Surgery Date is set, now it's decision time!

[MrsBray]

I thought I had made up my mind firmly. Then I went to the cardiologist. Then I went to the surgeon. Here is what they have to say.

Cardiologist: Definitely go bio-prosthetic. Why? I'm young - 42. He said I've got a lot of living yet to do, and shouldn't have to think about being careful and blood thinners forever. Also, if any other surgeries come up - and since I'm "young" it's entirely possible, given my estimated life span, that blood thinners would be a major consideration. He cited a case where a mid-40s female patient with a mechanical valve had to have a hysterectomy, and was in hospital a lot longer than she should have been, as there were issues with internal bleeding. That really scares me!

Surgeon: Definitely go mechanical. Research shows that bio valves don't last as long in younger patients, but there's no reason given for that yet. He's concerned that if I go bio, I will be back in 5 years for another surgery. He said that while he does want to earn money, that's NOT the way he wants to do it. He said if I were 52 years old I *might* be able to sweet talk him into a bio valve, but was adamant that a bio valve would not be the best choice for me right now. And "No, you cannot wait until you're 52 for this surgery." I have 2 concerns for the mechanical - 1) blood thinners. Forever. (Not a daily big deal for me, it's just a pill. It's the whole thing - out kayaking, slip and fall on an oyster bar, become shark bait. I also wonder how blood thinners will affect my menstrual cycle.) 2) I'm scared that once I hear the damn thing ticking/clicking, I will NEVER be able to un-hear it. (I was told once "Don't ever count your steps while walking, because you won't be able to stop. MMhmm. There were 52 stair steps between my freshman dorm and my 8am class. That was 25 years ago. 18 steps from the front door to the car. 17 more to the mailbox. I don't like odd numbers. Grr!)

I've got 2 weeks to make a decision. And I know that no matter what, I will ALWAYS second guess my decision. What do you say?

 

[neil]

Firstly welcome aboard, good news whichever you choose is gonna be a good choice for YOU, bottom line is you have to choose which you think is best for your life no body elses, thats why its a tough choice, even the experts cant agree so what chance of we lol, what do you want ? you have already got good info from both the cadio and surgeon, none of us on here are medically trained we just have opinions, it sounds as though you know the fors and against on both, remember both are good choices,

 

[Lynlw]

At your age, either choice would be good, with the odds very high you will live a long happy life. So since that is the case, I would go w/ my gut, do you feel more at peace when you think of one set of risks against the other? The other option and something many people do anyway when having a major surgery, is you could always get a 2nd opinion from another surgeon. Since you already have 2 opinions a 3rd would break the "tie' so to speak.

FWIW I'm curious is there anything about you, that would make the surgeon think at 42 a bio valve would only last 5 years, sure that happens but pretty rare for person in their 40s according to most stats, I'm not saying you would get 20 years,like the chances of someone in their 60s would, but 5 is pretty below average.. Did the surgeon say which mech or tissue valve he would use?

 

[njean]

Hello MrsBray and welcome to the forum.

I had double mechanical valve (mitral & aortic) implants in 1975 at the age of 24. At that day and age, a patient was not given a choice between tissue or mechanical. And even if they had, I would not have known what to pick since there were no known resources available such as the internet or forums such as this one, to help you decide. So my surgeon did the picking according to what he thought would be the best for me and I thank him for making that choice.

So for 38 years I have been on Coumadin (anticoagulant) and have led a pretty active life. I also went through a total hysterectomy in 1997 and yes, I did have to spend a bit more time in the hospital due to the Coumadin but it all turned out well. Besides that surgery, I have had several other major surgeries including two more OHS and have gotten through them as well. You'd be surprised just how much the human body can endure....I can attest to that!

Note: Before the hysterectomy, I had some years where I had terrible menstrual periods but it was due to a cyst I had on the ovaries which eventually led to the surgery.

Most recently I had to have an emergency appendectomy and then too, I spent a few more days in the hospital than the normal person would have due to the anticoagulants and the doctors not releasing me until I was therapeutic (in range).

As you can see on my signature, the other two OHS that I have had, happened due to unlikely and unfortunate circumstances....one caused by the sutures coming "undone" around the ring of the mechanical valve and the other surgery (2006) due to scar tissue buildup which does NOT happen to everyone with a mechanical.

So yes, you have a tough decision in front of you but the good thing is, that whatever valve you decide to go with is better than doing nothing at all.

Good luck to you and please ask whatever questions and or concerns you may have....we're here to support you!

