Tissue or mechanical?

[shellyb]

My husband is having his aortic valve replaced. He's 56. We just had his heart cath done on Tuesday. He doesn't have any blockages which is a good thing. The surgeon we met with seemed to be offering somewhat outdated information. When we asked about tissue valves he said that they only last about 10 years. Everything we've read is more in the range of 15-20 years. I know my husband is a little on the young side to go by those years. It seems as though it is a difficult decision and doesn't get any easier by reading more information. We're getting a second consult from Cleveland Clinic and are leaning towards going there than rather than with the surgeon we met with on Tuesday. We were told that my husband's valve is borderline serious/critical but that we still have time to check out options. It scares me that his valve has gotten to that point. It will be nice to get a surgery date and get it over with.

Shelly in SD

 

[Phyllis]

Welcome, Shelly. I'm glad you found us. Most of the new tissue valves with the newest treatment to prevent calcification are advertised to last 15-20 years. A second opinion is always good and Cleveland is one of the best places to get that. I know how anxious you are to get a surgery date, but doing your homework before is a "good thing" as Martha Stewart would say. Your husband is at that age that is difficult to decide on tissue or mechanical. Check out all the threads on valve selection and be sure to come back with any questions you have.

 

[Lynlw]

Hi Shelly, I don't know if you saw this thread, but it is actually written by the Cleveland surgeon about tissue valves in younger people http://valvereplacement.com/forums/showthread.php?t=21821
I'm glad his cath went well and my son doesn't go there, but I've always heard great things about Cleveland,Your husband will be in good hands, Lyn

 

[Marguerite53]

I am 53 and my surgery was 17 months ago. I chose tissue (particulars below in blue type). My cardiologist said it was time to see a surgeon when my stenotic aortic valve reached .7 cm squared. At that point, several other medical things occured that I needed to take care of, and by the time I got into surgery 4 months later, my valve was measured at .53. (not good at all!!! but no damage to the heart, so it turned out okay.) What is the measure of your husband's valve?

In no way was I an emergency situation. My surgery and recovery have been textbook (excellent!) and I'm not in terribly good shape (overweight and not consistent with exercise, but eat very healthy....very)

I would think, if you could get into Cleveland Clinic soon, you should be safe. Obviously, the cardiologist would have to advise you on this. I think is is VERY wise to get a second surgical opinion, and to explore the feasibility of a more state of the art heart hospital.

Please keep posting and let us know how it goes for you and your husband.

Welcome to this wonderful community!

Marguerite

 

[Karlynn]

Best wishes on your decision. As Phyllis said, your husband is at an age in the "gray area" where it can be difficult weighing the options. There are many success stories on both sides of the equation.

Don't be afraid to ask any and all questions here!

 

[dlangton]

I had my aortic valve replaced at age 56 last December with a tissue valve on the advice of my surgeon and two separate cardiologists. Any surgeon---I don't care who it is---who tells you that tissue valves last only ten years is not up-to-date and you should not hesitate to go shopping for someone else. Technology advances, thank God! Three cheers for technology!

HURRAH! HURRAH! HURRAH!

 

[MaryC]

Hi Shelly,
I can't speak to a valve type personally, since I had a mitral valve repair. However, my brother, 48 years old, had a mitral valve replacement in September '06 and he opted for a bovine tissue valve. I can only say he is doing great! He has a very physical job that involves lifting a lot of weight and has had no issues.

 

[ALCapshaw2]

Welcome Shelly,

Researching all types of valves can be a time consuming task but is necessary to some extent in order to make an informed decision. Valve choice can also have implications for Surgeon choice since it is rare to find surgeons who use or are skilled with implanting ALL makes and models of valves. Many Hospitals, including some of the Majors, offer only a couple of Mechanical and a couple of Tissue Valves as their standard choices. It would be wise to ask which valves are offered at the hospitals you choose to visit and then research those valves / manufacturers.

I was in a similar situation to your husband age wise. My First (and only) choice was for a Bovine Pericardial Tissue Valve for my AVR which my surgeon agreed to implant. Unfortunately, due to Radiation Damage, he decided that implanting a Standard St. Jude Mechanical Valve (the one with the 30 year track record) was more appropriate. That was the first thing he told me, AFTER I awoke from surgery.

Bottom Line: It is a good idea to have a First and a Second Choice 'just in case' your first choice is not viable once the surgeon 'gets in there'.

'AL Capshaw'

 

[Bridgette]

Just out of interest, are there members here who have had their tissue valves for 15 plus years? And are there people around who have had a tissue valve for more than 20 years?
I am not trying to stir or inflame things I am genuinely wondering, because I hear so often on this forum that bovine valves will last 20-30 years, so I am wondering whether there are actually people around who have had them for that long, or is that just a projected longevity?

