Tissue Vs Mechanical

[manis.garg]

Hi,

Same Question again...with different set of conditions.

My Wife is having a Arotic Valve Leakage and Arotic Stenosis. Leakage is Moderate to severe whereas AS is mild.

She is 29 and we have one Baby boy (2 years 4 months) and presently not working.

We are confused between the two Valve types.

Keeping in mind the cons of Mechanical valve we are planning to opt for Tissue. I am not sure how correct this decision is . You guys can help me on this.

She doesnt want to be on lifelong medicine. Also we are banking on the medical sciences development and hoping that 15 years down the line, no surgery is required.

Pls suggest me on this.

Thanks in advance.
Manish Garg

 

[Ross]

If your planning on more children, then tissue is the route to go, even though it's going to mean additional surgeries down the road. Thing is, can you financially handle it later? Will she be physically fit enough to endure more, etc,. Each surgery takes a toll on you, so you don't want to be doing this just because it can be done. Of course, going mechanical doesn't mean the end of surgery either, but it gives her the best shot and never having to do it again.

Also be advised, should she develop chronic afib after surgery, which is a possiblity, she'll be on anticoagulants anyhow. I would recommend that you get the REAL information on Coumadin from those that take the drug. Too many myths and BS surround what people are told, which naturally makes it look unattractive. For me, I'd rather take a pill a day and avoid putting myself at risk for another surgery.

Both of my surgeries nearly ended me, so I'm no fan of someone resigning themselves to additional surgery. That's just my opinion.

 

[manis.garg]

Hi Ross,

Thanks for response!!

But then mechanical will have the condition of taking blood thinners rest of the life on regular basis. Doing this I have one disadvantage, this will keep reminding me of the surgery.

As mentioned in your reply " should she develop chronic afib after surgery, which is a possiblity" what this means..pls provide me some more details on this..

How common this is and what is the possibility!!
I am in India and keeping Indian conditions in mind what is the recovery time after the surgery. I have gone thu the editorials on the side effects and found them quite alarming.

What is the life span of Tissue valve and is their any posibility that this gets better in near future.

Also what are the parameters that can help me to arrive on the surgery time. I am planning for Mid Sep 2010.

Regards,
Manish Garg

 

[ALCapshaw2]

I recall 2 Young (20's) Female Members of the VR Forums opting for Bovine Pericardial Tissue Valves so that they could have children. They both got about 10 years of service from those valves before they needed to be replaced. Porcine Valves typically do not last as long as the Bovine Pericardial Tissue Valves.

You may want to look at the advancements offered by the On-X Mechanical Valves. See www.heartvalvechoice.com and www.onxvalves.com We have/had a few members who have been taking Coumadin for over 30 years. Proper management of INR is the Key to Success with anticoagulation. The Best Results come from patients who Home Test and Self Dose. The next best come from dedicated Coumadin Clinics with experienced Nurses who see hundreds / thousands of patients and KNOW how to properly dose the medication without causing the wild fluctuations that can occur from Over-Reacting to out of range measurements (typically from practicioneers, including Doctors, who see few patients and are more afraid of Bleeding Issues than the possibility of Stroke from an INR that goes too Low.)

I recommend that you read the Sticky's at the top of the Anti-Coagulation Forum Thread Listing and browse through that Forum for more information on Living With and On Anti-Coagulation. Also see AL Lodwick's website www.warfarinfo.com for more information from this retired Anti-Coagulation Clinic Director / Registered Pharmacist who now tours the country giving lectures to Medical Practicioneers on How to Manage Coumadin Patients.

'AL Capshaw'

 

[kfay]

Hi Ross,

Thanks for response!!

But then mechanical will have the condition of taking blood thinners rest of the life on regular basis. Doing this I have one disadvantage, this will keep reminding me of the surgery.

As mentioned in your reply " should she develop chronic afib after surgery, which is a possiblity" what this means..pls provide me some more details on this..

How common this is and what is the possibility!!
I am in India and keeping Indian conditions in mind what is the recovery time after the surgery. I have gone thu the editorials on the side effects and found them quite alarming.

What is the life span of Tissue valve and is their any posibility that this gets better in near future.

