which valve???????

[maisiejane]

Saw my surgeon today and the good news is the results from my Angiogram came back all good I am now on the waiting list which is running at 6 months at present, I have stated that I can come in at short notice so hopefully I will get in sooner.
My surgeon is recommending a mechanical valve, but from the moment I knew that I would eventually need surgery I had decided on a tissue valve, he says at my age 52yrs, I would need repeat surgeries as the tissue valve only lasts 8 years. I don't feel I could manage with the constant ticking and I don't like the thought of taking blood thinners for the rest of my life. I have to phone him in a week with my decision.

 

[Gail in Ca]

My cardio says they tell patients the tissue lasts from 8 to 20 years.
It really comes down to whether you want to know you will have repeat open heart surgeries, or go with mechanical and probably won't need repeat surgeries.
Some people need warfarin even after a tissue because of issues after surgery.

 

[Heart Of The Sunrise]

I had the same fears that you have about being on blood thinners and the incessant ......tick...tick ...tick. I have had no problems being on Coumadin and I am only occasionally aware of any noise from my ON-X valve, usually late at night just before falling asleep. It is not unpleasant nor does it keep me awake....it is very subtle! I could not imagine going thru 2, 3 or 4 more surgeries. My mother turns 90 in February. There is longevity in my family. I am very happy with my choice to go mechanical! I was completely asymptomatic. Yet, once I found out that surgery was inevitable, I saw no useful purpose in waiting. I credit dick 0236 and others on the site with helping me lose my fear of the necessity to be on blood thinners.:thumbup:

 

[T in YVR]

I too, had some questions about going on coumadin and how it impacts your life (or not) if I choose mechanical....I'm still waiting for my surgery date, but I met with the surgeon 2 days ago to sign consent forms and tell him I am going mechanical/On-X. There's alot of good threads on this topic here. I'd encourage you to read them (e.g. under 'Valve Selection' - "Daily Impact to Your life of Being on Blood Thinners")....there's some great advice and insight from people here. I'm happy with my decision to go mechanical and can't wait to get a date locked in... I just don't want to have to put my life on hold like this again, and I don't want to have OHS multiple times if I can help it. Inevitably there's pros and cons to both. I imagine you get used to the ticking and I have read that many people rarely hear it unless its very quiet. Apparently the larger the valve, the more noticeable the ticking.
Tony

 

[The mail man]

I'm 51 years old and had my aortic valve replaced with a St. Judes mechanical valve on April 17th of this year. Yes, there is a slight ticking sound that is noticeable to me but is usually masked or eliminated by other noises/distractions. To me the sound has never been bothersome, I usually don't notice it at all. Like others have said, my primary reason for not going with a tissue valve was not wanting to go through OHS again if at all possible. Another positive thing is you don't have to find your pulse anywhere to check your heart rate. Just time one minute on your watch and count the clicks. :thumbup: So far, being on Warfarin has not been an issue at all.

Good luck with your decision and your surgery. You will be surprised at how good you will feel and how your life will improve once you have it all behind you and you resume your normal routine.

Take care,
The Mail Man

 

[clay_from_nj]

The OpenPivot is supposed to be extremely quiet, and I usually cannot even hear mine - truly, I have to be in an extremely quiet place, in just the right position, and then I can hear a soft and distant ticking, like a watch, or maybe a clock in the next room. Warfarin has caused me absolutely no trouble at all. I've gotten plenty of cuts and scrapes, and never a big deal; I wear a helmet on my motorcycle and my bicycle. Another OHS would be absolutely certainly painful and uncomfortable and risky and take me out of commission for a month or so. The decision, for me, was hands-down no contest for the mechanical valve. My preference going in was for the On-X, but my very experienced surgeon was extremely pleased and comfortable with the ATS (which actually performs better by some measures), so I went there, knowing that there is really very little difference, either one being a vast improvement over my old worn-out bicuspid valve.

Of course it goes without saying, choose the best for YOU, and you'll be just fine.

 

[Duffey]

I received a tissue at age 53. Eight years later, no problems, no indication at this time that I'll need one in the near future. If I had it to do all over again, I'd make the same choice.

