What Type of Valve?

[Lezlie Talley]

Hello,
I am a 48 year old woman with arotic stenosis. I have been told that my valve is at a severe stage and will need to be replaced. The cardiologist is pressing towards a tissue valve, however, with my age and some of the research I have done I am wondering if a mechanical valve would not be better. The cardiologist also informed me that the aortic valve replacement is less likely to clot. Any helpful information would be great. Thanks

 

[JimL]

Hi, Lezlie, and welcome! I was 46 when I had my aortic valve replaced with a mechanical.
Your question is one of the most frequently asked questions. The correct answer to your question is: Whatever you decide. Of course, that answer is always subject to correction by the surgeon during surgery.
Since I have a mechanical valve, I am highly prejudiced in that direction; I have no trouble with coumadin. You are correct that the risk of clotting in the aortic position is less than the mitral position.
You can gain much valuable information and many opinions on this forum. Then you can talk to your surgeon and reach a game plan agreeable to both of you.

 

[Ross]

Best thing to do is just start reading threads. There is no one answer, though at your age, I'd be inclined to go mechanical. Reason being you'll be close to 70 when you need a tissue replaced or perhaps sooner. I question what shape you'll be in then. You certainly do not want to do this time and time again, once is enough and not at all would be nice, but we don't always have that choice do we?

If you decide on mechanical, I would highly advise you learn all you can about Coumadin from our resident expert, Al Lodwicks site at www.warfarinfo.com There are far too many myths, urban legends, and general nonsense being spread from the great people that prescribe the stuff to us, the medical community. You've probably already heard a bunch of bull and I want you to be making an informed decision, not based on hearsay nonsense.

I'm getting carried away again, welcome to the forum! I do that sometimes.

Read around, use the search function and ask questions. We've all been through it, so it's the real deal info that your going to get. Also bare in mind, make a 1st, 2nd and 3rd choice in valves, because you cannot always get what you want. It depends on your anatomy once the surgeon is in there.

 

[epstns]

Hi, Lezlie,

I'd echo (bad pun, I know) what Ross said. Your choice is your own, but at your age I would be inclined to think mechanical, just to minimize the possibility that a re-op would be needed. I'm a bit older than you (at 57) but the last time I discussed valve choices with my cardio we both agreed that given the current valve choices I would be best served with a mechanical, probably the St. Jude's. My mom used coumadin for many years for CHF, and it wasn't a monster for her to deal with, so I imagine I could deal with it as well.

Welcome to The Waiting Room, the virtual room in which many of us await our own turns in the OR. Read all you can, ask questions any time. I don't think you'll find a more friendly or more knowledgeable group anywhere. . .

 

[gordy]

Hello Lezlie, you have a very tough decision to make. I was in a very similar situation (48 years old, aortic valve replacement). After much thought, prayer, and research I decided on a tissue valve. My surgeon is really impressed with the new generation of porcine valves, and thinks I could easily get 20 years out of this valve. Having said that, I am still in recovery from my surgery (4 1/2 weeks). This surgery has been no picnic for me. While it hasn't been unbearable, it has certainly been intense, and I hope it is a long time before this valve craps out. There is a lot of information out there, try not to let it overload you. When you do finally come to a decision, feel good about it and don't look back. There are a lot of super people here that have helped me immensely. Don't hesitate to call on them for help.
Good luck, and God Bless!

 

[Karlynn]

Hi and welcome!

Most of us feel really good about our own valve choice. Which just proves that you need to go with what makes you feel most comfortable. Getting a mechanical doesn't mean you'll never have to have surgery again. Things do go wrong and we have a few members who've had to have their mechanicals replaced. Also, getting a tissue doesn't mean you won't have to take Coumadin. Sometimes (although not frequently), valve recipients develop chronic Atrial Fibrilation, which requires them to be on Coumadin.

I had my mitral valve replaced with a St. Jude mechanical 13 years ago while in my early 30's. So far, so good in all areas. Life on Coumadin is something to be monitored and managed. But diabetics have to do much more testing and monitoring than we do.

After having gone through OHS (open heart surgery) I hope to never have to do it again. Other's feel they'd rather repeat surgery than take Coumadin - back to that personal choice issue.

Be wary of what doctors tell you about Coumadin that may frighten you. It's a serious drug, but some doctors will make you think it should be used only in the worst of scenarios.

Best wishes!

 

[Lezlie Talley]

Thank You all for the support and information. It has been appreciated greatly. God Bless Lezlie

Hello,
I am a 48 year old woman with arotic stenosis. I have been told that my valve is at a severe stage and will need to be replaced. The cardiologist is pressing towards a tissue valve, however, with my age and some of the research I have done I am wondering if a mechanical valve would not be better. The cardiologist also informed me that the aortic valve replacement is less likely to clot. Any helpful information would be great. Thanks

 

[KathyH]

Hi, I had my surgery 1 month before I turned 50 and I went with the mechanical. My surgeon thought that was best in my case. I have diabetes too, so who knows what shape I'd be in for a reop in 15 or so years. I am happy with my choice. Everyone is different, it is a big decision.
Kathy H

 

[perkicar]

Hi, I had my surgery 1 month before I turned 50 and I went with the mechanical. My surgeon thought that was best in my case. I have diabetes too, so who knows what shape I'd be in for a reop in 15 or so years. I am happy with my choice. Everyone is different, it is a big decision.
Kathy H

My surgery is coming up in May, and my surgeon has already told me he's going to use a mechanical valve to avoid resurgery. I know it doesn't guarantee it, but at least I can do part of it. I'm not thrilled about the idea of being chained to coumadin the rest of my life, but I can live with it.

