Valve Decision - Mechanical or Tissue

[tjadams]

My surgeon stated the Edwards series bovine tissue valves are now passing 20 years in existing patients. The newer versions of these models are improved at resissting scar tissue encroachment and calcification, the main reasons tissue valves fail.

My surgeon has not had to re-op on any patient of these valves due to failure since he has been operating. He is in his 60s. He is Dr. Larry Schorn.

I have an Edwards series 3000 25mm.

And no my Dr. did not give me 27 years. He said I can hope for 10-20 years with reason. I am hoping for 20.... So 55 was a bit of a stretch... I just threw the age out there... sorry.

 

[geebee]

TJ,

It is never wrong to be optimistic and I hope you beat the odds with your valve. I am sure Karlynn was not trying to make you apologize. It is important for information to be as correct as possible on this site since people come here looking for answers and guidance that will greatly affect the rest of their lives.

Thanks for letting us know the valve type and I am sure you know that it is a good valve sure to give you many years of good health regardless of the length of time.

Best wishes.

 

[cp172]

Hi Guys,

While I am hoping for a mitral repair my surgeon has recommended a Medtronic Mosaic as a plan B. He said I should get 15-20 years with the tissue valve and the risk from surgery for a replacement at 70 (I am 53) would be less than risk of problems from warfin as I age. He said that if I wanted mechanical he recommended the On-X. I got the impression that lawsuits will keep doctors recommending warfin for patients in this country with the On-X for the near future. This all make sense? Anyone out there with a Medtronic Mosaic mitral valve? 15-20 years sound right?

Man this is all so confusing

Thanks,

CP
In the waiting room and bouncing off the walls.

 

[geebee]

CP - you are correct - this is a very confusing issue. Those of us who had our first surgeries many years ago did not have much to worry about. We went into surgery to save our lives and the surgeon made the choice of valves. I was able to choose the valve type for my third OHS and I chose mechanical again because coumadin has been a non-issue for me since 1980. Many doctors these days seem to shy away from coumadin more (IMHO) because they do not understand it or take the time to realize that properly managed ACT does not require danger or a lifestyle change.

I was so sick before my first OHS that I would continue to choose mechanical if I ever need surgery again as tissue replacement valves deteriorate like originals. If you were not symptomatic before surgery it probably doesn't matter but not everyone is so lucky.

There are many members on here who have had many years of coumadin usage with little problems. There are not that many members who have had a repeat surgery at 70 so it is hard to make comparisons. We who have had multiple surgeries know the problems that can happen but there are many statistics quoted that seem to negate our experiences. Only you can determine just what to take away from such discussions.

Just do as much homework as you can. Talk to lots of people 70 and above and try to get a feeling of how they would handle OHS. Talk to lots of people on coumadin to discuss their feelings. Put it altogether, bake it in a pie, have a slice and you will have your answer.

Best wishes in your research.

 

[cp172]

Gina..Thanks for the info.I do not have any symptons that I know of. Sometimes I get tired and sometimes I have trouble concentrating. I have no idea if its the getting older or regurgutation. The info off VR sure is helpful.
When I get back to work next week I will try to find some folks with similar propblems to talk with.I have been off this week and spent most of the time vegitating inside as it has been cold in Ga. (dropped below 20 two nights in a row )

You'all are the best!

CP

 

[Karlynn]

Hi CP - your surgeon was correct in telling a 53 year-old that a tissue valve should give you 15 - 20 years. What gets confusing is when surgeons and doctors give the statistics gleaned from research where 60 (or there abouts) tends to be the mean age of the study group and they're using those numbers when talking to someone in their 20's or 30's. Those longevity numbers just don't apply to younger adults due to the active chemistry that tend to wear out a tissue valve more quickly than someone in their 50's or 60's. That was my concern with TJ's post.

I don't necessarily agree with your surgeon's view about Coumadin risk being more than surgery at 70. As Gina said, lack of knowledge by the medical community in general tends to really bias many doctors. It's a real point of frustration for those of us that have taken Coumadin for years. It's the opinion of many of us that if the medical community would try to get into the 21st century with their Coumadin information they wouldn't be so frightened of putting someone on the drug.

At 53, you are in the grey area for the decision process. Valid arguments can be made for both types of valves. You just have to choose which feels the best for you. I was very symptomatic prior to my MVR, so the thought of having to go through another such time as a tissue valve wears out didn't appeal to me at all. And it may or may not have happened. You have not had that experience, so we both approach/ed our decision from our own perspective - and that's all you can do.

And as far as the weather dipping below 20 - sniffle sniffle I'll be happy to send you some of our -15 w/ wind chill.

Best wishes!

 

[cp172]

Hi Karlynn - thanks a bunch for your thoughts.I have been on Warfin for the last year due to AF and have been scared to death. I bought an electric razor and for a long time was the fool on the highway driving half the speed limit to avoid a wreck. I was even afraid to go fishing for fear of getting a hook in me or having a fish fin me. I have learned a lot from you and the other wonderful VR members.

My hat is off to you and any other brave souls dealing with subzero weather.In my neck of the woods if the weather gets in the 20's it is considered a crisis.Thank goodness it will get up into the 70's Monday (I plan to go fishing ).

