Valve Selection 1

[Bob Bates]

Hello, I am a new member facing AVR on Nov. 3rd at Duke Medical Center (Dr. Donald Glower). I am a 58 yr. old male, and of course I am debating the choice of a valve. I am leaning towards the tissue valve, and specifically the Carpentier-Edwards Perimount Bovine . I would very much like to hear from anyone who has had this valve implanted. Why did you choose it, and of course how you are doing with this valve. I was very active, and wish to return to a very active lifestyle (running, backpacking etc.), so I want to be sure this valve will allow me to do that.

This is a great site; I've already spent many hours on it as a guest, and realize that this choice is very individuallized.

 

[Ross]

Welcome to the board Bob.

Until the rest of the members wake up and get going this morning, I'll take the time to welcome you.

There are some who've had your surgeon and some with that valve, so give them some time and they'll speak up. I realize your active and all, but if you don't mind my saying it, I think you'd be better off with a mechanical valve. Coumadin isn't a big deal, you can remain active, you just have to be a little more careful about cutting yourself, you won't need another surgery 12 to 20 years down the road unless something really unforseen were to occur, but the choice is yours of course. I just hate to see people having to have this surgery more then once. Each time is progressively harder and harder.

Well good morning and hang in there until the rooster crows across the country.

 

[Bob Bates]

valve selection

valve selection

Dear Ross- thanks for your reply and advice. Yes that is the great dilemma isn't it; no coumadin, verus the reop. Since I haven't even been through the first surgery yet, I am afraid I may regret my choice of a tissue valve when I see how much of an ordel this surgery is. However, I alredy have some scars from mishaps in isolated places (backpacking), and I don't want to be inhibited from doing the things I want to do if I am on coumadin, hence the tissue valve. Others have expressed this rationale, but to me its not having to deal with coumadin for the next 25 years or so (I hope at least that long), versus the risk of that second operation.

 

[ALCapshaw2]

I understand your dilema Bob. Your goal of 25 years for a tissue valve seems 'optimistic'.

For similar reasons, I requested a Bovine Pericardial Valve which has realized 90% durability at 15 years in studies and counting. Some early placements are reaching 20 years now. Unfortunately, after 'getting in there', my surgeon decided a mechanical valve was a better option for my situation.

For someone who wants an active lifestyle, I still think a good tissue valve is a good choice with the realization that another surgery will be needed later in life.

'AL'

 

[Ross]

The surgery itself isn't that big of a deal anymore. Pain wise, I've had much much worse. The worst part of heart surgery is what they do to your sternum and the way they lay you out like a fillet with your shoulder blades nearly touching each other. Don't get me wrong, it's still a major surgery and your body won't like you for a couple of days afterwards. Once you get passed that initial trauma, it's not so bad.

Coumadin isn't the big ugly evil monster that alot of people make it out to be. I still can't get over how antiquated some doctors are about the stuff. The medical profession has not kept up with the advancements over the years. Unless your a lumber jack, cliff climber, sword fighter, cycle racer, or football player, I think you could deal with it. The only thing that would make me change my mind is if you do alot of tumbling and hitting your head with that backpack on. Then it might not be a good idea.

When you post, use the new thread button to start a new topic, otherwise, just use the reply button to post a reply to the existing thread. Not a big deal, I can fix these things. The forums take a little getting used to but your tough, you can handle it. hehe

 

[Bob Bates]

Thanks Ross and Al. When I mentioned the 25 years I meant that would hopefully be my total remaining lifespan, not the valve life. I understand that the CE bovine valve would probably be in the 15 to 20 yr. range at best, probably less due to my age. I do motorcycle by the way, another lifestyle issue for coumadin use, and my wife and I want to travel a lot more after I retire.

 

[Ross]

Your too spunky. You'll easily surpass 83 years old.

 

[Nancy]

Hi there, Bob-

Welcome to the site.

What is the reason for your needing this surgery, congenital, rheumatic fever, or something else. Not that I'm being nosy, but it might make a difference in how you view your new valve.

My husband has had 3 valve surgeries, and 2 lung surgeries which are as bad, if not worse than heart surgery. I can second what Ross has said about additional operations later in life. It is not only the obvious healing which can take the body up to a year to fully finish, but the body suffers a great deal from the additional trauma of major, major surgery. Even though the surgery will go just fine, that was true in my husband's case, your body still has major issues of many natures which go on and aren't there during the first virgin surgery.

