I have read many of the posts on this site from people with tissue valves and others with mechanical valves and I cannot move off of first base. Maybe it's OCD on my part, who knows. Everybody says don't choose a valve based on tomorrow's technology/science, but then surgeons are also telling patients they can have their next valve replaced through a catheter. I hear from some patients that they want to have their first surgery be their last surgery so they go the mechanical route. I also hear the hope that the ON-X valve will be able to use aspirin only in a few years instead of Coumadin. There seems to be nothing that is nosing me in any direction and I am worried that I will not be able to decide and the surgeon will get pissed off leading to a stressful situation. The coumadin thing scares me trying to keep that delicate balance correct and all but the tissue valve makes me feel like a time bomb also. and then bacterial endocarditis can take both valves down in short order. Any of you been there before?
Worried I'm not getting any closer to valve selection with less than 1 week to go
- Thread starter canon4me
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ski girl
Well-known member
We have ALL been there before! It is both good and bad that both choices are really very good so there is no clear winner. I wish I could give you an answer . . . Good luck with the decision, and I guarantee you won't be the first indecisive person your surgeon has dealt with!
ski girl
Well-known member
Just noticed that you're less than one week from surgery, so I will make a decision for you. 
How old are you?
How old are you?I was just a bit older than you at time of surgery. I was 63, and opted for the Edwards bovine tissue valve. Our reasoning was that the newest generation of this valve "should" have a typical life of 15 to 20 years, and if I needed it replaced again I would just have to make the future choice based upon technology in the future. We did discuss the possibility of catheter-implanted valves, and the possibility exists, but was not a major factor in my decision. I would really suggest that you have a deep chat with your surgeon. He/she may have recommendations and reasons for making them. The ultimate decision is yours, but you can make it with the help of your surgeon.
I'll have to admit that my valve choice was affected by my surgeon's input -- he was on the development team for the valve and had already implanted many of them, with excellent results. So far, I'm a happy camper.
I'll have to admit that my valve choice was affected by my surgeon's input -- he was on the development team for the valve and had already implanted many of them, with excellent results. So far, I'm a happy camper.
ski girl
Well-known member
Tissue. As Steve says above, a tissue valve may actually last the rest of your life!
BTW I went tissue in 2010 and now have a mechanical valve due to a bout of endocarditis that almost killed me. I'm happy enough with my mech valve but I would prefer to still have my cow part!
BTW I went tissue in 2010 and now have a mechanical valve due to a bout of endocarditis that almost killed me. I'm happy enough with my mech valve but I would prefer to still have my cow part!
jhc1
Well-known member
canon4me-I'm in the same boat as you...54 years old, 9 days out. I'm going in for a root/ascending aneurysm repair that may require AVR. My choice was tissue, based on lifestyle considerations. As many have said, there is no wrong answer, just go with your feeling. That was tough for me-being a data driven engineering type. I'm sure you've found that you can justify either choice based on data from the internet! Good luck, and let us know how it turns out...
Joe
Joe
I'm fairly sure I will not make my decision until visiting with the surgeon. I'm a probation officer with a desk job, but my wife and I have a 16 acre virgin prairie acreage that we work on all the time cutting wood, conducting prescribed burns, mowing with a tractor and so forth. We are active people going on prairie walks, etc. Up until about two years ago when I got scared because of the aneurysm I lifted weights a lot in my home gym, often over three hundred pounds in the bench press and did a lot of running on my treadmill and some super setting. I'm concerned about accidents. i.e. chainsaw and being on Coumadin while working on our prairie. I like the ON-X because of not wearing out. I guess we are only renting these bodies. They just weren't built to go the long haul I guess. Where is Dr. Leonard McCoy from Star Trek when you need him?
There is no wrong answer, just what's right for you.
At 54, last year, I chose mechanical. My primary motiviation was no re-operations. I'd already had 3 operations and did not want to willingly sign me and my family up for a fifth. In addition, the field I work in is unstable thus my health insurance and liberal sick time policy may not be there in the future.
I had no real fear of warfarin since my older relatives have been on it successfully for many years.
At 54, last year, I chose mechanical. My primary motiviation was no re-operations. I'd already had 3 operations and did not want to willingly sign me and my family up for a fifth. In addition, the field I work in is unstable thus my health insurance and liberal sick time policy may not be there in the future.
I had no real fear of warfarin since my older relatives have been on it successfully for many years.
Rachel
Well-known member
I agree with the others, there is no wrong choice.
I went with tissue at age 45 knowing that I will wear it out sooner than if I were older. This is such a personal decision and each one of us will have our own unique reasons for selecting what we select. For me, Coumadin/Warfarin didn't scare me, nor did another surgery - but ticking noises did - go figure.
Here's the thing though - once you're done with surgery and fully recovered you will feel so much better! This is saving your life regardless of your choice.
