Valve selection

[dsaf2001]

Going into surgery in week. NYU hospital Dr Galloway, who is suppose to be one of the best. Feel great have had no symptoms picked up condition a few weeks ago from a routine physical. Long and short very lucky as I'm very healthy great shape. Age 52 and all the doctors and the two surgeons are strongly in the camp of the Edwards tissue value, just hard to know if that is indeed the right choice, as choice blood thinners for life with mechinal or reop down the road with tissue
Welcome thoughts

 

[Jkm7]

This is one of the hardest choices you will make.

There are very valid reasons for choosing either and only you know which is the best for you. It is one of the few times doctors truly leave the final decision to us absent any compelling reason for one vs the other in a particular patient.

I am a little older than you and chose Edwards bovine valve. For me, it was the absolute right choice and I am grateful I made that decision. I did not want to risk having a loudly ticking valve and no surgeon can say in advance if your valve will be more or less noisy. Size and body shape do not dictate. A large barrel chested man could have a very loud valve while a petite little old lady could have a near silent one. I can't stand the sound of a ticking clock and a loud valve would have been awful for me. Many here say they get used to it in time. Others struggle more.

Coumadin for life for many becomes easy and they deal with it well. Others have a harder time with it. I wanted to avoid it if at all possible.

Some (not all) surgeons order a 2 - 3 month course of coumadin while our own tissue grows over the seat of the valve to prevent clots. I had a hard time getting in range and had to take a huge dose to even come close. My surgeon did not like that and told me to stop early from what he had originally prescribed. I could not know in advance my body would demand so much coumadin to try and reach my ideal range. I certainly was happy I did not have to do that for life.

On the flip side, we do not know how long our tissue valves will last, no one knows. The new generation hasn't been in use long enough to have th exact data. Most top surgeons say 20 years is within reasonable possibility for 60 year old and older. At 52 perhaps yours might last a bit shorter, but no one knows for sure. A re-op is not out of the question.


We all feel for you making the choice as we all know what it is like.
You have to be more than a little unsettled to have just learned you need the surgery and to be having it so soon.

Almost all of us will agree the wait for the surgery is the worst part so in an odd way, you are lucky it is happening so quickly for you.
Let us help you in whatever way we can.
All best wishes.

 

[dsaf2001]

Thanks, i very lucky to have had found before any lasting damage was done. I fact the only difference I will say from what you said is that I ,wet with twomworld class surgeons and my cardo. All felt very strongly tissuenvs mechanical and the NYU point of view was tissue. That being said i guess you trust the experts. My doctor who discovered this isnthe only one saying mechanical. The surgeons both felt at my age less risk with reop even 20 Yeats from now vs. Blood thinners for that long.
Im with the best doctors and now just ready to on the other side
Thanks for your imput

 

[Jkm7]

My Mass General Surgeon was very much in favor of tissue valve for me and many of his patients. I am sorry my post was confusing in that regard. He was totally supportive of my choice for tissue valve as was my cardio.

Mass General Hospital, year after year, is rated in the top five ranking for heart centers throughout the U.S.
Truly a world class facility.

Here is a link to U.S. News and World Report where you can find their annual ranking for hospital, by specialty.
http://health.usnews.com/best-hospitals

 

[dsaf2001]

Your post was not confusing at all.
Very helpful good to know mass general feels the same way as my doctor. The good news are there are so many great hospitals and doctors who have made this standard opeation

 

[neil]

hi welcome aboard, i was 51 and choose piggy valve,like jkm has said its a personal choice, at the end of the day i didnt fancy being on anti coags the rest of my life and am very glad with my piggy friend, which ever you choose is gonna be better than the one you got now,

 

[dsaf2001]

Thanks for the feedback, looks like m going with a cow so i guess no steak or burgers for me...

 

[drivetopless]

Trust your gut feeling (aka heart)

Trust your gut feeling (aka heart)

Embrace your decision and don't look back.
I love my On-X valve, but If I had surgeons at NYU in concensus over the tissue valve I would have gone with that, too.

Good luck with your surgery.

 

[dsaf2001]

Thank you, I agree that's why they get the big bucks!

 

[Lynlw]

Your post was not confusing at all.
Very helpful good to know mass general feels the same way as my doctor. The good news are there are so many great hospitals and doctors who have made this standard opeation

Sounds like you're at peace with your doctors and valve choice. that's good. If it helps, in general the surgeons at Cleveland clinic usually reccomend Tissue (edwards) for their patients in their 50s(even 40s ) too. Have any of the surgeons you talked to mentioned the chances of replacing this new valve in the cath lab and not open heart surgery when the time comes? Hopefully a couple decades from now.