My husband had rheumatic fever as a teenager, and the aftereffects of rheumatic fever can stay in your body for a lifetime. His first surgery was for an AVR, his second was for an MVR, and the third was to repair a leak in the mitral. In addition, he has a pacemaker, and his tricuspid is leaking, but does not need surgery. He's been on Coumadin 25 years, soon to be 26, and has had no bleeding issues associated with Coumadin in all those years. He was very active as a younger man. At this point in his life (he's 72) he would be very, very high-risk surgery, if anyone would agree to do surgery on him. His body is now hyper-reactive to anything that comes his way.

So what I am getting at is that various medical conditions can have very different scenarios. With something like rheumatic fever which is ongoing and can be progressive, you might want to consider a mechanical. In that case it would be very prudent to avoid as much trauma to your body as possible.

This is the most difficult decision, as you have no doubt seen from all the debates about it.

Best wishes.

 

[Granbonny]

Hi Bob

Hi Bob

Welcome to our site. I had my mech. valve at age 61..17 months ago. Coumadin has never been an issue..other than to remember to take a pill a day....We have many members with Mech. valves that do all the things you enjoy.. Just remember. we all want to get back into our things again..but it takes 1 full year..to feel the same as before surgery....You have a wife now..who will be able to help the first few weeks..You will feelvery tired...then you can ease into a bit more activity..As far as falling, ect. you do not have to be back-packing. I fell going down steps last week.No bruises and Gina tripped over her water hose last week. Any valve you choose will be a good one. And btw. I'm planning on chasing the men in the Nursing home down the Halls when I'm age 95: Nurses will have to remind me to take my coumadin. Bonnie

 

[bvdr]

Hi Bob,

I can't speak about your valve choice but Dr. Glower has been the surgeon of several of us here. He replaced my mitral valve with a St.Jude Mechanical at Duke almost a month ago. He used the heart port procedure on me and I don't have to deal with some of the sternum issues during recovery. He is a very talented surgeon. I am 55 and really didn't consider getting anything but a mechanical as if at all possible, I do not want to do this again.

 

[Bob Bates]

Thanks again to all that just replied. Wow, I can,t believe the responce. Frankly, I am at work and should be doing my company's business, but for reasons you all can appreciate, this is a hot topic with me right now. Happy to hear the responce about Dr. Glower at Duke,: he came highly recommended. The reason for my valve replacement is a congential bicuspid aortic valve, only discovered when I was in my mid-forties.

Yes it is a dice roll about what kind of condition I'll be in for the second surgery. It seems that most folks have no major issues with coumadin. But if you do have problems, you are going to have to live with them the rest of your life. I think I'd rather gamble with that second surgery.

Still hope to hear from folks who have had the CE Perimount bovine valve implanted: or like me are considering that valve.

Regards

 

[Gisele]

Hi Bob!

Hi Bob!

Welcome to this site. Here you will find that most eveyone will agree that Coumadin isn't as bad as you might think. I had been on coumadin for 21 years and would still do active things such as ski, etc. I might be the exception to the rule compared to the other members with having difficulty controlling my INR, but don't let this scare you. My INR's had always been irractic, I guess that is just how I am built.

Currently I have been off my coumadin now for approx. seven weeks due to a subdural hematoma (bleed in my head) from the coumadin. This is unusual for a patient to have a bleeding incident, so please don't go by me. I think that our resident coumadin clinic guy Alldowick has posted a study that was done regarding bleed incidents. Look under the Coumadin thread and you should find it.

If it means the difference between one lifetime valve and facing multiple surgeries, you might want to investigate the mechancal valves and consider it as an option.

Good luck..........Gisele

 

[Tom]

Hi Bob,

Here's another post from a guy who went with a tissue valve. I had my AVR at age 45 and opted for a cryo-preserved homograft (cadaver valve). I'm also active and like to snow ski, mountain bike, and recently took up mountain climbing. I fall alot, especially skiing and biking. I did not want to have to worry about bleeding episodes, and realize I will have to undergo at least one more surgery in the future. But for me it was worth it and I have been doing fine with my tissue valve. As everyone has stated, it is a very personal choice. Also, different surgeons have their own preferences, so it is probably best to choose one who uses the valve you want frequently. So best of luck with your choice and welcome to the site!

