Tissue v Metallic

[cebolla59]

Hi there.

I am new to the site and just deliberating about which way to go!

I am awaiting surgery for aortic valve replacement in the UK.

I am 51 reasonably fit, play golf, go to the gym a couple of times a week and also do occasional mountain walking. My work is office based.

I have obviously discussed the options with both surgeon and cardiologist and they have different views....my surgeon would go with tissue and the cardiologist down the metallic route!

I think I am aware of all the pros and cons and ultimately will have to make my own decision but any views would be welcomed.

Gary

PS. I have found the site very informative

 

[nngbwh]

I want to say hi and welcome you aboard. If you do search you will find tons of info on tissue vs mechanical.
I think it was just a personal choice for me. Good luck with your decision and keep us updated.

 

[wvu mountaineer]

I had aortic valve replacement surgery in 1998, when I was 51. I had a fairly active lifestyle and chose a homograft valve. This was to avoid cumadin. The valve performed well for 10 years; however, I am now 64 and have been told that I will need to replace the aortic valve again, probably in January. I am going to select a mechanical valve this time to avoid the need for further replacements. Thinking back, I wish I had chosen this option the first time.

 

[Superbob]

Just wanted to welcome you to the forum and wish you success with your upcoming surgery. Your comment about being aware of the pros and cons of each valve choice suggests you already have done some research. If you search the topic here, you will find a great many debates that go on and on, with folks arguing for one type or the other.

I got a tissue device at age 63 after great deliberation and have been pleased with it, but all our situations are different, and I do not advocate -- it is very much a personal decision. If you have specific questions, I am sure you will get many informative responses from the good folks here.

 

[ElectLive]

I am 51 reasonably fit, play golf, go to the gym a couple of times a week and also do occasional mountain walking. My work is office based.

I have obviously discussed the options with both surgeon and cardiologist and they have different views....my surgeon would go with tissue and the cardiologist down the metallic route!

I think I am aware of all the pros and cons and ultimately will have to make my own decision but any views would be welcomed.

Gary - The good news is that you sound like a great candidate for either valve choice, and each one should do well for you. The bad news is you do have to decide. For every good argument for one type, there is an equally good argument for the other. For some, it may boil down to simply re-op versus anticoagulation. Others take a more holistic approach, and literally try to weigh every single consideration, major and minor.

It is very personal, and you miay not be there yet, but at some point, more than likely, it will just hit you, and you'll know what is best for you. I researched as much as I could, here and elsewhere, changed my mind several different times, and didn't decide until just prior to surgery. So, don't be discouraged if you're unsure, it's part of the process.

If you're looking for input, you may want to zero in on a few specific aspects of either valve choice that seem most important to you, and post questions accordingly. Best wishes to you in the process and welcome to the community.

 

[dick0236]

I think I am aware of all the pros and cons and ultimately will have to make my own decision but any views would be welcomed.

Gary

PS. I have found the site very informative

Welcome Gary.....you will find much information on this forum, but as you say, "ultimately will have to make my own decision". I believe that this is one of the best sites for good, accurate information...pro and con, regarding valve choice and it, most certainly, is a personal choice. Educate yourself, make the decision.... "git 'er dun" and don't look back.

 

[neil]

firstly hello fellow brit, agree with what has been said above, do your homework, dont be to swayed by any ones opinion as thats all they are, both tissue and mech have got good and not so good points about them,the main one there are gonna save your life, which ever you pick will be good for you ok

 

[Bill B]

