The "ultimate" choice tissue vs mechanical HELP

[MrP]

Hi Bob, three years ago I was 49 when I had my BAV replaced and ascending aorta resected and replaced with composite St. Jude mechanical and Dacron graft. At this age and into the early 50s, you are in a gray area, and the decision to go mechanical vs. tissue is very difficult to make. In my case, I decided to reduce risks of a redo operation later in life, and therefore to accept risks associated with coumadin management. So far in my case, coumadin management has not been a problem. I'm still very active and have had no complications. The ticking of the mechanical valve was difficult for me to adjust to, however, I no longer think about it too much. These risks were acceptable to me, as the idea of another "for-sure" surgery down the road was not. In addition to increased risks, you must consider the costs of another surgery....monetary costs, emotional changes and psychological recovery, and physical recovery time.

 

[Robert Alan]

MrP, Tobagotwo( islands??) and Traveler,
Thanks for responding. You have drawn my attention to a possibility not considered before now. Thinking (and hoping) if my aortic valve were repaired, just how long would that last? Who knows for sure, but an area I have not covered to date. It will be interesting to hear what my surgeon has to say about that.
I just read some information on the surgery itself, and what to expect following the procedure. Do you have any insight for me? Was it the most horrible experience of your life? Is it like pain never before experienced?
What about the wonderful drugs of today? ( I don't mean to sound like a druggy, but I have a low tolerance to pain)
Thank you again for sharing.
Bob

 

[MrP]

How long a valve repair will last for you will be a function of many variables, and your surgeon will know this answer better than any of us. For example, do you have a bicuspid aortic valve, regurgitation, stenosis and significant calcification? Or is your native aortic valve trileaflet? Let your surgeon know you want to avoid a future open heart surgery, and so you want his fix to last with minimal risks of repeat surgery and still provide a good quality of life with manageable risks.

With respect to the pain, morphine and pain meds will work fine after surgery.

 

[mntbiker]

I just read some information on the surgery itself, and what to expect following the procedure. Do you have any insight for me? Was it the most horrible experience of your life? Is it like pain never before experienced?
What about the wonderful drugs of today? ( I don't mean to sound like a druggy, but I have a low tolerance to pain)
Thank you again for sharing.
Bob

I had impacted wisdom teeth removed just prior to my surgery. That was worse then the pain related to the valve replacement. The only bad part for me was the removal of the chest tube. Fortunately that pain was brief.

 

[WayneGM]

Originally Posted by Robert Alan
I just read some information on the surgery itself, and what to expect following the procedure. Do you have any insight for me? Was it the most horrible experience of your life? Is it like pain never before experienced?
What about the wonderful drugs of today? ( I don't mean to sound like a druggy, but I have a low tolerance to pain)
Thank you again for sharing.
Bob

I hate pain, and was pleasantly surprised how pain free I was post-op, thanks to the wonderful meds. You definitely knew you had OHS when you moved around, or had the dreaded sneeze, but when relaxed in a comfortable position it was fine. The worst part for me was when they pulled out the pace maker wires. For some reason they didn't seem to come out as smoothly as the drain tube (which I hardly felt at all). Taking out the urine catheter didn't hurt either, and I really dreaded the thought of that one!

You will know when the pain meds are wearing off, so don't be afraid to ask for more. In fact, they were very specific about not trying to be brave and ask for them when you need them. The call button was my best friend those first few days and nights.

 

[Superbob]

I echo what Wayne said. I was very much surprised how little pain I experienced. I had been advised (on here, among other places) not to try to do without the pain meds. Instead I took them when offered. Percocet was particularly helpful while in the hospital. When I got home after 5 days, I didn't need any additional pain meds.

