Surgery is officially recommended

[SatoriFround]

I just got back from my long awaited cardiologist appointment. The doctor said I needed a new valve and surgery for my ascending aortic aneurysm. So I have been referred for surgery and am getting an angiogram next week. One thing I am confused about is he stated that tissue valves are preferred for those with bicuspid valves. Is this accurate? He was really pushing a tissue valve saying I could get TAVR later. I brought up all the things talked about here and he just kept acting like it wasn't accurate. He said valve in valve is fine, that it isn't a problem that the opening gets smaller because it is such a minimal amount. He kept saying 20 years. Then he basically said mechanical valves fail all the time and it is just as risky to go mechanical. I mean, he isn't a surgeon, but... he was really pushing the tissue option. Has anyone here been told it is better to choose a tissue valve if you have BAV?

 

[pellicle]

Hi

The doctor said I needed a new valve and surgery for my ascending aortic aneurysm. So I have been referred for surgery and am getting an angiogram next week.

great news ... onward and upward I say.

Here's wishing you a textbook surgery and an uneventful recovery

:-D

On this:

Then he basically said mechanical valves fail all the time and it is just as risky to go mechanical. I mean, he isn't a surgeon, but...

claims require evidence .. failure is very very rare. However reoperation for other circumstances does happen. What is politely ignored is that in such a situation, no matter what valve you have, you're needing a reoperation.

Most common need for reoperation is aneurysm ... which you are getting in your 2 for 1 deal.

Best Wishes

 

[dornole]

Can’t speak to your issue since I have mitral and my guy said mechanical 100% (I am 56 and have rheumatic heart disease that actively attacks tissues, so I agree). But we may be going through this on a similar timeline. I had pre op tests last week, getting a tooth pulled next week and then hopefully scheduled. I feel crummy and very much ready to get this done asap.

 

[SatoriFround]

Hi


great news ... onward and upward I say.

Here's wishing you a textbook surgery and an uneventful recovery

:-D

On this:


claims require evidence .. failure is very very rare. However reoperation for other circumstances does happen. What is politely ignored is that in such a situation, no matter what valve you have, you're needing a reoperation.

Most common need for reoperation is aneurysm ... which you are getting in your 2 for 1 deal.

Best Wishes

The doctor he referred me to is a great surgeon with a very good reputation. I googled him. LOL That said, after my angio when I schedule the surgical consult I will be scheduling with a second doctor that I choose. Hopefully get my two opinions one on top of the other. I am just a little afraid the doc I am being referred to is biased towards tissue.

 

[SatoriFround]

Can’t speak to your issue since I have mitral and my guy said mechanical 100% (I am 56 and have rheumatic heart disease that actively attacks tissues, so I agree). But we may be going through this on a similar timeline. I had pre op tests last week, getting a tooth pulled next week and then hopefully scheduled. I feel crummy and very much ready to get this done asap.

It's a bit funny. He made me wait forever to give me the test results, and then I get there and he is like, let's get this done! LOL Told me the referred surgeon doesn't drag his feet and can get me in quick. Still getting opinions from two surgeons though.

 

[pellicle]

I feel crummy and very much ready to get this done asap.

sorry to read this ... sending positive vibes your way.

Hopefully you have nice weather there and can enjoy some sunshine at least

Best Wishes

 

[pellicle]

I am just a little afraid the doc I am being referred to is biased towards tissue.

as long as the surgeon you're being referred to has an open mind.

My views are "apparently" well known here (but people who hate me here don't seem to recall the following) but I know that I have been clear that:

• bio can be a good choice especially if you don't have high Lp(a) and if you are the sort of person who isn't inclined towards good dilligent INR management
• one can expect a good 10 years from a bio, but beyond 15 its a craps shoot
• the data is clear that if you follow the patients with a bio for long enough, a fair percentage end up on ACT (some recent posters here even thread)

Warfarin management isn't difficult (ask Seaton)

Everyone is different (despite a huge intersection set) and so its a personal choice.

Best Wishes

 

[SatoriFround]

as long as the surgeon you're being referred to has an open mind.

