Tissue vs mechanical

[greeny47]

Hi. Just wanted to know how many people in their mid 50’s chose tissue or mechanical. My surgeon really thinks tissue Valve. Thanks

 

[Warrick]

https://www.valvereplacement.org/threads/tissue-vs-mechanical.887572/#post-898050

 

[dutchboy]

Opinions all over the place on this. At 59 1/2, my surgeon, Dr. Thomas Gleason said, "I'll put in whatever you want, but I recommend mechanical". Lot's of wonderful/informed people on this forum; some have tissue valves, others mechanical. Do your homework and make your decision.

Good luck!

 

[stephenismycopilot]

Hi. Just wanted to know how many people in their mid 50’s chose tissue or mechanical. My surgeon really thinks tissue Valve. Thanks

I posted this on another thread just now on the same topic: I was 37 and went with tissue (Inspiris Resilia) at the very strong suggestion of my surgeon and cardiologists. The three months I was on warfarin, we never really got it stabilized. I'm now seven months out and all is going well. It's a very personal decision, and as you'll see on this forum, there are passionate defenders in both camps. But really you know yourself and your lifestyle better than anyone else. And remember: there are no wrong decisions.

 

[caro]

The tissue vs mechanical thread is very helpful. My dad got a mechanical valve in his mid 50’s. He is almost 70 and has had no issues. I had surgery earlier this year at 30, and his experience helped me choose mechanical. The surgeon I ended up with was pro tissue for everyone but he still does about the same amount of tissue and mech replacements. I chose him because of the minimally invasive technique. The first surgeon I met with was pro mechanical and 3 out of 4 cardiologists I’ve met with over the last year have been pro mechanical. Some surgeons are heavily aligned with a tissue or mech device company. Just something to be aware of. Doctors will have mixed opinions so it is always good to read the forum and talk to people who have had the surgery. Something I had to keep reminding myself- both choices are better than what I was born with. Best of luck!

 

[sylviayasgur]

Hi Greeny, valve choice is a very personal
thing. There is no right or wrong choice- either is lifesaving. My dad had a mechanical valve ( st. Judes)for some 20+ years (passed away at 86, that valve served him well). My husband had a ross procedure at 49 and needed to have the valve replaced 17 years later; he did not want to be taking Coumadin. He is still glad he made the choice he did. My dad, on the other hand, had an easy time managing his Coumadin ( except the few times doctors screwed up after non related surgeries- he almost bled out ). Read all you can here, educate yourself and then see how you FEEL. Again, your decision will be right for you. Please keep us posted. Good luck and be well!

 

[Bryan B]

I was 50 when I had my 2nd surgery (1st was a Ross Procedure in 2004 but I developed an aneurysm which required my 2nd surgery in 2011). My surgeon was pretty neutral on the valve selection even though he was heading the clinical trials on TAVR at Duke at the time. He only gave me his recommendation for which brand of valve he preferred for mechanical (On-X) and tissue (CE Pericardial) and let me decide. He did say that given the progress they were making on TAVR he thought I would be a viable candidate for that type of procedure by the time I needed a replacement, and that did influence my decision to end up choosing to go with the tissue valve.

 

[Thomas]

At 56, I went with Mechanical. I figured I've got enough time left and didn't want to go through the surgery again if possible.

 

[user 15848]

At 62 I was also given the choice, Surgeon said below 65 is a choice to be made, But, i could not see myself "planning" ahead of time going back to a hospital for another "for sure" surgery tavi or not, with a tissue one, not to mention that now Viruses are the new normal since November-2019, Am i ever glad i chooose On-X !

 

[MdaPA]

I believe it also comes down to one's faith and trust in the surgeon as well as the recommended device and procedure.

My darling wife (50 at the time) had her 3rd OHS in 2017. The immediate concern then was her bovine MV (lasted 17 years) needed to be replaced. In her 1st OHS in 1997, she had a ROSS procedure so (after 20 years) her AV and PV also had some leakage/stenosis, but not deemed at the critical or severe stage yet. So in 2017, she visited two very reputable and experienced valve surgeons.

One surgeon wanted to just replace her bovine MV with another tissue valve and leave the other valves for another day (means a likely 4th or more OHS down the road). The objective here was no need for anti-coagulation therapy and to limit the complexity and duration of the surgery. The other surgeon strongly pushed for mechanical replacements to the MV and AV and then see once inside how to deal with the PV and TV (to repair or replace).

