Surgeon says he chooses whether Bovine or Porcine - Sound reasonable?

[TXWildflower]

When I met with my surgeon again recently, he told me that I get to pick whether I want tissue or mechanical valve, but if I pick tissue - which I have -then he will decide from there whether I get Bovine or Porcine. One was stented and one was stentless and I cannot remember which was which now (should really get better informed on valve types/terms).

He thinks that it is almost certain that I have BAV , but even the heart cath did not confirm that. So once he gets in there and gets a chance to see my aortic root - that will be the deciding factor over whether he uses stented vs. stentless.

Does this sound reasonable to y'all? I didn't argue with him. He is one of the best in town so I am trusting he knows what is best for me and my situation.

 

[Gail in Ca]

Yes, for each of my surgeries the surgeon got the final say on type of valve. When they get in there, they can really see what to give you for the best results. For my last surgery, he was going to give me another mechanical, or it might have ended up a homograft with the ascending aorta attached, it all depended on the condition of the existing tissue around the old valve. Also, he was intending to repair the mitral, but it might've ended up with a new replacement. I trusted my surgeon, he exudes confidence, and has a great reputation for great outcomes.
All the best!

 

[Kathy McCain]

Sounds very reasonable to me. I have the stented porcine. Next months it will be three years. So far, it's doing great!!

 

[normofthenorth]

One reason it's reasonable is that you want your surgeon to implant a valve (s)he's experienced and comfortable with. Each surgeon tends to have a personal preference, or more likely one fave tissue valve and one fave mech valve. POSSIBLY some stented and some unstented. . . but you get the idea.

So if you strongly favor one specific model of valve, it makes sense to shop around for a surgeon who uses it. Some people have even contacted the manufacturer for local referrals. . .

 

[TXWildflower]

All very good points. Especially the point about surgeons having their preference/experience with certain valves. I'm not quite sure in what way my aortic root will affect his decision I'll have to ask him that. He showed me the procine one I believe and I think it was stented, but someone had made off with the bovine one. Maybe a Longhorn fan? Just a little levity.

The group out here never fails to help me understand what to expect. Thanks!

 

[neil]

rhena ,all good points made above ,by the way i knicked the porcine one.........honk honk lol

 

[epstns]

Rhena, My surgeon is of the same opinion. We can choose direction (tissue of mech valve) but they will determine which valve thay feel will be the best "fit" to your heart and aorta. I'm very comfortable with that approach -- after all, they do this all the time and we chose them for their skills and experience.

 

[Duffey]

rhena ,all good points made above ,by the way i knicked the porcine one.........honk honk lol

Good reason to get a bovine valve like I did, Rhena!:biggrin2::biggrin2:
Seriously, I had no input into which specific valve I was getting.

 

[ShezaGirlie]

Rhena ~ has your surgeon mentioned the 'horse' valve? Just asking since JUST-WAITING is getting one in Austin installed by Dr. Oswalt..

 

[TXWildflower]

Rhena ~ has your surgeon mentioned the 'horse' valve? Just asking since JUST-WAITING is getting one in Austin installed by Dr. Oswalt..

Yes and no. I consulted with two surgeons in the same practice. Dr. Dewan and Dr. Oswalt. Dr. Oswalt mentioned the ATF Equine and I looked into it and it sounds wonderful, but in the end, I decided not to take the chance because of its limited track record. It could be a real winner though. Had I decided to go with the equine, I probably would have picked Dr. Oswalt who has experience with that. Just like Just Waiting - Dr. Oswalt also mentioned the Ross for me, but I ruled that out as I see no need to go messing with a valve that isn't screwed up already. I think the same reason Just Waiting eliminated the Ross.

Dr. Dewan and I just made a better connection. Medically speaking he is more conservative than Dr. Oswalt and my gut told me to go with him. Just Waiting and I have been PMiing back and forth since our surgery dates are fairly close together (his is Monday) and mine is just over two weeks later, we are both going to the Heart Hospital of Austin, and our surgeons are from the same practice. I told Just waiting though that I'm going to be really jealous if his valve lasts longer than mine!! In which case I should have taken the risk! It does look like a slick valve, but I'm happy with my decision. I think Just Waiting is going minimally invasive too - if possible.

