Valve Question

[BGold]

Doc says it’s time to replace aortic valve, I’m 57 years young and know the book says I should get a mechanical valve. I’m very active, have no other medical issues and feel I’m in the prime of my life. If I go bio I could realistically need three operations. This may be common knowledge but I don’t know… can you start with a biological and get 10 +/- years Coumadin free and then be replaced with a mechanical valve or does that no make sence since at that age they recommend biological. I have appointments set with two surgeons next week but thought I would check with all you seasoned experts that I thank for all the informative input I get.

 

[Heart Of The Sunrise]

Bgold: I'll be 57 in April. I was faced with the very scenario you descibe. I decided to go mechanical. I only want to go through this once. You could start tissue and then go mechanical. This was not for me.

 

[tom in MO]

If you start with a tissue valve, what it is replaced with will be a different decision at a different time.

Tissue valves last longer in older people, the older the patient the longer the valve will last.

For example, if a tissue valve lasts 15 years in you, and you are 72, you would probably get a biological valve, since you may not need a third. However, if your tissue valve lasts 5 years, you may decide to opt for mechanical since the first tissue lasted only 5 years.

 

[Luana]

Even if you do get a tissue valve, there is no guaranty you won't need to take Coumadin. I made my decision based on what would give me the least more surgeries, and after waking up after surgery, I was real glad I made that decision.

 

[BGold]

tom
makes a lot of sence. My head is spinning... I tend to second guess all my decisions so I may just drive myself crazy.

 

[BGold]

Best wishes for a smooth procedure and speedy recovery

 

[Greg a]

BGold WELCOME to the forum ,,,,another factor to consider is the advancements made RECENTLY in Trans cath replacement http://content.onlinejacc.org/article.aspx?articleid=1377006

http://content.onlinejacc.org/article.aspx?articleid=1377006 it should not be a sole factor but taken into account ....kind of like buying stock futures

 

[Jkm7]

Most surgeons would likely say a tissue valve at 57 years old is a perfectly reasonable choice.
It is a very personal choice and only you can make that decision but you are well into an age range when it is a practical choice if that is what you want.

Wishing you the very best through this journey. It is remarkable how much this surgery has advanced and in an active, otherwise healthy patient, every reason to think you should get through this easily with minimal bumps.

 

[Rebecca]

At the age of 54 I went with a tissue valve (pig). A mechanical valve does not always last a life time. Most people with a tissue valve are not on Coumadin but a few are put on Coumadin. Ask your surgeons.

 

[VegasBAV]

I just went with a tissue valve at 41. My surgeon and cardiologist both said they would have done the same thing if they were me.

 

[dtread]

Make sure to factor in Open Heart Surgery (OHS) recovery time into your overall conditioning plan if you're going with tissue valves. Based on my experience I figure roughly a year to get back to near 100% of pre-op conditioning for each OHS. That is what it took me. Repeat OHS to avoid Coumadin seems a high price to pay to me.

 

[neil]

hi bgold, i was 51 when i had my porky pig,was told i would need another op down the line, dont know where 3 re ops would happen at the age of 57, unless you are very very unlucky, for me another re op was preferable to being on anti coags for the rest of my life and the risks that can bring, i guess thats the choice everybody has to make, and as you have seen that decision is pretty 50/50, good luck and remember which ever valve you go with is sure better that you got now,

 

[epstns]

bgold, I think the others have given you some good advice. I would also discuss valve choice with your surgeon - and maybe a second discussion after he has the results of your pre-op angiogram. At that point in time he will know all he is likely to know about the structure of your heart and your arteries. That may affect his recommendation about valves. While you are discussing valves, ask the surgeon what the expected service life is for various tissue valves in patients of your age. Each new "generation" of tissue valves seems to have longer life expectancies. My surgeon told me he would be surprised if I didn't get 15 or more years from my bovine valve (age 63 at implant), and that 20 years is a distinct possibility.

It might also be worth getting a second opinion from Cleveland Clinic. IIRC, they are now implanting about 85% tissue valves in patients in their 50's and older. They feel that the way the tissue in the new valves is specially treated should give them very long service lives.

Once you have all the data you can stand, on both tissue and mechanical valves, then you will be prepared to make your own choice and not feel that you have to second-guess yourself.

 

[Jkm7]

Coumadin is not a 'simple matter' for all people. For some, it's easy and not a major factor for them.