 

[Traveler]

MrP, Tobagotwo( islands??) and Traveler,
Thanks for responding. You have drawn my attention to a possibility not considered before now. Thinking (and hoping) if my aortic valve were repaired, just how long would that last? Who knows for sure, but an area I have not covered to date. It will be interesting to hear what my surgeon has to say about that.
I just read some information on the surgery itself, and what to expect following the procedure. Do you have any insight for me? Was it the most horrible experience of your life? Is it like pain never before experienced?
What about the wonderful drugs of today? ( I don't mean to sound like a druggy, but I have a low tolerance to pain)
Thank you again for sharing.
Bob

Good luck on the repair question - there is a good, recent ournal article out of Mayo on this that my wife ran down and I think the answer is 10-20% chance of failure within 5 years after that expect it to last 10-15 years. The question of how long is difficult because your surgeon can only judge that once he's seen the valve not before and even then there is little data to support the answer just a feeling.

As far as the pain - I didn't find the surgery to be barticularly painful and I'm not good at pain at all. My hernia operation was far more painful. The surgery was scary but I think I was more scared of not knowing what would happen afterward than I was of the surgery. I was worried about personality changes, not being able to do the things I wanted to, etc. So far (less than 2 weeks post surgery) it seems like I shouldn't have worried about anything - I'm not depressessed or angry, I'm not confused, I've been walking 4-6 miles/day, I've been working 2-4 hours/day. Basically everything I worried about hasn't been an issue.

The only place where I'd admit to a little anxiety would be in the area of marital intimacy - I've haven't been quite up yet for that and I've been blaming the increased dosage of toprol following surgery - but the doctor tells me to that a wait of 3-4 weeks is prudent anyway and that everything will be okay. So I'm probably just being worried when I don't need to be. I tend to be a little bit high control and a little bit of a worrier.

At the almost 2 week point I'm still using pain meds but not a lot of pain meds. So I wouldn't worry about the pain - or too much of anything.

 

[Adrienne]

I also am in agreement with what Wayne said. I will even go a step further, at least in my case. When I got home, I was told I could take Tylenol for the pain. I NEVER took it!!! Granted, coughing, SNEEZING, moving in certain directions was painful, but if I didn't do those things, it was just a bit sore. I should add that I am a total wimp when it comes to pain, so no, it is not as bad as one imagines. I know a part of pain is psychological, and I think I was just so happy and relieved about the results that I probably felt the pain less than I would have if that had not been the case.

 

[tobagotwo]

Hospital discharge papers say right on them: free to resume sexual relations. As in...immediately.

Toprol or any of the beta blockers can totally mess with your capabilities, but the surgery itself does not. A number of us barely made it home before returning to that portion of our lives. No missionary position, however. Boys with broken breastbones don't do pushups.

As far as your repair: If you have a tricuspid aortic valve, and you are having a valve-sparing root repair (resection or resection/Dacron) procedure, the repositioned valve has a much higher chance of success and may last many years, perhaps indefinitely. The reason is that the regurgitation (insufficiency) is a result of distortion caused by the growth of the root, rather than an issue with the valve itself. If the valve is bicuspid, the chances of it being a longterm success are lessened. Still, if there isn't a calcification issue, and it were me, I'd certainly go with it.

In your fifties, a current, major brand tissue valve is not going to fail in five years, nor likely in ten. There is enough data not to have to ignore a misleading comment from a previous post. This is not to interest you in swaying your plan, but simply an informational rebuttal to a notion stated earlier. I had my own valve implanted at 52, and expect many more years out of it. My main concern is that I don't want the valve to last too long, as I do want my next surgery before I'm seventy.

Best wishes,

 

[ScottInFlorida]

Duke - I was there about 3 1/2 weeks ago

Duke - I was there about 3 1/2 weeks ago

Can't say much about the valve choice - mostly because I could not decide between tissue or mechanical, I decided to hang onto mine as long as possible (I needed an aortic arch aneurysm repair but my valve should last another 10 years or so).

I chose Duke over Texas Heart Institute and Cleveland Clinic and I was very happy with the choice.

I don't remember anything on the day of surgery or in ICU. But, once I got into a private room, the pain was not that bad. The nurses would ask for my "pain level" for medication (1 to 10) and I would be about a "3" at night but I only took pain medicine once during the day. The time in the hospital went by very fast. I was happy to have tubes removed (I was hoping to get out in 4 days but had to stay 5 days). I don't remember anything painful about their removal. I was just too happy to get one step closer to getting out of the hospital. I think the staples were worse - each one stung a little when it was removed.

