Rosebud54
Well-known member
Dan, thanks for the information and the pictures...they were very educational.
Which type of valve...tissue or mechanical for 56 yr old female
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Jkm7
Well-known member
I agree. At age 56, most surgeons would suggest you have a much better chance of a tissue valve lasting 16-18-20 years. The newest version are new enough they really don't know they won't last even longer. They expect for someone in the around 60 year range to certainly get more than 12 years from their tissue valve. Almost any/every surgeon would agree choosing a tissue valve at age 56 is a perfectly reasonable thing to do and most would select that for themselves/family were they to need this surgery.
Philip B
Well-known member
Longevity?
Longevity?
Just out of curiosity, do we have any members who've managed to get 12+ years of service life from a tissue valve?
I've seen many posts from members who've experienced having their tissue valves fail within a few years and I've seen lots of discussion about research concerning advancements which may result in longer lasting tissue valves.
Perhaps I just failed to pay attention and missed something. I surely hope that's the case.
-Philip
Longevity?
Just out of curiosity, do we have any members who've managed to get 12+ years of service life from a tissue valve?
I've seen many posts from members who've experienced having their tissue valves fail within a few years and I've seen lots of discussion about research concerning advancements which may result in longer lasting tissue valves.
Perhaps I just failed to pay attention and missed something. I surely hope that's the case.
-Philip
ALCapshaw2
Well-known member
The Question to ask is How Many Tissue Valve Recipients have achieved "16-18-20 years" from their valves" (I expect the answer is Very Few)
and what percentage of Tissue Valve Recipients do they represent.
How old is Tobagotwo? He had his Tissue Valve replaced after 5 years.
We've had other members who had to have their tissue valves replaced in less than 2 years.
What does the 'Bell Curve' look like for 10 or 15 year old tissue valves?
What will the Bell Curve look like for the new and improved tissue valves? We simply Do Not Know.
Welcome Rosebud, I hope you get helpful info here. Which ever type of valve you get odds are that you will have a long happy life either way. Of course BOTH types of valve have their risks. As you know Tissue at age 56 means you most likely will need another surgery, (Unless percutaneous valves are approved-by cath) and Mechanical means you will have to take Coumadin and the risks that go along with that.
As for tissue valve longevity, the stats for the perimount bovine valve showed very good (85% still going well) at 18 years and the Hancock II has about the same stats
Of course since VR.org has only been around for 11 years, and most people join when they have some questions or find out they need heart surgery, chances are pretty slim you will find members who have had any kind of valve last 20 some years (beside Dick) We have member that have had their tissue valves replaced earlier than they hoped and some members who've had mechanical valves replaced (that they were hoping to never need replaced)
You are very lucky to have a sister who is a heart nurse, If you read something here or anywhere online you might want to ask her about it.
As for tissue valve longevity, the stats for the perimount bovine valve showed very good (85% still going well) at 18 years and the Hancock II has about the same stats
Of course since VR.org has only been around for 11 years, and most people join when they have some questions or find out they need heart surgery, chances are pretty slim you will find members who have had any kind of valve last 20 some years (beside Dick) We have member that have had their tissue valves replaced earlier than they hoped and some members who've had mechanical valves replaced (that they were hoping to never need replaced)
You are very lucky to have a sister who is a heart nurse, If you read something here or anywhere online you might want to ask her about it.
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Rose, valve choice is a contentious issue on the forums, but it seems to me at 55-65... it's close to a toss-up for an average person. Either choice would be reasonable. It's not possible for us to say what valve would be best because, well, we aren't you.. we also don't have enough information about you, and we're not doctors. Without knowing the nuances of your situation, it's really kind of ludicrous for us to suggest which valve type is best for you. ESPECIALLY in your age group, where one valve for one person may be totally inappropriate but very obvious for the next person in your age bracket.
