to all this) I use a food scale to measure amounts of K-intensive foods, which allows me to record my daily total K intake. I presume that soon I won't need to do that--but it's been helpful so far, and reassuring. No problems at all keeping my INR in the right range. Good luck, and will be thinking of you.

 

[pellicle]

Hi

I use a food scale to measure amounts of K-intensive foods, which allows me to record my daily total K intake. I presume that soon I won't need to do that--but it's been helpful so far, and reassuring. .

Good to read a fellow measurements oriented person. You are one step further than me, as I never bothered measuring food, but have done a bit with INR stuff.

Happy to share my basic spreadsheets system and talk you through some of the assumptions in its construction. I gather you've also read my goldilocks dose post too
P​​​​​M me and I'll tee up a time to chat (say Skype or something)

It's nearly midnight here so happy New Year folks

PS: for the interested my full range of INR related blog posts is under the INR label on my blog (here)

 

[neil]

if you wanna go mech go for it, we are very lucky we have a choice imo

 

[Tojomiami]

Hey all, I am scheduled for my second AVR with a mechanical valve January 17th. I am a bit nervous but ready. Will post from the other side. Thanks fro everyone's help!

 

[dick0236]

Good luck and come back and let the forum know how it went.

 

[neil]

good luck see you soon

 

[Warrick]

All the best not long now!

 

[jwinter]

I wish you well also. Come back when you feel up to it and let us know how it goes.

 

[Tojomiami]

Hey all, I had my second AVR on January 17th and my failing homograft was replaced with an On-X mechanical valve. I will admit the second OHS is much tougher than the first. I had four chest times this time, and only 2 the first time. All is going well but I have needed pretty heavy doses of beta blockers this time to keep my heart rate and blood pressure under control. They stopped my lisinopril that I had been taking for years. Just adjusting my warfarin now to keep my INR between 2 and 3, and walking for exercise. Feels good to finally be home in Miami. I loved the people at Rochester and the Mayo Clinic, the most caring and professional group of medical professionals I could ever hope for.

 

[pellicle]

Hey all, I had my second AVR on January 17th...

glad to hear that the landing was smooth ... lets hope that the taxi into the terminal is also smooth and "no baggage is lost"

best wishes

 

[neil]

great news

 

[dick0236]

Glad all went well. Stick around, your experience will help others in making reop decisions.