Also what are the parameters that can help me to arrive on the surgery time. I am planning for Mid Sep 2010.

Regards,
Manish Garg

Manish, Afib is Atrial Fibrillation, which is a rhythm problem that anyone who has heart valve problems and heart surgery can develop. It makes you more prone to develop blood clots, so if she develops it, she will most likely be put on coumadin until they can stop a-fib. Usually, a-fib can be controlled with anti-arrhythmics, or, a cardiac ablation. I don't know what the percentage of people who develop it is, but it is not uncommon. It really does come down to whether or not the two of you would like to have other children. If you do, I'd definitely go tissue, if not, at her age, I'd probably have to go mechanical.

We have had a couple of other members on here who have had surgery in India...hopefully they will be along to tell you of their experiences in your country.

Kim

 

[manis.garg]

Hi Kim,
Thanks for that!!

I request the memebers to share the experience of Surgery (from where in INDIA,DELHI/NCR) they have undergone. I am in touch with some senior doctors but I am just exploring the best and you guys have already done that..

Thanks for the support!!

Regards,

Manish Garg

 

[manis.garg]

Hi,

Reports of First Eco Done foe my wife...

Impression:
a) Moderately Severe Aortic Regurgitation
b) Mild and Non Calcific Valvular Aortic Stenosis (Peak Systolic Gradient across Aortic Valve= 33mmHg
c) LV Normal in size with adequate systolic Function (LVES = 55%)
d) RV Normal in size with adequate systolic Function

Symptoms are : Short of Breath and Chest Congestion at times.
Need to know the exact state and what time we have in our hand b4 surgery.

I have consulted 3-4 cardiologist but each of them have given different opinion in terms of surgery. 2 of them suggested me to go for surgery in next 3 months and 2 others told me their is no rush and can wait for few years...I am confused and very much deppressed getting these from experts..

Is this going to happen in next 6 months Or > 1 Year

Can anyone suggest me here...I am in process of consulting to some more experts here in India.

Regards,

Manish Garg

 

[Jkm7]

Cardiologists sometimes seem to wait longer to recommend surgery than the surgeons. You don't want to wait too long and have permanent heart damage.
You may wish to consult with a surgeon or two and see what they say as to time frame for when your wife should have the surgery.

As an aside, I had bovine tissue valve replacement 2 1/2 years ago and (knock wood) have had no a-fib issues. That is not to say I may not at some time in the future but so far so good.

If you and your wife want more children, then for sure, a tissue valve would be her choice.
I'm sure there will be others here who will comment for you and hopefully one of the vr.org people who had their surgery in India.
We have heard many very good things about the quality and success of heart surgery in your country.

Best Wishes and please let us know how things develop for you and your wife.

 

[hook]

There is a new valve option that is offered in Europe, and will be approved by the FDA soon, if not already. It is tissue valve that is delivered by cath and dropped into position like a large stent. It can be replaced the same way. I could not wait that long so I got the ticker; no way I want to go through this again. The anticoagulant is not so bad once you get you INR in line and get a home tester. I have been taking a pill every day for over 25 years; it is no big deal at all.

I always hear this argument about anticoagulants, but I have to think therewill be advancements in drug therapy for us folks.

 

[Lynlw]

Hi Kim,
Thanks for that!!

I request the memebers to share the experience of Surgery (from where in INDIA,DELHI/NCR) they have undergone. I am in touch with some senior doctors but I am just exploring the best and you guys have already done that..

Thanks for the support!!

Regards,

Manish Garg

Welcome, I don't personally know much about the hospitals in India, There have been a few members who had surgery in India, One Lived in China at the time but traveled to go to Apollo. I did a search here and this thread seems to have good info on different Hospitals in India, http://www.valvereplacement.org/for...8-Valve-Replacement-in-India&highlight=apollo

 

[Luana]

Hi Manish,
If you and your wife want to have more children, then the choice is a tissue valve. If it were me, I would base my decision solely on that. I wouldn't bank on what may or may not be the future in valve replacement. Yes, valve replacements may be dramatically different in the future, but it's possible not everyone needing one will qualify for that type of procedure, or she may need a replacement before those procedures are in use.