"Beam me up Scotty"
I went with tissue at age 45 knowing that I will wear it out sooner than if I were older. This is such a personal decision and each one of us will have our own unique reasons for selecting what we select. For me, Coumadin/Warfarin didn't scare me, nor did another surgery - but ticking noises did - go figure.
Here's the thing though - once you're done with surgery and fully recovered you will feel so much better! This is saving your life regardless of your choice.
"Beam me up Scotty"
Jkm7
Well-known member
That about sums it up and we have all had to make the choice you are now faced with making...... with the same information you have.
Best Wishes. It is a very hard decision (for some) to make.
Jkm7
Well-known member
If, hopefully not, you were to have an accident with your chain saw, being on coumadin or not would make no difference. You'd be in a world of hurt even if not on coumadin.
I chose tissue valve and am so grateful I made that choice but I am older than you and that is a factor.
neo
Well-known member
Worried I'm not getting any closer to valve selection with less than 1 week to
Worried I'm not getting any closer to valve selection with less than 1 week to
This is definitely a tough call. Even my surgeon and cardiologist were on the fence. After talking through all the pos/negs with them, most of which you listed, I eventually settled on tissue. There are alot of great tissue valves, like the Edwards magna, and others if you need a root. I went with the SJM Trifecta. It's been in use for a while in Europe, and approved a few years ago in the US. I called the manufacturers and spoke with the reps. It seems that the Trifecta may be the most hemodynamically close to a native valve on the market, while at the same time having the newer calcium treatments, like the magna.
I got a large 29mm valve and am very pleased with how I've felt in the month since it was placed. I am happy with my decision, and appreciate it when docs say they hear no murmur. The one thing I was taken off guard by is that I can hear my valve and feel it sometimes. People say this is normal after surgery until everything heals and gets "tighter" in there with scar tissue etc. Regardless, I can really feel it in there, especially in the morning when I wake up. I think it's the closing sound/feeling of the valve that you can kind of hear beating off your sternum or through your neck. I have an ascending aortic graft, and I'm thin, so I'm sure that can only be amplifying it. My wife can sometimes hear it when it's really quiet at night in bed.
Whatever the case, I am thrilled that everything is functioning great, and that I can live a normal life, just knowing that ill probably have to do this again someday. Know that the hardest part of all of this is the mind buildup to surgery, and thinking about all the possibilities and risks right beforehand. Once you get there the day of, its really not that bad. You go to sleep and wake up a little later, a little bit groggy. You'll do great! Good luck with your decision!
Worried I'm not getting any closer to valve selection with less than 1 week to
This is definitely a tough call. Even my surgeon and cardiologist were on the fence. After talking through all the pos/negs with them, most of which you listed, I eventually settled on tissue. There are alot of great tissue valves, like the Edwards magna, and others if you need a root. I went with the SJM Trifecta. It's been in use for a while in Europe, and approved a few years ago in the US. I called the manufacturers and spoke with the reps. It seems that the Trifecta may be the most hemodynamically close to a native valve on the market, while at the same time having the newer calcium treatments, like the magna.
I got a large 29mm valve and am very pleased with how I've felt in the month since it was placed. I am happy with my decision, and appreciate it when docs say they hear no murmur. The one thing I was taken off guard by is that I can hear my valve and feel it sometimes. People say this is normal after surgery until everything heals and gets "tighter" in there with scar tissue etc. Regardless, I can really feel it in there, especially in the morning when I wake up. I think it's the closing sound/feeling of the valve that you can kind of hear beating off your sternum or through your neck. I have an ascending aortic graft, and I'm thin, so I'm sure that can only be amplifying it. My wife can sometimes hear it when it's really quiet at night in bed.
Whatever the case, I am thrilled that everything is functioning great, and that I can live a normal life, just knowing that ill probably have to do this again someday. Know that the hardest part of all of this is the mind buildup to surgery, and thinking about all the possibilities and risks right beforehand. Once you get there the day of, its really not that bad. You go to sleep and wake up a little later, a little bit groggy. You'll do great! Good luck with your decision!
jag004
Well-known member
I'm only 39 days post-op, so I don't know the benefits of my Edwards Bovine Pericardial Tissue valve yet. But I fought with this decision every second for the 6 months that i was diagnosed all the way up until surgery. I'm 37, and know that mechanical was very obvious. But, I wasn't ready for Coumadin or any type of restrictions. I'm hoping for 8-12 years out of this one, then ill decide on my next step. I'm hoping they can go thru my leg next time. Or, I hope the On-X trials go great and ill get that. Either way, I got one more OHS coming. And if all else fails.....I get a St Jude's or On-X and take my Coumadin pill everyday.....which is still a beautiful thing. In a nutshell, I just wanted to keep my options opened for now. Im terrible at making ANY decisions. Somedays I think I made the wrong choice......other days I think I'm 100% right.
