Valve choice in a young man of 33 years old

[CANI33]

Hi to everyone. This forum is amazzing for me. Im from Argentina. I have a bicuspid aortic valve and I need an aortic valve replacement because I have now a sintomatic severe aortic stenosis. The desicion about the valve choice is very dificult for me between a mechanic valve (ATS low noise?), tissue valve (ST JUDE EPIC with anticalcification technology), ross procedure, homograft... Thanks

 

[geckley]

Well I'm only 38 myself and am going to have several valves replaced on the 11th of November. At my age the surgeon has said the best choice for me is mechanical. Everyone here will give you their insight. Use it to aid you in making the right choice. Ultimately the choice should be made between you and your surgeon. Good luck in your quest. By the way welcome aboard. Do you have a date set for surgery? Everyone here cares about everyone else it is a good place to talk about anything because most of us have been over the mountain once or are waithing to take the trip.

 

[CANI33]

I dont have yet a date for the surgery, but a think is near... Thank you very much for yor fast response. If you need anything, im here!

 

[ALCapshaw2]

Since you have a Bicuspid Aortic Valve, I encourage you to read through the Bicuspid Aortic Valve and Connective Tissue Disorder Forum for LOTS of informative and useful information on those related conditions.

For Mechanical Valves, I like the relatively new (1996) On-X Valve (see www.onxvalves.com and www.heartvalvechoice.com) with the Standard St. Jude Master's series valve as a backup 'just in case'. (see www.sjm.com) You may also want to look at the ATS and Carbomedics websites.

 

[davidpa28140]

Welcome to the forum, I'm 32 and my doctor seemed to think highly of the ON-X valve. Lots of poeple have had great success with the Saint Judes though.
As already mentioned you and your surgeon will discuss the options. Each person has thier own reasons for what type of valve they would choose, when it came time for me to decided on a valve I chose the ON-X in the hopes that I would be able to take lower does of warifin in the future. You will find lots of information on this site.
Dave

 

[CANI33]

Thank you very much David. Do you now something abouth the on-x valve noise compared with others?

 

[Roger Frank]

I'll second the On-X choice. FWIW, I can hear mine only with a stethoscope.

My 2 cents,

 

[Guest]

My OnX is quiet. I can hear it in a quiet room, when I'm bending over from sitting to tie my shoes, when I stretch before running, lean into a mirror, or stand in front of windows or doors. When I was at Cardiac Rehab, the tech could hear my valve while I was talking with her, we were standing a few feet apart, but I could not hear it. I cannot hear it right now while I'm replying to you. I hear it at night(quiet room) but it does not bother me, it does not keep me awake.

Overall, I'm very happy with my OnX, I'm waiting to see what the clinical trials tell us as far as reduced INR, not necessarily reduced coumadin dosage. I'm on 40 MG a week now, no problems, I test at home, call in my INRs. The amount of coumadin needed to keep you in range depends on how your body metabolizes it. Some folks take 5 mg a day, some take more. Coumadin has not interfered with my activities and what I want to do.

Everyone is different, reaction to meds is different, what is right for each of us is different. Read as much as you can on the ACT forum, home testing forum, valve choice forum. Lots of good information here and lucky for us that VR exists to provide 'real life' experiences.

 

[ctyguy]

Im 43 and had my valve replace earlier this year with a mechanical (On-X). I chose mechanical because it gave me the best chance of not having another surgery. Given my age it was nearly 100% probable that I would need another surgery later in life if I chose a tissue valve. Maybe 2 or 3 more surgeries even. Everyone must make that decision for themselves. The drawback to a mechanical valve is the fact that you will need Coumadin for the rest of your life. Thus far it has not been a problem for me, the biggest issue is simply being sure to take my pills each night. I have forgotten once or twice and took them the next morning without issue.

Just know that no matter which way you go there is a life after OHS. It doesn't mean you have to make huge lifestyle changes.

Best of luck to you !

 

[spartangator]

Know that you will make the right choice for you after reading all the information you can and talking with your physicians. I don't imagine valve choice is an easy decision for anyone. However, whatever option you pick, be certain that you choose a surgeon with lots of experience in that procedure.