 

[dick0236]

I just responded to your other thread about how you are coping with the "what ifs" that can happen.....or not happen. From my own experience I can say that "blood thinner" management is no problem..... I have not had any "what if" I need additional major surgery, so again, blood thinners have posed no problem..... if you get bitten by a shark you will have a problem, blood thinner or not...my hunch is that if you live a real long time you will be on a "blood thinner" for something(I live in a retirement community of a couple hundred seniors and I think there are more people on "blood thinners", than not on "blood thinners", for something, and to my knowledge, only three of us have valves(two mechanical, one tissue).

It is your call, and we all agree that either choice will correct the problem.....it's the future surgeries that bother me...and as an "elderly person", I am now almost 78, OHS is not something I want in my future.....although I guess that may still be a "what if"....but probably not.

 

[maisiejane]

Welcome to the forum,
I haven't been a member too long but this question is asked frequently and the responses you receive are passionate and personal to the individual replying, I my self have chosen to go for a tissue valve (Bovine) I did my research, listened to what others on here said about their experiences, but the final decision was down to me and what I felt I would be happiest living with. Both types of valves are excellent it is just down to personal preference, but when you have made your decision then stop reading the valve selection posts it just fogs up your decision this advice was passed onto me by another member and it has been invaluable. Good luck with your decision, there is no wrong or right.
Deb xxx

 

[AZ Don]

Hi,
The decision between valves is such a difficult choice, because both are good options yet each has it's weaknesses. You shouldn't second guess your decision. You will make the best choice you can based on the information available to you at the time. If you decide you prefer tissue will your surgeon support your decision and is he comfortable and as experienced with tissue valves?

I will say that it seems to me that most on this forum have had good results whether they had to have a re-operation or take warfarin regularly. It is likely that you will too.

 

[Freddie]

Lyn has a good point...a tie breaker and N Jean makes a valid point.

At 47 my surgeon made the decision for me, saying "I don't think you'd want to go through this surgery again".

I also thought/read that you could still be put on warfarin (blood thinner) after surgery for a period of time - someone will correct me if I'm wrong about this.

Neil, Dick, Don & Deb have good conclusions.
Sorry but's it's your choice.

 

[dtread]

As a veteran of open heart surgery I'd recommend you listen to the surgeon. Its not an experience you want to put yourself through any more than necessary. Once is more than enough.

 

[Lynlw]

Lyn has a good point...a tie breaker and N Jean makes a valid point.

At 47 my surgeon made the decision for me, saying "I don't think you'd want to go through this surgery again".

I also thought/read that you could still be put on warfarin (blood thinner) after surgery for a period of time

- someone will correct me if I'm wrong about this.

Neil, Dick, Don & Deb have good conclusions.
Sorry but's it's your choice.

Yes, alho it is not as common now, some doctors will put people who get tissue valves on Coumadin for the first couple months (usually 3), while everything around the valve heals. I believe in recent years it is more common to be put on aspirin the 3 months, and some depending on a few things like where the valve is, dont use anything.

Yes it IS possible to get a tissue valve and end up w/ long term Afib so -as of now end up on Coumadin, but it isnt that common for younger people, at least from my time here i dont recall many tissue valvers ending up on it. But as Dick said, you might end up on Coumadin for Afib when you are older even if you never had or need heart surgery.

 

[epstns]

Lyn - I am one who has a tissue valve but wound up taking warfarin for the first 3 months. In my case it was because I had a lot of trouble with afib and irregular heart rhythm just after surgery. This is more common among aortic valve patients than most people realize. I'm one of the extreme cases, though, and have had a pacemaker since day 5 post-op - but since I've remained in normal sinus rhythm I no longer take warfarin.

MrsBray, you are one of the "younger" patients here. At 42, I'm a bit surprised that your cardio suggests a tissue valve - unless you still plan on having more children. Most cardio's suggest tissue valves for women of child-bearing age, but recommend mechanical valves for younger patients who no longer plan family additions. Their reasoning is that for patients in their 40's, the odds of needing a re-operation are quite high, and most patients only want to do this surgery once. If you are OK with the prospect of at least one repeat surgery, then the tissue valve is the easy choice. If you think that you really only want to do this once, the choice that gives you the best chance for needing only one valve is the mechanical.

As some of the others have said, neither choice is "bad." Either one extends your life. Each has positive and negative points, and you must make a value judgement as to which is better for you.

 

[river-wear]

Hi MrsBray,

I'm going through the same decision process as you are now. I'm a little older (46), but am still in the gray area where making a choice is harder. I asked my surgeon about tissue valves wearing out faster in younger patients, and he says that's more for people in their 20s or maybe 30s. (If anyone has info on valve deterioration in "younger" patients that specify age ranges, please let me know!) He said to figure on it lasting 15 years. He also said that's what he would choose at age 51, even though he says warfarin is no big deal, and that with home monitoring you can cut your risks associated with it significantly. Ultimately, he reiterated that either choice is a good one.

