Shopping for heart valves

[heartburst]

I'm scheduling my heart valve replacement surgery for early April 2016. I'm a 50 year old male. I have a bicuspid aortic valve with severe regurgitation. I also have an aneurism in the ascending aorta, 4.8 cm. These last months have been a journey of reluctant acceptance. I'm now at the point of deciding what kind of valve to put in, mechanical or tissue. I'm really leaning toward tissue, but I want to give the mechanical a fair chance. It seems like I was just predisposed to choose tissue, my gut choice, and I notice in researching, I look for evidence to support that decision instead of the benefits of a mechanical. Is it worth having more than one OHS in a lifetime? How will my body recover from surgery now, and then when I'm say 63 or so? The reassuring thing is that I've found this community of thoughtful people that are in the same boat as myself. I notice in the forums, no matter what valve choice people make they are happy with it.

 

[JulienDu]

Hello

How is your health in general ? Do you have any others issues ? Are you on any other drugs ?

I have had 2 surgeries ( one at a 10 years old and one at 29 ) already and though both went perfect, I would hate to have a third one. The older you get, the harder it will be for you and although there is a possibility that TAVRs will be an option, you do not have a guarantee and this is neither the miracle solution as TAVRs do have higher risk of stroke than standard OHS replacement and calcification of previous valve stays, which could create additional issue like mild regurgitation.

If I was 50, in good shape, with no specific issues that could create complication with the AC therapy, I would lean toward the mechanical because I would hate to have to go through an OHS in my late 60's or 70's and this will be much tougher than in your 50's. If you have a family they will have to live through this choice and it might be harder for them than you. But as you know, although a Mechanical is meant to last 2 lifetime, there is no guarantee that you will not be re-operated but the chance of another OHS is very very very small compare to a tissue.

As for living through AC therapy, there are many experienced members on this forum that can tell about their experience, I am too new to this and my experience would not be relevant.

 

[honeybunny]

Welcome to the forum. My gut was also tissue, and like you I looked at information that supported my choice and went with that. But please don't rule out mechanical until you have heard from others here. Also, when I was in my surgeon's office a few weeks ago I looked at some TAVR literature that mentioned it not being an option (yet) for replacing an already replaced valve. I did not make my decision for a tissue valve based on the possibility of TAVR when the time comes to replace it, but this information surprised me nonetheless. The reasons for my choice were a preference for not being on warfarin and the potential for the mechanical valve ticking; I'm not sure I could have tolerated that noise though others here with mechanical valves don't mind it and in some cases find it comforting. I'm also 11 years older than you and my rationale is that I may not outlive my valve. My surgeon (world reknowned) was fine with my decision either way.

 

[Faramacho]

TAVR are becoming more and more an option; I am a surgical nurse and I have done probably about 15 TAVR operations so far (our hospital does on average two a week) ; however, right now TAVR are reserved for those that are too sick for an open procedure; the thing with TAVR operations is the skill of the team doing them, there is definitely a big learning curve for the Cardiac Interventionist and the Surgeon, and as mentioned above, the achilles heel of TAVR surgery is stroke; As of this date the majority of our TAVR operations are done under local anesthesia with no incision, just percutaneous needle sticks; I can tell that at my hospital the majority of the valves we put in are the porcine valves, not the mechanicals

 

[heartburst]

I'm in good health, and on Atenolol for my heart condition and Valtrex for herpes. I'm not betting on being saved the discomfort of a re-op with TAVR. Thanks for the feedback, I'm looking at mechanical with an open mind, it's not ruled out.



BAV replacement, repair of ascending aorta scheduled for April 2016, Kaiser Sunset, Los Angeles, CA. Dr. Yun

 

[dick0236]

A mechanical valve will probably not require a reop in your senior years. I've just turned 80 and am in good health...and would not want to look forward to that operation and recovery again.

 

[JulienDu]

I can tell that at my hospital the majority of the valves we put in are the porcine valves, not the mechanicals

Maybe because most of the patients that go for a valve replacement are 60 and over ?

