2nd OHS in 3 years for AVR scheduled for 3/31/15

[LynnS]

Well here I go again. OHS surgery for AVR scheduled at Univ. of VA 3/31/15. My Medtronics bioprosthesis (pig) aortic valve is calcified after less than 3 years (I was 56 when replaced). I originally was operated on for aortic regurgitation, now its calcified and stenotic. The gradient across the valve is 65. I understand that that number is bad (determined from my echo in Jan). I originally chose a biosprosthesis because I had 2 episodes of bleeding into my abdominal wall when on coumadin (for atrial fib) ( or Lovenox) and in the throws of bad asthma. I also need my left coronary artery bypassed in the region of former myocardial bridging that was not operated on the first time.
This time thinking hard on a mechanical (On-X my surgeon suggested). I sure don't want to go for #3 OHS and I am still "young" for the bioprosthetic valve. I definitely bruised much more on the coumadin before, not looking forward to that. I am sure I was not well regulated...will want to do home monitoring of my INRs. What is the best machine?
Thanks for the help and moral support!
LynnS

 

[pellicle]

Geezuz Lyn I am so sorry to hear this

I wish you all the best with the surgery

I am using the Coaguchek XS and am very happy with it

Pleas email me ifyou want someone to listen and bounce ideas off

Hot mail and my username

 

[camgough]

Hi Lynn,

I posted a very similar topic not too long ago. I am sorry for your news, but really can relate to you!

My "spared" aortic valve gave out around 4 years and was just replaced. My surgeon and I also chose an On-X aortic valve. I am 4 weeks since my second surgery (I'm 34) and feeling pretty good.

Your INR may be managed at a lower level for an On-X valve than it was for A-Fib, and may not have the same unwanted complications you had before.

Good luck!

 

[cldlhd]

I'm sorry to hear this also.I thought the newer generations of tissue valves supposedly had some sort of anti calcification treatment?

 

[epstns]

Gosh, Lynn - Didn't they offer you the extended warranty on the pig valve? Unfortunately, none of us know if we will be the one whose tissue valve lasts 5 or 25 years. I'm sorry to hear that you got the short one.

I think you're making a good decision. I know that if I was faced with the same issue, that's what I would do. At least this time you know the drill.

We're all here wishing you well, and wishing you a fast, smooth road to healing again.

 

[dick0236]

...will want to do home monitoring of my INRs. What is the best machine?
Thanks for the help and moral support!
LynnS

I have used the CoaguchekXS for a year with good results. It is the same meter that my doc uses in his INR lab and I periodically check my meter against his to validate readings. The other popular meter is the INRatio2 which I used prior to my current meter. I was satisfied with that meter, but due to a strip safety and strip availability problem I became uncomfortable. Home meter use has become very popular and is generally covered by health insurance. I am on Medicare which covers my cost on an 80/20 split (about $5/test). I test weekly thru a program administered by Coaguchek Patient Services in Indiapolis IN (1-800-428-4674) with very good results.

 

[tom in MO]

I also use the CoagucheckXS. Fine machine, but they are distributed by Allere in this country. They are a hard company to deal with. Make sure you keep good records of your interactions with them and order your supplies well in advance.

 

[dick0236]

I also use the CoagucheckXS. Fine machine, but they are distributed by Allere in this country.

Tom, I agree about Alere being a "pain" to deal with. I dealt with them in the past and agree that the service was very poor. If you are in a "program" you might call the number
(800-428-4674) . It is a Roche Subsidiary and the service is extremely accurate and prompt. If you are not in a program you should be able to buy supplies from them for prices similar to Alere.

 

[pellicle]

Dick

I buy mine online from medical suppliers. I did a quick Google and prices are about the same as I pay for cash here in Oz . I pay about $140 for 24 test strips delivered. That's about $5.8 a test

 

[Lisa2]

Aw, Lynn, I'm sorry to hear this. It sounds like you're in a good place regarding your decision and I think you're making the right choice (although I'm sure you don't know whether to laugh, scream, or cry or maybe do all 3).

I don't have any experience or advice to give regarding INR testing (I have a homograft). I just want to wish you well. Good luck and keep us posted!

 

[tom in MO]

Thanks Dick. I got off the Allere train because my insurance company dropped them. However, the new provider is just a pass through for Allere...isn't that sweet. Since technically they gave me the monitor for free and just charge me for the strips, I can get them anywhere. However, after I meet my yearly deductible (which I'd do anyway for other reasons) it's a little cheaper to use the "preferred provider."

 

[LynnS]

thank you all for all of your replies!if I was going mechanical I would definitely do self-monitoring. Well I went to the surgeons office thursday and he said he would use a tissue valve for himself. He is relatively young and athletic.he suggested I talk to my medical cardiologist which I did. That cardiologist strongly recommended I not get a mechanical valve because of my prior 2 life-threatening bleeding episodes in my abdomunal wall when I had severe coughing from asthma and was on coumadin. He discussed using the Ross procedure but I understand that is not as much recommended in adults. So I am probably back to a tissue valve which I will know for sure come Monday. I have one more talk with the surgeon at that time.the choices he mention were the magna ease and St Judes Trifecta valve. his preferences the magna ease given its long-standing track record. He said the Saint Judes trifecta valve also seems to be quite good although again not as long a track record.so many decisions! Thanks again for all of your help!

 

[neil]

Hi Lynn so sorry to hear about problem. Reading all your story I would have edged towards mech but listen carefully to your cardio and surgeon there are the experts here. IMO they would have the greatest influence on my decision

 

[Heart Of The Sunrise]

Sorry to hear of your need for second OHS.
I just passed my second anniversary with my ON-X valve.
I home test with the CoagucheckXS. meter.
My INR is stable in my range of 2.0 to 2.5.

Makes sense to stay with a tissue valve due to your bleeding incidents.

Best of Luck on Tuesday!

 

[pellicle]

Hi Lynn

.. That cardiologist strongly recommended I not get a mechanical valve because of my prior 2 life-threatening bleeding episodes in my abdomunal wall when I had severe coughing from asthma and was on coumadin.

that sounds like sound reasoning to me ... there are a number of health reasons to beware of being on warfarin and that sounds like it would be a risky combination.

I wish you all the best in making your choices. I wish I could say something more helpful.