Second surgery vs. Coumadin

[Cleats58]

I am 47 years old and have two middle school boys. I am a basketball coach and Boy Scout Master. I am scheduled to have AVR at Mayo on Jan 17th. I have taken the time to read through the related threads(mech. vs tissue) but I am still scared and somewhat confused about the whole process.

My question is; What are the benefits/drawbacks of a second surgery vs. a life long committment to Coumadin? I have been e-mailing my surgeon, Dr. Sundt, who appears to be giving me a choice.

Thank you in advance for your understanding.
Clark

 

[lovejoy]

I am 46 years old, had AVR March 29,05. I chose mechanical and am on coumidin. I have not had any changes in lifestyle. I own and operate a hardware/feed store (HEAVY lifting) have 45 grandchildren, play paintball, bike riding, camping etc... I am a very active woman. I would chose 1 surgery over multipulies anytime. Good luck to you. Whatever choice you make will be the right one.

 

[Ross]

I will speak for myself. I've had two surgeries now and in each case, I nearly lost my life. I know I will not make it through a third. This is a surgery that you do not want to be repeating over and over again. Some people didn't make it through their first, so this should be a good indication of how dangerous that it can be. The odds are in your favor, that things will work out just fine, but with each successive attempt, your odds go down big time.

You'll either go in, have surgery and be fine or you'll go in have surgery and have a nightmare on your hands. I'm sorry if this sounds scary, but it's the truth whether some want to believe it or not. Yes my case was a bit unique, but the operation is still the operation.

At your age, I would not hesitate to go mechanical and hope that I never had to have another surgery again. That is no guarantee, but it's in the realm of possibility. Tissue you could be looking at 2 or maybe even 3 more times and look at what ages you'll be then. Still think you'll be up for it considering you haven't had your first yet?

I'm only shedding light on it from my point of view. Others think I'm full of it, so you may as well too if you wish. No hard feelings either way.

 

[Natanni]

You asked what are the benefits/drawbacks of a second surgery vs a lifelong commitment to coumadin; I have heard that the risk of surgery is about equal to the risk of long term anticoagulation therapy, but I also think it varies on the kinds of things you do in life. Basketball coach? Any chances of getting smucked in the head with a ball? Our son plays hockey, and we have had two near misses with a hockey puck flying near us in the stands this year. That was kind of scary. Boyscout Master? Not sure of everything involved here, but I will say that my husband has every intention on hitting the Boundary Waters with our son this summer Living with coumadin changes your life, but I think it safer now than it was 15 years ago before they had adequate testing equipment and dosing is more appropriate. But you will always be at a higher risk of a major bleed. My husband motorcycles, snowmoblies, and ATVs...and he still went mechanical. He wanted to reduce his chances of another surgery as much as possible. Both his surgeon and his cardiologist said he would burn through a tissue faster due to his age and job. His cardio only gave him about 7-9 with a bovine valve. Surgeon said maybe 12 years tops. It is very hard to predict the future of open heart surgeries and long term ACT--both may make advancements within the next 10 years.

Good luck with your choice! I think one of our members just had surgery with Dr Sundt. My husband had his surgery at the Mayo, and had excellent post op care!

 

[Lynlw]

Hi, my son Justin is a Scout, I was wonderring, what kind of trips does your troop do? Justin has sailed the Keys for a week and he was sick but his troop has hiked the appalachian trail, some of the trips he has done, they pretty much are in the middle of nowhere. That was my first thought when I saw Scoutmaster and coumadin, would be IF something did happen could you get to a hospital quickly?Lyn www.caringbridge.org/nj/justinw

 

[Mike C]

A couple quick benefits of second surgery, meaning you went with tissue:

No ticking (alhtough many do not hear it anyway)
No Coumadin
avoid blood draws, daily pills
do not have to worrie about major bleeds
no worries about diet, alcohol, meds you are taking

Drawbacks:

How many additional surgeries will be required (1?, 2?)
Each successive ohs has greater risk of death and complications
Every OHS , even the first, has risks
effusions, afib, pumphead, infections, etc
do you end up on coumadin anyway after first or second surgery?

 

[geebee]

Hi Clark and welcome.

I have been on coumadin for over 25 years and have led a normal life. Over the years I have ridden dirt bikes, street motorcycles, raced 27' sailboats, scuba dived, hiked, etc. I have had a few injuries (foot broken 2X, deep laceration of a couple of fingers, even a few head bangs) and, although my bruises have been scary to see, have come through with no permanent damage (although some people might disagree with no head damage) .

A couple things to realize. There are never guarantees with OHS. Even if you go mechanical, things could happen that require additional surgery. I am a prime example of that. However, 99.9% (this my "guesstimate" and it is not based on scientific research ) of the people who choose mechanical do not have the problems I have had. If you decide on tissue, you are guaranteed additional surgeries and not guaranteed that you won't need coumadin for a "side effect" of surgery such as a-fib. If you decide on mechanical you are guaranteed you will need AC therapy for life and chances are you will not need additional surgery.

I almost died during both my second and third surgeries. Yes, I made it but I would not do anything that would REQUIRE me to have another surgery. I am certain I would not make it through a fourth.