AZ Don
Well-known member
VERY difficult choice. I felt that I only had bad choices, but of course they were better than not doing anything. It can be difficult to compare these different risks but this presentation posted just a couple days ago does a pretty good job of it:
http://www.valvereplacement.org/for...linic-Presentation-on-Artificial-Heart-Valves
Generally the data seems to be pretty equal between bio and mechanical but this presentation gives an edge to mechanical. Bottom line is that the valves and the surgeries available today are amazing, will likely be even more amazing in the future, and you will likely do pretty well going either way.
If you still can't decide you could ask your surgeon to recommend. Generally that is a surgeon's role - they are the expert in this field.
http://www.valvereplacement.org/for...linic-Presentation-on-Artificial-Heart-Valves
Generally the data seems to be pretty equal between bio and mechanical but this presentation gives an edge to mechanical. Bottom line is that the valves and the surgeries available today are amazing, will likely be even more amazing in the future, and you will likely do pretty well going either way.
If you still can't decide you could ask your surgeon to recommend. Generally that is a surgeon's role - they are the expert in this field.
I hear of patients going tissue an then on a reop going mechanical if needed. I watched a lot of YouTube videos today about percutaneous valve replacement surgery. I want to explore this with my surgeon and see what he says regarding a second surgery doing this and how many times can this be repeated in a patients lifetime. I have lots of questions for him.
sood
Well-known member
I chose mechanical and I can t you for me the ticking is a lot more annoying then warfarin. But I'm getting used to it. Everytime I hear it I think of the possibility I won't have to have another surgery. Also remember there is not much data on percutaneous aortic valve replacement. There is no data at all that shows how well they will be able to stack these valves on top of each other during re-ops. There is no guarantee you won't be on warfarin with a tissue.
With that being said you are 57. The tissue may last you quite a while. I was turning 36 days before my surgery and for me it was a no brainer. I did think about re ops with the catheter and going tissue, but for me there was just too much unknown there about what happens in the future. Whereas with the mechanical there was a very clear understanding of the future.
With that being said you are 57. The tissue may last you quite a while. I was turning 36 days before my surgery and for me it was a no brainer. I did think about re ops with the catheter and going tissue, but for me there was just too much unknown there about what happens in the future. Whereas with the mechanical there was a very clear understanding of the future.
I'm 54 and leaning quite strongly toward mechanical. I have paroxysmal atrial fibrillation, which thankfully has only occurred 3-4 times in the past 5 years. The a-fib could lead me to warfarin anyway at some point. So, this along with my STRONG desire to be "one and done" and it's mechanical for me.
Scott
Well-known member
It's been about 20 months since my sergery. My inr stays in range 2.0-3.0 if I just stay away from a few things. Other than that I eat whatever and how much I want. I only hear mine tick if it's really quiet and I lean forward in a chair. I did second guess my decision many times because I feel like a prisoner with the doctor visits for my inr and warfarin script. I now do home testing. Its alot better but not much cheaper. I have to buy my strips frome edgepark and call them every time I use one. Controlled and expensive. Its a small price to pay to have my life back. I don't bleed that much more than before. I just try to do things a little safer. More safety equipment. If I had to do it again I would make the same choice.
Whatever you choose will be a good choice. The only bad choice is not having the surgery.
Whatever you choose will be a good choice. The only bad choice is not having the surgery.
SuzanneSLO
Well-known member
I am 54 and having AVR on Thursday. I plan to have a tissue valve.
My surgeon authored one of the studies on re-operation risk. I felt comfortable that he would do everything possible during the first surgery to make the second one as risk-free as possible.
Thanks to everyone on this Board, I felt very comfortable that I would be able to manage Coumadin just fine on a day to day basis had I chosen the mechanical.
I had some concerns, however, about the lack of understanding about managing mechanical heart valve in the medical community for those one-off situations, such as major dental work or injury. I live in a small town and shopping for a knowledgeable health care provider might prove difficult.
I expect that fewer medical personnel will the be under the spell of the rumors and superstitions by the time I need a re-op. That will again make it a very hard choice.
Best of luck in making your choice. I admit that I became much calmer about the whole process once the decision was made. -- Suzanne
My surgeon authored one of the studies on re-operation risk. I felt comfortable that he would do everything possible during the first surgery to make the second one as risk-free as possible.
Thanks to everyone on this Board, I felt very comfortable that I would be able to manage Coumadin just fine on a day to day basis had I chosen the mechanical.
I had some concerns, however, about the lack of understanding about managing mechanical heart valve in the medical community for those one-off situations, such as major dental work or injury. I live in a small town and shopping for a knowledgeable health care provider might prove difficult.
I expect that fewer medical personnel will the be under the spell of the rumors and superstitions by the time I need a re-op. That will again make it a very hard choice.
Best of luck in making your choice. I admit that I became much calmer about the whole process once the decision was made. -- Suzanne
