Valve Question

[James_Terry]

I just trying to find the way to research the types of aortic valve that are use to replace mine. This will be my 3 time getting it replaced and I'm 30 years old. The first time I chose the pig valve and that didn't last an hour or so after they closed me up and now I have the freestyle valve and had it for just over 9 years. My last echo so that it decrease in size by .6 mm I believe and now I'm in the severe aortic stenosis. I just want to research to try to get the one that would last for the rest of my life. Thanks for any information in advance.

 

[pellicle]

Hi and welcome

I just trying to find the way to research the types of aortic valve that are use to replace mine. This will be my 3 time getting it replaced and I'm 30 years old.

short answer first: any of the modern bi-leaflet mechanical valves such as the ATS/Medtronic , St Jude or On-X valve is what I'm going to say you should do as that is the only choice which gives you any possibility of:

I just want to research to try to get the one that would last for the rest of my life

I too have had 3 OHS's (1 repair at 10, one homograft at 28 and this (ATS) at 48.

They fixed an aneurysm on the last surgery.

I have put together a bundle of salient information on my blog: here
Its a lot of reading and so dig through it methodically and carefully

I will say that everything that every surgeon or doctor I've spoken to backs up ... you don't want to be having multiple operations and at 30 with 2 already behind you this third will be complicated there is no two ways around that. There will be a bunch of scar tissue in there and that will make the surgeons job difficult.

Do not give much credence to the "TAVI" sayers because for you at your age there is a critical point they ignore: the TAVI valves last less time and you can only have a valve in valve replacement once before a reop is needed. This will essentially leave you with the same time equation as a tissue valve that you already know will not last 20 years (or untill you are 50 in your best case),

Lastly I'll say that warfarin management is now days very good, especially (and in particular) if you do it yourself. I have a lot of information on that on my blog too here. So if you are anxious about warfarin as a peril put that at ease because its highly managable and many myths exist which are baseless.

So unless you have any other serious complications you have not mentioned then my recommendation stands.

Lastly if you have any questions or want to just call me for a chat PM me and I'm happy to give you my number. I can call USA or UK on my phone plan for no additional charges or I have skype too.

Best Wishes

 

[dick0236]

Hi James. You will find a lot of discussion on this site regarding valves. If you want a valve that will last a lifetime, you will be looking at one of the mechanical valves. I've had mine since I was 31 and am now 80.....on the same valve. One of your sources will be your Cardio and Surgeon.....see what they recommend. Do a search on this site and you'll find a lot of good info.

 

[Protimenow]

I got a mechanical at 41. I've been managing my anticoagulation since 2009 (although I like to let the clinics think that they have a part in this, too, so they can refill my prescriptions). I had a problem with one meter giving me values that were in the safe range when my actual INR was in a danger zone, so I use a different meter, and get a monthly blood draw to see that the meter and lab are within a reasonable range of each other.
Warfarin will probably not require many changes in your life. It's inexpensive, and the meters and supplies aren't necessarily that big a deal anymore.
I have no regrets about getting the mechanical valve 25 years ago.

 

[Agian]

James, you're a young man who has already had two ops.
As someone who recently had a replacement (first time), this is the advice I would give my brother: Go mechanical.
Warfarin management is a very minor pain in the arse.
I got the biggest On-X the surgeon could find, so it's a noisy fecker. But, a small price to pay.
The on-x has guards to protect against Pannus.
The risks: Endocarditis, as with all prosthetic valves.
Clots and bleeds can be minimised with tight INR control.
I agree with the other lads.

 

[James_Terry]

I have been on Warfarin since the first to surgery and 2 month after I though I didn't need it and that turned out to be the wrong choice by me. I have to take Warfarin, metoprolol, aspirin and they put me on ranexe yesterday.

 

[Agian]

Between our elder statesman, Uncle Dick (aka Master Splinter)

.... and our resident Warfarin Gurus (Messrs Pellicle and Protimenow)

.... you will get the best advice there is, in relation to Warfarin. You've come to the right place.

 

[Protimenow]

This is great. You've put me in good company with Pellicle. Of course, Statler and Waldorf (or at least Waldorf for me) may have been even better images.

 

[neil]

your best bet for no more re ops would be mech although that's not 100%, plus you will be on warfarin the rest of your life which is the trade off,

 

[pellicle]

Hi

your best bet for no more re ops would be mech although that's not 100%, plus you will be on warfarin the rest of your life which is the trade off,

few things in life are 100% certainties except death, taxes and the need for a reop in a 30yo who gets a tissue prosthetic. There is a strong possibility that with a mechanical he may have it for life free of reoperation, but there is ZERO possibility of that at his age with a tissue prosthetic.

Don't be wishing #1 and #3 on him to soon now Neil

 

[Nocturne]

My thoughts would be that maybe a modern tissue valve, which might last longer than historical ones, could buy some time before getting a future mechanical valve that might be superior to what is available now, and might not require anticoagulants at all.

 

[Nocturne]

My thoughts would be that maybe a modern tissue valve, which might last longer than historical ones, could buy some time before getting a future mechanical valve that might be superior to what is available now, and might not require anticoagulants at all.

 

[dick0236]

My thoughts would be that maybe a modern tissue valve, which might last longer than historical ones, could buy some time before getting a future mechanical valve that might be superior to what is available now, and might not require anticoagulants at all.

