What type of valve replacement

[Jkm7]

My guess would be that there is a higher percentage of us who've had 2 or more surgeries that decided on mechanical the second time to try and avoid a third, than there are who went with another tissue. I know there are exceptions but once youv'e had 1 surgery and are looking at a 2nd, a third doesn't sound like a real good idea.

Armed with that knowledge I would have made a different decision 8 years ago and gone mechanical the first time.

I am one of those who chose tissue valve at my second surgery. For ME, it was the absolute right choice. Certainly does not mean it is the right choice for someone else.

As it turned out, I would have had to be on 100+ mg of coumadin / week and that makes me very uneasy. I know... the correct dose for anyone is that which keeps them in their range but I (Me - not anyone else - Me) did not want to take 100+ mg of coumadin weekly for the rest of my life. Of course, that was not my only reason for choosing tissue.

 

[Lynlw]

I am one of those who chose tissue valve at my second surgery. For ME, it was the absolute right choice. Certainly does not mean it is the right choice for someone else.

As it turned out, I would have had to be on 100+ mg of coumadin / week and that makes me very uneasy. I know... the correct dose for anyone is that which keeps them in their range but I (Me - not anyone else - Me) did not want to take 100+ mg of coumadin weekly for the rest of my life. Of course, that was not my only reason for choosing tissue.

I don't think you are that rare in choosing tissue for your 2nd OHS. Many of the people on the Adults with CHD forums, most that have been dealing with their hearts or having very complex surgeries their whole lives, choose tissue valves for surgery that isn't their first (but didn't have that valve replaced before). I've wonderred about that, and chances are am completely wrong, but thought for many of them, maybe the fact most of their lives, they've had procedures or meds that are pretty new or rare at the time but now are pretty common or routine, and since there are not a ton of Adults with CHD centers they have to go to bigger hospitals and their doctors are involved in much of the research going on, So they might take into consideration research that is currently being done, more than people would who haven't been relying on research helping them their whole life. Also, at least for some I personally know and talked to about it, they are already pretty tired of so many tests and doctors and meds, they rather not add more to the mix.

 

[dick0236]

Having read some of your comments i've come to the conclusion that the majority of my problems is due to piss poor management by my clinic in relation to my dosage (as stated by a few of you !). The warfarin doesn't particularly agree with me, when first out of hospital after op was on 2.5mg daily, i am currently on 12mg daily. My diet doesn't change, my lifestyle doesn't change yet my INR can go from 1.3 some weeks to 5.1 other weeks - no identified reason yet the clinic obviously adjust the dosage depending on INR. I was additionally diagnosed with an over-active thyroid Jan 2010 which means more meds and potential pitfalls.
Rufus

My first reaction, if I had an INR spread from 1.3 to 5.1 over short time periods, would be poor management and frequent dosage adjustments that were causing the "yo-yo" effect. I would think that even the addition on "new" meds would be adjusted for within a short time....but I am no doctor.

I had the "yo-yo" happen to me several years ago with a new doc. I began to keep a simple spreadsheet showing date, INR, dosage, med changes and have only had to make minimal warfarin dosage changes for the past couple years. During this time I did identify one serious interaction with a new med.... stopped the med an my INR quickly stabilized.

 

[kfay]

I don't think you are that rare in choosing tissue for your 2nd OHS. Many of the people on the Adults with CHD forums, most that have been dealing with their hearts or having very complex surgeries their whole lives, choose tissue valves for surgery that isn't their first (but didn't have that valve replaced before). I've wonderred about that, and chances are am completely wrong, but thought for many of them, maybe the fact most of their lives, they've had procedures or meds that are pretty new or rare at the time but now are pretty common or routine, and since there are not a ton of Adults with CHD centers they have to go to bigger hospitals and their doctors are involved in much of the research going on, So they might take into consideration research that is currently being done, more than people would who haven't been relying on research helping them their whole life. Also, at least for some I personally know and talked to about it, they are already pretty tired of so many tests and doctors and meds, they rather not add more to the mix.