If we suggest mechanical, and you have chronic stomach ulcers and some GI bleeding along with uncontrolled hypertension and diabetes... we probably just did you disservice. If we suggest tissue and you're totally healthy with a strong family history of living to 105, again I think we might've miscalculated. Even so, as I mentioned before, they have percutaneous valves on the horizon. It's just a very, very personalized decision.
If we suggest mechanical, and you have chronic stomach ulcers and some GI bleeding along with uncontrolled hypertension and diabetes... we probably just did you disservice. If we suggest tissue and you're totally healthy with a strong family history of living to 105, again I think we might've miscalculated. Even so, as I mentioned before, they have percutaneous valves on the horizon. It's just a very, very personalized decision.
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ALCapshaw2
Well-known member
One more comment (and question) about your BAV and Aortic Aneurysm.
Is your BAV a congenital condition? BAV and Aortic Aneurysms are often a sign of a Connective Tissue Disorder.
IF you have a Connective Tissue Disorder (CTD), and you find a Surgeon who has experience with CTD and understands how to sew a valve into such tissue, it would be wise to ask about the ramificaitons of having Repeat Surgeries with such tissue.
FWIW, I became intrigued with BAV and CTDs after reading the compelling story of a former member who had to have a valve replaced when the first replacement valve's stitching started to come 'undone'. A well known Aorta Surgeon in the Dallas area saved this patient's life which fostered my belief that it is important to find a surgeon with experience doing the procedure YOU will need.
Is your BAV a congenital condition? BAV and Aortic Aneurysms are often a sign of a Connective Tissue Disorder.
IF you have a Connective Tissue Disorder (CTD), and you find a Surgeon who has experience with CTD and understands how to sew a valve into such tissue, it would be wise to ask about the ramificaitons of having Repeat Surgeries with such tissue.
FWIW, I became intrigued with BAV and CTDs after reading the compelling story of a former member who had to have a valve replaced when the first replacement valve's stitching started to come 'undone'. A well known Aorta Surgeon in the Dallas area saved this patient's life which fostered my belief that it is important to find a surgeon with experience doing the procedure YOU will need.
I only got seven years from my tissue valve and it seemed to fail so quickly over a 2 - 3 month period that by time I could arrange surgery I was in bad enough shape that I barely survived the second surgery. That wasn't the plan when I got the tissue valve. I was out of the hosptal in 4 days the first surgery. Surely it would be the same for the second. It wasn't. I was in the ICU for 5 weeks and in the hospital for a total of 2 months. Some folks have an easy time with the second surgery, some like myself not so much. It's kind of tough as you plan you first surgery to know what will happen your second surgery. I advise trying to avoid a second surgery.
Rosebud welcome to VR.
Al
I think you encapsulated valve choice very well in your statement.
Al
I think you encapsulated valve choice very well in your statement.
Jkm7
Well-known member
A few comments:
First, I won't suggest one valve over another -- it's certainly not my place to do this (and I commend everyone who has responded for similarly not making a specific recommendation either way).
Second, there's research going on to develop different medicines for managing the risk of clotting that is associated with mechanical valves. It is POSSIBLE that, some time in the next decade or two, the 'lifetime of coumadin' issue will become something of a non-issue (as long as the price of the medication isn't ridiculous).
Third, a more practical concern: If you need a reoperation - even if it doesn't involve cracking the chest to do it, will you be able to pay for it?
Personally, if I hadn't had my surgery when I did (I lost job and insurance less than a year after my AVR), I wouldn't have been able to have the surgery. If my St. Jude's valve starts to fail today (I'm hoping that it doesn't), I'd probably have to just wind up dying because I have no insurance, am not of Medicare age, and couldn't pay for any medical services. I don't mention this to point out my personal situation, but to bring up the potential issue of a person with a tissue valve probably needing a replacement or repair at some time in the future - and some possible issues about how to pay for that repair. If the health care changes are repealed, a valve replacement would probably be a 'pre-existing condition' ruling out coverage for future operations.