 

[Bob Bates]

Gisele, sorry to hear about your bleeding problem. I understand that can happen, and it no doubt is very manageble.

My issue with coumadin is no one thing; its the cummulative effect of all the issues. Potential clots, testing, dealing with the Dr. to regulate dose if issues arise, potential bleeding problems, resrtictions on other drugs, and diet watching. I am sure it becomes very routine after a while. But again its a tough choice: avoid all of the above, or face a second surgery. It seems as if it is a question of having to deal with a set of risks and inconviences spread out over 25 years, or facing one big risk down the road. And as others have said before, who knows what sort of procedures and devices that may be there when the second surgery comes due.

Regards

 

[Gisele]

I agree

I agree

Bob, this is such a personal decision and I agree--Coumdin is a big fat pain in the butt, BUT if you have no choice it is better than nothing.

You are fortunate to have imput into your selection. I was 26 when my valve was implanted and I wasn't given a choice. They tried a tissue valve at first, but the valve I needed was too large so they went with mechanical. Things were very different back then. I don't regret having a mechanical even though I have had many complications over the years.

Go with what you and your doctor are comfortable with, and let us know what your final decision is. Good luck.

 

[Bob Bates]

Gisele- thanks and of couse you are 100% correct, each person's situation is very different. If I was 26 and facing this, I also would probably opt for the mechanical valve ( I am 58), or go for the Ross. I might be able to withstand one more opertion when I hit my seventies, but probably not several more, which would be the case if I was in my twenties.

Also, several folks here have said it takes about a year to get back up to speed after surgery. Is that true for most folks? I am a little surprised by that; I assumed it would be a few months, but I have not yet addressed this issue specifically with my surgeon. Of course it would depend a lot on what kind of shape you were in to begin with, which would vary greatly with age and physical condition.

Regards

 

[Nancy]

It'll take about 6-8 weeks for you to feel human again, and about a year to feel back to your old self. But things can vary a great deal. After 8 weeks you will be able to do a lot, but will still be sore and will tire easily.

 

[Bill Hall]

Bob - I have a homograft in the Aortic position and a Mitral repair, so no coumadin. I take one aspirin each day. There is definitely a trade between the mechanicals and tissue. I chose the tissue and might actually go with the mechanical if I do this again. I had my surgery at age 47 in 2001, so a re-surgery would be maybe 15 years or 2016 (or maybe longer). I would be retired (hopefully) and the coumadin would be less of an issue regarding activity. The re-surgery is definitely a concern and I am not looking forward to it. However, maybe I got lucky, but the surgery was not the worst pain I had or the worst experience. I know I could get through the few days when things are uncomfortable and then get better. Good luck with your decision, there is no easy solution.

 

[EVELYN]

Hello Bob and Welcome to a wonderful place!!

I'm Evelyn, whose husband, Tyce, had a mechanical AVR in June 2002. We looked at other choices and both he and the surgeon thought the St. Jude's mechanical would be the best for him. That was what we went with and haven't looked back. He, too, is extremely active....even if he does cut himself or bleed, it hasn't been prolonged or cause a problem. I do know that post surgery he said he was glad he wouldn't have to go through it again.....God willing.

The coumadin has NOT been any problem. We do have our Protime machine to thank for that. I don't think there's any food you can't incorporate into your regime....it's only an adjustment on the coumadin. Once you get that in your brain, it's fairly easy. Of course, vacations and summers surely seem to raise that level up, but we like to blame it on RAIN'S DOG.....it works!!

I wish you much luck in your search. You will certainly get many opinions on this site....you just have to be comfortable with your choice. The more you know, the more comfortable you will become with one.
Good luck and again welcome.

Evelyn

 

[Bob Bates]

Thank you Evelyn and Bill. Unfortuanately, your responces seem to be an example of what I am finding on the site. For every satisfied tissue valve recipient, there are mechanical valve people on coumadin who are also not having any problems or issues.

Even though I am leaning very much toward the tissue (CE Perimount Bovine), I admit to doubts , since at age 58 I will need the reop. After the tissue valve implant operation, i may think that that is the last thing in the world I want to go through again. But that is part of the decision making process, i.e. gathering as much information from all sources before making that final decision.

Thanks again for your thoughts.

Bob B.