This is The Great Debate, both for us and for the healthcare practitioners. There is a age-related "standard" recommendation with a cut-off at age 65, but that is just too facile for most of us. I personally fussed over this choice for a couple of months, reading literally all of the primary literature, since I had a background that would suggest I should be able to comprehend and analyze this. What a mess. For the most part, good data is just not there despite millions of people who have undergone this operation and dozens of attempts to answer the question. At 8PM the night before the surgery I finally made the decision. I found one particular paper to be fairly convincing, but I don't really want to push that because on re-review later on, after the surgery I ended up seeing it differently. Hah, hah. Oh, well. It's too bad the medical community is so divided over this. I guess you could say at this point, there are simply advantages and disadvantages to either choice, and you have to decide which is more important. My surgeon had a very specific recommendation, the opposite of your surgeon, and ultimately I went along with him and my feeling at the time that the data favored his recommendation for me. I'm very happy with how things went for me, and I trust this will work out the same for you as it does for nearly everyone. Either choice far surpasses doing nothing. Oh, and looking up, I see Neil said what I said much more succinctly in just one sentence!

 

[Luana]

I went along with my surgeon's suggestion of a mechanical valve. I was about your age when I had surgery and he said a tissue valve would mean another 2, possibly 3 additional surgeries. Even though I'd never had heart surgery before, somehow I knew I wouldn't want to have it more than once if I didn't have to. Some people don't have a rough time at all; some people do. No one knows how it will go. Being relatively young and healthy does not guarantee an easy surgery.

 

[enkaynj]

Gary,
Your situation is exactly the same as mine. My surgeon (and I ) liked tissue, my cardio mechanical. I am 51 too. I had my surgery this past July. I went with tissue. My surgeon who is involved in trials of percutaneous valve replacement technique is pretty confident that the technology will be perfected by the time I need my replacement valve.
That is somethingelse you should ask your cardio about.
Good Luck in making the right choice.

 

[Cooker]

Hi Gary and welcome ... I was 49 (almost 50) when I had my AVR ... I also play golf, walk for exercise and am very active at work ... Valve selection is a big topic but boils down to personal choice ... I chose to go mechanical on the advice of my cardiologist, my surgeon was OK either way ... whatever you choose I'm sure it will right for you ... Good luck:thumbup:

PS. I find taking warfarin daily a non-issue, just another pill.

 

[chaconne]

Hey Gary,

I'm planning to have surgery for aortic regurgitation and aneurism in November. I'm 41 years old, very active and have only mild symptoms. For the last year, since finding out my BAV had gotten worse, I've strongly leaned toward mechanical. My reasons are:

1. More likely a one-time operation. I don't want to be back in the same situation I am now a few years from now. Repeat surgeries can increase the chances of getting Atrial Fibrillation and other problems.

2. The risk of problems being on anticoagulants seems low, as long as proper precautions are taken. There is a lot of misinformation out there, but people on this web site, and friends I know who are on them, prove otherwise.

3. I believe that anticoagulants other than Warfarin will soon be available to mechanical heart valve patients (asparin/plavix, Dagibatran), or lower doses of Warfarin.

4. As a JPL/NASA engineer, I must admit that the idea of having such a high-tech device clicking away in me (hopefully the On-X) seems very cool.

I hope the best for you in your search.
-Steve

 

[LeakyUK]

I like my mech valve, warfarin is not a problem and I am hopeful my quick access hatch will not need to be re-opened in the future.

 

[hook]

I was driving myself nuts over the options. I went with mechanical, and just after surgery had buyer’s remorse; natural I guess. After my fifth day in recovery the surgeon told me he would have had me on long term Coumadin therapy anyway due to other issues, so we went the right direction with the mech.

Everyone has to make their own decision based on reliable information, just make sure that information is not BS. For me the Coumadin regiment and home testing is not that big a deal. I don't see any real changes in how much I bleed or feel with the drug. The only hassle is the issues with planning other surgical procedures.

 

[cebolla59]

Thank you all for your comments and advice..I still haven't decided by the way!