The tissue valve manufacturers like to say their valves will last 20 years, but, their data includes older people, too, and there are a fair amount of VRs done among people over 65, and that age group is who gets the longest mileage. Typically, tissue valves need replacing sooner in young people. She may or may not get 10 years with a tissue valve. She may get 15. There really is no way of knowing.

As for lifelong medication, there are things other than VR that could happen and have her on lifelong medication (hypothyroidism, for example), and that are not difficult to manage. While it's unlikely she would need to be on warfarin with a tissue valve, there is no guarantee of it.

 

[ALCapshaw2]

Manish -

Unfortunately, I am not familiar with the guidelines for recommending surgery for Aortic Regurgitation.

I do know that for Aortic Stenosis, many Cardiologists and Surgeons (in the USA) use 0.8 square cm or less as their "Trigger Point" for recommending Aortic Valve Replacement. This number can be determined reasonably accurately from an EchoCardiogram by a skillful technician. The accuracy of that measurement is highly dependent on the skill of the technician. I'm thinking that a TransEsphageal Echocardiogram may give a more accurate picture. This requires placing a transducer down the patient's throat to be placed behind the heart for a more direct view of the heart.

'AL Capshaw'

 

[Philip B]

Choices

Choices

Your wife has a number of issues to consider. Other members have elaborated on a lot of the pros and cons associated with the different available replacement valves. One thing is for sure... whatever valve your wife chooses, it will be a good choice. Regardless of whether the valve is tissue or mechanical it will probably prolong her life.

-Philip

 

[OldManEmu]

Manish
I have copied your update from Penny's thread into this one, so members can add their comments.

Hi,

I think I am heading towards Tissue Valve.

My wife is bad in taking medicines Or not easy going with medicines and she even dont want to make this as an habit. I have to push her for medicines in case of normal problems.

But now , what are the valve available under Tissue value. What are the options.

Is this correct that in Young patients, life of the valve gets reduced?

I need to know the commercials of such valves. Pls provide the inputs.

Yes the younger the patient the faster a tissue valve will fail.
Most of the durability statistics that manufactures quote are for 60+ year old patients.
At 29 a tissue valve will most likely need to be replaced again before she is 40.
Even with a tissue valve your wife will need to take low dose Asprin every day.
I am uncertain what you are referring to with your comment

I need to know the commercials of such valves

 

[manis.garg]

Manish
I have copied your update from Penny's thread into this one, so members can add their comments.



Yes the younger the patient the faster a tissue valve will fail.
Most of the durability statistics that manufactures quote are for 60+ year old patients.
At 29 a tissue valve will most likely need to be replaced again before she is 40.
Even with a tissue valve your wife will need to take low dose Asprin every day.
I am uncertain what you are referring to with your comment

HI,

Thanks for that.

I was referring to the price of Tissue Valve.

Manish

 

[OldManEmu]

Manish, I am only familiar with the price in Australia in AUD.
All the valves both mechanical and tissue are in the same price range AUD 4k - 6k.
The mechanical valves that have a conduit attached are about AUD 7k, these are used if the ascending aorta needs replacing.

 

[manipreet04]

hi i m mani kant from u.p. lucknow dr. suggest me for volve replacement in auj 2011 pls suggest me the best surgen in india

 

[Lynlw]

hi i m mani kant from u.p. lucknow dr. suggest me for volve replacement in auj 2011 pls suggest me the best surgen in india pls ..

Hi, If you click on a persons name and go to their profile, it shows when they last were here, Manis hasn't been here since july, so most likely won't see any posts here. you could try PMing them and they might reply to that.

There aren't many members who had surgery in India, most of us are in the US but I know another older member (who doesn't come here any more)Choudou went to the apollo when he lived in China for his surgery, here is a thread discussing different hospitals in india if that helps http://www.valvereplacement.org/for...8-Valve-Replacement-in-India&highlight=apollo Maybe you also could pm, the members in that thread who have experience with surgery in India.
Good luck.
ps you should edit your post and remove your phone number, this is a very public forum, you probably don't want your phone number out there.

 

[manipreet04]

ok sir thanks for urr suport

 

[Marc]

Hi Manish,

what about the Ross procedure? Wouldn´t that be a choice? Or aortic valve repair? One should not forget these possibilities!

Greetings,
Marc