Unless your lifestyle carries a certainty of a LOT of head injuries, I would suggest you go mechanical. You can then relax, take your coumadin, have a few blood tests, and go on with your life fairly certain that your days of OHS are behind you.

Best of luck to you.

 

[Nancy]

My husband has had three valve surgeries. He has two mechanicals, aortic and mitral. He's been on Coumadin for 28 years.

He has been told that he is now almost inoperable, and that his mortality rate at this point in his life would be 75-80 percent to the bad. But he does have multiple and devastating co-morbidities.

First heart surgeries are around 98-99 percent to the good. Second surgeries are close. Third surgeries depend a lot on how your overall health is. Fourth surgeries are tough, not matter what.

As you age, you will pick up other medical conditions, just like everyone else. Hopefully, your heart condition will not worsen much, later on in life.

View the heart as a very small organ and each surgery is invading it in a big way. Scar tissue happens with surgery, can't get away from that. Adhesions happen too. Tissues become more fragile each time they are cut.

The surgery is a very tough one.

But each person has to make their own decisions on valve choices.

Please also keep in mind that if you are trying to avoid Coumadin, many people end up on it anyway because of atrial fibrillation which happens to many heart surgery people.

Lots of issues to think about and that is why this topic is discussed so much.

 

[Kate]

Hi Clark!
This is a very difficult choice and one that should not be taken lightly. My opinion (and that of many medical folks) is that the overall risks of multiple surgeries vs. lifelong anticoagulation are about the same for someone your age. So, then the question becomes which risks are you most comfortable with? At 38, I chose biological because (like you) I was going to one of the best heart hospitals in the country (Cleveland in my case) and knew that the risks related to first and repeat surgeries were very low (under 2% for my first and likely to be under 4% for my second.) That, combined with other factors (poor coumadin management in my small town, liking to have a beer or two in the evening, not wanting to maintain a consistent diet, being a big klutz, etc.) led me to choose biological. Although many who posted previously had a very hard time with one or more surgeries, I did not. Sure, it wasn't fun and there were some bad days, but generally it wasn't nearly as bad as I thought it would be, I was home in 5 days and feeling reasonably okay within a month. As I'm younger than you, my bovine valve may not make 15 years but every study suggests that yours would (maybe even 20) making the chances of multiple repeat surgeries quite unlikely.

Please understand - I'm not trying to convince you to choose biological. Personally, I think that's inappropriate except in the most clear-cut situations (ie a young woman who wants to get pregnant). I'm just trying to ensure that you get a balanced view of your options. Read as much as you can, reflect upon what's important to you in life, and I'm sure you'll come to know what's right for you. Best of luck, Kate

 

[Cleats58]

Hi, my son Justin is a Scout, I was wonderring, what kind of trips does your troop do? Justin has sailed the Keys for a week and he was sick but his troop has hiked the appalachian trail, some of the trips he has done, they pretty much are in the middle of nowhere. That was my first thought when I saw Scoutmaster and coumadin, would be IF something did happen could you get to a hospital quickly?Lyn www.caringbridge.org/nj/justinw

Lynlw - Ours is a small troop in a small town, I am trying to garner parent involvement before we take on a high adventure trip of the like you have discribed. As for now just spring and fall camporees and summer camp. I do not think my choice in valve will have an affect on my ability for either trip. the boys would like to go to the boundry waters at some point however.
Clark

 

[Lynlw]

Good Luck w/ your troop, I know how hard it can be to get parent involvement sometimes ( Justin's first troop was over 50 years old and folded right after he became Eagle, he was only 14 and wanted to stay involved so he joined a troop that he was going to Sea base w/. IF you ever can go to Sea Base, Justin loved it, actually he (and my husband ) was going to do it again this past summer, but his heart surgery kept getting postponed, so there wasn't enough time to heal. Have fun , scouts are great, Lyn (BTWJustin's eagle scout project was making cough pillows for the kids after heart surgery)

 

[KAJ]

Clark,

I wanted a tissue valve because I did not want to deal with coumadin. However, due to my past medical history, my surgeon strongly recommend a mechancial valve. I took his his advice and am glad I did. Less than 1 week after surgery, I went into A-Fib. Because of that, even if I had a tissue valve, I would have been on coumadin anyway. My surgery was almost a year ago. So far, coumadin has not been the monster I initially feared .

In regards to your fears, I can assure you we have all had the same or similar fears. Please do not hesitate to voice them. If you like, send me a PM. We are here to encourage and help you.

