Surgeon recommends mechanical, but what do I want???

[judy13]

My surgeon and cardiologist both recommend a mechanical valve for me. The brand he prefers is carbomedics. To me its not the brand so much as tissue vs mechanical. I am 48 yrs old and have been reading everything I can about valve selection. It seems the two main issues are the prospect of another surgery, or life on coumadin. I know there are no guarentees either way. I think I am leaning towards mechanical, though every time I read something new I question my decision. I know that this is a personal decision but any input would be appreciated.

 

[mainframe]

There is no right answer or we'd all have the same valve. If you choose a tissue valve, you might still have to take coumadin because of afib. Those who take coumadin say it's not a big deal. It hasn't been for me the last 7 months.

Those who opt for tissue and require a second surgery all have different experiences the second time. Some find it easier than the first; some (like me) have a much tougher time the second time around. Some still choose tissue the 2nd time and look forward to a 3rd. Some go mechanical the second.

Good luck with your decision. It isn't easy and just because someone here chose a particular valve doesn't mean it's the right one for you. Trust your surgeon and have both a plan A and a plan B just in case once the surgeon is "in there" things might change.

 

[Lynlw]

The only advice I can give, when making any of the decisions you have to regarding heart surgery or any other medical issues is to listen to your gut. Wether it is deciding where to have surgery, who to LET operate on you or a loved one, or any other tough decisions you have to make is listen to what your gut tells you. I have been torn many times choosing the "right" thing for Justin and when I get to the decision that is "right" I feel a sense of peace about it. Some times I thought we made a decision, but it never felt right I never felt at peace and sure I was making the best choice, and then when we changed out minds, I felt the peace and didn't keep questioning myself.

 

[kerri73]

Hi Judy!

I have to agree with the other posters. There are pros and cons to both, and you have to go with your gut and what you think is the best for you. I am 36 and have been on coumadin since I was 24 with no problems whatsoever. I still had to have a second valve surgery 12 years after the original valve (both artificial), so nothing is ever a definite. To me, though, the coumadin has never been anything I have feared or that has made my life more difficult or kept me from doing anything, etc.

Good luck with your decision and keep asking away if you have more questions!!
Kerri

 

[Jkm7]

My surgeon and cardiologist both recommend a mechanical valve for me. The brand he prefers is carbomedics. To me its not the brand so much as tissue vs mechanical. I am 48 yrs old and have been reading everything I can about valve selection. It seems the two main issues are the prospect of another surgery, or life on coumadin. I know there are no guarentees either way. I think I am leaning towards mechanical, though every time I read something new I question my decision. I know that this is a personal decision but any input would be appreciated.

It is very unusual for surgeons to recommend which valve. They far more often do not say which a person should get unless there are very specific scientific reasons for it.

This is one decision the patient really has to make..... and is a hard choice for many. My choice for tissue was not difficult. I knew for me it was the right choice but only you know what is the one for you.

It is a hard choice with pros and cons for each.
Good luck deciding. We all understand and remember well when we were making the choice.

 

[Bina]

No backing out now.....I've put you on the calendar.

 

[dick0236]

On this forum, it seems to boil down to two primary issues, being on warfarin(coumadin) forever, although the newer mechanical valves show the promise of reduced warfarin need and the necessary re-ops with a tissue valve although simpler surgeries may eventually be available.

For me the warfarin thing has never been a big deal, but it does require the commitment to take the pill and test routinely. I have never found this difficult, although I did pay a price a long time ago for ignoring this commitment. As for a reop, it is becoming increasingly more likely that the operation I had at age 31 will be my only surgery. I sure hope so.

Your choice is....do I want the perceived hassle of being on warfarin, or do I want the uncertainties surrounding multiple surgeries. Good luck with your decision.

 

[Philip B]

Recommendation

Recommendation

Since when is it unusual for a surgeon to recommend a particular type or brand of valve. Mine made a recommendation. I think many of them make recommendations all the time.

Perspectives among members here vary. Despite the best efforts of members like me to convey positive experiences with coumadin, there are members who remain convinced that coumadin has horrible side effects. Everyone's entitled to have his/her opinion.

Personally, I believe either way people go on the valve type issue, there's no wrong choice if the valve they chose prolongs their lives. It sounds like you understand the major issues involved with the mechanical v. tissue debate. The choice is less about right and wrong, and more about choosing which type is the best fit for you.

-Philip

 

[Bill B]

My surgeon was very specific in his recommendation but said he would do whatever I wanted. I fussed over this for a month or so. It's not easy when you think there must be a "right" answer and a "wrong" answer, but the exact data you would need is not there, incomplete, conflicting and subject to interpretation.

 

[Jkm7]

Many posters here specifically say their surgeons discussed mechanical and tissue valves with them but left the choice to them.
That is what my surgeon did..... answered all my questions, discussed both with me but did not suggest which I should choose. When I told him my choice was tissue, he approved.