My views are "apparently" well known here (but people who hate me here don't seem to recall the following) but I know that I have been clear that:

• bio can be a good choice especially if you don't have high Lp(a) and if you are the sort of person who isn't inclined towards good dilligent INR management
• one can expect a good 10 years from a bio, but beyond 15 its a craps shoot
• the data is clear that if you follow the patients with a bio for long enough, a fair percentage end up on ACT (some recent posters here even thread)

Warfarin management isn't difficult (ask Seaton)

Everyone is different (despite a huge intersection set) and so its a personal choice.

Best Wishes

I am still leaning towards a mechanical. It just doesn't make sense to have to get sick again and get another valve. I understand I can still have problems with a mechanical, but there is a far greater possibility of the mechanical lasting for the rest of my life.

 

[pellicle]

Hey

I can still have problems with a mechanical,

you can still have problems if you are a functioning athlete ... life always holds secrets.

However in the main if you handle your INR in any reasonable sort of way you'll minimise those problems and reduce any surprises by being on ACT (so surprise strokes are far less likely)

but there is a far greater possibility of the mechanical lasting for the rest of my life.

I feel a high level of confidence to say that the mechanical valve won't be the death of you ...

Best Wishes

 

[carolinemc]

I just got back from my long awaited cardiologist appointment. The doctor said I needed a new valve and surgery for my ascending aortic aneurysm. So I have been referred for surgery and am getting an angiogram next week. One thing I am confused about is he stated that tissue valves are preferred for those with bicuspid valves. Is this accurate? He was really pushing a tissue valve saying I could get TAVR later. I brought up all the things talked about here and he just kept acting like it wasn't accurate. He said valve in valve is fine, that it isn't a problem that the opening gets smaller because it is such a minimal amount. He kept saying 20 years. Then he basically said mechanical valves fail all the time and it is just as risky to go mechanical. I mean, he isn't a surgeon, but... he was really pushing the tissue option. Has anyone here been told it is better to choose a tissue valve if you have BAV?

Have the same issue and was replaced with a St. Jude's Aortic leaflet valve. I was 36 at the time. It depends on your decision. You are doing great in doing your homework. And he may be pushing it for there is an incentive for him.

 

[SatoriFround]

Have the same issue and was replaced with a St. Jude's Aortic leaflet valve. I was 36 at the time. It depends on your decision. You are doing great in doing your homework. And he may be pushing it for there is an incentive for him.

Yeah, it sucks that there are always financial considerations for the doctors. Money shouldn't play into a recommendation, but as we all saw with the opioid epidemic, it does.

 

[SatoriFround]

Hey

you can still have problems if you are a functioning athlete ... life always holds secrets.

However in the main if you handle your INR in any reasonable sort of way you'll minimise those problems and reduce any surprises by being on ACT (so surprise strokes are far less likely)


I feel a high level of confidence to say that the mechanical valve won't be the death of you ...

Best Wishes

The doctor also said to stop all my work outs. He said walking is fine, but even the 120 I allowing my heartrate to get to is too high.

 

[Protimenow]

You're painting all doctors with a broad brush.
NOT all doctors prescribed opioids to anyone who asked.
Not all doctors are doing surgeries for the money.

Some doctors do it because they actually want to help people.

The situation with the money IS an issue -- with Medicare and insurance companies drastically reducing the actual amounts they pay doctors, many are having a hard time just staying in practice. Malpractice insurance, licenses, office staff, office rentals, office equipment, supplies, etc. can eat into what doctors actually earn.

I'm not defending ALL doctors, but it's useful to NOT paint them all as greedy people who see all patients as dollar bills.

 

[SatoriFround]

You're painting all doctors with a broad brush.
NOT all doctors prescribed opioids to anyone who asked.
Not all doctors are doing surgeries for the money.

Some doctors do it because they actually want to help people.

The situation with the money IS an issue -- with Medicare and insurance companies drastically reducing the actual amounts they pay doctors, many are having a hard time just staying in practice. Malpractice insurance, licenses, office staff, office rentals, office equipment, supplies, etc. can eat into what doctors actually earn.

I'm not defending ALL doctors, but it's useful to NOT paint them all as greedy people who see all patients as dollar bills.

Dang, I am sorry. I didn't mean ALL doctors. LOL There are definitely some good ones out there.

 

[SatoriFround]

Hey

you can still have problems if you are a functioning athlete ... life always holds secrets.

However in the main if you handle your INR in any reasonable sort of way you'll minimise those problems and reduce any surprises by being on ACT (so surprise strokes are far less likely)


I feel a high level of confidence to say that the mechanical valve won't be the death of you ...