You can tell I'm more conservative, because I asked Dr. Dewan what was his preference and that was to do the sternotomy - they have easy access and can see what they need and can typically get in and out faster. The less time on the pump the better as far as I'm concerned. I already feel like I have pumphead!! I don't like the idea of the long scar, but hopefully it will heal well and I can just wear it as a badge of honor. I am going to ask him about a median sternotomy though on my next consult.

 

[normofthenorth]

Fascinating choices and tradeoffs, we either consciously make or have made for us!! The addition of the ATF to the tissue-valve mix makes things even more fascinating than they were (or than I KNEW they were) 2 months ago, when I was pre-op!

 

[JUST-WAITING]

I did my prelim medical workup yesterday and will travel back to Austin for the procedure I go in 5:30 and should be in surgery by 7:30 they showed me a movie to educate me all about the surgery - I felt funny - with all I have gained from new friends and my on research -The movie seemed 3rd grade level - I now carry a small keychain horse that makes horse sounds I am not being childish "more that normal" but in my life I have learned that attitude is important and I carry the responsibilty for my attitude. I also had a talk with my anesthesiologist and promised him a beer if he got me to the other side/ he said "done deal" - I will notify txwildflower as soon as possible and she can post for me - THANK YOU TO ALL ON THIS SITE - I NOW CONSIDER YOU FAMILY-sometimes disfunctional though . LOL

 

[normofthenorth]

Tell that anesthesiologist that he only gets the beer if you REMEMBER that you promised him one!

 

[Luana]

It sounds totally reasonable to me. That's why I don't think folks here should get too attached to a particular type of valve, mechanical or tissue, before surgery. It may not turn out to be the right one for you. I was supposed to get an On-X valve, but because it didn't fit right, I got a St. Jude.

For all those splitting hairs over the data and research about one valve vs. another, IMHO, it's really not worth it.

 

[normofthenorth]

OTOH, I bet that at least 99% of HVR patients who express a preference for the TYPE of valve they want -- mech or tissue -- DO get what they want. And since many or most surgeons already have a preference for a small number of specific models of valves (in each type), even the model is probably 95% predictable, once you choose a surgeon. The other 5% would be cases like Luana's, where something surprising happened during the actual OHS (or maybe during the immediately-pre-op TEE) that wasn't predicted by the pre-op echo, CT, and angio/cath, which changed the choice of valve. (Of course, all these % numbers are my guesses, but they're informed guesses! )

 

[ShezaGirlie]

Rhena and Just-Waiting (the stud..:biggrin2 ~ yeah, it'll be a while before you live that one down..:angel:

Y'all have certainly done your homework and chosen the best valves for yourselves. Heck, I didn't have a choice and my valve and my tires both got recalled in the same year - 2000. Got the tires replaced, but his old valve is still clickin'..!

All the best day after tomorrow in Austin for you Just-Waiting and Rhena - we'll be waiting to hear how 'the stud' is doing. Truth be known, I'd bet his wife made him pick that one..:thumbup: Yeah, those west Texas guys -- they're just different!

 

[ALCapshaw2]

It sounds totally reasonable to me. That's why I don't think folks here should get too attached to a particular type of valve, mechanical or tissue, before surgery. It may not turn out to be the right one for you. I was supposed to get an On-X valve, but because it didn't fit right, I got a St. Jude.

For all those splitting hairs over the data and research about one valve vs. another, IMHO, it's really not worth it.

Did your surgeon meet with an On-X representative before your surgery?
or review their instructional video?

On-X uses different Sizing Guidelines than the other Mechanical Valves
(presumably because of the design differences).
They also have a special recommended 'tacking' to stableize the valve before stitching sequentially around the sewing cuff.

 

[ALCapshaw2]

Tell that anesthesiologist that he only gets the beer if you REMEMBER that you promised him one!

THAT post should be put into the "stickys" for All Newbies to read 8-0

 

[JUST-WAITING]

Thanks Janie - I am sitiing here lauging so hard I am crying. But my wife is laughing harder - NO RESPECT!!!

 

[normofthenorth]

Thanks Janie - I am sitiing here lauging so hard I am crying. But my wife is laughing harder - NO RESPECT!!!

You may want to practice restraining the rotflmao laughter, since it may HURT in the first few days after surgery! Or maybe not, with your minimally invasive surgery. . . Keep us posted.