The "ultimate" choice tissue vs mechanical HELP

[Robert Alan]

Hi to all,
I am Bob, and have been watching and reading in the wings of this great site for awhile now. I have a date with the surgeons at Duke Medical in Durham, NC (remember lacross?) on March 15. for a Valve Saving Aortic Root Replacement with the possibility, hopefully not, of an aortic valve replacement. I have to have made a decision in case I need a valve replacement once they get in there and have a close look at the valve. I am 51 years young & fairly active.

Is there anyone of you out there with a mechanical valve? If so, I would appreciate your reply.

I am currently thinking, (not knowing the pain levels yet of surgery) that the tissue valve is less hassel, but yet facing another surgery in my early
70's. The mechanical valve, I would have to watch what I eat or "drink" and the effects on my INR for the rest of my life. HELP!!

 

[Susan BAV]

Hi Bob and Welcome! (We seem to have a large proportion of "Bobs" on this site; nice to have another one!)

A mechanical valve might last you to age 81, or longer. There is a lot of discussion on this site currently about the On-X valve which sounds promising. You may have the option of the Ross Procedure where they take your pulmonary valve and put in your aortic position and put a homograft in the pulmonary position but I think you need an extra-expert to do that. I have a tissue valve and am fine with that choice and would choose it again but there is no guarantee that tissue valves can keep a person Coumadin free because of the possibility of post-op A-fib, which can resolve as mine did.

One of the best things I read here was to find an excellent and highly recommended surgeon and ask him what he would recommend for you. Also ask him what he would choose for himself in your situation.

Best wishes with your selection. Post all your questions. You will get a variety of replies!

 

[Phyllis]

Welcome, Bob. To begin with, I suggest you take a look at another Bob's thread: http://valvereplacement.com/forums/showthread.php?t=14330 and then you can spend many hours going through the various posts on the valve choice section of the forum. You will find that at your age, this is a weighty decision and a "hot" topic. Just remember in the end, that any choice you make is a good choice and a much better one than not having the operation at all!

 

[cherbam]

Hi Bob,
I have two St. Jude mechanical valves, Mitral and Aortic and my tricuspid valve is bovine. They are no problem at all. I take coumadin everyday and that's not a problem either. I am 41 and had the surgery 2 yrs ago. I chose the mechanical because I am hoping to skip another OHS in this lifetime. I know a lot of people on this site lead very active lifestyles and many have been around along time and have heard all of the stories. They have great advice. The only thing I can add is go with your gut feeling after you have talked with your surgeon.

 

[geebee]

Hi Bob and welcome.

If you haven't read this thread, please do. It will alter your perception of having to watch what you eat and drink all the time.

http://www.valvereplacement.com/forums/showthread.php?t=17116

I have been on coumadin for over 26 years and it has been a non-issue for me. Other than bridging for surgical procedures, there has been no inconvenience. I am one of those people for whom a mechanical did not guarantee additional surgeries but that is because my body manufactures a lot of scar tissue and that affected the workings of the mechanical valve. The St. Jude I have now does not seem to be bothered by it or my body has changed enough that the scar tissue production is less.

For most people, a mechanical should last their lifetime. We have a brand new member who has a Starr-Edwards mechanical that was implanted in 1967.

As our forum moderator says - the only wrong choice is no choice.

Best of luck to you.

 

[Karlynn]

Welcome Robert - Just sit back and read! If you have any questions at all, don't hesitate to ask.

 

[temp69]

Have the On-x and it's working just fine. I drink some wine, play tennis, don't worry about what I eat (I eat very healthy, since I'm trying to lose 5 pounds). I'm 55 and the thought of having to go through OHS again to replace the tissue valve was not attractive to me, and my doctors (all four of them) did their best to convince me that the On-X was the way to go. I had it done at UCLA by Dr. Laks, one of the tops in the field. Coumadin gets a little getting used to, but it's become a regimine and it's now not a big deal.

so, i would recommend the On-X valve. but if you decide to go with the tissue there are plenty of people who champion that was well. I had some trepidation about skiing, but bought a helmet and had a blast.

feel free to email me if you have questions. good luck!!

