On-X Aortic Heart Valves: Safer with Less Warfarin

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Successful AVR - Info for anyone getting close to surgery, or with Acute Stenosis

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  • Successful AVR - Info for anyone getting close to surgery, or with Acute Stenosis

    I would like to share my recent experience to help anyone in a similar situation.

    Surgery:
    AVR with On-X 23mm ; 3 Nov 2017
    Surgeon : Dr. V Kasirajan @ VCU Health in Richmond, VA
    Complications: (1) Full heart block, due to mechanical valve installation (block still remaining as of 21 Nov) requiring Pacemaker installation on 7 Nov ; (2) A few days of Atrial fibrillation, heart naturally went back into sinus rhythm thereafter

    Background:
    BAV with mild aortic stenosis diagnosed Mid 2014
    Mild stenosis still in Mid 2016
    Actute stenosis diagnosed in Mid 2017
    DOB: 1974

    More information:
    -Noticeable symptoms only after acute stenosis. Once symptomatic, I understand it is very very important (even more so for young/active people) to have the valve fixed ASAP. Mine went from mild to severe quickly: surgeon reported that the valve was highly calcified (meaning it was not really acting like a valve!). Please do not skip an echo if you are being monitored.
    -Even with the complications (Atrial fib, Pacemaker), I felt confident along the way that there would be positive outcomes; the science is well understood and practiced at a high level.
    -Chest tube, catheter, and external heart pacer wire removal are really not a big deal: 2 second of some discomfort. Breathing tube removal is not pleasant, but not terrible.
    -Able to walk 100yards after 2days
    -After 1 week, able to walk for 30minutes with no issues
    -The standard of care at VCU was really impressive.

    Any questions? Let me know and I'll do my best to answer.


  • #2
    Thanks for the info, I go in tomorrow (about 13 hours, yikes)..

    Pretty similar case here, 41, mild stenosis, moderate insufficiency, fairly big aneurysm (forget exact size), starting to develop pulmonary hypertension, etc.

    Good to hear things went mostly well for you.

    Didn't know a block was a thing with mechanical valves... Well one more thing to worry about hehe.

    Anyway, hope the recovery goes speedy for you


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    • #3
      Good post, guest. I ended up with a pacemaker as well, for the same reasons, when I had my AVR done 3 years ago. Pacemaker has not been an issue, as far as I can tell. There is a useful site www.pacemakerclub.com which I now follow (and post on occasionally) to find out what issues might arise in future.

      Take the recovery gently!
      Mechanical aortic valve replacement, CABG x 1 and pacemaker, Sept 2014, at age 49. Insulin dependent diabetic.

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      • #4
        Your story is a good one for all to read. Wishing you the best in your recovery. WTG on keeping an eye on things and having your check ups. i have a year old ON-X and have no experience with afib(not positive if I know how that feels) .

        A few people here, like Andy, post on their pacemakers and make me feel like if that was something to deal with it can be done, Very helpful they are.

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        • #5
          I'll agree that after the initial "tweaking the device" period, pacemakers are a big non-issue. Sometimes it takes a couple of visits to the PM clinic to get all the optional settings right for your personal activity preferences (especially is you're a gym rat as I am), and after that, the only time I am fully aware that I have a pacemaker is when I look in a mirror with my shirt off.

          Even having one of my leads fail, the subsequent lead removal/replacement and device replacement was just a day in hospital and a few days of recovery. The worst part of that one was not being able to drive a car for a week after the new lead was implanted.

          The potential for complete heart block is not so much related to which type of valve you have implanted as it is to the process of replacing the aortic valve itself. The nerve bundle that conducts pulses from the upper chambers of the heart (atria) to the lower chambers (ventricles) runs very close to the area around the aortic valve. Sometimes, depending upon the individual patient's physiology, the degree of calcification and the surgeon's skills, they damage the nerve bundle when the cut out the native valve. When this happens, partial or complete heart block is the result. I remember that my surgeon was a bit miffed that I required a pacemaker, as he probably felt that my situation spoke poorly of his surgical prowess. I didn't feel that way, but others asking his statistics might disagree.

          Be sure that you put your device "through its paces" before you consider that project complete. Often, once the patient begins to heal, they find that they need the pacemaker to be adjusted to allow for higher max heart rate or faster acceleration, in order to keep up with the patient's increasing abilities.
          Go Class of 2011!

          Steve Epstein
          9 Years in The Waiting Room, then on February 28, 2011,
          AVR with 23mm Edwards Bovine Pericardial Tissue Valve, Model 3300TFX, Pacemaker - Boston Scientific Altrua 60 DDDR IS-1 and CABG (LIMA-LAD) at Northwestern Memorial Hospital, Chicago by Dr. Patrick McCarthy and the most wonderful team of professionals I could ask for. New pacemaker (Boston Scientific L101) and ventricular lead, July, 2016.

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