Valve Selection Decision

[3GUN]

I'm 3 months short of 60 and will be undergoing AVR and a single bypass next month. Upon meeting my surgeon, the topic of valve choice came up. She basically said there was no way she would put in a biological valve given my age. I met with my Cardiologist to discuss at which time he told me that decision was up to me. He then referred me to a different surgeon whom I will meet next week.

I am in excellent health otherwise. I have led a very active lifestyle, at the gym 4 times a week doing cardio and free weights, ride bikes and walk the beach every day. Still participate in sports and want to continue to do so. I have read a ton of data, and this site has it all. When I made out a list of advantages/disadvantages to each valve type, there is no way I can convince myself to go with a mechanical valve. Life on Coumadin and all it's nuances is not the quality of life I envision for my remaining years. I am prepared to assume the risk of another surgery down the road, at the same time hoping technology will advance to the point that re-surgery is not as invasive as what I'll be going through next month. Additionally, I'm hoping the bio valves of today are likely to last somewhat longer than those used in the past.

I will discuss this with my new surgeon and hope he agrees with me and allows me the choice. I assume it is his job to tell me about the risks of each and let me decide. Am I being too short sighted by demanding a bio valve to avoid life on Coumadin?

Thank you in advance for taking the time to respond.

 

[river-wear]

At your age, and since you said you're willing to risk another surgery, it isn't unreasonable to want a tissue valve. You may be over-estimating the effects of being on Coumadin but you still should go with what you think is right. See what surgeon #2 has to say. I'm surprised any surgeon would say "no way" to a tissue valve for a 60 year old; seems most of them are pushing that way for most patients, regardless of age.

Good luck with your decision and your upcoming surgery.

 

[MrsBray]

I understand your dilemma, and am glad you are talking to a second surgeon! "Life on Coumidin and all it's nuances" has not had any change in my quality of life. I still do all the fun stuff (kayaking, hiking, thrill rides) and eat my usual diet (maybe a little bit healthier now?). I was on a maintenance medication prior to surgery, so adding the Coumidin didn't change any routine. I've used a few more bandaids since surgery than pre-surgery, but I'm also a lot more active and have always been a little bit of a "Do, then think" person with jerky and hurried movements. My cardiologist and my surgeon said ultimately the choice was up to me, and one strongly advocated tissue and the other even more strongly advocated mechanical. They both had valid reasons. I chose mechanical for one reason: I do NOT want to go through valve deterioration symptoms again nor a second surgery. I was worried about the Coumidin and the ticking noise - now (5 months out) it's all second nature. I have an extra pill or two at night, and I see a nurse every 4 weeks to make sure by blood levels are in range.

Sometimes I wish I had chosen tissue - it seems that I can hear my ticker at the most inopportune times - in the middle of a meeting, intimacy.... Then I remember how I physically felt the week before surgery - so deeply tired, winded from walking to the mailbox, weary - and I don't want to feel that again. I know that even with a mechanical I *may* have complications and the future is never known, but I do know that the chances of me needing a re-operation are much slimmer with a mechanical than a tissue.

If I could go back in time and change my decision? I wouldn't.

 

[pellicle]

Everything every one else said but I venture you know nothing of life on warfarin. Make what ever decision you make based on actual facts not myths which are often wrong and slanted at best.

Best Wishes

 

[dick0236]

. ....Am I being too short sighted by demanding a bio valve to avoid life on Coumadin?

Thank you in advance for taking the time to respond.

Choosing a bio valve only to avoid Coumadin(warfarin) is, in my opinion, shortsighted. I am, and always have been, very active and have lived most of my adult life on Coumadin. I am now 78+, still very healthy and active,...and just had my annual cardio checkup where the doc told me that there is no reason my current mechanical valve won't take me the rest of the way. If you stay active and healthy after your surgery, there is no reason you will not live well into your senior years and,personally, I would not like the idea of having OHS in my senior years.....however, this is my opion only and I'm sure you will make the decision that is right for you. .

 

[Paleowoman]

I'm 3 months short of 60 and will be undergoing AVR and a single bypass next month. Upon meeting my surgeon, the topic of valve choice came up. She basically said there was no way she would put in a biological valve given my age.

