valve choice for the young

[pellicle]

Hi

a friend of mine has asked me to talk with her friends son (who is less than 30) about his choice of valve. Currently the Surgeon suggests that he has no preference for tissue or mechanical. He will be having an Aortic valve.

I can only assume that this means that there are no issues which the Surgeon is aware of that select against mechanical valves.

So before I speak with the fellow, I would ask here if anyone can bring up any points which I may not have considered or yet known of in this area.

I will be taking the approach of suggesting:
* that it is his choice
* discussing the pros and cons of each
* discussing reoperation and valve lifespan
* mentioning pannus growth interfering with the (mainly mechanical) valve
* anti-coagulation

I may indeed point him here too.

thanks for your inputs

 

[Ola Thoresen]

Re: valve choice for the young

At that age, choosing mechanical is at least for me, obvious. Surgery is not that fun, and the thought of having to go through this every 10 years is not my kind of dreams.

When it comes to anti coagulation there is nothing to worry about. I too was a bit concerned. I have never had to use any medication before so I was both worried about forgetting it, and on the other hand, that it would take up a lot of time and be problematic in all kind of ways.
It is not! I take two small pills every morning. That's it. It will not make you a bleeder. You will not get bruises for nothing. If you cut yourself, it will stop bleeding just as before (it might take a few more minutes, but not a big deal). You can live your life just as you used to.

In addition to the two pills, I go to an INR check regularly. I am 2 months post op. and already "regularly" means once a month. It started as twice a week, then once a week, now every month, and probably even longer if the level stays stable.
I have a home checker - coagucheck xs - which I can bring with me on holiday and that I use to check my own levels every Monday. But that is just because I want to, not because I have to. I am a statistics nerd, so I love making graphs and tables.

There are other things to worry about, but anti coagulation is really not one of them.

 

[pellicle]

Ola

I found this interesting

http://web.archive.org/web/20091231184542/http://www.warfarinfo.com/

I have a mechanical valve and home test too. For me this was the most desirable choice.

 

[Jkm7]

You might wish to mention some people with mechanical valves never get used to the clicking sound. There is no predicting which valves could be louder in some patients than others as body shape and size is not a true indicator. A large, barrel chested man could find his valve loud while a petite little lady could have a near silent mechanical valve.

 

[pellicle]

You might wish to mention some people with mechanical valves never get used to the clicking sound.

Will do. It is a problem to me still after a year, which is of course still short of never

 

[OldManEmu]

Does he work in an occupation such as police officer or fireman were anti coagulation therapy isn't usually permitted?
Other occupations that anti coagulation therapy can have issues with are heavy vehicle (truck and bus) driver licensing. Anti coagulant therapy is something the licensing authorities need to be notified of, and a cardiologist usually is required to notify the licensing authority regularly regarding the correct level of anti coagulation control that is being maintained to keep your license.
One of my relatives has to do a similar thing to maintain his heavy vehicle licence being a diabetic.

 

[pellicle]

Does he work in an occupation such as police officer or fireman were anti coagulation therapy isn't usually permitted?

an interesting question. He is as yet not working (at Uni), but as I understood it was considering the Police.

Anti coagulant therapy is something the licensing authorities need to be notified of, and a cardiologist usually is required to notify the licensing authority regularly regarding the correct level of anti coagulation control that is being maintained to keep your license.

even more interesting, as in my case my cardiologist (not my cardiac surgeon) would have no idea as to the adherence to my anticoagulation (potentially my doctor may)

thanks for that Australia specific input mate!

 

[ottagal]

Old Man Emu makes a good point. I recall one of the nurses telling me about a 20 something year old patient opting for a tissue valve due to his working conditions. Unfortunately, that is all I recall.
Don't forget that there is also the chance of being on coumadin if one develops afib post-op. However, I recall reading a study that a large percentage of those who develop afib post-op, are temporary. My understanding is coumadin is discontinued once the afib resolves. This actually happened to a friend who underwent AVR and ended up having afib for 2 months.
I wish I could find that study now...

 

[carolinemc]

Jim, hate to tell you this, but I am so used to the clicking, that I never hear it now. And I am not a light, little lady. It depends on you if you keep hearing it or not. I like to feel mine, it just works like the real thing. Just whatever you get used to. Hugs for you today.