Why did you choose a tissue valve?

[SASKIA]

Hi there,

To all of you with tissue valves, I have been really interested and surprised reading through this site to find a few younger men who have had bovine or porcine valve replacements.

I have a porcine valve and my reasons for choosing a tissue valve were twofold: the main one was I wanted to be able to have children in the most natural way possible (I am 26 years old) and the other was I did not want to be on Warfarin or other anticoagulants so early in life.

One of the surgeons I spoke to pre-op was rather incredulous when I said I would be having a tissue valve but I had done a LOT of research and was adamant that was what I wanted. I am very curious to know why others opted for a tissue valve (especially men), as it most likely means another surgery for us in the future.

Thanks!
Saskia

 

[edjspi]

I chose a bovine valve at age 29 because I didn't want to be sentenced to coumadin for the rest of my life. The other reason was because my cardio seemed confident that I could get at least 10 or 15 years out of it. By that time, the thought is that there would be more options in technique and valves available for the repeat surgery.

Now I'm 6 years into it and facing my second AVR on 9/7. this time I'm going mechanical, as i don't want to take the gamble I did the first time. Plus I'm going with an On-X valve, hoping that somewhere down the road I will be able to reduce or replace the coumadin with aspirin to treat it.

-Eddie

 

[NealR]

I was 50 when I had both a aortic and mitral valve put in. My surgeon, although this was his personal recommendation, insisted I would need one more surgery. However, he also discussed the freedom and less time and energy maintaining a mechanical valve. But both were good choices. After nearly one year, I am doing very well. In my studies and research between the two, I learned quite a lot. You hear a lot of (at least on this forum) people advising against betting on the future and newer technologies. But this is happening. In fact, the hospital right down the street from me, replaced a valve in a 12 year old,,,through a catheter. Furthermore, I had an on-line chat with a Dr. Gillinov from the Cleveland Clinic, who is at the head of this cardiac revolution and main proponent of tissue heart valves, who all but assures, when my valves do go bad, they both will be replaced by the catheter process. You will get a lot of arguments and no shortage of feelings on this subject. Me personally,,,,for better or worse, I can go through another OHS, I did it once, I can do it again. If the technology catches up in time,,,,,all the better. In the meantime, I never have to worry about taking my blood INR's, clicking sounds from the middle of my chest, bleeding, or watching what I eat. I can travel and move around with no fear, participate on whatever sporting event I like, and am thankful for everyday. In the last 9 months, I am in better shape than the last 30 years,,so I have tons to look forward. However, I would also add that in reading many of the post in this forum, there are a ton of mechanicals that have educated themselves and can do almost exactly, if not more, that what I just mentioned. But I am indeed satisfied with my choice,. ANd what ever technology evolves, whether installing new valves through a tube, or a new and improved surgery...I am ready and ok with this. My brother had exactly the same surgery two years before I did, at the same hospital, by the same surgeon. There were "little" differences, little improvements, just in that short period, but made a difference. And both were full OHS). Most surgeons seem to pick on this magic number of 45 for consideration of Tissues,,,however, in the coming years this number will become lower. I should tell you, however, that this new catheterized procedure is principally designed for those that are too ill for major surgery, or for those who have already had a replacement valve installed, mechanical and tissue. Take a loot at the main manufacturer, Edwards Life Sciences (EW). That stock, in all this economic turmoil, only goes one way. I f I new more about them a year ago,,,I would be a rich man.

Can't wait to read the responses.

 

[tprice54]

I had a bovine tissue aortic valve at age 52. Honestly, thanks to this site, I really did not favor one type over the other, but when pressed for a decision, I said tissue. The surgeon inderstood that if he got in there and found a mechaincal would be better for any reason, I had no problems with that. In fact, it took me a day to remember to ask what kind they actually put in! If for some reason mine fails early (as some have), I would probably go mechanical......

 

[OldManEmu]

Saskia
I was 41 in 2004 when I received my porcine valve Aortic valve.
I was a candidate for a Bentall however my heart function was so bad that they didn't think I would survive it so did a straight AVR with a tissue valve.
My heart has now remodelled and is normal size and function.
I am now 6 years post AVR and I live a completely normal life, no Warfarin and no lifestyle restrictions.
I snow ski, do track days on my motorcycle, train at least 5 days a week at the gym and live a normal life.
If my Aorta continues to expand and needs replacement in the future I will go tissue again.
My cardio who is only a few years older than me indicated that this would be her path as well.
If I wasn't a border line Bentall my next AVR would be by catheter in the cardio’s opinion.

 

[BAVD John]

I chose a bovine valve based on the recommendation of my surgeon. I was about 3 weeks shy of my 54th birthday when I had my surgery. My surgeon told me that there was about an 80% chance that I could get 15 years out of my valve. He did not guarantee how much time I would actually get out of the valve. He did state the success rate for a second surgery was about the same as the first even though I would be older. He also thought the delivery method for another valve could probably be done by catheter. However, he did not guarantee that my next valve would be implated by a catheter. My surgeon has had implanted valves in older patients by catheter. He also told me that if he was having my surgery he too would select the exact valve he implanted in me.

