The Big Question
The Big Question
Prem, you have asked what is perhaps the most often discussed single question. Most of us have asked this question and only with time can we know what our choice brings. Whether fortunate or unfortunate, there is no way to know the best long term valve choice for any individual. Your surgeon knows more about your heart while you know more about your own life what you want to be able to do after surgery. It takes these two elements to arrive at a decision so you must discuss the options with your surgeon.
That said, by now you are familiar with the two basic directions - mechanic or tissue. They both come with baggage. Still, all the statistics available cannot predict your personal outcome. Mechanical valves should last indefinately but they are rigid and things such as tissue growth can degrade their performance although for most people the chance of this happening is small. Here, your surgeon may be able to shed some light on this possibility as he prepares for your valve replacement. As well with mecanical valves, into the near future, it will be necessary to use anticoagulation therapy to avoid blood clots but as you read of people's experiences here, you should know that anticoagulation isn't a great problem for most. Tissue valves do not require anticoagulation therapy other than a daily aspirin and in the presence of tissue growth can continue to function but the valves themselves are at greater risk for damagage caused by bacterial infections. Mechanical valves cannot be damaged themselves but the suture sites are more suseceptible to these same bacterial infections known collectively as endocarditis. For most people endocarditis is not a major concern but it can happen and some individuals are more prone to developing these infections. Reviewing your medical history with your surgeon may possibly be of some assistance in highlighting any particular risk you might have. Finally there is the question of how long a tissue valve may last and the answer is that no one knows. Some have failed in a short amount of time but there are many functioning still at 15 to 20 years. As well, some tissue valves can now be replaced without open heart surgery but this is new and no one will know how effective it is for some time to come. Mechanical valves have a much longer track record because they have been used since Sept. 21, 1960 Philip Amundson became the first successful valve replacement patient.
What you can be certain of is that any valve choice will reduce your risk is death now and let you live a normal life. We all live with risk every day of our lives. Philip Amundson lived for 17 years with his mechanical valve until he fell from a ladder while painting his house. We drive cars, we ride bikes, we do all sorts of things that put our lives at risk. When you choose a valve type, you can only make your choice by balancing the different types of risk with which you are most comfortable. Sadly, there is no simple equation into which we can plop variables to arrive at a completely satisfactory solution and, more frustrating, the variables are somewhat different for each individual. Assuming there is no reason that you have no obvious health issues that would indicate one valve type over another, I think you must consider which risks are most troubling and which you can live with most easily.
My surgeon expressed concern about tissue growth around my new valve because this very thing happend to my Uncle a few years ago causing his mechanical valve to fail so my Doctor recommended a tissue valve. I had planned on a mechanical valve but how could I discount my surgeon's knowledge and years of experience so I went with his recommendation? As you read about different valves and peoples' experiences, you may find that you develop your own preferences. Discuss them with your surgeon and the two of you should be able to arrive at a valve choice with which you are comfortable.
Larry
