Valve replacement decision

[Carolyn Russo]

7/8/07 I am in need of making a decision as to what valve to have implanted. I'm 62 1/2 and I don't want to face another open heart surgery unless absolutly necessary.
I am a wreck and need some sound advise - it sounds like you did a lot of research......what are your thoughts?


Carolyn

 

[Ross]

Carolyn at your age, it's hard to say. You could go tissue which may or may not last the rest of your life. Mechanical will last unless something unforeseen should happen like infection of the valve, but you would also be on Coumadin for the rest of your life. Coumadin is not the big bad monster that so many make it out to be. I've been on it for 6 years now and it hasn't affected my diet or lifestyle at all. The worst part about it is finding people who really know how to manage your Coumadin care. There are far too many professionals that do not know and spread persistent myths about the drug also.

The newer tissue valves hold promise, but they haven't been out long enough to do a 25 year study on to really determine how long they'll last. If you absolutely do not want to go through this again, which you shouldn't, Mechanical would be my vote. Please see Al Lodwicks website at www.warfarinfo.com and read as part of your studying about Coumadin.

 

[geebee]

Carolyn,

As Ross said, you are at a tough age for decision making. Many people will tell you a tissue will last your lifetime but that is because they expect you will not live past your mid-80's. I, personally (and with God's permissions) expect to live well into my 90's which I think is becoming more and more realistic in this day and age.

However, I am also one of those people who has had multiple surgeries with a mechanical valve. I point that out because, although it does happen, it is in the minority. Unless you are one who produces a lot of scar tissue or are prone to infection, a mechanical should last more than your lifetime.

Having been through multiple surgeries, I always advocate the choice that will require the least amount of surgeries. If I had to have my valve replaced again tomorrow (or even 10 or 15 years from now), I would go mechanical again.

You have to weigh the pros and cons and only you and your surgeon can make the final decision. We can only offer our experiences and opinions.

Best of luck to you as it is a difficult decision.

 

[Rich]

I have to agree with Gina and Ross.
You are too young to go with a tissue valve.
Even if a tissue valve lasted twenty years, would you want to have replacement surgery when you are in your eighties ?
Rich

 

[dick0236]

Carolyn...the earlier posts say it correctly, the choice of valve type is a choice that should be made after listening to the advice of your cardio and surgeon based on YOUR circumstance.
I have a mechanical aortic valve that is now 40 years old. It appears that this valve may last my lifetime (I certainly hope so), but if I needed a replacement now, it probably would be another mechanical (all else being equal). I am comfortable with the routine and probably would find a "tissue valve" scary, just like a first time patient.
It seems that valve choice is often influenced by the concern over ongoing anti-coagulation therapy (Coumadin warfarin). I have been on the drug since my surgery and have never found the therapy to be difficult. My choice of diet, lifestyle or activity have not been altered.
There were no valve choices when my surgery was done so I didn't face the problem of "valve choice". Cardiologists and Surgeons get paid BIG $$$ for their expertise and knowledge and if I ever need surgery again, I expect my docs to make valve decisions WITH me that are in my best interest.

 

[ALCapshaw2]

The (improved) Bovine Pericardial Tissue Vavles look interesting with "hoped for" longevity of 20 to 25 years.

For Durability, the STANDARD ST. Jude Mechanical Valves hold the record at 30 years and counting with a good track record.

The On-X Mechanical Valves offer several technical improvements and the possibility of *reduced* anti-coagulation. See www.onxvalves.com or contact Catheran Burnett at [email protected] for a very extensive information package on valves in general and the features of the On-X Valves in particular.

'AL Capshaw'

 

[tprice54]

valve choice

valve choice

As long as others are ok voicing their opinions, I would vote for the newer bovine tisse...as others have said, they could be in the 25+ year range, as that just may be good enough.

 

[MarkU]

The most important factor in my decision to pick a mechanical valve was to minimize the possiblility of future repeat surgeries. It was tough enough at 47and I'd prefer to not to go through it again. Going on seven good years since my AVR - hard to believe sometimes.
Coumadin can be a bit of an inconvenience at times, but in truth, it has not had any significant effect on my lifestyle (As I'm writing this I'm resting from a twenty-mile training ride on my triathlon bike).
Most important thing is to make a decision you feel comfortable with and then don't look back.
Good luck,
Mark

 

[Susan BAV]

Welcome to the site; glad you found it. There is a "sticky" thread at the top of this Valve Selection forum that includes balanced information about several different types of valves; it was written/compiled by a member named Tobagotwo and you may find it very informative. Also, a bit of advice I received here early on that I found helpful was to find an excellent and highly recommended surgeon that you are comfortable with and explain your situation in detail and ask him what he/she would personally choose in your situation and why. Hope all goes well for you. Take care and post again.

 

[dlangton]

My $0.02

My $0.02

Disclaimer: I was faced with this same question and made a choice based on evidence, a roll of the dice, and the advice of an excellent surgeon/cardiologist pair, so I may be biased on this topic.

At age 56 I looked at the options and went with a third generation Medtronic Mosaic porcine tissue valve which, with luck, will last me until age 82 or so. I also considered that technology is always improving and if something else doesn't kill me by that age and I need a replacement, advanced surgical techniques will make it easier.

 

[Superbob]

Roll of the Dice

Roll of the Dice

Carolyn,

There have been thoughtful posts in response to your question. I'll chime in because my age at the time of OHS (63) was so close to your current age (62 1/2). It is a difficult decision for anyone but at our age there is a special consideration: Do we think we will live long enough to require another valve replacement?