Lyn, I'm one of these people...I received a tissue valve with my second surgery, knowing full well that I will be looking at probably 2 more surgeries because of my age. I have confidence that the Dr'.s I chose to go to have a lot of experience dealing with re-ops, more so than most surgeons. I have always gone to large, university based research hospitals (Vanderbilt, Duke, Mayo) and have played guinea pig myself once or twice in my life. I grew up taking a ton of meds for my heart and was relieved when a couple of years after my first surgery, I was finally able to get off of them.

 

[dtread]

I disagree with the first part because so many people are mismanaged that a trial is likely NOT to show the person what it's really like. If you have a pee poor manager, your going to have problems from the get go and it doesn't need to be that way.

After thinking about it I agree that you are right. My assertion that a trial period on Coumadin might help someone understand what its like is probably not going to be that helpful. Also, taking Coumadin does involve more than just "popping a pill". I was simplifying in both cases. Coumadin is not a monster though, but it does take some knowledge to understand and some effort to properly manage, although it is not an overdue burden once one gets on home testing. My thought was that if someone did go on a trial period for a while they would at least get a feeling for what the side effects are. In my case I was pleasantly surprised by the lack of side effects. But the management of the dosing was an effort until I got on home testing. To truly understand Coumadin, one must understand the INR ranges, dietary implications, testing intervals, and dosing. Its not overly complicated but does take a little time and effort. Also, if one is not on home testing, taking Coumadin does involve periodic visits to a lab for a blood draw. And yes, there are implications if one is going to have a medical procedure that involves bloodletting; i.e., the so called "bridging" where one is put on heparin or some other anticoagulant drug like lovenox for the medical procedure.

 

[Luana]

I'd recommend that your friend have his doctor give him a prescription for Coumadin (aka Warfarin) and have him try it out well before his operation to see how he likes or dislikes it.

Well, there's one other major consideration about this that makes it not a good idea. Post-surgery you may be taking medications that you're not taking pre-surgery (even if only temporary), and it's usually the interactions with certain other medications that cause the most problems in warfarin management. It just doesn't seem to me like something you can test-drive and see if you like it, and it's really not about liking it; it's about having it well-managed.

Just my 2-and-a-half cents.

 

[Ross]

After thinking about it I agree that you are right. My assertion that a trial period on Coumadin might help someone understand what its like is probably not going to be that helpful. Also, taking Coumadin does involve more than just "popping a pill". I was simplifying in both cases. Coumadin is not a monster though, but it does take some knowledge to understand and some effort to properly manage, although it is not an overdue burden once one gets on home testing. My thought was that if someone did go on a trial period for a while they would at least get a feeling for what the side effects are. In my case I was pleasantly surprised by the lack of side effects. But the management of the dosing was an effort until I got on home testing. To truly understand Coumadin, one must understand the INR ranges, dietary implications, testing intervals, and dosing. Its not overly complicated but does take a little time and effort. Also, if one is not on home testing, taking Coumadin does involve periodic visits to a lab for a blood draw. And yes, there are implications if one is going to have a medical procedure that involves bloodletting; i.e., the so called "bridging" where one is put on heparin or some other anticoagulant drug like lovenox for the medical procedure.

Precisely and it's not rocket science nor hard to figure out. It's laughably easy, which is why I can't understand the lack of great management.

 

[dtread]

Well, there's one other major consideration about this that makes it not a good idea. Post-surgery you may be taking medications that you're not taking pre-surgery (even if only temporary), and it's usually the interactions with certain other medications that cause the most problems in warfarin management. It just doesn't seem to me like something you can test-drive and see if you like it, and it's really not about liking it; it's about having it well-managed.

Just my 2-and-a-half cents.

I've had some drugs prescribed in the past that had some side effects that I didn't like. Although I don't like taking Coumadin, I was pleasantly surprised that Coumadin does not seem to have side effects that really bother me. I guess the idea of a trial period of taking Coumadin by someone is not that great an idea. Probably would not gain much.

To check drug interactions all you have to do is go to Google and do a search on "Coumadin interactions". Yes, while you're in the hospital and immediately after you will be given quite a few drugs. Hopefully folks can get off most of them. I was fortunate in that Coumadin is the only drug I'm on, but while I was in the hospital I joked with the nurses that they were going to have to send me to detox.