 

[dick0236]

From your "bio" you are a Cardiologist. You know what you are facing and the pros and cons of the valve choices and other procedures. Sometimes, we get too close to the problems and "can't see the forest because all the trees get in the way". Do your homework...make your decision....and don't look back. Remember that you are walking the path that many have walked, successfully, before you. Welcome to this forum and I hope you have an uneventful surgery and fast recovery.

Personaly, I kinda like the mechanical valves.

 

[ALCapshaw2]

Thank you very much David. Do you now something abouth the on-x valve noise compared with others?

There is a discussion of the Noise Issue on one of the On-X websites. As I recall, they made 2 contact points on closure to specifically lower the contact noise. On-X has a person in charge of Patient Education (Catheran Burnett, RN, [email protected]) who will be happy to answer your questions.

How well a patient hears mechanical valve noise is highly dependent on their Body characteristics (i.e. how big they are, how much muscle on their chest, etc.

I have a St. Jude Master's series Mechanical Valve in the Aortic Position. Most of the time I do NOT hear it at all. If I take a Deep Breath and Hold it, I can hear a low level 'clicking'. Sometimes I like to do that just to hear how my heart is beating.

Some patients have reported they can hear their valve if they lay on one side (I forgot which) but not the other. Others report hearing it in Quiet places, especially if there are Hard Walls such as tile in bathrooms.

MOST report that when they do hear their valve, they find it a to be a 'comforting' soft sound. Only a few patients report being disturbed by the sound of a mechanical valve. Some of them use fans or devices that play various background noises such as beach sounds of the surf coming in to override / distract them from the sound of their valve.

'AL Capshaw'

 

[geebee]

If you go mechanical, you cannot go wrong with choosing either a St. Jude or On-X. If I had to replace my current St. Jude (for any reason other than a structural failure), I would go with a St. Jude again because I have had no problems in over 14 years. Just my opinion, of course. I have already experienced what can happen with a newer valve and am just not a gambler.

 

[Cooker]

Welcome to the zoo ... There are several fine valves and the one you pick will be right for you ... I have the St Jude mechanical and so far it has served me well ... Good luck.

 

[Eva]

Hellow and welcome to this wonderful website,

This was the hardest time for me too before my surgery. Do a good research based on real facts and share what you read with your surgeon and/or cardio.

Once you make a decision, things will get easier. Good luck.

 

[CANI33]

Thank you very much for you opinion!

 

[davidpa28140]

Cani33,

After being opened up for the OHS the doctors discovered that I had a membrane blocking a normal aortic valve , so all they had to do was cut it out. So I can’t tell you if I can hear the valve or not, I think that has a lot to do with your size anyway.

I did do some research before the surgery ( I was told I would need a replacement valve) I was sold on the ON-X in the hopes of not having to check my INR levels in the future. (I’m a real sissy about needles) There is no guarantee that the on-x will ever be approved for use with out warfarin , but I was willing to gamble it. It also helped that my surgeon recommended it. At any rate, I feel for your position, rest assured after this is behind you things only get better, I’m two months post op and can walk further now than before the operation, and I don’t have to have doctors scaring me over my “bicuspid” valve anymore.

Have a nice night ,
Dave

 

[MarkU]

I chose a St Jude mechanical valve when I had my surgery eight years ago at age 47. The main factor in my decision was to avoid future surgeries in the future. I continue to lead a very active lifestyle (I do triathlons). The only time Coumadin has been an issue has been during colonoscopies or dental procedures when I needed to do a Lovenox bridge.
I'm sure you'll make the right decision for yourself.
Good luck,
Mark

 

[carolyncox]

If you go mechanical, you cannot go wrong with choosing either a St. Jude or On-X. If I had to replace my current St. Jude (for any reason other than a structural failure), I would go with a St. Jude again because I have had no problems in over 14 years. Just my opinion, of course. I have already experienced what can happen with a newer valve and am just not a gambler.

I agree... I have had my St Judes mechanical valve for 19 and half years, with no probs - touch wood, apart from finding out that I now have anuerysms.

 

[surfsparky]

Hi and Welcome,
My husband Chris had BAV and chose the Ross Procedure 5 years ago at the age of 32.
All's well and great to be living on the 'other' side of the mountain!
All the best,
Yolanda