 

[dsaf2001]

Few thing first thanks for the post. Great to know wht CC does, actually I hear the head of CC studied with my doctor, nyu seems to be the place that started and master this surgery.
In terms of future reop yes maybe the cath mAybe the way too go but that is helpfully nom sooner than 15 to 20 years, which is a lifetime of innovation in the medical world. So yes the hardest parts first shock to learn I need this as I'm healthy with no symptoms. And then who to you pick my neighbor is also a world class surgeon who saved my dad four years ago from major blockage so this choice was painstaking hard. Our neighbor trained at NYU and his mentor is the same doctor who my surgeon trained with. As. Matter of fact the local hospital NORTH SHORE LIJ a fine place all of there heart surgeons all spent some time in their careers at NYU. So now just waiting for d-day Monday the 23 RD of January
Ready to go and get on with life....

 

[Boston Tiger]

It's interesting to hear that your doctors are strongly in the camp for tissue. My surgeon didn't push me either way, since at 51 I was in the grey area between the two. He said that he leaned toward mechanical valves for someone five or ten years younger, but tissue valves for someone that much older. I waffled in the months leading up to surgery, but finally asked for a tissue valve if it was needed. However, he was able to repair my mitral valve rather than replace it, which made all the concern about that issue in the lead-up to surgery a moot point!

 

[dsaf2001]

Good for you I'm in need of aortic replacement, I guess 51 and 52 does seem to make it grey to a lay person, I think it's the feeling less long term risk for reop vs. 25 plus years of blood thinners
Glad it worked out for you

 

[Jkm7]

Please excuse my lack of knowledge but is NYU the same hospital as New York Presbyterian?

 

[dsaf2001]

No it's different it NYU Lagone Hospital (Lagone is former founder of Home Depot)' it's New York University Hospital the other is New York Hospital which is also expectional Hosptial I was born there and so was my kids, they also have excellent heart. My primary doctor just preferred NYU as he was very close friends with Dr Galloway mentor and knows him well.

 

[neil]

i know a lot of people hope for avr to be done by cath in the near future,but for me personally i still think id prefer the chest open way,not being a surgeon myself lol i just prefer them to have easy access to my heart,yes the op is not easy but it was cert no where near as bad as i thought,

 

[dtread]

The choice largely boils down to whether you choose to take anticoagulant medication or have reoperations. Speaking for those who were almost killed by the surgery, and had a rough recovery, I know I made the right choice with a mechanical valve. Also, as a fitness buff, it took me about a year to get back to near 100% of pre-op conditioning. The anticoagulant medication (Coumadin, aka Warfarin) has almost no side effects for me and has not been a problem. Valve noise is practically nil. The relative freedom from reoperation with a mechanical is a blessing, both spiritually and physically. Get your calculator out, because with a tissue, which usually fail between 12 and 20 years, you're probably going to need a reoperation when you're in your 60's and probably another in your 80's. Something to think about.

 

[dsaf2001]

Yes all very good counter points. At this point I have meet with two world class surgeons and my cardo. Doctor all feel strongly about tissue
It is not easy choice at all as both choices have pros and cons
The toughest is you have no pre notions as to how your body react to surgrey and or the blood thinners.
Happy itmhas worked for you

 

[Lynlw]

The choice largely boils down to whether you choose to take anticoagulant medication or have reoperations. Speaking for those who were almost killed by the surgery, and had a rough recovery, I know I made the right choice with a mechanical valve. Also, as a fitness buff, it took me about a year to get back to near 100% of pre-op conditioning. The anticoagulant medication (Coumadin, aka Warfarin) has almost no side effects for me and has not been a problem. Valve noise is practically nil. The relative freedom from reoperation with a mechanical is a blessing, both spiritually and physically. Get your calculator out, because with a tissue, which usually fail between 12 and 20 years, you're probably going to need a reoperation when you're in your 60's and probably another in your 80's. Something to think about.

On the other hand I know several people who had terrible complications, I guess if they wanted to think of it that way they were almost killed by surgery, they think they did great since they ended up better than before- but still rather avoid a mechanical valve and anticoagulants. Actually there are quite a few members here who had their valve surgery as their 2nd 3rd 4th OHS so knew before hand what they were signing up for and still choose tissue valves and even if they had complications with that surgery still are happy with their choice. Just like all the people I know on their 2nd mechanical valve are glad they chose that.
ESPECIALLY if you are getting your first tissue valve today I really doubt IF your second valve failed while you were in your 80s 0r more like 90s. you would need OHS to replace it, chances are in forty years, (probably even 20) that would be replaced by cath, so it would be highly possible to avoid more OHS AND not be an "elderly" person on Coumdin (or whatever anticoagulant is common then) and it IS riskier on the "elderly"- which usualy is counted as 65 and up as far as Coumadin studies..

I would tend to agree with your surgeons, who do this day in and out, which is why you said above you most likely would get cow.

 

[dsaf2001]

A little bit of knowledge makes me dangerous so I will listen to te doctors who have the greatest array of experience
Not easy this time next week, I should be closento being done and moving on the side of this
I ust the waiting is getting to me