Tissue valve may not be a viable option for me now.

[marc_kowal]

Had my pre-test done today for the surgery this Monday and all the results came back good. Meet with the surgeon to discuss the operation and he tells me that due to previous damage to the aortic root, they would perform a Bental Procedure. I had orginally stated I wanted a tissue valve (really wasn't ready for anti-coagulants yets due to the type of work I do and having 2 young boys and I'm only 40), and the surgeon told me because of that choice, the operation to replace that valve 10-15 years from now would be a lot trickier and the mortality rate would be about 15%. Mortality rate for the operation on Monday is only 5%.

That scared the hell out of me and my wife. So now we're talking about the pros and cons of the mechanical valve.

Just wondering what others would do in my shoes.

 

[Nancy jane]

Hi Marc. Ouch. Hard one to think over. I'm 3 weeks post op - tissue valve & while I can't help other than offer support - my gut says to ask for a second opinion. Do u have that option ? Best of luck to u
It's all such a personal thought process. Nancy - st Louis.

 

[Nancy jane]

Duh. With surgery Monday I guess a second opinion isn't much value. From what I hear warfarin is t that big of a deal.

Good luck. Nancy jane

 

[Magnacruz]

Marc, good luck with your upcoming surgery.

I would personally prefer to avoid another heart surgery even if the mortality rate were 0. I have had both types of valves. The tissue valve was nice because I could just forget about it, at least until it started to deteriorate. I never liked the idea of taking blood thinners, but it has not stopped me from doing what I want to do. I have coached basketball, football and softball and I was a motorcycle safety instructor for several years. It really has not affected my life other than checking my blood levels regularly. If I were involved in contact sports or were a professional stuntman it would be a different story.
Can you put things out of your mind and not let them bother you, or would it keep you awake at night knowing that your tissue valve will likely wear out someday? It never bothered me knowing that my valve would someday need replaced because I was too busy enjoying life. Mechanical valves usually outlast tissue valves, but that is not always the case.

 

[dick0236]

That scared the hell out of me and my wife. So now we're talking about the pros and cons of the mechanical valve.

Just wondering what others would do in my shoes.

I was kinda in your shoes. I was young(31) and had two young sons. There were no options for me, other than a mechanical valve, at the time I had the surgery.....but looking back, I'm glad I got a mechanical valve because I have needed no further surgeries. You don't say what you do for a living that would make anti-coagulants a problllem. I graduated from college a couple months before my surgery, so I was able to pick a safer "office job" after my surgery, although in hindsite the valve, or warfarin, has seldom interfered with my life or lifestyle.

Either valve choice will correct the immediate problem......although the choices all have their pros and cons.

 

[yotphix]

Hey Marc,
I was 39 at the time of my operation, and am 42 now. I am a marine engineer (employed on a luxury yacht), a runner, inline skater, cyclist and motorcyclist. I camp, I mess around on the water, travel internationally, pretty much anything I want. I'm also planning to start a family in the near future. Having a mechanical valve, and being on warfarin hasn't slowed me down a bit. I get banged up pretty regularly like I always did, and bruises are a little more frequent and bigger/more colourful. Cuts are barely more 'bleedy', and even tattoo artists say I'm no different than anyone else.
Sounds to me like your decision is being made for you by circumstance. Take the time to peruse the anti-coagulation forums here, and the home monitoring forum. When the time comes for you to deal with that, I doubt you'll find it a bigger deal than the rest of us do. The people who have the hardest time with it really seem to be the people who have the misfortune of being managed by uniformed or incompetent managers. If you are able and willing to live a fairly consistent life as regards diet, exercise and pill taking routines, warfarin is a great solution, with virtually no side effects. (Though you can blame anything you like on it - I tell my wife that it affects my short term memory and attention span! Make up your own symptoms to excuse your short comings.! Why not? )
Best of luck with the coming events and decisions. Looking forward to your posting on Anti-coag with the news that it turned out not to be such a big deal.

