Tissue versus Mechanical

[dtread]

There are a very few people that it has been discovered are allergic or have adverse reactions to Coumadin/Warfarin. For those folks they have had no choice but to put them on some other anticoagulant. With Plavix (and baby aspirin) being one possibility. You might want to see if they might be willing to put you on Plavix or some other anticoagulant instead of Coumadin/Warfarin. Even if you get a tissue valve it's not 100% guaranteed that you won't have to go on anticoagulants. There is a small percentage of folks that get tissue valves that have to go on anticoagulants (usually due to atrial fibrillation)

 

[Ross]

There are a very few people that it has been discovered are allergic or have adverse reactions to Coumadin/Warfarin. For those folks they have had no choice but to put them on some other anticoagulant. With Plavix (and baby aspirin) being one possibility. You might want to see if they might be willing to put you on Plavix or some other anticoagulant instead of Coumadin/Warfarin. Even if you get a tissue valve it's not 100% guaranteed that you won't have to go on anticoagulants. There is a small percentage of folks that get tissue valves that have to go on anticoagulants (usually due to atrial fibrillation)

Umm no offense, but whom are you speaking of? I don't know anyone that this has happened to.

 

[dtread]

Umm no offense, but whom are you speaking of? I don't know anyone that this has happened to.

Not any particular person (and nobody that I personally know of), but I had researched previously and found mention of very small number of folks that have experienced allergic or adverse reactions to Coumadin/Warfarin. This is a very small percentage of the general population; probably way less than 1% (I don't know the exact figure). But nevertheless there are some folks that are allergic to it or experience adverse effects such as skin necrosis or purple toe syndrome, in which case it may require discontinuance of Coumadin/Warfarin. If you go to Google and search on "Allergy to Coumadin", "Allergic to Coumadin", "Allergy to Warfarin", or "Allergic to Warfarin" you can find a number of results.

 

[Penny]

Thanks dtread for your reply. I guess I just have to say it is not an allergic reaction that concerns me. It is the question of being able to absorb the drug/s that will prevent a stroke. celiac disease creates damage internally which will then prevent my body from absorbing the drugs. With this disease the damage is done without warning.

 

[Penny]

Oh ya forgot to mention I got my surgery date! July 13 th is the big day!

 

[Ross]

We'll eventually see you in the presurgery forum.

dtread, thanks. I've heard of people being allergic to the dye in that tablets and having to use 10mg tabs because they are dye free, but that's only allergic reaction I know of. The rest are possible, but very unlikely, side effects.

 

[ALCapshaw2]

I recall reading of at least one member who thought about 'trying Coumadin' BEFORE having surgery, just to be sure it would be tolerated. I believe at least One Physician concurred and gave an Rx to 'try it out' while others weren't so sure a short trial period would be a worthwhile test.

For someone who potential risk factors or concerns about allergies, I'm thinking that a trial period might be beneficial.
It would certainly be worthwhile to discuss the option with one's PCP and/or Cardiologist.

'AL C'

 

[Snoviper]

I had to get a tissue valve (Pig Valve) do to it being the tricuspid valve. I would have chosen tissue anyhow because I didn't want to be on anticoagulants and riding a motorcycle. I hope too that they make enough advances in technology so that it is a much easier procedure the next time I need to go in.

 

[Penny]

Nice bike Snoviper!
I spoke with my GP re my choice of valve, he thinks I really need to consider my choice carefully for if my Celiac does become active again then I won't be able to absorb Vitamin K which interacts with anticoagulants. Basically told me it could create a lot of baggage. So I am thinking the tissue one is still my better choice even though it means surgery again...
Now if I could just get this arm infection under control. Round 2 of antibiotics, if these ones don't work they tell me it's the hospital for me

 

[dtread]

Thanks dtread for your reply. I guess I just have to say it is not an allergic reaction that concerns me. It is the question of being able to absorb the drug/s that will prevent a stroke. celiac disease creates damage internally which will then prevent my body from absorbing the drugs. With this disease the damage is done without warning.

Penny, I'm very familiar with Celiac; several members of my family have it. I've been tested twice and fortunately I'm negative so far, which I'm very glad of because I know what the restrictions are. You have to be ultra careful when preparing food etc to not get even the tiniest amount of gluten whatsoever in your food or you're going to have a reaction. At any rate my point was not that I thought you might be allergic to Warfarin or Coumadin. What the point there was that there have been a very few isolated cases of folks that have had adverse or allergic reactions to Coumadin/Warfarin, so for those folks they have had to take those folks off Coumadin/Warfarin. For them they have had to find some other anticoagulant; e.g., Heparin or possibly Plavix. Heparin is expensive. Plavix is more expensive than Coumadin/Warfarin, but not prohibitively expensive. So my thought was perhaps you could explore the possibility of using some other anticoagulant than Coumadin/Warfarin with your Doctor. Don't know if that would make any difference regarding Celiac, but perhaps. Don't know how Plavix would play with Celiac - that would have to be researched. I agree that Coumadin/Warfarin is probably not a good idea if you have Celiac.

 

[ShawnB]

Is there any way to TEST the coumadin BEFORE your procedure? Maybe do a trial run far enough ahead of surgery?????

I had my aortic valve replaced with a mechanical four weeks ago. I'm 48 years old. I too was going back and forth between having to
do coumadin vs not doing coumadin. Now that I went through the process, I'm GLAD to have a mechanical valve. I don't want to go though
that again. We do finger sticks for blood tests.