 

[sweetmarie]

Welcome Gary, I had AVR in January/11. I was 52 at the time. I went with mechanical, personal choice. I've read quite a few threads since then, about some mechanical and others tissue. Don't want to steer you one way or the other but from what I've read, those that went mechanical have not reported often that they regret their choice. I have on the other hand have read more about tissue owners wishing they had gone mechanical, especially those that are due for another surgery. I haven't actually made a survey, just from what I remember reading. I will be corrected if the masses feel otherwise. Good luck in either choice.
SM

 

[normofthenorth]

Not sure I've seen the "buyer's remorse" being very one-sided here, but maybe -- and we're hardly a random sample, since most of the happy customers fade away from the forum. . .

I'd mostly say "+1" to the posts above, but I have a perspective that hasn't been mentioned yet: If either kind of AVR (tissue or mech) and the follow-on treatment (like AntiCoagulant Therapy, aka ACT) goes perfectly, there's not much to choose. So I suggest balancing the downsides: Imagine for a second that (a) you go tissue and need a re-op sooner than the studies (or your Docs) suggest -- or that you have to be on ACT/Coumadin forever anyway. Then imagine (b) you go mech and need another OHS in 10-ish years (probably NOT because your valve failed, but there are lots of other reasons). Now figure out which "downside" would make you feel worse, or have you beating yourself up worse over your decision. (And go the other way, obviously! ;-) )

I find this "minimize the downside" approach sometimes clarifies a complex decision. (Even if you don't find it illuminating, THAT might be helpful!)

 

[Jkm7]

Just one little tissue valver here who is thrilled with my choice for bovine valve. It was my second surgery so I clearly knew exactly what I was facing when I made that choice. I would make the same choice again. I am only three years out and know things could change at my next echo (which is scheduled for next month and I know I will stress) but for ME, tissue was the right choice.

 

[ElectLive]

Norm makes an interesting point. Hindsight is 20-20 as they say, so might be good to try those lenses on beforehand. With that said...it is tough to take hope out of the decision. Much more enjoyable to plan for the best than the worst.

In any case, there's a subtle difference I think between "buyer's remorse" and "if I had it to do over again". There's no crystal ball here and no guarantees. The best decision at the time may go wrong, but that doesn't mean it was the wrong decision, with the information available at the time.

I've read some isolated posts regarding regret too, both ways, no idea if weighted to one side or the other, but felt pretty equal. What I've seen much more so, though, is an overwhelming majority of patients who are happy with their decision. It's extremely likely, Cebolla59, you will be too.

 

[Chris M]

Welcome Gary!

Tissue vs Mechanical is THE $64,000 question around here! I think it's really a case of weighing up all the options and trying to decide which of the two is better suited to your lifestyle or is the least "objectionable".

Some say that Mechanical, with the associated addition of a lifetime on Warfarin and all that that entails, is a very small irritation every day. Compare this to the relative day-to-day freedom of a Tissue valve which will probably serve you for a decade or so after which you will have to face another surgery. All this is a case of a daily "drip-drip" of inconvenience vs Another Big Surgery somewhere down the line.

Both types have their advantages and disadvantages. Both carry a certain level of risk. It's not uncommon to have more than one change of view as you weigh up your own personal choice. I know I did...

For me my first thought was that I would defnitely go mechanical... no way did I want to have to do the surgery more than once!... a few weeks later I had a complete change of mind and felt a huge relief that a tissue valve would free me of a life chained to Warfarin... then a little later I met my surgeon who gave me a few facts that eventually caused me to change my mind yet again! In the end I had a mechanical valve implanted four months ago (I'm a 56-year-old female) - all went well, I am totally happy with my choice and the Warfarin has really not been much of a problem at all. For different reasons I think I would also have been just as happy with a tissue valve as either type means I will no longer die within 3-5 years!!

I'm sure you will eventually reach a decision that suits YOU. Don't worry if you find yourself dithering, that's normal, it's one heck of a decision to make! But once done and the surgery is over I think you will just be so glad to have it all behind you and a normal life expectancy restored... which is the whole point of the exercise!

Anyway... best of luck to you from a fellow English member, I'm sure you'll do just fine in the long run!