My wife was very reluctant to go with the mechanical valves because of the diet restrictions and the other impacts a lifetime anti-coagulation may have. In the back of her mind was what the surgeon from her 2nd OHS in 2000, who replaced her MV (repair failed during ROSS procedure 3 years earlier) with a Bovine valve, said to her. He said, "If it was me having to decide between tissue or mechanical, I would rather have a mechanical problem than a medical problem" - meaning he would rather have a mechanical issue with a tissue valve that can he can deal with/fix in isolation than introduce other potential medical problems throughout the body as a result from being on lifetime anti-coagulation therapy with a mechanical valve (e.g. increase bleeding risk from surgeries/ falls/accidents, blood clots, diet restrictions/interactions, bridging for surgery/procedures, etc).

The decision my wife had to make was very hard. She had all her valves that needed consideration. In the end, it was the trust and faith in the 2nd surgeon (and nurses and hospital!) that lead her to the decision to go the mechanical route. Still today, almost 3 years later, she still questions if she made the right decision when faced with things like an INR out-of-range, or that huge bowl of escarole soup loaded with vitamin K she can't have, or when she needs me to give her Lovenox shots to bridge her for a surgery, or when she gets some spots on her arm and she asked "is that from the warfarin?", or when she can't sleep at night because she hears the valves "clicking". She says "I would had rather faced a 4th or more OHS down the road than have to worry about and deal with these downsides/limitations of anti-coagulation therapy". Then that's where I and her doctors step in and tell her she made the right decision by reducing the likelihood of a 4th OHS and the risks that brings (hopefully TAVR will replace her cadaver PV and repaired TV if/when ever needed).

Hope this helps in somebody's decision making.

 

[pellicle]

My wife was very reluctant to go with the mechanical valves because of the diet restrictions and the other impacts a lifetime anti-coagulation may have.

its always saddening to me how this point, which is often very flawed and magnified beyond its reality, is used by so many to make a decision.

I hope this blog post helps your wife.
http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
and that this one helps you to see that managing procedures can be straightforward
http://cjeastwd.blogspot.com/2017/12/perioperative-management-of-inr.html
She doesn't need to give up the salads (kale or even spinach)

 

[MdaPA]

its always saddening to me how this point, which is often very flawed and magnified beyond its reality, is used by so many to make a decision.

Pellicle, I see your point but sometimes emotions come into play like it does for my wife. I'm the logical one so that's why I'm in charge of reading up on all the valuable information on this forum to help her better manage her INR.

I have read most of your blogs. One good tip I passed along to her is using a rubber band. This allows her to easily get a reliable sized blood sample without "milking the finger".

She doesn't need to give up the salads (kale or even spinach)

You are right, you don't want to nor have to give up foods with vitamin K, as long as you are consistent. She does try to eat a consistent amount of green vegatables/salads, including spinach, kale and brocoli. But the days of her eating a huge bowl of escarole soup (as an entire meal) would be troublesome for her INR that week. A small bowl is doable, but not in excess.

 

[pellicle]

Hi

Pellicle, I see your point but sometimes emotions come into play like it does for my wife.

the problem I have is that some twit put that out there in the first place and its not actually correct .... all part of the (at bet) outdated BS (at worst outright oldWivesTales) that the medical people love to espouse to make them feel somehow "in power" ... (speculation as to why)

...you don't want to nor have to give up foods with vitamin K, as long as you are consistent.

you don't even need to be consistent. Test and know thyself, I'm sure you'll find that it makes less difference than you think. I believe that you'll find that the >10 years managing themselves people here will agree that its not anywhere near as significant as its made out to be; and the >5 years managing themselves people are probably still counting out celery by the 1/4 ounce.

I literally no longer pay attention to what I eat and only pay attention to measuring myself on Saturday and making sure I take my pills every day.

Best Wishes

 

[LondonAndy]

Hi. Just wanted to know how many people in their mid 50’s chose tissue or mechanical. My surgeon really thinks tissue Valve. Thanks

I see from your previous posts that you have already had a tissue valve, and so this will be a replacement. So you already know the experience of open heart surgery, and I guess it depends how many times you are willing to go through that, bearing in mind it gets tougher each time both because you will be older and less strong, and because of scar tissue from previous surgeries.

For me, the balance was easy when I made my choice 6 years ago: I only wanted this surgery once if at all possible, so at age 48 and a lot I chose mechanical. I am an insulin dependent diabetic, so was already taking daily medication and daily finger pricks to monitor blood glucose. So adding another daily pill and a weekly finger prick for INR was no big deal. The clicking you get with mechanical valves I have found surprisingly quiet and only notice it when I pay attention to it. I am happy with my choice, inconsistent with my vitamin K foods and my alcohol consumption, though that is moderate anyway. Weekly monitoring enables me to adjust my Warfarin dose myself to suit. For others their lifestyle and personal view on medication makes the choice more in favour of tissue, though there is no guarantee you avoid Warfarin that route - my mother had a tissue valve and has been on Warfarin permanently, though in the last couple of years she has been changed to taking one of the new anticoagulants that does not require regular monitoring. She is now 81 and in need of a replacement, but cannot face the trauma of the surgery and is avoiding it. Her health is poor and I do not think she will be with us much longer.