 

[Fundy]

I'm sort of curious as to why the mortality rate is as high as 5% for this operation?

 

[Madsometimes]

I was told a similar thing. I had bentall done and was told that the mortality rate for my operation was 3%, but it would be 10% for a re-op. I went for a mechanical, because I knew that I would stress out every time I went for an echo. I know that with a mechanical valve, there is still a possibility of re-op, but felt that it would be a certainty with a tissue valve.

As it happens, I would probably be on warfarin anyway, because I have developed flutter post op.

 

[Cooker]

I chose the valve that would give me the best chance to avoid a 2nd OHS ( I relied heavily on my cardiologist and surgeons advice). I have been on ACT (warfarin) now for over six years with no issues. I’m sure the choice you make will be the right one for you ... Godspeed on Monday!

 

[tprice54]

Although I ended up choosing a tissue valve 5 years ago, if visiting this site does anything, it should show that EITHER valve works fine; that warfarin can be managed quite successfully, and the only bad choice is doing nothing. That said, it does appear your choice has been made for you, embrace it and get prepared!

 

[Superbob]

Although I ended up choosing a tissue valve 5 years ago, if visiting this site does anything, it should show that EITHER valve works fine; that warfarin can be managed quite successfully, and the only bad choice is doing nothing. That said, it does appear your choice has been made for you, embrace it and get prepared!

I second what Tom said. Wishing you well as you go forward. You should do fine. I wouldn't fret about those statistics. The rate of success for the Bentall's is very high.

 

[dhudson]

I kinda agree with yotphix. I work in the emergency roadside service industry for AAA of Arizona. Been a truck driver mechanic, police officer and various a sundrie jobs not requiring a college degree. I am about to have a valve replacement, probably this year in next couple of months. My Doc recommends a mechanical because of my age, 58, he says i need something that will last me 30 or 40 more years instead of 4 to 8 years. Since I am personally allergic to more than 1 OHS if I can avoid it, I will. My Doc explained it this way. If I bleed 1 minute withoput ACT, with it I will bleed 2 minutes. Personally, i am not going to worry about it. Do what I gotta do, and I'll be darned if I am going to change my lifestyle and give up doing what I enjoy. Anyway, for what it's worth Good luck to you, and hope all goes well.

 

[ElectLive]

Marc - I faced a somewhat similar valve scenario, although slightly different circumstances. Plan A for my surgery going in was valve replacement and separate aneurysm graft, the root left alone. However, my surgeon wanted to discuss Plan B with me ahead of time, in case he determined after he got in there that the root should be replaced as well. This Plan B would have been a Bentall. We agreed ahead of time that he would put in a tissue valve under Plan A but a mechanical valve under Plan B, due to increased reoperative risk after a Bentall.

While many of the best surgeons are recommending tissue valves in increasingly younger ages, part of the math behind the argument is typically low reoperation risk for valve replacement. But when the root comes into play, part of the math changes, and limiting reoperation becomes more important. Just so you know, the mortality impact of the aortic root shared by my surgeon was lower also, but as I said, the recommendation was still the same.

Everyone's situation is different, and you're still the one with the biggest stake in the decision, so obviously it's important to reach a comfort level too. It's both a blessing and a curse to have a any choice in the matter, since both types of valves have different sets of benefits and risks. Any of us could think about what we may have missed out on if we had the other type of valve, however the decision happened. I think the best thing for all of us to do is try to focus instead on the most important positive (a brand new valve) and then take whatever unique benefits of our particular valve as a "bonus".