 

[pellicle]

Hi

.... These last months have been a journey of reluctant acceptance. I'm now at the point of deciding what kind of valve to put in, mechanical or tissue. I'm really leaning toward tissue, but I want to give the mechanical a fair chance

Ok... so assuming you mean that, then for a starter listen carefully and attentively to this:

http://mayo.img.entriq.net/htm/MayoP...articleID=4071

There is a lot in there and the guy knows what he's talking about (note, that may have problems on Chrome).

Then read this:
http://cjeastwd.blogspot.com/2014/01...r-choices.html

These are not "better health" fluff, but hard core real peer reviewed data.

Ultimately I believe that reops are something to be AVOIDED indeed every medical professional I know in Australia says the same thing. Of course in the USA its big business to do reops.

There is nothing wrong with a tissue valve ... except that at your age its almost a certainty that you'll need a reop.

The "fluff" you read about reop vs warfarin will tell you unequal information. It will say "reops are no more dangerous than warfarin" : what they fail to qualify is a plethora of salient points.

• if they make a mistake during surgery you may end up on a pacemaker, the chances of this escalate significantly at reop
• if you get an infection during the surgery (and its more likely on the redo) you may not die within the 60 day mortality that they measure against (70 days later its ok to die) and you may just need a full sternum removal ... but that's ok, you won't appear on the stats because you didn't die
• most of the data against warfarin and AC therapy is not from valvers like us, its the full spectrum of fundamentally ill people who are on warfarin because of a stroke history.
• most of the people on warfarin are elderly and began warfarin elderly and do not manage themselves because being elderly they're confused easily and make mistakes
• most people have zero idea about operations and what the surgeon faces with scar tissue

Read this post I just put up in discussion with Harriet to take her mind off her post surgical struggles. http://www.valvereplacement.org/foru...096#post863096

it documents my struggles at 48 with dealing with my infection (btw, I'm still on antibiotics because the risk of coming off them is high that I'll need a reop if the infection comes back)

Harriet is a reasonable example of what may happen to you when you are recovering from surgery when your elderly and frail. So my point there is that you want your ops when you're young and strong and can stay strong.

I'm going to my friends mothers funeral tomorrow ... she had OHS just after me (in time) but at the age of 67. Her recovery was difficult and her attitude failed her (she gave up after a year of struggling with depression and small complications).

This is not buying a washing machine.

Later you write:

I'm in good health, and on Atenolol for my heart condition and Valtrex for herpes. I'm not betting on being saved the discomfort of a re-op with TAVR. Thanks for the feedback, I'm looking at mechanical with an open mind, it's not ruled out.

that's among the wisest things I've read posted here.

I've got lots of stuff on my Blog about managing INR on warfarin. The technology to allow us to do that is getting better all the time. Warfarin is shaping up to be the best AC drug on the market, made stronger by management of INR in concert with electronics and computing. Just look at how much easier life is for diabetics.

 

[heartburst]

Thank you, this information is greatly appreciated. I'm learning so much about this condition and treatment, and maybe even something about myself.

 

[epstns]

Hi, heartburst, and welcome to The Waiting Room, the virtual room where many folks await their own turns at valve surgery.

I'm older than you, and had my "first" valve replacement at age 63. I chose a tissue valve, because I was old enough to be in that range where they say that I might or might not need another replacement. The current generation of tissue valves are expected to have useful lifespans of 15-20 years (some longer, some shorter). When I had my surgery, the general consensus was that for patients past their mid-50's, tissue valves would be the choice. Patients younger than mid-50's were advised to choose a mechanical valve. This was because the research was showing that tissue valves implanted in patients younger than mid-50's were calcifying faster than those implanted in older patients.

Personally, I still subscribe to the slightly older theorem that the cut-off point for tissue vs. mechanical valve choice should be around age 60. That gives a slightly larger margin for error in favor of longer valve survival among the tissue valve patients. So, my personal opinion (and remember that opinions are worth double what you pay for them. . . ) would be to opt for the mechanical valve and have the higher odds of only doing it once in your long and healthy life.

Pellicle and Dick are tow of our most experienced warfarin patients. Read their posts to see the real truth about how much or how little warfarin has impacted their lives. My take from reading these posts is that warfarin is a very manageable medication, as long as you learn how to manage it and you pay attention to it. From the "outside" it doesn't seem that warfarin has really changed anybody's lives, and I can say that my own mother used it for the last 10 or 12 years of her life, and I never saw any problems on her part.