I find that a really strange thing to say. I know that a few years ago most surgeons would have said that for sure, but in the last few years they are changing more over to biological valves at our age (I was 60 when I had my AVR last January). There's a thread here on forum (I'm sorry I don't have time to find it with the forum being so slow) but it is a fiarly recent thread where there was discussion about bio or mechanical and someone quoted a surgeon saying that at 55 he would choose bio and that things were going that way. So I would think it's a surgeon's preference that you are hearing and one surgeon may say different and another the same.

I carefully looked at mechanical and biological valves in the years before I was approaching AVR, I researched it thoroughly. I had hoped I would reach at least 65 when I had it which would have made my decision even easier (bio) but I didn't, I was 60. I was always very sure I wanted bio as I have other health issues plus I woudn't want the noise either. Having bio at 60 I know I will most likely need a re-do before I reach my life's natural end and that is certainly a scarey thought. On the other hand, they may be able to do TAVR in the bio valve I have (read that the other day, not sure it's true) which means it won't be so bad, plus techniques get easier as time passes. Anyway, both my cardiologist and surgeon were quite happy with my wanting biological, no one even tried to disuade me. My surgeon chose the make of valve (Edwards Perimont), she didn't give me a choice in that, but anyway I didn't feel it was up to me since I wasn't sewing it in ! And I'm very happy with her choice as I wanted a bovine valve.

All the best with what you go with, it's important that you are confident with it. I'm sure that getting a valve that you definitley don't want would be a bad idea since you are the one that has to live with it - might be important to find a surgeon who is happy with what your decision.

 

[neil]

hi, looks like you have decided what you want, good choice in my opinion, i didnt want to be on anti coags and the problems that you may have with them,saying that many on here do well on it,go with what you think and dont be to swayed with others choices after all its your call, good luck and am sure you will do just fine

 

[pellicle]

Dear 3GUN

I agree with Neil above when he says:

go with what you think and dont be to swayed with others choices after all its your call,

every person is different, and that's visible in the replies. Paleogirl provides an insight into her feelings on the choice and so does Dick and MrsBray. I have a mechanical valve myself and find warfarin to be a non-issue and in fact the opposite is true: I find the entire thing adds interest for me. Being totally responsible for my own dose I have undertaken learning about it to maximise my outcomes and minimise my risks. For me I view this as being something which actually forces me to be aware of my health. Having already had 3 operations up to this point in my life another surgery is very risky (especially considering the infection I now may or may not be still carrying courtesy of my last operation).

I feel that you need to weigh the facts as well as listen to the views posted here of others. The facts are the facts (the interpretation of which may or may not be disputed) however the stories people relate can give you a perspective on things. These perspectives will allow you to consider the facts from your own frame of reference (where you stand, how you feel).

Of course how you feel about something (or even someone) may change over time. You may meet someone you like, to find years later they were a bastard. Equally you may meet someone you find abrasive but they turn out to be a good friend in the following decades.

Any valve choice is a good valve choice because it will be far better than the valve you have (or they wouldn't be replacing it) and will allow you to live a better life than if you didn't change it. However the choice you make can't be "undone" should you find that you're hanging around with a bastard.

Conventional wisdom would suggest that a tissue valve is a good choice for the elderly and that a mechanical for the younger. There are good reasons why such is put forward (such as the degradation of tissue valves and the concern of people being on warfarin). To me the degradation of a tissue valve (not something in dispute by the way) is something out of my control, but the concerns of warfarin (such as effects caused by being a dill and taking the wrong dose, not monitoring your INR sufficiently, being recalcitrant in taking, being of higher propensity to bleeds even without warfarin ... ) are something which I can have a hand in.

Personally I never really had a choice laid at my feet until this surgery (well, back in 2011) and in earlier surgeries I was either too young (nine) or was more or less told that a homograft would be the best (by a surgeon who was then convinced that was the best option, turned out he was only partially right). This time I was given the choice and told the outcomes of each choice. I picked mechanical in a very short time.