 

[bulldog]

Have the On-x and it's working just fine. I drink some wine, play tennis, don't worry about what I eat (I eat very healthy, since I'm trying to lose 5 pounds). I'm 55 and the thought of having to go through OHS again to replace the tissue valve was not attractive to me, and my doctors (all four of them) did their best to convince me that the On-X was the way to go. I had it done at UCLA by Dr. Laks, one of the tops in the field. Coumadin gets a little getting used to, but it's become a regimine and it's now not a big deal.

so, i would recommend the On-X valve. but if you decide to go with the tissue there are plenty of people who champion that was well. I had some trepidation about skiing, but bought a helmet and had a blast.

feel free to email me if you have questions. good luck!!

HELLO'
do they do alot of the ON-X in California and if you couldn't have had the on-x would you have went with the st.jude. I can't find anyone up here to do it. I'm wondering how much different the two are.
Thank you Bob

 

[Tom F.]

I had a valve sparring aortic root repair in 2002. My second choice was a Ross Procedure, which I would encourage you to at least investigate.

 

[Superbob]

One Bob to Another

One Bob to Another

Hi Bob from yet another Bob (we are working toward a Kingdom of Bobs here ) Sometimes I go by Rob when I want to separate myself from the pack.

Welcome to this great site. You asked for the perspective of folks with mechanical valves, and there are lots of good people here who can help you with that.

I didn't quite understand something you said about the prospect of having "an aortic root replacement" that might spare the valve. It is probably a gap in my understanding (I am forever finding out things I didn't know on this site) but I've never heard of the root being replaced and the valve retained. I had an enlarged aortic root and a leaky valve, and they were replaced with a combined root-and-valve. I went with tissue, but I was 63 at the time. Possibly this will be the only one I will ever need, but there's a chance, if I live to be an old, old man, I will face a re-op, or a decision just to let nature take its course. (In which case, I will come on here and allow all those who told me two years ago that I should choose mechanical to say "I told you so."

I think you understand the basic dilemma. There are pros and cons to tissue and to mechanical. With tissue, there is a greater chance of a re-op, or re-ops, and that's not be taken lightly. With mechanical, there is a greater chance of some restrictions on lifestyle and hassle in getting the necessary drug regulated just right. Lots of good folks here say it's not been such a hassle to them personally, and I believe them. But some do report differently.

As is said here often, the only wrong choice is not making a choice and forgoing the life-saving procedure. All best wishes to you.

 

[Tom F.]

Rob - let me explain the valve sparing procedure, as developed by Dr. Tryone David in Canada. Basically, where the ascending aorta or aortic root has an aneurysm, but where the value itself is normal or near normal, they can go in and removed the diseased section of the aorta, replace it with a dacron section, then suspend the valve within the dacron. It is often termed a "valve sparing" procedure. I had it done in 2002, and thus far anyway it seems to be working.

 

[Superbob]

Okay, thanks Tom. I have learned something new (to me) on vr.com today, which is not unusual for me. I am glad you have done well with that valve-sparing procedure and I hope it works for Bob as well.

 

[starfish11040]

Bob (the bionic one),

Something you said reminds me of something that has been bothering me for a while. You said you may need a re-op if you live to be an "old, old man". Different doctors come up with wildly different numbers on how long a tissue valve can be expected to last. My cardio told me five to ten. Some others on this board have been told the same. But on this board I've also seen the number twenty (or more) bandied about. Apparently that's what you're expecting. Are the doctors who tell patients that the valve will last such a long time speaking on the basis of a hopeful expectation? What's the evidence?

The question is: How many people actually have tissue valves that have lasted twenty years? I'd like to hear from them.

 

[Karlynn]

Sorry I'm not the Bionic One, but I'll tell that tissue valve longevity is directly connected to the age of the recipient as well as the type of tissue valve. I saw in your profile that you are retired, so, barring any other medical issue that could affect the valve, I would hazard a guess that your cardio is going off of old information for someone in your age range. (unless you're 35 and retired and then I'm just plain jealous!) 5-10 years may be the outlook for someone in their 20's.