Anyway, ask your doctor if there is any way to test your absorption rate on the coumadin before your surgery (of course well in advance of your surgery).

 

[pamela]

Good news to anyone pursuing the tissue option, at least in Alberta. Some links include: cbc.ca TAVI Surgery and News Article; as well as Who is benefitting.

Take Heart

 

[Ross]

Good news to anyone pursuing the tissue option, at least in Alberta. Some links include: cbc.ca TAVI Surgery and News Article; as well as Who is benefitting.

Take Heart

Except that it's experimental and used only on patients that cannot tolerate full OHS.


Doctors at the University of Alberta have for the first time performed a heart procedure aimed at helping patients for whom open heart surgery is too risky.

Transcatheter aortic valve implantation, or TAVI, helps elderly patients suffering from aortic stenosis, a blockage of the heart's aortic valve. While the condition is usually remedied by open heart surgery, that poses too great a risk to older patients.

 

[Luana]

Anyway, ask your doctor if there is any way to test your absorption rate on the coumadin before your surgery (of course well in advance of your surgery).

The only problem with this is that with the celiac disease, the absorption of the drug can fluctuate; it may be fine at times and not so fine at other times, as the celiac is not a static condition. I think that's the concern with the Coumadin; it's not a dosage or tolerance problem. If there's times it's not being absorbed, she won't be anti-coagulated; that's a problem.

 

[Penny]

You are dead on with your quote Luana. I could have a stroke before I knew anything was wrong.

Pamela, your post regarding TAVI surgery is the another reason why I am thinking of staying away from the mechanical valve. In 10-15 years there will be a good chance that this procedure will no longer be in the experimental stages. I live a ferry ride away from Vancouver where the doctors are performing this procedure now. I know there are no guarantees that it will be available but I think I am willing to take that chance. Is it a good decision? Well not sure,but I won't know if I don't give it a shot! Worse case scenario.... I have more surgery which everyone is assuring me it is not as bad as one would think.. and if it is terrible I will just go with the mechanical next time...

 

[ottagal]

http://circ.ahajournals.org/cgi/content/full/117/2/253
I resurrected this link that I had saved a while ago. It is from the AHA journal, 2008 and is titled Choice of Prosthetic Heart Valve in Today’s Practice. It is a bit of a read, but discusses the pros and cons of both tissue and mechanical valves as well as some of the current rationale being used when deciding on a tissue valve for a younger patient. The case study used is a 50 year old man. I hope this doesn't confuse you too much!

 

[Luckyguy17]

In 10-15 years there will be a good chance that this procedure will no longer be in the experimental stages. I live a ferry ride away from Vancouver where the doctors are performing this procedure now. I know there are no guarantees that it will be available but I think I am willing to take that chance. Is it a good decision? Well not sure,but I won't know if I don't give it a shot! Worse case scenario.... I have more surgery which everyone is assuring me it is not as bad as one would think.. and if it is terrible I will just go with the mechanical next time...

Penny, I went from bio to mechanical and came back to bio, with similar thoughts and then again some will tell you that mechanical is the only way to go.
You do well to be as informed as possible, Otawagal's article is another very good source and then it sounds like you really need to have another meeting with the surgeon, for possibly a plan A and a plan B and read his/her comfort level with your preference and why...
Unfortunately or fortunately in my case and I am likely not the only one, they can really only fully evaluate, once you are in OHS and they need a series of options on size etc...so makes sense, that they have a full complement of spare parts on standby and am a believer that the surgeon would like you to get OHS once (with planned longevity compromise)...what i mean are that we as patients can only follow the general guidelines of preference...your surgeon with their experience will likely know what would work best for your particular condition and may need some lattitude and your trust to make the judgment call, on the prosthetic he/she is familiar with and what should work best for you...as you certainly have read so far, there is compromise, whichever route you take

 

[heartman77]

I will be thinking of you on the 13th and saying a prayer that everything goes smooth and that you will be well on your way to a great recovery......Warm Heartfelt hugs.....Michael

 

[Penny]

thanks Michael, time is a ticking for sure. I am at the stage where I just try not to think about it. Keeping busy around the house and in the garden which in turn keeps me a whole lot calmer. Still waiting to hear from my surgeon but have decided if she doesn't call me in the next couple of days I will just pick up the phone. Assertiveness is a wonderful thing! lol

 

[Cherie']

Hey all - I too am struggling with the decision of whether to get a mechanical or tissue valve. Just found out I have a ascending aortic aneurysm and a leaking BAV approximately one month ago after a visit to ER thinking I was having a heart attack. Never knew I had any heart issues or BAV and am now scheduled for surgery July 28, 2010 - which also happens to be my birthday! I am not going to lie - the whole thing is a bit overwhelming. I am 45, female, healthy, non-smoker, not overweight, etc. so I am in shock a bit. I have been reading all your posts and am so confused. First I was thinking mechanical, but I am scared of being on Coumadin for the rest of my life which could easily be 45+ years (my grandmother is 98!) and has anyone had a mechanical valve for that long without reoperation? Heck half the time I cant even remember to take my thyroid medicine! Now I am thinking maybe a tissue valve which may get me to 55-60 yrs old and then do mechanical. But the thought of another surgery scares me. I hear of people talking of hearing the ticking of their valves and irregular heart beats and that is freaking me out!! The only symptoms I have now are some shortness of breath and some chest pains. Maybe I should try to push off surgery a year or two to buy me time - I AM TERRIFIED and CONFUSED!!!