Best Wishes

So this is the message I just got from my friend (who is a cardiac thoracic surgeon)
"Tissue Valves can be very good option for a bicuspid valve replacement. There are new types of tissue valves that have been developed that have proven to be very durable. Yes Mech valves do last forever, however you will be on a lifetime of high dose of blood thinners. So usually not recommended if you have other health conditions that may result in internal bleeding. You are at an age where I would also go with a tissue valve - probably Resilia tissue valve."

 

[Kristianna]

I’m 54 and need surgery within the year. What age range are you in that the surgeon is recommending a tissue valve as I am trying to decide what to do as well.

 

[Survived03]

I will give you my story and it’s not for everyone. At 43 yo I had a Tyrone David valve sparing procedure and lived an unencumbered life with the exception of being diligent about my bp. This procedure left my native bicuspid valve in place. I knew full well that I would most likely require a new valve sometime in the future. So 20 years later my valve was severely stenotic and needed to be replaced. At 63 I made the decision to go with a bio valve via OHS, again expecting a replacement some time in my future. There was nothing to indicate that I will not be a candidate for TAVR for a valve in valve replacement. It’s not a given though, but I felt confident in that assessment. Based on other medical issues I felt bio valve was the way to go. Again I am living an unencumbered life and taking it all in one day at a time.

Edward’s Inspiris Resilia bovine valve was the choice.

 

[SatoriFround]

I will give you my story and it’s not for everyone. At 43 yo I had a Tyrone David valve sparing procedure and lived an unencumbered life with the exception of being diligent about my bp. This procedure left my native bicuspid valve in place. I knew full well that I would most likely require a new valve sometime in the future. So 20 years later my valve was severely stenotic and needed to be replaced. At 63 I made the decision to go with a bio valve via OHS, again expecting a replacement some time in my future. There was nothing to indicate that I will not be a candidate for TAVR for a valve in valve replacement. It’s not a given though, but I felt confident in that assessment. Based on other medical issues I felt bio valve was the way to go. Again I am living an unencumbered life and taking it all in one day at a time.

Edward’s Inspiris Resilia bovine valve was the choice.

Thank you for sharing your experience.

 

[dornole]

I’m 54 and need surgery within the year. What age range are you in that the surgeon is recommending a tissue valve as I am trying to decide what to do as well.

I am 56 and having mitral valve replacement within a month, pending scheduling. I'm getting a mechanical based on my surgeon's strong recommendation and completely agree with him on this decision.

56 is young by valve standards. The whole calculus changes based on age because a) if you are old enough, you'll outlive a tissue valve. If you're 70+, there's a solid chance of that happening b) The older you are, the longer the valve lasts (your body is easier on it) so that makes it even more likely for an older person to have a good run with tissue c) Risk of major and fatal bleeds sharply increases at age 75+, so avoiding anti-coagulation by using a tissue valve becomes more attractive.

Ask your doc but from what I have read here there seems to be a lean toward mech for people under 60, to tissue for over 70, in between is middle ground . . . there is a TON of info on here re valve choice and vigorous debate. Docs vary how much they are "up to you" vs "go this way"

In my case, I have rheumatic heart disease, so my own immune system will attack a tissue valve and destroy it, even worse than it attacked my native valve. My surgeon said a tissue valve in my case might only last 3-4 years. And I'm already on anticoagulants because I got afib. So for me it is pretty much a slam dunk. Obviously I can't get heart surgery every 3-4 years - I doubt I could even find a surgeon to attempt it beyond surgery #3! And I gotta be anticoagulated anyway so the main benefit of tissue is off the table for me. One and done, baby. I'm glad I'm relatively young and healthy for that one OHS too.

I am a little concerned about advanced old age (will I be able to manage my warfarin properly if I start to lose my marbles, will I have a bleed) but that can be managed and let's face it, we're all going sometime . . . I feel lucky to have made it this far.

 

[carolinemc]

Yeah, it sucks that there are always financial considerations for the doctors. Money shouldn't play into a recommendation, but as we all saw with the opioid epidemic, it does.

I do not pay my cardio. Insurance like Medicare does. And it never plays. And I think you meant Covid, for Opioid addiction has been around for many years. LOL!