Should I choose a mechanical valve or a tissue valve?

[Agian]

Hi




Classic. Hard to avoid the dipstick joke that comes along with that

LOL :biggrin2::biggrin2::biggrin2::biggrin2:

 

[Agian]

Pellicle, you mean the less risk with tissue comment? Something the surgeon told me. His personal experience, I guess.

 

[ski girl]

I had a tissue valve for 11 months and got endocarditis requiring emergency AVR redo. I've had my mechanical valve for 22 months and no endocarditis. Therefore, tissue is more problematic.

I'm being a bit facetious . . . but in reality, the chance of endocarditis is really REALLY low and any difference in endo rates between the two is likely 'not very much' and 'ever so slightly less not very much'. The risk of endocarditis shouldn't decide your choice of valve.

Just do all the dental hygiene stuff to reduce your risk!

 

[Agian]

I had a tissue valve for 11 months and got endocarditis requiring emergency AVR redo. I've had my mechanical valve for 22 months and no endocarditis. Therefore, tissue is more problematic.

I'm being a bit facetious . . . but in reality, the chance of endocarditis is really REALLY low and any difference in endo rates between the two is likely 'not very much' and 'ever so slightly less not very much'. The risk of endocarditis shouldn't decide your choice of valve.

Just do all the dental hygiene stuff to reduce your risk!

Intuitively, you'd expect it would be more common with tissue valves.
One would hope that doing the dental stuff would eliminate the risk.

I asked my cardiologist why people didn't take regular antibiotics, long-term, to prevent this from ever happening. Dumb question, apparently.

 

[neil]

you can read to much into peoples opinions,i would rather take note of my cardio and surgeon as they are the experts not some internet stranger,now heres the problem,they both disagreed on what valve to have, now if there cant agree what chance have we lol,it shows there is no obvious answer,we go on our personnel choice, my cardio told me no way would he want to have another op,my surgeon said no way would he wont to be on long term warfarin, but there both agree either is better than the one i had, for me i agreed with the surgeon as i didnt not want to be on warfarin long term and the problems that might occur, one of my friends went the other way,i can tell you we have many a good humoured argument who made the right choice ha ha,

 

[Midpack]

Should I choose a mechanical valve or a tissue valve?

Hi!
I have a question regarding valve options that i have not seen addressed. Let us put aside the lasting factor, the anticoagulation issue, the noise, and all the well known pros and cons of mechanical vs tissue valves.
What about performance? I mean their efficiency as heart valves, allowing or avoiding blood flow. Are both options equally good? I ask this not only regarding normal life, where i imagine both to be good, but specially focusing on intensive physical activity.

Regards

 

[Heart Of The Sunrise]

I started out thinking tissue because of a fear of all the negativity about the necessity to be on Coumadin. However, I found the prospect of multiple re-ops
at increasing older ages a worse prospect. I have had no problem adjusting to Coumadin. My EF went from 45 pre-surgery to 60 post-op. I only occassionally hear my ON-X valve. I had it up to 160 BPM at the gym tonight. I am just over 18 weeks post-op! I am extremely happy with my decision to go with the ON-X.

 

[Luana]

Great answer Luana. Was your native valve 'normal', or did you have bicuspid?
Have you gone mechanical?

No, no bicuspid valve here. I had rheumatic fever as a child, and that's what made me a higher risk. As a teenager, I had an endocarditis scare, but it turned out I had mono. My doctors back then put the fear of God in me about endocarditis.

I'm glad they did, but the bozos I saw when I was ill, even when I mentioned endocarditis, kind of laughed it off. This was a long time ago. Docs are much better now, and if anyone who is at risk and thinks they might have it, just be insistent. The determining test for endocardidits is blood cultures. They're usually read at 12, 24, 36, 48 hours, and maybe more, to see if there is growth of bacteria.

And as for tissue being a guaranty of no warfarin, well, if you develop afib problems you'll most likely need warfarin. Of course, you may not have afib problems, but tissue valve is not a guaranty of no warfarin ever.

VR surgery was much more difficult than endocardidits. If you've never had heart surgery before, you don't know what it's like. Most of us do fine, though it is no romp in the park. I've had surgery before, but nothing was even close to what VR was like for recovery.

My bottom line was that I didn't want another surgery. Mechanical is not a guaranty of no more surgeries, but chances are very good you'll never need another VR.

 

[AZ Don]

Hi!
I have a question regarding valve options that i have not seen addressed. Let us put aside the lasting factor, the anticoagulation issue, the noise, and all the well known pros and cons of mechanical vs tissue valves.
What about performance? I mean their efficiency as heart valves, allowing or avoiding blood flow. Are both options equally good? I ask this not only regarding normal life, where i imagine both to be good, but specially focusing on intensive physical activity.
Regards

From what I understand, both are equally good at the start. The mechanical valve is generally expected to last a lifetime without breaking down. The tissue valve can be expected to last maybe 20 years, but especially in younger patients they can deteriorate sooner, and that is likely to affect physical activity.

 

[Agian]

Don, you just got me thinking. OK let's say a tissue valve lasts 20 years, which is great. But, at year fifteen, how comparable would it be to a fifteen year-old mechanical valve?