Thanks
Bridgette

 

[Susan BAV]

Hi Shelly - Welcome to the site; glad you found it! There is a really good thread toward the top of this Valve Selection forum, called a "sticky" thread, some writings by a member here, Tobagotwo, weighing and presenting the valve options in a balanced manner. I hope things go really well for your husband. Is he a bicuspid, by the way? Usually bicuspids have particularly clear arteries and such. If that is his diagnosis, you and he may also want to research www.bicuspidfoundation.com for more specific information regarding that issue. Please tell him hello for us. Hope all goes well for you. Take care and please post again.

Edit - I see he is a bicuspid. You will likely find that site I mentioned very interesting.

 

[Lynlw]

Just out of interest, are there members here who have had their tissue valves for 15 plus years? And are there people around who have had a tissue valve for more than 20 years?
I am not trying to stir or inflame things I am genuinely wondering, because I hear so often on this forum that bovine valves will last 20-30 years, so I am wondering whether there are actually people around who have had them for that long, or is that just a projected longevity?

Thanks
Bridgette

Off the top of my head I can't think of anyone here that had tissue 15 -20years, but there are a few on another board I am a member of. IT could just be a matter of from MY experience, people tend to join groups like this when they are going thru something/looking for advice, so maybe when more people need their tissue valve replaced there will be more members. The other board I'm on has alot of people with heart issues in addition to the valve (like Justin who's 19 and had 5 OHS, but only 1 was a valve replacement) so even tho their valve is fine,they joined for other reasons if that makes sense.
I haven't seen many people here say 20-30 years, usually people say 15-20 but the CE bovine valve has a pretty good track record with 80% still implanted after twenty years in patients over sixty. and that was the older version before they added anticalcification, so that "should" last even longer, it just isn't old enough yet. Here's alittle about it http://valvereplacement.com/forums/showthread.php?t=18628
Lyn

 

[Bridgette]

Thanks Lyn.

I only know one person personally that has a tissue valve, so I was genuinely wondering.
The guy I know is 81, and he has had his porcine valve for ten years. He told me that the doctors have said that if/when it fails, they won't be replacing it - that's the doctors in the publicly funded health system we have in NZ.
I said what about going private, and he said no, that even docs in private practice would not do it. I think the reason being that he has multiple other health issues that would make another op very dangerous, ie he wouldn't survive it.
But he has a good attitude to life really - he says when it (the valve) fails well that means his time is up. And I reckon he has lived to a good age anyway considering his health problems....anyone that lives to 81 is doing pretty well in my book.

Bridgette

 

[tprice54]

Welcome

Welcome

to our little site! I concur with Al, it is good to have a back up. I have the CE Bovine, but went into surgery totally comfortable with either that or a mechanical, thanks to this site. Read as much as you can and ask away....

 

[ALCapshaw2]

Hello again Shelly -

I second the suggestion to read the "Sticky" by Tobagotwo at the top of the Valve Selection Forum.

Note that EVERY Valve has it's Positive and Negative Attributes. People who choose their valve replacement usually end up selecting the valve whose negative attributes they believe they can best live with.

The Down Side of Tissue Valves is that they don't last forever. The Bovine Pericardial Tissue Valves are made from the pericardium of a Cow's Heart. They have a proven track record of 80% durability at 18 years (maybe more now). The latest Bovine valves have an anti-calcification treatment that is *hoped* to extend the valve durability to 25 years or more.

I don't know enough about Procine Valves to comment, other than to say that there are improved versions with extended lifetimes. Perhaps others with more knowledge of these options will come forrward.

The Down Side of Mechanical Valves is that patients will need to be on Anti-Coagulation Medication for the rest of their lives to minimize the risk of Clot formation. Anti-Coagulation Medication (Coumadin or the Generic Warfarin) is often referred to as "Blood Thinners" which is an unfortunate misleading and inaccurate description. The Biggest Danger of this medication is falling into the hands of an anti-coagulation manager (nurse, doctor, pharmacist) who does NOT understand how to properly maintain a stable INR.

When starting on Coumadin / Warfarin, it is best to find an Anti-Coagulation Clinic where they manage hundreds or thousands of patients. EXPERIENCE counts! The BEST results come from Home Testing with small Finger-Stick instruments once the patient is comfortable with how his body adapts to anti-coagulation.

One of the Best Sources of information on Living with Anti-Coagulation is AL Lodwick's website, www.warfarinfo.com Al Lodwick is a Registered Pharmacist and Certified Anti-Coagulation Care Provider who manages his own clinic in Pueblo, Colorado. He also monitors the Anti-Coagulation Forum here on VR.com and offers advice to anyone who asks.