 

[Rich]

Hi Lezlie,
I was 58 at the time of my surgery,that was almost nine years ago.
At that time my surgeon told me I was too young for a tissue valve.
It is a tough and personal decision, who knows what will be out there in 10 or 20 years.
Although there is no guarantee with any of them my St. Jude mechanical has been great, Coumadin has not been a big issue either.

 

[Debrinha GT]

Three surgeries

Three surgeries

Hi Lezlie, I just want to add my two cents here. I've just turned fourty and I've been having mitral valve replacements ever since I was ten years old, three so far and all tissue. Just over a year ago, I was told that the valve I've now had for over nine years is narrowing and I'll need my fourth surgery in a couple of years. As to my next choice, well, I'll go tissue again. Although I'm well aware of the risks of reoperations, I feel far more comfortable with tissue valves than I would with the use of Coumadim. As many have said, it's a very personal choice and I've made mine. I wish you luck with whatever you decide and will be praying for you. Take care.
Débora

 

[geebee]

Hey Ross

Hey Ross

Did you just squash another party crasher???

 

[RCB]

Did you just squash another party crasher???

He had some extra WARFARIN- and he used it Sooooooo SWEETLY

 

[geebee]

So true -

So true -

And with such a pretty face .

 

[Ross]

Did you just squash another party crasher???

Hmm could be!

 

[RCB]

And with such a pretty face .

A face that could KILL a thousand rats

 

[tobagotwo]

Lezlie,

While it's technically true that a biological valve is less likely to clot, if you're taking Coumadin with a mechanical valve (and you certainly would), your chances of a thrombosis (clot) are very similar to someone with a tissue valve.

As far as a mechanical valve lasting the rest of your life: it might, it might not. Certainly the tissue valve would not be expected to. There would be at least one reoperation with the tissue valve.

I was 51 when I had my AVR, and I preferred and have a tissue valve for myself, for a variety of reasons. But if you're under 60 or so (and you certainly are), and your overriding concern is that you want the best possible chance of never having to have a valve reoperation, then mechanical is the way to go. It would also be the valve of choice if you have signs of myxomatous tissue syndromes sometimes associated with BAV (again, if you're under 60 or so).

You should look through posts and assess the concerns and difficulties of warfarin use, and its effects on your lifestyle. If those are reasonable to you (and many find that they are), you should consider pushing for a mechanical valve. After all, it is you who will live with the outcome, not the doctor, and you need to be content with your life choice.

In a twenty-year study, 76% of St. Jude valve owners had them for over 20 years. Source: J Thorac Cardiovasc Surg. 2001 Aug;122(2):257-69; Twenty-year experience with the St Jude Medical mechanical valve prosthesis. Ikonomidis JS, Kratz JM, Crumbley AJ 3rd, Stroud MR, Bradley SM, Sade RM, Crawford FA Jr. http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14688722

You might want to look over the types and brands of mechanical valves. St. Jude valves are the most common by far, but some of the newer designs seem to be quite promising in their clot-resistance, such as the On-X.

When you choose, be content with your choice, and enjoy its advantages.

Best wishes,

 

[RCB]

Things to ask your cardiolgist

Things to ask your cardiolgist

A couple more consideration for you that haven't been discussed in this thread:
1. Remember, if you choose a tissue valve, there is a good chance
that you would still end up some time in your life on warfarin - see the "One Valve For Life" panel disscusion and show that to your cardiologist!

2. Keep in mind that it is the people who have no experience ( and lots of times bad information ) are the ones that express the biggest fears of warfarin.

I mention these two points, because it seems they are so important to a final decision and often are errors of omission by even medical professions such as, but not exclusive to your cardiologist .
Good Luck and you will be fine!

 

[Dirk]

Warfarin/Coumadin is not an issue for me, but the unsolved problems with HITS.

See the following post:

http://www.valvereplacement.com/forums/showthread.php?t=8507&highlight=hits


Dirk

 

[Limp_Anzac_Bizkit]

G'day leslie.

Its already been covered before i know about the forums and reading pros and cons personal choice etc, but one piece of information has been left out i think you should be made aware of, and that is to always discuss any of the manufacturer's claims on their websites if you do some researching on the internet with your surgical team with what ever type of valve you decide.

Alot of the info on alot of the websites i researched were sales pitches and while not lieing, weren't entirely open and honest either, they are in it to make $$ so naturally won't give the oposition a plug and say buy their product over mine, it would be better in your situation.

The surgical team have access to all the latest data and will steer you clear of any known anomolies for a particular model in specific scenarios.

Godd luck and all the best.

Todd