 

[ALCapshaw2]

I chose a bovine valve based on the recommendation of my surgeon. I was about 3 weeks shy of my 54th birthday when I had my surgery. My surgeon told me that there was about an 80% chance that I could get 15 years out of my valve. He did not guarantee how much time I would actually get out of the valve. He did state the success rate for a second surgery was about the same as the first even though I would be older. He also thought the delivery method for another valve could probably be done by catheter. However, he did not guarantee that my next valve would be implated by a catheter. My surgeon has had implanted valves in older patients by catheter. He also told me that if he was having my surgery he too would select the exact valve he implanted in me.

Your Surgeon, Dr. Patrick McCarthy was recruited (Stolen according to Ross) from the Cleveland Clinic which was closely invloved in the development of the CE Bovine Pericardial Tissue Valve if I understand that relationship correctly. I believe that is their most often used valve. At age 54, it is certainly a reasonable choice for the reasons you / Dr. McCarthy cited.

'AL Capshaw'

 

[john79t]

I also got the Bovine valve at age 61. I had no other cardio vascular problems and no other health problems save a hip that needed replacing. My sugeon recommended the bovine valve because of my age and need for another major surgery. I had an echo last week and had a great report from the Cardio. Also the fact that my mother died from mismanagement of coumidin was a factor in my decision.

 

[Duffey]

So far the men have all chimed in.
My turn!
I had a bovine implanted 5 years ago.
I had some experience with warafin, and its propensity to complicate other medical treatments. I decided I didn't want to deal with act issues if I didn't have to.

 

[neil]

i choose a porky pig tissue, was 52 when i had the op, that was over 2 years ago, very pleased with choice as people have stated didnt fancy clicking,taking anti coags,etc,

 

[irel]

It has now been 5 mos since my bovine aortic valve was replaced along with a double bypass. I am now 69 and feeling better. I have changed my diet, quit smoking and cycle 15-20 kms 3 time per week. I need to exercise more and intend to do so. I am hoping my tissue valve lasts for 15 years and like others hope to see advancements so that I will not have to undergo another OHS.

 

[Johan]

At my first session with the surgeon, he suggested an ATS mechanical, in fact pulled a demo model from his drawer for me to look at. So we were all set on a mechanical and warfarin.

I then started to be interested in the ON-X and my surgeon said he was not comfortable with that valve but referred me to the University of Cape Town Dean of Surgery who had a lot of experience with the ON-X. I discussed it with both surgeons and we got to the stage where I was going to switch hospitals and surgeons to get the ON-X.

My original surgeon then called me in and suggested I consider a tissue valve at my age of 66. He left it with me and I venture to say that I made a very informed decision based on the input from 2 surgeons, 2 cardiologists and my own reseach, to go for the bovine pericardial. The concensus from the medical experts was that I could get 15 years out of the valve, putting me in my eighties. And then ??????...well what ever will be will be.... I see on Adam Pick's blog a lady of 101 received a trans catheter sapiens valve recently....

 

[Lynlw]

At my first session with the surgeon, he suggested an ATS mechanical, in fact pulled a demo model from his drawer for me to look at. So we were all set on a mechanical and warfarin.

I then started to be interested in the ON-X and my surgeon said he was not comfortable with that valve but referred me to the University of Cape Town Dean of Surgery who had a lot of experience with the ON-X. I discussed it with both surgeons and we got to the stage where I was going to switch hospitals and surgeons to get the ON-X.

My original surgeon then called me in and suggested I consider a tissue valve at my age of 66. He left it with me and I venture to say that I made a very informed decision based on the input from 2 surgeons, 2 cardiologists and my own reseach, to go for the bovine pericardial. The concensus from the medical experts was that I could get 15 years out of the valve, putting me in my eighties. And then ??????...well what ever will be will be.... I see on Adam Pick's blog a lady of 101 received a trans catheter sapiens valve recently....

http://www.valvereplacement.org/for...ergoes-Transcatheter-Aortic-Valve-Replacement

 

[mitchner9g]

Hi there,

To all of you with tissue valves, I have been really interested and surprised reading through this site to find a few younger men who have had bovine or porcine valve replacements.

I have a porcine valve and my reasons for choosing a tissue valve were twofold: the main one was I wanted to be able to have children in the most natural way possible (I am 26 years old) and the other was I did not want to be on Warfarin or other anticoagulants so early in life.

One of the surgeons I spoke to pre-op was rather incredulous when I said I would be having a tissue valve but I had done a LOT of research and was adamant that was what I wanted. I am very curious to know why others opted for a tissue valve (especially men), as it most likely means another surgery for us in the future.

Thanks!
Saskia

I have colitis, I didn't want to deal with the anticoagulation that would make a bowel flare up worse, so I've opted for surgeries that use biological valves.