I realize that mechanical valves also occasionally fail - but the risk of such failure is much smaller than with tissue valves. In general, if you believe you will live long enough to need replacement of a tissue valve, consider how you'll pay for that replacement surgery -- in your case, by the time your valve (might) be getting problematic, you may be on Medicare. I don't know if Medicare will cover such a procedure or how much co-pay will be required (or whether or not this will be excluded for coverage).
I hope you make the decision that is best for you and wish you a very successful surgery, easy recovery, and great success with whichever valve you choose.
First, I won't suggest one valve over another -- it's certainly not my place to do this (and I commend everyone who has responded for similarly not making a specific recommendation either way).
Second, there's research going on to develop different medicines for managing the risk of clotting that is associated with mechanical valves. It is POSSIBLE that, some time in the next decade or two, the 'lifetime of coumadin' issue will become something of a non-issue (as long as the price of the medication isn't ridiculous).
Third, a more practical concern: If you need a reoperation - even if it doesn't involve cracking the chest to do it, will you be able to pay for it?
Personally, if I hadn't had my surgery when I did (I lost job and insurance less than a year after my AVR), I wouldn't have been able to have the surgery. If my St. Jude's valve starts to fail today (I'm hoping that it doesn't), I'd probably have to just wind up dying because I have no insurance, am not of Medicare age, and couldn't pay for any medical services. I don't mention this to point out my personal situation, but to bring up the potential issue of a person with a tissue valve probably needing a replacement or repair at some time in the future - and some possible issues about how to pay for that repair. If the health care changes are repealed, a valve replacement would probably be a 'pre-existing condition' ruling out coverage for future operations.
I realize that mechanical valves also occasionally fail - but the risk of such failure is much smaller than with tissue valves. In general, if you believe you will live long enough to need replacement of a tissue valve, consider how you'll pay for that replacement surgery -- in your case, by the time your valve (might) be getting problematic, you may be on Medicare. I don't know if Medicare will cover such a procedure or how much co-pay will be required (or whether or not this will be excluded for coverage).
I hope you make the decision that is best for you and wish you a very successful surgery, easy recovery, and great success with whichever valve you choose.
every valve choice has good and bad points,my surgeon told me very straight, tissue you will need another op most likely, mech you will be on anti coags which no one wants to be on regardless of what is said, BUT there will both save your life and BOTH serve you well in most cases,to me its a win win situation,listen to the experts and dont be to swayed by one man or womens experience ,
It's funny. Now that I have a meter - and can test my INR as frequently as I want, and warfarin is so affordable, I really don't mind being on an anticoagulant. I may not have said this years ago when I had to go to a lab, occasionally, for a blood draw; wait for a day or so for results; and pay $1 or so for each Coumadin pill. Right now, I don't even see managing my INR to be much of a deal at all. (If I did a lot of traveling, had an irregular and unpredictable schedule, and had to take meter and strips with me this may be a bit more of a problem, but for me - and I presume many others - anti coagulants are no big deal)
yes and most people on anti coags would agree, but it isnt a case of just popping a pill,it can cause problems hence the medical experts are trying to find an alternative, like with a tissue the medical experts are trying to find an alternative to repeat ohs,what i am trying to say is theres good and not so good with both, hence the hard choice,
Yes, Neil, it can be a hard choice. Not everyone is suited to self testing - or can properly take their medicines on a daily basis. For those of us who can, the anticoagulants really aren't much of an issue. An affordable and effective alternative to warfarin that doesn't require testing or dosage adjustment would be great - and may eventually become available.
If I was 56 and had to make the choice between tissue and mechanical, I'm not entirely sure what I, personally, would select. As others have said, 56 is probably a point where the pros and cons for either type of valve may be roughly equal. My father's in his 90s (thank God), so I can probably expect that whichever valve I chose would have to last another few decades -- if both parents died younger than I am now, my decision of anticipated life left may be slightly different and may favor a tissue valve.
There are SO many factors involved in selecting a valve that I certainly don't envy anyone having to make such a choice - particularly someone in their 50s or 60s.