As others have said, whatever choice you make will be a good one, based on your priorities in life. At least we have a choice of how to extend our lives.

 

[greeny47]

Thank you all for replying. I am also having my tricuspid valve repaired which is what why the surgeon wants to replace my 10 year old tissue valve so I don’t end up with another heart surgery in 3-5 years. So many tough decisions.

 

[tom in MO]

Hi. Just wanted to know how many people in their mid 50’s chose tissue or mechanical. My surgeon really thinks tissue Valve. Thanks

I was exactly 55 when I got my mechanical valve. I wanted to avoid a second operation.

• I do not like operations. Every one I've ever had was a success, but not a 100% success.
• I've had a cousin and father die due to medical mistakes. It's real.
• Health insurance in the US is dependent upon one's job and I work in an area where job security is unclear. The world economy is in turmoil, best to avoid future major medical expenses if one can. If you choose tissue you will need routine echos and a reoperation.
• I did not want to put my family through another operation.
• I did not want to lose another 8 weeks to a reoperation.
• I did not want an operation in my 70s (if lucky).
• I did not want a second slow decline in heart performance until my "new" valve needed replacement.

It's a personal decision. One thing I've observed is that it seems it is surgeons who push tissue and cardiologists who say it's OK to go mechanical. Don't forget that doctors are biased, surgeons like to treat everything with a scalpel, cardiologist think anticoalgulation is not a big deal since they have lots of patients on it.

When it comes to warfarin, for me the biggest downside is not being able to take NSAIDs for arthritis, having antibiotics for minor surgery (e.g. mole removal) or tooth cleaning and the potential impact upon future surgeries. My St. Jude mechanical valve can handle low INRs, so my only surgery since mechanical valve implantation needed me to drop my INR for a day or two (e.g. ~2 days w/o warfarin) and it went fine w/o additional anticoagulation. However, when it comes time for a double knee replacement, I might be only able to do them one at a time.

 

[jcgtok17]

At 50 I had a tissue value (St. Jude Medical GT) installed in Japan. No air time given to mechanical. So far so good. Minimal meds. If it lasts < 10 years and OHS required I'd likely go with mechanical though.

 

[RealtorRick]

Diagnosed with BAV with calcification at age 46. At age 52 (2012) it was time. Spent 6 years researching and still was not sure. Decided to roll the dice with Mechanical to reduce the odds or reoperation later in life. Had great insurance and good health. Did a St Judes Mechanical, due to long proven history. Take Warfarin and test at local medical clinic 1x per month. No NSAIDS but can take a dose now and then, just not days worth. Tylenol is fine. Had prostate cancer surgery and bridged off the warfarin with self administered Heparin shots. Had some bladder bleeding 1 week post surgery that was tied to a poorly inserted catheter. Took a week of lowering the Warfarin dosage to get bleeding stopped. Also bridged off Warfarin 2x for colonoscopies. Again no big deal. I eat what I want, just need to be consistent. People who say you cannot eat greens are wrong. You eat consistent, adjust dosage to the diet. It has been 8 years, never regretted my decision at all.
FYI: I had an infection a week after prostate surgery and walked into the ER. Had a resting heart rate of 204. Diagnosed as Atrial Flutter. They checked the valve and it was perfect. Not sure if the tissue would have withstood the infection and stress. Managed the AF with low dose Sotalol. All is good!

 

[Superman]

For me, 10 years ago it would have been mechanical slam dunk decision. Even if I was in my mid-50’s. Today it would depend entirely on my faith in the progress if TAVR as an option down the road.

I’ve been on Warfarin for nearly 30 years and I’m still in my 40‘s so I don’t have any plans to stop taking it any time soon.

Mid-50’s? Hope for 15 years and a TAVR at 70 to last how long? Another TAVR at 80 (optimistically)? Or am I stuck with a second OHS at 70 or even 80 if they can’t stack a third valve? I don’t know. Seems like a fair bit of uncertainty vs the certainty of a mechanical valve outlasting me. Daily meds will be a reality as we age anyway. The pill I don’t care about. Testing gets figured out and staying in range isn’t hard for most.

For me, having two OHS’s (one for the aortic valve, one for an aneurysm) before I turned 37 - avoiding those is a much more important thing to me.

Unrelated- I don’t think I ever fully appreciated how young I was dealing with all this until joining these forums.

 

[Suckyvalvegurl]

Very hard and very personal choice. At age 56 I went Bovine as I hate all things medical (and I am a nurse lol). I work in research and I was willing to roll the dice that something would be available when I needed it. I was also VERY lucky to be able to have truly minimally invasive AVR without cracking my ribs or sternum. I think this raises your tolerance greatly for possible future surgery.