That said, I am hoping to get a mechanical valve implanted for my fourth surgery in a few weeks and gambling that I can manage my colitis with my GI doc's help.

On-x if they can do it.

Why? They're running out of places to stitch things to in there, and I'm only 38.

 

[JeffM]

I went with a porcine valve at age 52 and am about to celebrate my 2nd valversary on 9/12. I made my decision knowing that every option has its advantages and disadvantages. I know I'll need at least 1 more AVR, but I'm hoping to get 15 - 20 years out of this one. When it's time for replacement, I'll look at the options available, success rates, mortality issues, surgical techniques, etc. at that time and make my decision. My reasons for going with a tissue have been sited in earlier posts: didn't want coumadin knowing i'd be needing a few other types of surgeries, primarily orthopedic stuff. Didn't want increased possibility of an internal bleed should I or someone else make a little slip up in my ACT management. What if I have an aneurysm? Didn't want the ticking....I'm one of those people who hears things that no one else hears already. It would drive me bananas. A "big ole pig valve" as my surgeon referred to it, allows better hemodynamic performance than a mechanical valve would without the red blood cell damage caused by a mechanical. This was especially important because of the intensity level at which I workout (primarily cycling). I don't like taking medicine and already have to take Flowmax, which makes me terribly lightheaded. Coumadin would be 1 more medication for my body to deal with and it's no light-weight. These are my reasons for going the tissue route. Am I looking forward to another heart surgery? Hell no. But I carefully considered my options and am quite comfortable with my choice and, so far, based on my last echo and my heart's continued remodelling, pleased with the results.

 

[Cooker]

I chose a bovine valve at age 29 because I didn't want to be sentenced to coumadin for the rest of my life. The other reason was because my cardio seemed confident that I could get at least 10 or 15 years out of it. By that time, the thought is that there would be more options in technique and valves available for the repeat surgery.

Now I'm 6 years into it and facing my second AVR on 9/7. this time I'm going mechanical, as i don't want to take the gamble I did the first time. Plus I'm going with an On-X valve, hoping that somewhere down the road I will be able to reduce or replace the coumadin with aspirin to treat it.

-Eddie

This is why I went mechanical ... I just did not want another surgery and at the time (49) it was almost a sure thing if I went tissue ... I look at ACT as a gnat, sometimes a bother but usually unnoticeable ...

Everyone has to choose for themselves and only you can determine what's right for you ... Eddie, you will be in my prayers on the 7th, good luck!!

 

[Jkm7]

My valve replacement was my second heart surgery so I fully knew what to expect. I chose tissue valve and am grateful from the bottom of my heart (pun intended ) I made that choice.

I cannot bear the sound of a ticking clock and would not risk having a loud clicking valve. My surgeon said body size and shape is absolutely no prediction of which patient's valve will sound loudly and which will not. He has had quiet valves in tiny, very petite ladies and loud ones in barrel chested, large men.

I absolutely did not want to be on coumadin for life and this was before I learned how much I would have had to take daily. My surgeon told me in advance of my surgery, with tissue valve, I would have a three month course of coumadin until my own tissue grew over the newly inserted valve. When, at 2 1/2 months, he let me stop taking it, I was taking 90 something mg per week and still never got to my full range. It is sure I would have been taking more than 100 mg weekly by the time they got me in range and that makes me queasy at the thought. No way to have known this in advance.

I know the adage here is there is no such thing as too much coumadin and the correct dose for everyone is the dose that keeps one in range. Yes, that is correct. However, that is A LOT of coumadin and I can just imagine how much hassle I would have with procedures in the future and the providers who would have paled at the thought of handling potential bleeding in a patient taking 100+ mg of coumadin a week. It's bad enough dealing with ill trained providers in terms of coumadin management for folks on 'normal' doses. Someone like me would have had a major nightmare. I trembled each day when I downed so much of that medication. I hated it.

Just my thoughts and experiences.
For me, I made a great choice to ask for a tissue valve.

 

[neil]

jeff and jkm agree with you guys , good posts , thats why we choose tissue,

 

[Kathy McCain]

I chose tissue for the same reasons. You can't second guess yourself either! I certainly do not look forward to a second surgery. I am extremely noise sensitive, and I know the clicking and I would not get along! Alot of meds and I don't get along too well either.


Good luck to you!

 

[malibu82]

I chose a bovine valve based on the recommendation of my surgeon. I was about 3 weeks shy of my 54th birthday when I had my surgery. My surgeon told me that there was about an 80% chance that I could get 15 years out of my valve. He did not guarantee how much time I would actually get out of the valve. He did state the success rate for a second surgery was about the same as the first even though I would be older. He also thought the delivery method for another valve could probably be done by catheter. However, he did not guarantee that my next valve would be implated by a catheter. My surgeon has had implanted valves in older patients by catheter. He also told me that if he was having my surgery he too would select the exact valve he implanted in me.

reassuring to hear all of that! i have the exact same valve/size as you and had my surgery at northwestern as well on may 21st. dr chris malaisrie as my surgeon.