 

[kfay]

If your gut tells you that tissue is the best valve for you, then that should be the valve you get. It doesn't really matter what all of our opinions and bias' are, it is your life and you are the one who is going to have to live with your decision, not another single soul. There will be many people who will tell you that you are crazy for taking on more surgeries, that coumadin and the noise are not that bad. That's fine, for them, for their life. There are others on here who will tell you that coumadin is terrible, and surgery is a breeze. Again, that's fine, that's their decision. Even your own surgeon will not have to live with your choice.

We have had members on here who have truly had issues with the noise and vibration. If you really think this will be an issue with you, then choose what your first inclination has been. The bad thing about all this is that you won't know what the outcome is going to be until after you've made your choice. So, if you choose mechanical because someone talks you into it, and then the noise does turn out to be an issue for you, you are stuck with it. If you choose tissue, and you do only get 8 years (although with the newer generation of valves, at your age, you are likely to get more than that, however you most definitely will have at least one more surgery in your life time), and the surgery was unbearable, you will have to have the surgery again at least one more time (you could go mechanical that second time if you so choose).

I did receive a tissue valve because it was on the right side of my heart, so a mechanical valve wasn't an option for me. I see so many people struggle with this decision and in so many ways, I'm glad I didn't have to. I was 45 when I received mine, so yes, I will have more surgeries.

The best thing to remember is that any choice you make is better than the valve you have now. Once you make a decision, quit reading these threads bc there will always be someone trying to change your mind.

 

[knotguilty]

I had my AVR last year at 55 years old with a tissue valve. I asked doctors what valve they would want and all said tissue because of the anticuagulation therapy (warfarin). They can't say how long your valve will last even if it is a mechanical valve. I wanted to live my life without the constant worry of medicine and blood tests. I also don't think I could handle the constant ticking people say they have. I know there is a risk or a reoperation but I am hopeing it lasts 20 years before I have to have it done again. My PCP is handling me like I may never have to go back in. There are people I know as well as celebrities that have had tissue valves way before me and they all are doing fine. AVR surgery is so routine and done in almost every hospital now that I know of. The choice is yours and is personal. Good luck with what ever you select.

 

[pellicle]

This post could easily have been written by me.

The OpenPivot is supposed to be extremely quiet,

Warfarin has caused me absolutely no trouble at all. I've gotten plenty of cuts and scrapes, and never a big deal; I wear a helmet on my motorcycle and my bicycle.

Another OHS would be absolutely certainly painful and uncomfortable and risky

My preference going in was for the On-X, but my very

Of course it goes without saying, choose the best for YOU, and you'll be just fine.

Remember the following in your soul searching

- One day we are all going to need to be on daily medications. Its a shock at first, and avoiding it is a natural reaction. But is that a wise long term reaction? It is certain that you recover better younger. I can assure you that if you need another operation later in life recovery will not be a breeze.

- Recovery from subsequent surgery is often complicated by scar tissue ans other things left lying around after the earlier surgery (like the wires for instance)

Think also that this is a life changing thing. We all want to resist change, but change IS going to happen to you. All you can do now is influence it for a better future



- Each surgery brings risks, some are obvious, some are unpredictable.

 

[Heather Anne]

I am 48 and getting a tissue valve on Tuesday. Here were the main factors in my decision:

(1) I think the ticking would drive me crazy. I have a hard enough time listening to my heart beating as it is.

(2) I do not want to be on warfarin. I know many others cope with it extremely well, but I am a person of wide and varied appetites and activities, and I would not want to worry about my blood levels after a magnificent, indulgent meal that involved copious amounts of beef and pinot noir, nor would I want to worry about whether the Nepalese hospital that treats me after I fall off the trail during my trek to the Annapurna Sanctuary can deal with my blood clotting issues. I don't mean to say that people who opt for a mechanical valve are sissies who will never drink a couple of glasses of Pinot or hike the Annapurna Trail. Just that I don't want to worry about it.

(3) My cardiologist and my surgeon both recommended tissue with no hesitation, based on the expected longevity of the new valves at my age (8-20 years) and the fact that (a) healthy, fit people in their sixties tolerate thoracic surgery very well and (b) it is possible that the reoperation could be done via catheter if the valve lasts long enough.

(4) Most importantly: I am willing to undergo another open heart surgery with the attendant risks and 6-8 weeks of recovery in order to avoid (1) and (2).