 

[markp66]

Personally I would go for a mechsnicsl with bentall procedure. Some studies are excellent, some giving survival similar to age match population. However, 15% redo is way higher, I was told replacing a tissue valve in a conduit is very easy. Replacing a mechanical valve is trickier and may be around 10-15% mortality with bentall. However, that is robably on the high side. I had a bentall with mech valve. So far so good. There is absolutely nothing I have sopped doing. If you cut yourself it's really not a big deal. Head injuries are slightly more of a worry. I home test once a week and it's so easy to keep a low INR. Because I home monitor my range is 2-2.5. Bentall procedure is a longer op and I personally wouldn't like the op again. The longer you are operated on the more it messes up your body. Mechanical valves will last for the rest of your life without complications. Many doctors say there will be better and safer anticoagulants out soonish-10-15 years. Good luck and I'd definitely get a 2nd opinion on the survival rate of the op. 1st time round is probably 1-3% first time and 2nd 3-7% from every surgeon I've spoken to.

 

[marc_kowal]

Thanks for the advice everyone. Looks like mechanical valve will be the one for me now. Still kind of upsetting that I had a choice at first and now that power to choose is more or less gone. But in time I'll learn to live with it.

The thing that bothers me is that now I feel like I'll need to eliminate some of the things I had wanted to do with my wife and sons to avoid injury and big nasty bruises. I always wanted to teach my boys to ski when they were old enough (and hopefully my wife too ) but I've been run into too many times by other people to know this may not be a good thing for me to do now.

Guess I'm just venting from all of this stress. I just want this to be over with and start to get my life back again.

 

[tprice54]

Vent away! That's why we're here! Again, I have a tissue (and because of that, I have to say any doctor that says they only last 4-8 years I would run from!) BUT please keep an open mind on what you will be able to do post op. Sure, you may PERCEIVE the risk to be higher, but should it really stop you from doing something???

 

[Lynlw]

I kinda agree with yotphix. I work in the emergency roadside service industry for AAA of Arizona. Been a truck driver mechanic, police officer and various a sundrie jobs not requiring a college degree. I am about to have a valve replacement, probably this year in next couple of months. My Doc recommends a mechanical because of my age, 58, he says i need something that will last me 30 or 40 more years instead of 4 to 8 years. Since I am personally allergic to more than 1 OHS if I can avoid it, I will. My Doc explained it this way. If I bleed 1 minute withoput ACT, with it I will bleed 2 minutes. Personally, i am not going to worry about it. Do what I gotta do, and I'll be darned if I am going to change my lifestyle and give up doing what I enjoy. Anyway, for what it's worth Good luck to you, and hope all goes well.

I'm glad you are happy with your decision, but was wonderring what kind of doctor, cardiologist, surgeon etc? said you'd get 4-8 year getting a valve while you are 58?

 

[Madsometimes]

I'm no sportswoman, but I would have thought skiing would be fine, but protective head gear should be worn.

 

[bdryer]

Hi marc

Dude, I'm a 56 year old who NEVER gave up snow skiing because of ACT and my MAV. I had an On-X AV implanted for this reason, as I can keep my INR close to 2. If I go below I know the experimental PROACT study has been successful to date with an INR of 1.5 - 2, supplemented by Dly 81 mg ASA. My ACT clinic says it's fine to ski, just keep the sport in check. I live in a Canadian city at the base of the Rocky mountains. Skiing is part of life. Bye the Bye I ski 90% of my days on race stock stuff. One of my co-workers plays hockey. We both drink brewskies and enjoy our winter sports. I'm also a Tri guy who rides cyclocross. Thats the original mountain bike which is nothing more then a road bike modified for dirt. Yes I have gone down and did NOT bleed out from the abrasions. A great quality helmet is a must, then again it always was. Go get your MHV, enjoy life, teach you kids to ski and be respectful of ACT.

marc, both my coworker who plays hockey and myself are techies. A ding to the hands is not life and death!

 

[bdryer]

It blows me away that because we are on ACT, folks perceive us to be hemophiliacs. God get a real! Sorry just needed to vent. Virtually all of our long time members here have an excellent understanding of ACT. I am grateful for the guidance they have given ME. Thats why I have a MAV and continue with my sports, once again ....with RESPECT for ACT.