Karl

 

[Geo]

Clark,

I am in the same boat as you. I am 48 and need to make a choice for a 2/2 surgery date. The confusing part here is that there are valid arguments on both sides of the coin. I have been investigating this question over and over the past few weeks. I spoke to a friend who choose a bio valve and had surgery a year ago and felt this surgery was not as bad as she anticipated and was happy with the choice. There are many folks on this forum who, through experience say to avoid more OHS's due to risk factors and go mechanical. Being on coumadin, I am thinking about other medical issues that may come up, (with me my back goes out a few times a year), and what medications that I will not be able to take due to being on coumadin. I am also thinking as I am sure you are, in our 60's, then what. Another bio valve? Could that mean a 3rd OHS at 75 or 80? My wife has been on coumadin for 9 years with a mechanical MVR. She is managing it. I see the pros and cons to an extent. She had a biopsy and needed to get off coumadin and inject herself with lovanox for a week. Yes, that is eaiser than another OHS I realize that. She cannot have an MRI, maybe with the new St Judes valves you can?
There are adjustments. Thanks to this forum, I learned that even with a bio valve there is a risk of being on coumadin anyway because of a-fib. So many things to think about and the clock is ticking for both of us. Keep researching. This is a great place to do it thanks to the caring people who give us such great feedback.
Good luck,

George

 

[MikeHeim]

I will speak for myself. I've had two surgeries now and in each case, I nearly lost my life. I know I will not make it through a third. This is a surgery that you do not want to be repeating over and over again. Some people didn't make it through their first, so this should be a good indication of how dangerous that it can be. The odds are in your favor, that things will work out just fine, but with each successive attempt, your odds go down big time.

It is true that some people don't make it through their first surgery, but it is important to note that this is EXTREMELY rare. My surgeon has done over 600 first-time valve surgeries and hasn't lost a single person. He also stated that a patient without blockages and in reasonably good shape could expect a surgical mortality rate of virtually zero.

I thought the idea of this list was to support people, not scare them.

 

[RCB]

It is true that some people don't make it through their first surgery, but it is important to note that this is EXTREMELY rare. My surgeon has done over 600 first-time valve surgeries and hasn't lost a single person. He also stated that a patient without blockages and in reasonably good shape could expect a surgical mortality rate of virtually zero.

I thought the idea of this list was to support people, not scare them.

Well first of all the person who started the thread was talking about a SECOND surgery not first! My surgeons has done thousands of first time
surgeries and they have lost pts. Does that make your's better? I don't think so! Just less experienced. I guess your surgeon never had pts. like the three that have passed away that were Vr.com member in the last several years.

Telling it like it is, is certainly not trying to scare people, however there are already plenty of scared people here!

If you want to talk about scared people, the number one scare tactic that appears on this forum is the misinformed newbees who wondering here and start talking about "Nightmare of Warfarin" without knowing what the hell they are talking about. Spend a little time at Al's website. Listen to the members who have been on warfarin longer then some of these ignorant warfarin naysayers have been alive. We can not only "talk the talk" we can "walk the walk!"

 

[Ross]

I'm not sugar coating it for anyone. People have lost their lives first time around. Even more, second time around. It happens and it's a very real possibility that even a newbie should come to terms with.

The whole business of heart surgery is scary and if someone isn't afraid, they aren't human.

You can hate me all you want for scaring you by being forthwith, but you'll never be able to say I lied too you!

 

[tobagotwo]

I posted a combined response to this thread and Geo's thread, with some further considerations...

http://www.valvereplacement.com/forums/showthread.php?p=162894#post162894post162894

Best wishes,

 

[geebee]

If telling the truth is "scaring" people then I guess we certainly are "guilty" of scaring people. However, it makes no sense not to be honest on a website that people seek out to find answers. Some of those answers are not pleasant but they are true.

People die from OHS, I don't care what the stats are. If you (or your loved one) is the person who dies, stats don't mean beans. It is vitally important for people to have ALL the facts so they can make an informed decision.

Choosing a valve is what is important, much more than what type it is. It is merely important to make your choice with every tiny little piece of data you can gather.

 

[John & Joann]

I deleted our post so that no one was upset. Joann can not survive a 3rd surgery. The 2nd surgery was 12 hours. She weighed 88 lbs prior to the first surgery.

This is all fact. Make certain that you have a good surgeon at a facility that is equipped to handle your case. All patients and cases are NOT the same.

Always eager to help those in need of assistance. Sometimes the news is not always good.

 

[Mary]

I am 47 years old and have two middle school boys. I am a basketball coach and Boy Scout Master. I am scheduled to have AVR at Mayo on Jan 17th. I have taken the time to read through the related threads(mech. vs tissue) but I am still scared and somewhat confused about the whole process.

My question is; What are the benefits/drawbacks of a second surgery vs. a life long committment to Coumadin? I have been e-mailing my surgeon, Dr. Sundt, who appears to be giving me a choice.

Thank you in advance for your understanding.
Clark

I hope you've read as much as can, so you can make an informed decision. Tobagotwo's post is a concise summary of the pros and cons of mechanical/nonmechanical replacement, and it allows an easier point by point comparison.
When I joined the site in April, 2004, I initially believed that I would go mechanical. However, after reading almost every post, dealing with almost every aspect of valve replacement, I changed my mind and ended up with a bovine valve.
I often read that it's important that "newbies" know all the facts before deciding which type of valve will be implanted, and it is true! It is very important!
However, presented with the same information, some newbies choose to go mechanical; some newbies choose to go tissue. Either way, it's your decision; it's your life. That's why your surgeon is giving you a choice. Make a decision that is right for your life, then look ahead to the future, rather than reliving the past.
Mary