Your initial post suggests that avoiding a second VR is your No. 1 priority. If so, a mechanical valve may well be your best choice. Regulating Coumadin can be a chore but there is a lot of good advice here on how to get that done.

Usually, with tissue valves, you don't have to deal with the Coumadin regime. That has been my experience anyway. And maybe you can be a little less worried about hard falls and bleeding episodes (though plenty of friends on here who went mechanical seem to lead active lives).

A lot of factors went into my decision to go tissue. My device of choice seems to be a medical advance for someone needing a combined valve/aortic root replacement, as I did. I thought I would be a klutz at regulating Coumadin or anything else. I wanted the sense of freedom for my remaining years.

But in part it came down to what dlangton so appropriately called "a roll of the dice." I figured if this neat device lasted me 15 to 20 years and then wore out, I would either be at that point in time:

A. A spry, fit, and active codger in my late 70s or early 80s who could deal with a second replacement that indeed might (no guarantees) be done in a less invasive way. (I am doing my best with my dog-walking and exercise-biking to try to be in that condition.)

B. A decrepit oldster on his last legs because of a variety of conditions, not just the heart. Were that the case, I think I would just let Nature take its course and be grateful to God for the good life I've lived.

Or of course, I might not out-live the Freestyle valve anyway OR it might need replacing much sooner, who knows? All this would be easier if we had a crystal ball.

In any event, as is said here so often, there really is no wrong decision. Read all you can on the options, discuss them with your cardio and surgeon, and then go with what you conclude will work best for you. After you've done that, don't second-guess yourself. The technology is excellent for the various kinds of replacement devices.

All best wishes to you,

 

[Jim P]

Carolyn,

This is a tough decision, and I will weigh in with my experience. Bob?s eloquent summary described my situation and thought processes almost exactly. I was also 63 years of age when I first visited my heart surgeon. After thoroughly reading everything on this forum and many other sites on the Internet, I was still nearly 50-50 on mechanical vs. tissue, but I was somewhat favoring mechanical (On-X) valve as top choice. My surgeon is one of the principal investigators for the On-X reduced anti-coagulation clinical trial. However, after hearing me out, he recommended a tissue valve with the relatively new Thermafix (anti-calcification) process. We talked this over thoroughly, and I decided on the Carpentier-Edwards pericardial bovine tissue valve. Clearly there have not been sufficient years of real-world experience with this valve to know with any precision how long it will last, but there is some expectation (hope?) that this valve may last 20-25 years in a significantly high percentage of people. Obviously, only time will tell.

My experience and my decision should not affect your choice. My general level of health, family history, lifestyle, and future plans cannot possibly be the same as yours. Talk it over with your surgeon - he/she confronts these dilemmas daily and should give you good advice. He/she also must be experienced and comfortable installing the particular valve you choose. Your family and friends may also be good sounding boards.

You will most likely be far better off after surgery than you were before, no matter what valve choice you make. My philosophy: Once you make the decision, do not look back. Live the rest of your life thankful for the state of modern medical science that made your valve replacement possible

 

[Dennis S]

Carolyn,

Two years ago I chose a mechanical valve at age 58. I don't want to scare someone with the surgery in their immediate future, but it wasn't the kind of thing I would want to do again. Everyone has a different experience, but I found it difficult. My wife, who was also 58 had the energy and good health to stay with me for my entire 7 days in the hospital. I wouldn't expect her to have the same energy and stamina 20 years later. While in the hospital, they had me walk around the ward as part of my recovery. I would pass by the rooms of several elderly people as I made my rounds. What I saw were a lot of folks older, more feeble, and with less assistance than I had.

And finally, I was concerned that anticipating my health insurance situation 20 years down the road was too much of a roll of the dice. As it turns out, my health insurance has already changed in the last two years. I know my wife is very relieved that there is little chance she will be required to get me through a second surgery 20 years down the road.

 

[dtread]

Critical Choice

Critical Choice

At 58 I was leaning towards biological but then finally decided on mechanical. The main reason was that I did not want to go through surgery again and I did not want the psychological trauma associated with knowing that somewhere down the road I might have to go through surgery again. Also, I figured that a biological might become calcified or degraded in functionality over time. I just had surgery a month ago, but so far the Coumadin has been a non-issue. I have not noticed any side effects at all. What I might recommend to help your decide is that you see if you could get your physician to give you an advance prescription for Coumadin and try it out for yourself for several days (e.g., 5 days at about a 5 mg tablet per day ought to be about enough) and see if you have any side effects from it. Also, after going through surgery I would echo what most other folks on this website have indicated; i.e., that I would not want to ever go through surgery again - I consider the surgery to have been one of the worst, if not THE worst, experiences of my life. Going under the knife and going on the heart/lung bypass machine should not be taken lightly. That's my two cents worth. Good luck, Dan

 

[Ross]

Well folks, I think she's made up her mind, her surgery is tomorrow!

 

[Granbonny]

Carolyn left this morning for her Cath..at the Crozer-Chester hospital..and surgery tomorrow . she e-mailed me last night...and said,,she had thought she had made up her mind to go Mech..however..depends on what her Cath..today.....shows..., ect...Please keep her in your prayers...Her son will call me after the surgery...Carolyn just found out a month ago..One of the ASAP surgeries..that I have read on V.R.com. she had her pre-op yesterday......It must be bad..for they told her..after the Cath..surgery the next day...Please lets all keep her in our prayers tonight..bonnie

 

[WayneGM]

Wishing her my best......looking forward to her update from the other side.