Thanks,

CP

 

[catwoman]

CP:
I was 1 month shy of 53 when I had my MVR. My grandmothers lived to 99.5YO and 96YO and both my parents are still alive (Daddy will be 79 next weekend), so I went with mechanical.
My experience with warfarin has been pretty boring, probably because I home-test. My husband had MV repair 9 months ago and was put on warfarin when he developed arrythmia post-op. Our PCP's office ran his INRs, but I'm the one who ran interference with dosing changes. (Office staff was trying to be too conservative on dosage increases.) Our PCP's staff deferred to my suggestions for dosage increases. John was taken off warfarin last month, but he still has some PVCs.
John has seen me deal with warfarin for over 4 years, so he knew he could live with the drug. (BTW, he had chosen a mechanical as a backup, in case a repair didn't work out.)

 

[cp172]

Hi Marsha-It sounds more and more like warfin is less of an issue than I thought. Also looks like you came from a strong gene pool. WoW!

Thanks,

CP

 

[Karlynn]

Hi Karlynn - thanks a bunch for your thoughts.I have been on Warfin for the last year due to AF and have been scared to death. I bought an electric razor and for a long time was the fool on the highway driving half the speed limit to avoid a wreck. I was even afraid to go fishing for fear of getting a hook in me or having a fish fin me. I have learned a lot from you and the other wonderful VR members.

My hat is off to you and any other brave souls dealing with subzero weather.In my neck of the woods if the weather gets in the 20's it is considered a crisis.Thank goodness it will get up into the 70's Monday (I plan to go fishing ).

Thanks,

CP

If you are on warfarin already for AF - why is the surgeon recommending tissue? Is he thinking the replacement will fix the AF, or is he going to try to fix it during the surgery? (Does he know you're already on warfarin??)

I'm so sorry that you were scared to death. It's such a shame that so many myths are perpetuated and causing this fear. I do know how you feel, because I felt that way the first few years I was on warfarin. Many make you feel like you risk death from a tiny cut. I've had many cuts and gashes and I'm still around. Have you read the Stickie at the top of the Anticoagulation forum? Also take a look at some of the activities that our members on Coumadin participate in, in the Active Lifestyles forum.

Have fun fishing!

 

[cp172]

Hi again Karlynn-The surgeon says that the ablation he will do should fix the AF which is the result of the MVP. He also thinks there is an 85% chance he can repair the MV. I will read the Stickie and thread you referenced.Thanks.When I first went on warfin I planned to use duct tape on any cuts I might get until my wife could get me to the hospital. No one gave me any instructions or advice other than take no vitamins and eat no vegitables with "K". So I gave up turnips and lettuce and gained 10 pounds I did not need to gain. I am learning differently from all you "Veterans".

Thanks,

CP

 

[geebee]

Hi again Karlynn-The surgeon says that the ablation he will do should fix the AF which is the result of the MVP. He also thinks there is an 85% chance he can repair the MV. I will read the Stickie and thread you referenced.Thanks.When I first went on warfin I planned to use duct tape on any cuts I might get until my wife could get me to the hospital. No one gave me any instructions or advice other than take no vitamins and eat no vegitables with "K". So I gave up turnips and lettuce and gained 10 pounds I did not need to gain. I am learning differently from all you "Veterans".

Thanks,

CP

CP - some of your post just wants to make me cry. You did not need to give up any of the things you mentioned. I eat what I want, take vitamins (I do look for those without Vit.K, tho), shoot shotguns, ride motorcycles off road, scuba dive, shave with a razor, use sharp knives in the kitchen, etc., etc., etc.). Coumadin does not require a lifestyle change.

Please keep in mind that an ablation does not always work. I am not sure of the stats (especially since I am not very fond of them anyway) but I would hate for that to be a defining issue in your choice. In addition, I will pray that you get a repair.

I am not saying avoid tissue valves. I am just saying try to make sure you have all information (true stuff) in hand before making that final choice.

Best wishes.

 

[cp172]

Gina-Thanks! All this info is great. I feel like running around with scissors. And congratulations to Johnnycake23 for climbing over the mountain!




CP

 

[Karlynn]

Gina-Thanks! All this info is great. I feel like running around with scissors. And congratulations to Johnnycake23 for climbing over the mountain!




CP

Running with scissors is one of our jokes!

Some people do truly make you feel like you are going to spout like Old Faithful if you nick yourself. Believe me, I've had some pretty good cuts and gouges in 16 years. It really doesn't take that much longer to stop the bleeding.

 

[Ross]

Wish you could have seen me the first time I got my hand cut fixing brakes on the car. I jumped up so quick and started running before I figured out that I wasn't spurting all over the place like I'd envisioned and had been told. Since then, I've found pretty much 90% of what I've been told is nonsense.

 

[johnnycake23]

I am 28 years old. Two weeks ago I chose tissue. Now if things go well I will need a replacement before I am 55. I personally believe that the trials they are doing today with robotic assisted non chest cracking surgeries will be the norm in 5-10 years. I also believe that in 15 years they will have a more permanent solution for valve replacement being either a mechanical valve that does not need blood thinners, or a tissue valve grown from your own cells. In either case, My guess is that in 20 years we can all get our substandard valves replaced in a 4 hour day surgery and be out within 48 hours.

Now is this guaranteed? Of course not. I feel it is very likely.

If nothing else the pain killers can only get better :O

TJ, it's interesting you say that about tissue valves because after research and interviewing experts, especially my surgeon, that is what ultimately led me to choose tissue over mechanical - banking on the medical advances of the future allowing a possible (indeed probable) re-op via catheterization. I sure as hell don't want to get cracked again (I can't imagine anybody enjoying that) and I am hoping the decision I made not two months ago will have been the correct one. Another site member (bbb, I believe) followed a similar rationale if memory serves.

As the others, I wish you great luck. Please keep us posted on your progress.