If I was 56 and had to make the choice between tissue and mechanical, I'm not entirely sure what I, personally, would select. As others have said, 56 is probably a point where the pros and cons for either type of valve may be roughly equal. My father's in his 90s (thank God), so I can probably expect that whichever valve I chose would have to last another few decades -- if both parents died younger than I am now, my decision of anticipated life left may be slightly different and may favor a tissue valve.
There are SO many factors involved in selecting a valve that I certainly don't envy anyone having to make such a choice - particularly someone in their 50s or 60s.
ebjlady2
New member
I am having my second open heart surgery Feb. 8...replacing a St. Jude Mechanical Valve (first surgery March, 1986) and also having an aortic aneurysm repaired. I had the first surgery at age 37 and I am now 62. The mechanical valve has calcified and needs to be replaced before heart damage. I am still undecided on which valve to have this time.....coumadin therapy for 25 years has not been pleasant. I can't get INR's regulated for any length of time and also had bleeding issues...as well as levels not thin enough. I go to a protime clinic at my cardiologist and test several times a month....last year I had well over 59 protimes and also on Lovenox injections for almost a month due to a colonoscopy that involved bleeding. I had to have a second colonoscopy to have clips to stop the bleeding. I understand the chance of having a third surgery sometime later but hopefully there will be a better way to have a redo. So as of now I am leaning toward the tissue valve based on twenty five years of coumadin therapy. If this was my first surgery the mechanical valve would be more of a choice but I don't think I can deal with more long term coumadin. I have a list of questions and printed material to take with me to Duke on the 7th for my surgeon to go over with me. I will make my choice then...but my primary care dr, surgeon, cardiologist are saying that the tissue might be my solution. I just want to wake up from the surgery knowing I made the right decision and live to see is wonderful world.
ALCapshaw2
Well-known member
To get more exposure for your questions, it would be best to move (or copy and paste) this post as a New Thread in the Valve Selection Forum.
Unstable INR's are Very Often (most often?) the result of Poor Management.
Testing and Changing Dose too often will almost guarantee the dreaded "Roller-Coaster Effect".
Most medical authorities recommend letting your INR stabilize for at least 1 week (or 2) before re-testing.
HOLDING one or two Doses because of an INR between 3.5 and 5.0 will often make the INR "Drop Like a Rock".
Using Loading Doses" to bring your INR back up will often result in an Over Shoot which is then compensated for by another over-reaction in Lowering your Doses. It's like trying to drive at the speed limit by alternately Stomping on the Brakes followed by Flooring the Gas.
The BEST way to maintain a Stable INR is to Home Test and learn how to Self Dose using approved guidelines.
The Next Best way is to find a Dedicated Coumadin Clinic staffed with Nurses who have been properly trained and have enough experience dealing with Many anti-coagulated Patients to know to NOT over-react to minor excursions outside of your target range.
You may want to look over the Anti-Coagulation Forum, starting with the Stickys at the top of the Thread Listing, for more information and experiences with this subject.
The Worst Results typically come from isolated providers (often Nurses and/or Doctors) whose training was inadequate or out of date and who do not see enough patients to figure out how to manage them properly.
At age 62, choosing one of the longer lasting Tissue Valves is worth consideration.
If you come from a family of Long Livers (i.e. over age 80) then there is a good chance you might need another replacement in your later years. If you don't expect to live more than 15 years or so, a tissue valve could well last the rest of your lifetime. There have been many 'intense' discussions on Valve Choice in the Valve Selection Forum. Feel free to ask more questions as they arise.
'AL Capshaw'
Jkm7
Well-known member
My valve replacement was my second OHS and when my Mass General Surgeon started talking about possible valve repair, he didn't think it likely to be successful but wanted to try. I agreed for him to try but made it really clear a failed valve repair was my worst nightmare at that time. Unless he was so, so sure it would be successful long term, I preferred getting a tissue valve but that was my personal choice. I was relieved when I woke and learned I had the tissue valve which is truly what I wanted.
