Hi
ClickityClack;n875287 said:
This is my first post but I've been lurking for a couple weeks, trying to get my login sorted. I just wanted to say thank you for all the information and reassurances. None of it was for me directly, but I could identify with a lot of the people here and found many threads grounding and comforting.
I'm glad that all the posts we make answering the questions of each other helps those lurkers ... my experience of the internet (since about 1992) suggests that's exactly what happens.
I'm 38 and have a bicuspid aortic valve that was diagnosed in early 2010. The aortic aneurysm was first diagnosed in late 2011 at 4.8cm. Latest echo and confirming CT shows it at 5.0cm now.
that's actually pretty good, cos the main issue which drives the need for reoperation in a mechanical is aneurysm and then pannus formation. So you are getting one fixed in this surgery (the aneurysm) and AFAIK the On-X has some design feature which contributes to reduced pannus. Like everything pannus is a risk which is associated to factors and a small valve diameter is one of the factors.
I've never had surgery and I'm nervous as hell - can't even think about the specifics of the op without my heart rate going up.
its like a roller coaster ... there is a lot of anticipation in the lead up but in what seems no time at all you're out walking the park again and wondering if you'll stand in queue again.
In your post to ashadds you mention:
Comes down to warfarin or probably two more surgeries really. Having experienced neither, I'm unsure.
Well there is knowledge and there is experience. Knowledge tells us that if one rolls a dice there is a known probability of getting one of the numbers. If I roll a number you may roll a different one. Experience is when you learn that rolling dice in the casino always leads to losing money sooner or later.
The information cited about the risks of bleed and clot from warfarin is gathered from the millions of old people who are clot or stroke prone who are on warfarin because they had a stroke. Why they had a stroke is usually left a mystery for each individual and never addressed in the literature. The problems with being on warfarin are now clearly understood as being a management issue. The better you manage your INR and remain within range the less likely you are to have any incident.
The PROACT trial (done by On-X) is an excellent example of this. If you read past the abstract into the methods of these studies it reveals a lot. Their groups were tightly monitored and had INR tested weekly and were also tightly controled and had very high ratios of "in range". It does not take Einstein to work out that the key points that emerge across all modern (in the last 15 years) studies is that being in range and being in range most of the time is critical to good outcomes. How is this achieved? Regular (weekly in all study cases) monitoring and knowledge of how to proceed if you are out of range. There have been other studies which show that being in range > 90% of the time puts you in the same (lack of) risk group as the general population (who aren't on warfarin).
Of course age is a factor in this, as the aging process makes arteiys, veins and capillaries less flexible (elastin degrades for a starter) and more prone to damage (my dad was always getting some minor bump on his arm that bled and he wasn't on warfarin ... just 70). Warfarin does not make you bleed, nor contribute any way to making you bleed, all it does is make it take longer for bleeding to stop.
On experience I've had 3 surgeries now and I can assure you that when surgeons talk about the risk of reoperation they are quoting the stats of the risk of ONE reoperation. The third reoperation is trickier and the fourth. They also do not mention the inherent risks of there being other issues such as "oh look you now have a pacemaker" because during surgery something was cut which shouldn't have been because it was obscured by scar tissue.
They do not mention the risks of infection and the risks that actually you may take years on antibiotics (as well as a couple of surgeries that aren't technically heart surgeries) to clear that.
My personal view is that a tissue prosthesis probably frees you from needing warfarin (although that's not a certainty by any means, as much as 20% risk that you'll be on warfarin post op with a tissue) it brings with it the fact that you are now back in the waiting room at an earlier stage and being monitored in lead up to your next surgery. I view it that I can have ZERO input into guiding and influencing the outcomes of a tissue prosthetic but I have a lead role in guiding and influencing the outcomes of warfarin.
Myself I like to be not only responsible for my own life I like to manage it myself.
So I'm happy to be a clunker on rat poision ;-)
Don't be fooling yourself that you won't hear it (the valve) because you will ... but if you don't go psychotic on worrying about it you will find in a year or two that you don't notice it as much any more ... then after 5 years you'll just pretty much ignore it ... probably by the time your Dicks age (still on that same valve) you'll laugh about it.
Oh ... amusing anectode ... a US Soldier tried to commit suicide by taking an over dose of warfarin. He changed his mind and submitted to hospital. They put him on IV Vitamin K and there was no harm done.
I hope your surgery and recovery is smooth ... but if you hit any bumps then ... stop on by
Best Wishes