It's so hard to choose because you can't predict the future. A tissue valve might last longer than average for you and maybe the next time it could be done via catheter. Or you could end up on warfarin later anyway. Or the mechanical valve could have a problem down the road and you end up with another surgery... I haven't quite decided for myself yet, but the plan is to think positively and after analyzing it to death (I'm an engineer), I'll probably go with my gut. Ha. Then I'll take maisiejane's wise advice and stop reading these threads.

Best of luck to you!

P.S. I'm worried about hearing a mechanical valve click too! I remember someone writing on here are few years ago that you should try to embrace it because it's just affirming that you're alive. The surgeon said it'll be like living next to train tracks and I won't even notice it in a little while.

 

[neil]

good post michele, youve hit the nail on the head, also agree with maisiejane you can go round in circles and finish up with headache after reading the threads, once youve made up your mind go with it, it will be the best choice for YOU,

 

[clay_from_nj]

It's so hard to choose because you can't predict the future...I'm worried about hearing a mechanical valve click too! I remember someone writing on here are few years ago that you should try to embrace it because it's just affirming that you're alive. The surgeon said it'll be like living next to train tracks and I won't even notice it in a little while.

That's another thing that you can't predict. The same valve sounds different in different people. Many of us can only hear their valves under certain conditions, if at all, and others hear them quite a lot.

 

[ottagal]

Hi MrsBray,

... I'm a little older (46), but am still in the gray area where making a choice is harder. (If anyone has info on valve deterioration in "younger" patients that specify age ranges, please let me know!) He said to figure on it lasting 15 years. He also said that's what he would choose at age 51, even though he says warfarin is no big deal, and that with home monitoring you can cut your risks associated with it significantly. Ultimately, he reiterated that either choice is a good one.

I apologize if I am sidetracking on this thread. In response to your question, River-wear, I thought you might be interested in the following study: "Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age".

Background— Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults <60 years of age who were followed for over 20 years.

http://circ.ahajournals.org/content/116/11_suppl/I-294.full

 

[bw00]

Hi, Im also choosing for a valve and I am a young patient as well (18 years-old). I know how confusing it gets, everyone advices something different. The choice is all yours, but my cardiologist told me that if I was sure I would not need to have any children ever, she would advise me to go for the mechanical valve. She says it's the only reason why she would advise a younger patient to get the biological valve. About the ticking, that's also something I am worried about. But I was told it was like a new Swatch watch. You hear it ticking at first, but you'll get used to it. I also heard a lot about tissue valves not lasting as long on young people. I am not sure where I read it but in the article it said that 42 percent of the people under 40 had to get theirs replaced within 10 years. It was a Dutch article, but I can't find it anymore. Good luck with your choice, either is good. And second guessing is normal, I haven't even made my decision yet and I am already second guessing it haha!
X Berit

 

[mainframe]

Since I've had both, I'll chime in. Why not?

Pretty much everything I thought before my first surgery was wrong.

I don't want a mechanical valve and be on blood thinners. It will ruin my life. Now that I have a mechanical, it really is not big deal. A couple of pills in the evening. I don't alter what I do or what I eat in anyway. I've had a few surgeries (o.k., five) since I received my mechanical valve and bridging with Lovenox for the surgery was easy whenever I had to.

I was told my tissue valve would last 15 years by the surgeon. Maybe I'll be one of the lucky ones and it will last longer. Nope. It lasted 7 years. I had the tissue value implanted at age 45.

Advancements will occur in valve technology and or surgical procedure before I need another surgery. Nope. Basically the same valves and procedures in 2009 for my second OHS than in 2002 for my first.

My second surgery will be as easy as my first. Nope. My first sugery last around 4 hours and I was home in 4 days back to work (part time) in 2 weeks. My second surgery last 13 hours, I was in the hospital for more than 2 months. It didn't go well. (It's well documented in a thread from late 2009) Fortunately that's not usually the case, but we all roll the dice when we roll into the operating room for OHS. While you might not draw the short straw like I did, someone will.

Despite being called "anti tissue" more than once, I'm not. Heck I choose one too. But alot of the assumptions I made when choosing my tissue back in 2002 were wrong. But I do think that commiting to your second surgery before having your first by selecting a tissue value at a younger age really does require some thought. And yes both are better than what you have. Good luck with whatever you choose.