 

[AZ Don]

Don, you just got me thinking. OK let's say a tissue valve lasts 20 years, which is great. But, at year fifteen, how comparable would it be to a fifteen year-old mechanical valve?

It might be as good, it might not. I think it unlikely that it could be better. If you want real data, I highly suggest the presentation by the Mayo clinic that I linked to early in this thread. It specifically compares complications and survival rates of mechanical vs. tissue.

 

[Agian]

This thread has been an eye-opener.

 

[tom in MO]

Per my cardio, mechanical valves do not suffer from stenosis but tissue valves do. In general, mechanical valves should keep going. However, just like the bad valve we got from god, the tissue valve will fail over time with a reduced performance. Just like the original valve, the tissue valve may give you symptoms but maybe not. The way my cardio put it, a mechanical valve gives you new problems, a tissue valve puts you back at square one (I had a BAV) monitoring the valve and any its changes over time.

 

[Superman]

Cynic mode:

Surgeons are in the business of doing surgery. Very seldom do I see a surgeon making a recommendation that will lesson the chances of repeat business on an operation they see as fairly safe that generates a ton of revenue for the practice.

Seriously though - how often do we see it on here where a poster says, "My cardiologist is recommending mechanical, my surgeon is recommending tissue - what do i do?". Seems the sugeons are almost always the one recommending tissue valves.

I'm not saying one choice is that much better than the other. Whatever helps you sleep at night is my approach. But whenever you seek recommendations - always consider the source.

Yes, of course, they are all well educated and the most ethical people on the planet and would never ever base a decision on their pocket book if they saw it as a risk to the patient. But what if they didn't see it as a risk one way or the other? Would they not be inclined toward the recommendation that virtually insured more favorable future revenues?

All that being said - I went mechanical the first time and still had a 2nd operation for an aneurysm. But, but - it would have likely been my third! With possibly another three to go had I chosen tissue. No thanks!

 

[dick0236]

If you want real data, I highly suggest the presentation by the Mayo clinic that I linked to early in this thread. It specifically compares complications and survival rates of mechanical vs. tissue.

Thanks for the reference to that presentation. I glossed over the earlier post you reference since it was 30 minutes long, but it is too hot today to play golf or go fishing so I spent the time to watch it and I found it very informative. It actually put my mind at ease concerning Warfarin use in old age. My assumtion was that warfarin became more dangerous with old age but this Mayo presentation points out that "well managed" warfarin use can be a benefit for older folks since there are a number of age related conditions that benefit from a "blood thinner". I currently live in a retirees patio home development and was surprised to learn how many of my neighbor friends also take warfrin, and only two of us have mechanical valves. This point was drivern home for me as I developed my FIRST episode of A-fib about two weeks ago and my cardio was not overly concerned since I was already on warfarin. Thankfully, the episode appears to be transient, probably due to stress(battleing my cable TV, Interenent, Telephone company). This Mayo study also confirms that proper INR management is the key to living with warfarin......and it ain't "rocket science".

 

[Superman]

He suggested a tissue valve because "warfarin is a pain in the butt". No more, no less.

It's not all bad. It only resulted in one extra child so far. That's after 22 years and counting with no other complications.

I love it when surgeons who only deal with the immediate post op attempts to regulate dosing express this opinion. It is tough to regulate immediately post op. However, over time things tend to settle down. Took a good 6 months or more to re-regulate after my last OHS. My surgeon would think that's a pain. But they haven't seen me much since then. I've been stable again for 3 years taking just about the same dose as I was before my last OHS.

 

[dick0236]

The way my cardio put it, a mechanical valve gives you new problems, a tissue valve puts you back at square one (I had a BAV) monitoring the valve and any its changes over time.

"a mechanical valve gives you new problems".....????. My experience is that warfarin "cut me a lot of slack" over my years on it. One bad experience, that was totally my fault, in 46 years is a pretty good problem-less history.

"a tissue valve puts you back at square one".....????. Why would I want to go back to "square one" and have to do this all over again in a decade or so.......it wasn't that much fun the first time thru.

 

[neil]

its great that so many do well on here who take warfarin,but its still the 2nd biggest drug available that leads to adr to hospitals, that was pointed out to me by my surgeon although that was 5 yrs ago, on the other side i know i will need a re op, bottom line is if there was a clear cut choice we wouldnt be having this discussion, am sure we would all agree on one thing, that we didnt have to make the choice at all,

 

[pellicle]

Hi

if there was a clear cut choice we wouldnt be having this discussion,

Exactly and because it isn't, by having this discussion people can see as many sides of the argument, learn about statistical outliers, dispel as many myths, learn about alternatives and effects as possible.

So its all positive

am sure we would all agree on one thing, that we didnt have to make the choice at all,

Agreed

 

[kimcdougc]

Picking a valve is a personal choice. No right or wrong answer. I did all my research and then choose an On-x valve. I do not want surgery more than once. Although, the recovery has gone way easier than I thought it would. Coumadin has been a non-issue thus far. Good luck with your decision and everyone here will support you either way!

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AVR with On-x 21mm at age 53. Dr. Glenn Barnhart, Swedish Medical Center, Cherry Hill location, Seattle, WA. May 23, 2013.
Loving and living life to the fullest.