Why not get a mechanical now and get a new one if, and when, they develop the "superior" mechanical down the road. If they never develop such a valve you would have one that will last, even if it does require ACT. Plus, ACT really is not that big of a deal.

 

[pellicle]

My thoughts would be that maybe a modern tissue valve, which might last longer than historical ones, .

There have been no real changes in materials and we already have evidence the valve of just nine years ago failed. It's not like we are talking 20 years ago stuff. As recently as two years ago a fellow got as little as one ******* year from a modern tissue prosthetic, so arm chair pipe dreams with your life not on the line are immoral games with some innocent persons life.

Them there is the issue that 4th operations are very difficult and the man could die or be severely impaired in health.

Think about that again. Four surgeries. You guys have no bloody idea how dangerous that is.

Them there is the point that he is currently on warfarin. He has said he's not worried by that. I know that so many here are so vexed by their irrational fears of that boogie man but if you have no known medical issues with it then it's irrational to keep suggesting tissue just because you (third person infinitive you here) are terrified of warfarin.

The guy is thirty, the valve has to last ...

 

[James_Terry]

I want something that will last possibly for the rest of my life. Warfarin is not biggie to get my finger stuck every 30-40 days. More than likely I will have to have something done about the bypass I had done during the previous open heart. Most days Im just glad to wake up and enjoy life even though I can enjoy it the way I want to because I'm so limited to what I can to do.

 

[pellicle]

One thing I want to make clear and not be replying to anyone in particular is this:
Some here have not had a surgery, and have come here filled with terror at the thought. Suddenly after their first they are cured of that terror and suddenly its a maniacal "its a breeze, have a second, have a third"

This is equally irrational to the fear of the first ... its a fools paradise

Few here have had two and fewer still three or more.

Anyone who has the faintest whisp of conservative view will see that it is totally reckless to be advising people to have multipl surgeries, more so on a whim of "what if the tech improves".

Well what if it doesn't and what if the reality does not match the sales hype?

I ask you to read these posts:

http://www.valvereplacement.org/foru...039#post548039

And 2nd time the scar tissue and my heart was in center of my chest
when they made my incision,everything including my 16 year arotic valve
was scar tissued,it was much more difficult than 1st and i'd give anything
to have 1st surgery back,it was easier to get through than now.

i'm not a candidate for 3rd surgery they've told me,I have worked all
my life at jobs and now i'm told for various reasons ,of this surgery 2nd
time round that i cannot return to work,and recovery time for me will
be over a year,and believe me i am hurting in more than one way.

http://www.valvereplacement.org/foru...991#post490991

Life was wonderful for 31 years then in 2006 I had to go in for my 3rd to have the old aortic replaced with a new St. Jude. The old mitral valve was not replaced & it is showing signs of stress & needs to be replaced but I am just being watched & on the sidelines for a 4th OHS. A 4th is really scary & risky due to all the scar tissue that is on & around the valve.....so, I wait......

Next let me propose something as an experiment. I have two revolvers one has no bullets the other has one in it. You are told to pick one up (you are blind folded) and put it to your head and pull the trigger, most of you would be too gutless do to it because you do grasp the risk of that. Now that's only a 1/12 chance that you'll blow your brains out. Proposing multiple surgeries to a healthy 30 year old is far more cruel than that because they won't just die, they'll be left suffering degraded health and an uncertain future.

Think about that before your open your mouths and advise a young man to bet his health on your fears. Be honourable and be ethical with others health ... you aren't just playing with your own fears here, your playing with a young mans future.

 

[JulienDu]

Just become a ******* Terminator

 

[LondonAndy]

From the nature of James's comments I think he has already concluded mechanical is the way to go and maybe is asking which mechanical has the longest life expectancy? I don't actually know which one I have (! It's something I must ask at my 2nd anniversary checkup next month), simply that at age 48 I knew that didn't want to go through the trauma and risks of re-surgery if I went for a tissue valve. I have no regrets. I do not fall into what I think are the two problematic categories (a woman who may become pregnant or somebody who plays contact sports), I am already diabetic so used to finger pricking much more frequently than is needed for INR testing, so mechanical was a no brainer for me.

 

[Agian]

The guy is already on Warfarin, what was the question again?

 

[Agian]

PS St Jude's (stupid name for a valve) Regent is tried and tested. Very popular.

On-X is the one I got (biggest size) is the latest one. Has Pannus guards. They say the bigger the valve the less chance of pannus. Mine is bloody noisy, but so what? Older people can't hear it. Me and the kids are already used to it. I find that a thick shirt muffles it. I'm going through the 'let's check my INR a lot phase' and have bruised fingers. Again, so what?

Pellicle has an ATS (?) valve, which is known to be quiet.

I've been told that there is a bigger risk of endocarditis with a failing native valve.

Clots and bleeds? I'm actually amazed that problems aren't even more common, given the demographic of folks on Warfarin. Older people with AF and the like. Yes, people are getting INRs checked every three months. There's your main problem. I know an 80 year old who I tried to talk about this and he called me 'a young ****' (sorry, I was just hanging out to throw that in somewhere).

For people who keep banging on about Warfarin, we forget that there might be a SAFE alternative around the corner, no blood tests (shock, horror).

Now why are you all scaring the guy?