Only you know yourself so only you can make a choice on what is right, but you also need to make an informed choice. Hopefully people here can answer specific questions. I hope that we can help you to not only make your choice but feel comfortable with whatever choice you make. So in the interests of making informed choices I'd like to give you a presentation to listen to. Its from the Mayo and he makes some interesting points you may not know about.

http://mayo.img.entriq.net/htm/MayoPlayer1.html?articleID=4071

best wishes

 

[haggis basher]

Hi 3GUN
I don't quite understand your surgeon's ideas! I was 71 age when I had my AVR, and my surgeon would only give me a "TISSUE" valve. He didn't want to waste a mechanical one that would long outlive my life! (LOL)
I was/am an Australian Masters Runner, so do what you think is right.
I just had my 3rd AVR birthday.
Good luck and best wishes.
Brian

 

[Paleowoman]

Hi 3GUN,

Here's the thread I was looking for, it was started by Dean who is 48 asking about valves three weeks ago. It's four pages of posts which are really interesting to read, including links. Dean went for a tissue valve: http://www.valvereplacement.org/forums/forum/valve-selection/44142-i-have-4-days-to-decide-help

 

[SCCWS]

I had AVR surgery at age 63. My 2yr anniversary is coming up in 3 weeks. My Dr told me the pros and cons of both types but said he would not recommend either---it was my decision. But he did tell me that they were already doing some replacements with less evasive surgery for older patients. I chose tissue. My surgery was pretty easy overall. My post surgery bouts with coughing was the worst thing I had. However, I went to my own Dr to get some relief for the coughing and he found I had A-FIB a month after. So I went on Coumadin and the weekly blood tests. Frustrating since I chose tissue and here I was w Coumadin. Luckily the A-FIB passed after 2 months and never returned. I found the coumadin /blood tests an inconvenience so I am glad I chose tissue and the more I hear the next time( if it happens) I am convinced it will be the stint type. Good luck

 

[Mentu]

I, too, was 59 when my valve was replaced with a bovine pericardial valve. My surgeon was the one who recommended this valve for several reasons. He thinks they the new generation valves are likely to last much longer than the older biological valves and they do not require anticoagulation therapy. As well, the research being done to repair and replace the Edwards bioprosthetic valves should extend their working life without open heart surgery. Already some of the older ones that used the same stent as mine have been replaced using the Edwards Sapien transcatheter valves and other companies are pursuing similar research. There really is no wrong answer and, equally, there is no right answer to the question of which valve because all of them will serve you well. Any type of valve can fail and there is no way to know in advance which is more likely to do so in your chest. All we read about heart valves is based on statistical studies which are good at studying valve performance in large groups but statistics cannot predict the experience of any one individual. The primary considerations continue to relate to how you want to live after surgery and which valves can fill that desire.

Larry

 

[knotguilty]

When you are looking for opinions on valve selection, you will get a lot of emotion and discussion on both sides here. But I agree with you 3GUN. I was 55 when I selected a tissue valve. I knew a couple people who were a little younger than me who had it done a few years prior to me and they also had tissue valves. I asked a number of doctors, at my age what they would pick, and they all said tissue valve. So I don't know what the future holds for me but my cardiologist and PCP all are treating me as if I may never need another valve replacement. I would say that the one thing that really swayed me was the fact that there could be something go wrong with a mechanical valve too. There is no guarantee for anything so I thought it better to stay of the coumadin. And I fully expect another valve surgery in my life.

 

[3GUN]

Met with the head surgeon and things went well. He had no issue with me choosing a bio valve. In fact, he told me he would personally go that route as well, since he did not want to deal with Coumadin the rest of his life, and he is younger than I. IAC, surgery scheduled for 9/18. He chose the CE Perimount and I am good with that. For the single bypass, he also said he'd be using my Mammary artery to bypass my 70% blocked Circumflex artery.

Thanks to all of you who gave me your opinions in what was a somewhat difficult decision. Three weeks to go and I am more than ready to get my life back.

 

[Duffey]

Best wishes going forward!

 

[Paleowoman]

Met with the head surgeon and things went well. He had no issue with me choosing a bio valve. In fact, he told me he would personally go that route as well, since he did not want to deal with Coumadin the rest of his life, and he is younger than I. IAC, surgery scheduled for 9/18. He chose the CE Perimount and I am good with that.

I must say that it's very reassuring to hear what surgeons would choose for themselves. Wishing you well for the big day !

 

[neil]

also wishing you good luck, its a tough choice but some of us just dont want to be on coumadin,