One member reported that his Doctor suggested *trying* Coumadin BEFORE surgery to verify that he would have NO undesirable reactions to it and could be maintained at a Stable INR Level. I'm surprised more doctors don't suggest this approach. Of course this would be a bit time consuming given that it can take several weeks to reach a stable level and confirm that stability.

You and your husband are likely feeling a little overwhelmed by all of this. Just keep reading and you will begin to pick up the 'lingo' and get a 'gut feeling' for the options. Just ASK when you have questions.

'AL Capshaw'

 

[Superbob]

Shelly,

Just wanted to welcome you to the forum. AL and others have given you a good summary of the considerations. It is a tough decision because as you get a little older (or "more mature," as we prefer to say ) you try to figure how long the valve might last and how long the valve recipient might live, and try to match those up. Have to recognize that there are no guarantees, and an eventual re-op is a possibility. However, there are a lot of good choices, and strong advocates (who sometimes get very passionate) for them. You all just read and ask questions, and then be confident that you have made a good choice. I am very happy with mine.

Cheers,

 

[Cooker]

I just want to welcome you. As Bob said, there are many diffrerent opinions. Just read up and go with your information and what you are most comfortable with.

Oh, and Coumadin is not a big bad boggy man

 

[Karlynn]

One member reported that his Doctor suggested *trying* Coumadin BEFORE surgery to verify that he would have NO undesirable reactions to it and could be maintained at a Stable INR Level. I'm surprised more doctors don't suggest this approach. Of course this would be a bit time consuming given that it can take several weeks to reach a stable level and confirm that stability.

I don't know how valid a test this would be. It could be worthwhile if you are someone who has a lot of medication sensitivities, and happen to be one who reacts strangely to a lot of meds. But since Coumadin has very little side effects, and is easily managed (when done by people who know what they are doing) it would be just a case of deciding whether or not you are going to be someone who can stick to a daily medication. There are no predictors in this type of "trial use" that will let you know what your body will do in 30 years when you are older. It almost seems like telling someone who's considering a tissue valve to do a "practice OHS" to see how well their body bounces back so they know what future surgeries will be like.

The best way to decide is just do your research. Make sure you have accurate information and then make a decision on what makes you feel less uncomfortable with future prospects. (No one will ever feel totally comfortable with not knowing the future.)

I would also say that if you have a doctor or surgeon that heavily leans to one choice, and has horror stories of the other, would be someone you'd want to check off your list. The reality is that both kinds of valves are well received and well tolerated by most people. And the other reality is that a tissue valve doesn't guarantee a life without Coumadin, nor does a mechanical guarantee no more surgery. So as Tom said - your best decision is to have plan A, but also a plan B that you feel okay with. It doesn't do any good to be terrified of either choice because a doctor will not know for sure what they have to do until they get in and take a look. You will most often get your choice, but there may be something the surgeon sees that causes him/her to do something else.

Also try to keep in mind that the very scariest thing would be to not have the option for a valve replacement at all - like 50 years ago. We are all very blessed people for living in the time we do when we have the ability to fix our bad valves.

 

[WayneGM]

Welcome to the VR community. Sorry for the circumstances but glad you found us. I'll let others weigh in on the valve choice considerations as I had a repair. I was glad when I was given a surgery date as the wait was awful given I knew I had to have it. Best wishes and good luck to you and your husband.

 

[thenewmarket]

My husband is having surgery at Cleveland Clinic on September 27th for AVR and repair of an ascending aortic aneurysm. We are so grateful that we opted to go "far away from home" to this facility for their expertise. At home, after all the usual testing, CT, TEE, Heart Cath, etc. we were told by three physicians that my husband had a tricuspid aortic valve. They were headed toward repairing the valve along with the aneurysm surgery. At Cleveland Clinic, we were told by everyone who worked on my husband that he has a bicuspid aortic valve. Of course, all of this plays in when making decisions about surgical dates, etc. Are we excited about leaving our wonderful community and support system to have this surgery done? NO! However, in major life decisions you go with the best options for your situation. We feel confident that for us this is the best decision........

Also, someone mentioned the Bicuspid Foundation website. It is a wonderful resource. We are learning to accept and learn all we can about this condition as our children and future grandchildren may be recipients of a bicuspid aortic valve. We are focusing on the positives and remaining GRATEFUL that modern medicine has progressed to the point of being able to save the lives of so many with heart conditions.

I wish you well on your quest to obtain medical guidance. If I can be of any assistance in your quest, please feel free to send me a PM and I will give you my phone number, etc. Since we have just "been there and done that", I truly know what you are going through!!

 

[CathyK.]

Shelly
Welcome!! It is very much a personal decision, as you can tell by all whom have welcomed you. I also got a bovine tissue valve in Feb. of this year and was 44 yrs. old. I was told 25-30 yrs. hopefully. Wish your husband well and which ever valve he chooses, it will be right for him. God Bless!