 

[Luana]

I am grateful my surgeon recommended what he did. I had considered a tissue valve, but the deal breaker for me was another surgery.

 

[Philip B]

Many Posters?

Many Posters?

Yes, many posters here have noted that their surgeons didn't make a recommendation; on the flip side, many posters have also noted that their surgeons did make a recommendation.

Personally, I don't believe it's unusual for surgeons to make recommendations at all. There are many members here whose surgeons made recommendations regarding valve choice. Speaking for myself, I actively sought my surgeon's recommendation.

-Philip

 

[Penny]

I remember being so disappointed that my surgeon wouldn't recommend which one I should have. I have to be honest, I will most likely need surgery again and when I do, it will be mechanical next time.. you will be sitting on the fence wondering which is the right choice but it will come to you..

 

[Ross]

I will state this again for the benefit of all. I believe your primary consideration should be to only do this 1 time. Of course, there are other times that makes this impractical, such as being of child bearing age and still wanting to be pregnant, etc., but if your young, have no other real reason to have surgery again, why do it and take the risk? No, there are no guarantees that you won't have to do it again even with mechanical, but it highly reduces those chances.

This is a life changing event. It is a serious event. Why people think they should do this again and again, when they haven't had their first surgery, is beyond me.

 

[olefin]

This is a life changing event. It is a serious event. Why people think they should do this again and again, when they haven't had their first surgery, is beyond me.

Fully agree!

My surgeon didn't especially like using a mechanical for less than a year earlier I'd had major bleeding from a duodenal ulcer. But he also would not recommend a tissue valve because it would have to be replaced. After surgery I KNEW he made the right recommendation for in no way did I want to repeat surgery. And my surgery complications were not near as serious as some.

 

[yotphix]

My surgeon and cardiologist both recommend a mechanical valve for me. The brand he prefers is carbomedics.

My cardiologist and surgeon both made that very same specific recommendation to me 13 months ago. The surgeon went a step further and explained that that particular valve has a great track record (I believe it was no mechanical failures in 15 years of use and thousands of installations or something like that but I'm sure if you are really interested the stats are out there.) I was 39 at the time and neither of the docs felt that it made sense to guarantee me a re-operation when there was a perfectly good way to make it less likely.
I am taking coumadin, obviously, manage it myself and have completely returned to a normal life of working as an engineer on a yacht, motorcycle camping, running, rollerblading, cycling and have travelled to 4 countries. No problems or difficulties of any sort. If you are a little disciplined and can use a pen and paper you needn't fear coumadin.
Good luck with the decision.

Pal

 

[scott.eitman]

Tuesday will be my second time. As Ross is good at pointing out: why think about a 2nd or 3rd in the future. Please see the thread I started while making my decisison. These guys really helped.

http://www.valvereplacement.org/forums/showthread.php?35698-Internal-Bleeding-Concerns

I had a Homograft put in at 34. Twelve years later, I am faced with a redo. I can tell you, for me it is just as scary the second time around, if not scarier. I was not told 12 years ago that a second or third can become more difficult to perform. I assume that means more risky as well.

Scott

 

[Jkm7]

Scott,

Hopefully to ease your fears just a smidge, I had my second OHS four years after my first and it was very much easier on me the second time. Very much. I know that is not the case for everyone but it is for some. I am not an exception.

Sending you very best wishes your surgery goes smoothly and you have a bump free recovery.

 

[Lily]

Not to hijack -- But Scott, what a nice family picture! Best wishes to you

And Judy - Have you had the time to read a stickie by Tobagotwo somewhere toward the top of this Valve Selection Forum? I guess we all have to weigh our own variables and decide what is best for us. Someone said there's no right answer but I think actually there's no wrong answer. Hopefully you're going to be feeling much better very soon. Best wishes to you

 

[ARGreenMN]

My surgeon was very proactive at making recommendations for me too, which I appreciated. And my cardiologist and GP both supported what he was recommending. It's not like he was forcing me to do what he wanted, he was just making it very clear that he had a strong opinion, at least in my case (49 year-old, otherwise healthy). If I would have really wanted to go tissue (like I originally thought, and had told him) he would have done it. But he strongly recommended mechanical for me. And he even had a strong recommendation on which mechanical valve he preferred, but again, would do a different one if I really wanted. I ended up going with his recommendations, and so far am happy I did. No real issues with Coumadin so far, the ticking hasn't really been an issue, and I'm happy I most likely won't have to go through the surgery again.

The vast majority of my original fears about Coumadin (see my original post below) were later debunked, and I think rightfully so. But I also fully support those deciding on tissue. I agree with Lyn that at some point, you'll most likely come to an at-peace feeling about your decision, whichever way you decide, and I think that's your gut telling you it's the right decision. I think the most important thing is to fully understand the pros and cons of whatever choice you make. Then you can't go wrong!