For others, like me, it wasn't so simple. I was supposed to take it for three months after getting my bovine mitral valve but my surgeon told me to stop at 2 1/2 months. He wanted me off it sooner.

There was no way for me/my doctors to know in advance the way my body would process coumadin until I was on it. I was very grateful I had chosen a tissue valve and was able to stop the coumadin. It would not have been great had I gotten a mechanical and was forced to remain on the coumadin. I was on a huge dose and still did not reach my range. I understand the right dose for each of us is the amount that keeps us in our prescribed range but the dose I would have required for life was very, very high and my doctors didn't like that.

I surely would have had difficulties whenever I would need any procedures/surgeries that would involve possibble bleeding. Health care providers that would have had to deal with me for all those other medical/dental treatments that come up during our lifetime would have been unsettled working on a patient who required such high dosage of ACT.

 

[marc_kowal]

I had my surgery last year at age 41 and went back and forth between mechanical and tissue. I finally decided on mechanical. Being on coumadin can at times be a drag, but I would rather not potentially have 2 more operations (assuming the tissue valves would last 15 years). Keep in mind, that each re-op probably has a slight decrease in survival rate due to age, conditioning, prior scar tissue, and original tissue already removed.

Deciding on which valve to take is a very peronal choice and whatever you decide, feel comfortable and confident with it.

 

[escargome]

My story went like this, at age 56 the time had come to replace my aortic valve (bicuspid). I researched both mechanical and tissue on the internet, spoke with two different cardiologists and one heart surgeon. Because of my age, all three left the decision completely up to me. The heart surgeon sat with my husband and I for over and hour and half and we went over the pros and cons for both type of valves. Since all three doctors were around my age, I asked each one independently which valve they would choose if it were them and all three said given our ages and the changes in valve life, they would choose a tissue valve. But still not being 100% decided I waffled some more, then my internal medicine doctor unknowingly gave me the answer. When I had gone to him for my pre-surgery physical he gently reminded my that should I choose a mechanical valve, I could no longer forget to take my medication as he knows I sometime do with my oral diabetes medication, so for me on a totally personal basis I chose a tissue valve and haven't regretted my choice one single day.
This decision must be one that you make not on what other say or don't say, but what you know in your gut feels right for you. Once you decide, just focus on getting better after the surgery and living your life in a better state of health.
Best Wishes to you.

 

[dick0236]

I had my surgery last year at age 41 and went back and forth between mechanical and tissue. I finally decided on mechanical. Being on coumadin can at times be a drag, but I would rather not potentially have 2 more operations (assuming the tissue valves would last 15 years). Keep in mind, that each re-op probably has a slight decrease in survival rate due to age, conditioning, prior scar tissue, and original tissue already removed.
.

I think this post goes to the "heart" in the debate of "mechanical vs tissue". I never had to make a decision since tissue valves where not available in 1967......but the mechanical valve has allowed me to "bypass" several additional surgeries.....and the potential dangers of the re-ops. Warfarin is a manageable "evil" and it "can be a drag" at times.....but, for me, it has been worth the hassle, since I have been able to stay off a surgical table.....and that's a very good thing. That said.....IF, and its an unlikely IF, I should need my second surgery, I would probably go "tissue", if possible, since I doubt I could outlive that one.

 

[socalhome]

This was our hardest decision. My husband 50, healthy no meds prior and compliant personality struggled with which type of valve. Both mechanical and bio were better than his own, but neither are perfect and both come with risks which led to many discussions with various physicians, surgeons, reading many journals for months. As our cardiologist has said, if it was an easy answer, there wouldn't be so many publications regarding choice guidelines. Know that any valve is better than your own, and hope for smooth recovery and lengthy duration before you have to make any choice again!

 

[Jkm7]

Once you make your choice, do not look back.
Whichever you choose will be the right one for you. Make your choice and move along.
Don't second guess yourself or you can drive yourself looney for the rest of your life.

 

[yotphix]

hi bgold, i was 51 when i had my porky pig,was told i would need another op down the line, dont know where 3 re ops would happen at the age of 57,

Neil, I think he was talking about the distinct possibility that: 1. his valves will last 15 or fewer years, and, 2. he lives well beyond 80.
My grandmother opted for tissue when she was 70, a normal choice at the time but when she needed another replacement at 82, she wasn't deemed strong enough to survive another surgery. It was the failing valve which actually took her.
There's no telling what the outcome would have been with a mechanical. It's unlikely it would have failed at that early stage, though ACT is not without it's risks.