 

[Lynlw]

I apologize if I am sidetracking on this thread. In response to your question, River-wear, I thought you might be interested in the following study: "Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age".

Background— Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults <60 years of age who were followed for over 20 years.

http://circ.ahajournals.org/content/116/11_suppl/I-294.full

Here is another pretty good article. http://circ.ahajournals.org/content/117/2/253.full#ref-15 Choice of Prosthetic Heart Valve in Today’s Practice One of the interesting things in it is they take a 50 year old man and figure out the LIFE TIME Morbidity and mortality long term for each Choice, "Projected Future Risks After Aortic Valve Replacement in a 50-Year-Old Man, Assuming 30-Year Survival" taking into account the risk even if he had 2 REDO at various ages with a tissue valve and the risk of clots and bleeding in each decade of his life with a mechanical valve.

This is from 2008, so it doesnt discuss the chances of having Valves replaced by cath, like they already are doing

also
There recently was a session at the European conference, "New Data on Edwards PERIMOUNT Valves Demonstrate Long-Term Durability in Patients Aged 60 and Younger" today announced unprecedented long-term durability results for bovine pericardial heart valves, based on a study of the Carpentier-Edwards PERIMOUNT aortic valve in a subset of patients aged 60 or younger at the time of operation. The study tracked patients over a nearly 25-year period, achieved follow-up of 3,299 valve years and determined that expected valve durability for this population was greater than 17 years. The data were presented Friday at the 66th Congress of the French Society for Thoracic and Cardiovascular Surgery by Thierry" Bourguignon, M.D., from University Hospital of Tours, France.
http://www.edwards.com/newsroom/Pages/NR20130617.aspx the study hasnt been published yet

 

[clay_from_nj]

Lyn, if that study gives some detailed information on age vs durability, maybe we'll finally have something concrete to show just how much faster these valves deteriorate in younger (how younger?) patients. "60 and younger" is a pretty broad category.

It would also be extremely useful if there is a breakdown according to other factors, such as gender and co-morbidities. 20-something women, for instance, are probably hardly represented, if at all, and someone without concurrent artery disease (like me!) is usually not even mentioned in these studies. <rant> It's as if the whole medical system just assumes that all heart patients are elderly men with clogged arteries.</rant>

 

[Jkm7]

Since I've had both, I'll chime in. Why not?

Pretty much everything I thought before my first surgery was wrong.

I don't want a mechanical valve and be on blood thinners. It will ruin my life. Now that I have a mechanical, it really is not big deal. A couple of pills in the evening. I don't alter what I do or what I eat in anyway. I've had a few surgeries (o.k., five) since I received my mechanical valve and bridging with Lovenox for the surgery was easy whenever I had to.

I was told my tissue valve would last 15 years by the surgeon. Maybe I'll be one of the lucky ones and it will last longer. Nope. It lasted 7 years. I had the tissue value implanted at age 45.

Advancements will occur in valve technology and or surgical procedure before I need another surgery. Nope. Basically the same valves and procedures in 2009 for my second OHS than in 2002 for my first.

My second surgery will be as easy as my first. Nope. My first sugery last around 4 hours and I was home in 4 days back to work (part time) in 2 weeks. My second surgery last 13 hours, I was in the hospital for more than 2 months. It didn't go well. (It's well documented in a thread from late 2009) Fortunately that's not usually the case, but we all roll the dice when we roll into the operating room for OHS. While you might not draw the short straw like I did, someone will.

Despite being called "anti tissue" more than once, I'm not. Heck I choose one too. But alot of the assumptions I made when choosing my tissue back in 2002 were wrong. But I do think that commiting to your second surgery before having your first by selecting a tissue value at a younger age really does require some thought. And yes both are better than what you have. Good luck with whatever you choose.

Just for the sake of balance, I'd like to mention my first OHS went well, I healed without any bumps in the road and was make to my usual routine in about 6 or so weeks. I was critically ill at the time I had that surgery and was in CICU for about 5 days before I was well enough for them to do the surgery.

My second surgery was very much easier on me. The moment I woke from surgery, I knew I felt incredibly well, weak and tired bu not anything severe. I was moved to step down unit under 12 hours post op, ate half a turkey sandwich and was walking with the aid of my DH and nurse under 24 hours post op. Again, I healed quickly and without any bumps in the road.

I was at the same hospital (Massachusetts General), with the same surgeon and many of the same nurses/techs and support staff.

Each surgery for each of us is unique to us and the same person well can experience the same surgery in a different way.

For the person who sadly is so ill they are in the hospital for extended stays, there are many that are up and on their way home in 4-5 days for the second surgery.