It's a very personal decision. It depends on your personality, and the things you find more less bearable. Some people are willing to put up with the ticking and the coumadin to avoid another surgery. Some people would rather be cut open twice than listen to a little ticking sound and moderate their diet to accommodate blood thinners. There is no right or wrong answer.

 

[pellicle]

I don't mean to say that people who opt for a mechanical valve are sissies who will never drink a couple of glasses of Pinot

surely that would be the moselle drinkers ;-)

 

[big_L]

Very nice thread with well-thought out responses. Personally, I'm going mechanical with my AVR in 10 days. I have PAF and so warfarin could be a possibility anyway for me in the future. The Mayo presentation that shows a bit better survivability for patients with the mechanical helped me some with that decision. But, you know kfay absolutely nailed it. Most of us have a gut check decision and we need to honor that. If you don't go with your gut and then some awry happens, then you'll likely struggle emotionally and not deal with it well.

 

[Agian]

If it's convenient and easily available, could someone post the Mayo link?

 

[tom in MO]

I belive there may be some additional clarification needed.

Per "they can't say how long your valve will last even if it is a mechanical valve." Current mechanical valves will last the life of a patient. There may be other problems that require replacment of a mechanical valve (e.g., endocarditis) but they effect tissue and mechanical valves the same.

Per "I would not want to worry about my blood levels after a magnificent, indulgent meal that involved copious amounts of beef and pinot noir". Current warfarin therapy is to dose the patient's diet, not control the diet to maintain the dose. I, my mother, MIL are (or were) on warfarin and eat/ate "magnificent indulgent meals with copius amounts of beef and" cabernet. We did not worry about our INR and did not see the need, nor were asked by our doctors, to test after big meals.

Don't worry, either tissue or mechanical, the choice is life, thus there is no wrong choice. A philosopher once said if a choice is difficult, that is because both paths have equal merit, so rest easy no matter which path you choose.

 

[SuzanneSLO]

I choose tissue valve for the AVR I had 8 weeks ago. I am 54 and have a grandmother who passed away at 99 (and her siblings all lived into their 90's as well). I choose tissue knowing I would need more surgeries.

My concern about getting a mechanical valve was the apparent lack of knowledge that the medical community has about managing coumadin, especially in the event of unusal happening such as an unrealted surgery. Honestly, the laymen on this board appear to have more knowledge about day-to-day management than many medical professionals.

To be honest, one of my first thoughts after my surgery was that I had made a big mistake in choosing to have a tissue valve. I later realized that this feeling was similar to my feeling when I get seasick that I would prefer to have someone through me overboard rather than continuing to suffer.

As soon as the next day and certainly as I type this 8 weeks later, I am comfortable with my ability to handle another surgery and recovery. If and when the need for another AVR arises, I will again make a choice between valves. The medical advance I would like to see before that time is a better awareness in the medical community about the management of coumadin and an increased ability to self-test. -- Suzanne

 

[maisiejane]

Thank you all for your knowledgeable responses, I still remain unsure and I must admit to having a sinking feeling when I hear "have the mechanical one" this probably means that my gut instinct is screaming tissue valve, oh well I have a few more days to respond.
Thanks again, the support here is amazing, think I would have lost it years ago without the reassurance from this forum xxx

 

[big_L]

Here's the Mayo presentation.

Discussion here.

 

[Agian]

Thanks a million.

 

[Luana]

My surgeon is recommending a mechanical valve, but from the moment I knew that I would eventually need surgery I had decided on a tissue valve, he says at my age 52yrs, I would need repeat surgeries as the tissue valve only lasts 8 years. I don't feel I could manage with the constant ticking and I don't like the thought of taking blood thinners for the rest of my life. I have to phone him in a week with my decision.

My original damaged valve was much noisier than my mechanical valve. The only time I hear it is when I sleep on my side and ear is on the pillow, and even then it's not a distraction. Most of the time it's like it's in another room, not aware of it at all.

I was at a similar age when I had AVR. Surgeon told me with a tissue valve, I'd be looking at at least 2 if not 3 additional surgeries. That was the deal breaker for me.

Taking anticoagulants is no problem for me at all, no different than taking a pill for something else. I freely eat sald greens and vegetables and do not restrict vegetables at all.

If you're ok with having another 2 or 3 surgeries, by all means select a tissue valve, though even with the best outcome and recovery, it is no easy surgery at all.