I'll let those who are more versed in tissue valve longevity speak to the specifics of age and type of valve.

 

[Superbob]

Fair question. My doctors have issued no guarantees (because there can be none). But there is a body of research indicating devices like the Medtronics Freestyle are getting good longevity -- certainly well past 10 years in many cases. Of course, it's been well documented that tissues last longer in (already) old folks like me. After my last echo last summer, my cardio said this might --- might -- be the only replacement I'll ever need because it seems to be working so well. He said if the next echo is that good, we'll go to checkups every two years.

Tobagotwo is the expert on this. There was a thread several months ago on recent research on the Medtronics and another device. I'll see if I can find it and post it. Maybe Bob H will come along if we are fortunate and answer your question better than I can.

I don't think I implied any certainty about any of this. None of us has a crystal ball. I'll see if I can find the thread on research to better answer your question.

 

[Superbob]

Follow-Up

Follow-Up

http://www.valvereplacement.com/forums/showthread.php?t=18332&highlight=Freestyle+years


Check out this analysis (Item # 10 in the above thread) by Tobagotwo (who else but?) of tissue valve durability in folks 60-plus.

The stentless Freestyle that I have has been available just 10 years, but results at this point are good. Hopefully, I'll be around in 15-20 to let you know how it worked out.

 

[ALCapshaw2]

Check the Carpentier-Edwards website for information on their Bovine Pericardial Vavles.

If memory serves me correctly, I remember seeing a graph that showed 90% durability at 18 years when implanted in patients over age 60 at the time of surgery. Those curves dropped off more rapidly for younger patients.

'AL Capshaw'

 

[Robert Alan]

Thanks

Thanks

Thank you all for your referrals, encouragement, and information.
I am scheduled for surgery on March 14, so I guess that places me in the waiting room on this site.
I did receive some encouraging news last week from my surgeons office.
I called them for more info on the On-X. The nurse questioned my apprehension, as she understood he would be able to repair my aortic valve.
Well, while not quoting any percentages, he seems confident he will be able to do so, although, I do have to tell them my wishes in case a valve replacement is needed. I think it is going to be the On-X unless any of you can inform me why I should go another route.
Thank you all again, as I appreciate your insights and knowledge to an area
of life I still am trying to grasp..
Best regards,
Bob

 

[tobagotwo]

Another Bob weighing in...

The one thing that is a little disturbing about having those two "writings" set out as they are is that one was written for someone in their late 30s, and another for someone in their 40s. While many of the concerns remain the same, the risk profile changes with age. It would be nice if the age of each original recipient were placed with them, to keep them in context.

Bob, you need to do what you feel is right for you. The big thing is to weigh your fear of another operation against your fear of the the issues that can befall you under ACT. At your age, the survival rates are equivalvent either way.

I suggest strongly that you not judge valve type solely by whether the On-X will be available with aspirin-only ACT, nor that percutaneous valves may be available later for replacement. Neither of these is a shoo-in, nor likely to happen soon.

Best wishes,

 

[Traveler]

I did receive some encouraging news last week from my surgeons office.
I called them for more info on the On-X. The nurse questioned my apprehension, as she understood he would be able to repair my aortic valve.
Well, while not quoting any percentages, he seems confident he will be able to do so, although, I do have to tell them my wishes in case a valve replacement is needed. I think it is going to be the On-X unless any of you can inform me why I should go another route.

Hi Bob,

I could be wrong about this (and I'm a little confused about the nature of your valve repair), but with my recent aortic valve repair, my understanding is that that having aortic valve repair in your early 50's pretty much guarantees you'll need OHS again in 5-15 years, probably for replacement with a tissue valve. If that is the case and you are willing to accept that risk -- why not have the tissue valve as the back up and accept the future risk in the tissue valve case just like in the repair case?

Mark