The most pain that I have had (I am about 4 weeks from surgery now):
1. Unexpected sneezes (early on that was the worst pain)
2. When they removed the tube from my chest and my lung partially collapsed (a common event) - that was painful for a few minutes but it quickly went away
3. The incision on my right chest muscle still hurts when I stretch or get in certain positions (not sure if they do this for a valve replacement/repair but that one hurts worse than the sternum incision)
4. I do not like sleeping on my back but I am not ready to try to sleep on my side - this is more a discomfort but sometimes I will take a pain med just to help me sleep. And, I really really want to pop my back...

Don't get me wrong - I am not running around dancing and such. I am very cautious because I want this bone to heal correctly so I can get on with life (no heavy lifting or pushing or driving). You will get a white notebook with various suggestions such as how to get out of bed - I follow the suggestions in the notebook. Now (and for the next couple of weeks) I do some light chores and walk and I try to just let time fix this bone.

I agree with what others have said and I think you will find the pain is not nearly as bad as you imagine.

Good luck with your surgery!

 

[Susan BAV]

Welcome Scott! Glad you are doing so well!

 

[Magic8Ball]

MrP, Tobagotwo( islands??) and Traveler,
Thanks for responding. You have drawn my attention to a possibility not considered before now. Thinking (and hoping) if my aortic valve were repaired, just how long would that last? Who knows for sure, but an area I have not covered to date. It will be interesting to hear what my surgeon has to say about that.
I just read some information on the surgery itself, and what to expect following the procedure. Do you have any insight for me? Was it the most horrible experience of your life? Is it like pain never before experienced?
What about the wonderful drugs of today? ( I don't mean to sound like a druggy, but I have a low tolerance to pain)
Thank you again for sharing.
Bob

Good point, the tissue or repair may have the same timeframes..

As for surgery, i'm sure you've read it all but the morphine is great you will have at least 2-3 lousy days and then its normally all on the up and up day by day. Avoid coughing and sneezing at all costs, if you smoke now then stop way way before surgery and get the coughs out of the way as doing them when you have just had your chest wired together will not be your best moment...

As for the tissue/mechanical thing, i went mechanical (at 37) and yes you can no longer get drunk or play contact sports but i was getting too old for that crap anyway....the alcohol restriction has probably extended my life expectancy anyway, its certainly reduced my weight by a significant amount.

Read everything, decide on something, it will be the right decision.

Best of luck.

 

[Soilman]

Bob,

I'm not going to be of much help to many of your questions as far as personal experience goes. I'm further back in the waiting room than you are. However, if I had to make a decision on my replacement valve in the near future, I'd go with the On-X too. Everything I've read and learned about it looks promising for a possible coumadin free life in the future. As far as pain goes, everyone I've talked to about the surgery told me that the worst pain was the removal of the drainage tube. After that was coughing/sneezing.
I'll have Lori keep me informed about your progress. We'll both keep you in our prayers, expecially on the 14th.

Barry

 

[Robert Alan]

WOW!! Great responses thank you all.
It seems as my date gets closer I sleep less and spend more late night oil on VR.com. Scott in FL, I am happy to hear of your experience with Duke and Dr. Chad Hughes. I was on the phone with his office today with another bunch of questions in anticipation of my 3/14 date. I decided on Duke back in 1982, when my mother had emergency open heart in the middle of the night, which extended her life by 26 years.
Soilman (Barry) thank you for turning me onto this site. I could not believe it when Lori was telling of your story. It truly is a small world. I look forward to meeting you at some point. I will gladly keep you informed of my upcoming experiences. So far so good other than having to make some of the most important decisions of my life.
Magic 8ball, I like your quote there. I think my quote will be "It is what is, nothing more nothing less".

 

[Ross]

Robert thought I'd through this in here for you to chew on.

My native valve was repaired after my ascending aorta ruptured and wiped part of the valve out. Now mind you, were not talking traumatized valve for you, but my own experience. The best mine could be made left me with moderate regurgitation and lasted 6 1/2 years before I had to have a total AVR. I was in no condition to have the AVR during that rupture or it would have happened then. I'm not a fan of repairs. They are just too iffy for me.