Pellicle is right on another point -- you really don't want to do this thing more than once, if you have a choice. At your age, if you choose tissue, you will definitely need to do it again. Why go through it again if you don't have to?

 

[ForeverThankful]

I'm a 50 year old male. I have a bicuspid aortic valve with severe regurgitation. I also have an aneurism in the ascending aorta, 4.8 cm. These last months have been a journey of reluctant acceptance. I'm now at the point of deciding what kind of valve to put in, mechanical or tissue.

Hi heartburst!

I'm a 55 year old female and I had a bicuspid valve replacement and aortic aneurysm repair 4 1/2 months ago. I decided on a mechanical valve because I didn't want another operation in my 70's. I also figured that leading up to a second operation I would have to deal with symptoms of the valve failing which didn't seem pleasant.

I did my research which included talking to my family doctor who is the same age as me. I asked her what she would go with if she needed her valve replaced and without hesitation she said she would go with mechanical. She told me that she wouldn't put herself through such an intense surgery in her 70's if at all possible.

This is a personal choice and everyone has to do what they feel is right for them but I thought I would share my experience and thought process with you.

 

[Paleowoman]

Hi Heartburst - I had my bicuspid aortic valve replaced with a tissue valve two years ago when I was 60. I chose tissue knowing I would need another replacement when I will be in my 70's. My personal reasons for choosing tissue were that I didn't want to be on warfarin and I didn't want the ticking noise - I have very sensitive hearing and several doctors had already warned me that the ticking would be obvious - I certainly wouldn't find it reassuring ! So the choice for me was either having something awful in my 70's (the re-do) or having constant stuff every minute for the rest of my life (the noise and warfarin). I am not counting on TAVR for the re-do - in fact I wouldn't want TAVR unless it improves dramatically. Either choice is a good choice for you. None of my doctors, nor the cardiac surgeon, thought my choice was wrong. Once you've decided what you're going with it helps as the 'choosing' can be stressful in itself. All the best !

 

[W. Carter]

At 50 I would recommend a mechanical valve for sure. Warfarin is not that bad after your body adjusts to it and you will get use to the clicking sound. Hopefully sparring an infection of the valve it will last you a good 40 years.

 

[heartburst]

Thanks you for all your responses. It's making my decision process comforting and manageable. I'm currently educating myself on what Warfarin treatment would look like for me, through the Kaiser healthcare system. And now my leanings are toward the mechanical. I am still curious about tissue valves longevity. Are there any members here who have had a tissue valve for 13+ years? And if so what was your age when it was implanted? Viva LA Valvers!!

 

[neil]

hi heartburst, which ever you pick will be a good choice for you,as you can see from the posts its a 50/50 choice, I had my porky pig valve 8 yrs ago and after my recent scan its honking away merrily , good luck

 

[Zoltania]

I'm currently educating myself on what Warfarin treatment would look like for me, through the Kaiser healthcare system.

I was on warfarin for three months after my surgery at Kaiser, and their "Coumadin clinic" seemed very well organized. I got regular phone calls and emails with instructions on how soon to come in for my next INR check and how to change my dosage based on the results. They also responded quickly whenever I called or emailed with a question. Self-monitoring was never mentioned, but with such a short duration of treatment I don't think that would have made sense for me.

My stepfather got a mechanical mitral valve at age 76 at Kaiser in Colorado (he was adamant about choosing mechanical over tissue so he wouldn't need a reop). He is about to turn 89 and has now been on warfarin for 13 years. I don't know if self-monitoring was ever offered to him, but he does very well with their anticoagulation clinic; I believe he goes in for a test every six weeks or so.

For what it's worth, he says he can't hear any ticking, and none of us hear it when we're around him.

 

[MethodAir]

I have a conceptual issue with dead tissue placed in the human body, that doesn't rejuvenate, and degrades over a relatively short period of time. Especially when the body relies on it for its survival.

 

[neil]

Bit over the top. I could say I have an issue with a mech in my body and the need to take rat poison to stay alive. Swings and roundabouts

 

[JulienDu]

Yeah in fact you gotta chose between being a Cyborg or a Zombie

 

[neil]

Now that I like lol. So looks like a part in walking dead for me lol