AVR replacement at 41yo.. Which way to go ?

[dick0236]

..... but can anyone advise how it is managed in case of future surgeries (I will be needing some prostate
plumbing in a few years?).

Hi LeakyUK....and welcome to a very good site for information and support. Go to the Forums listed "Anti-Coagulation" and "Home Anti-Coagulation" for a good explanation and review of the "do's and dont's" of warfarin(blood-thinner:tongue2 management.

 

[ALCapshaw2]

Newly diagnosed with a leaky Aortic, not yet met with surgeon - CT Scan in a couple of weeks. Informative thread - and Warfarin does not seem too scary, but can anyone advise how it is managed in case of future surgeries (I will be needing some prostate
plumbing in a few years?).

The 'easy' answer to your question about other surgeries would be to suggest doing a Search on VR for keyword "bridging".

Most Surgeons will want their patients to go OFF Coumadin / Warfarin several days before the procedure. I asked 3 CardioThoracic Surgeons about their Bridging Protocol and got 3 different answers.

1 - NO Bridging, just go off X days before (typically 3 to 5) and resume the same night as the surgery.

2 - Stop Coumadin X days before, Start Lovenox (Low Molecular Weight Heparin) Injections 1 day later, every 12 hours, until 24 hours before the surgery. Then Stop the Lovenox. Resume Coumadin the same night after surgery, knowing that it takes 3 to 4 days to become fully effective. Do NOT resume Lovenox Briding.

3 - Stop Coumadin X days before, Start Lovenox Injections 1 day later, every 12 hours, until 24 hours before the surgery. Then Stop the Lovenox. Resume Coumadin the same night after surgery. Resume Lovenox Injections somewhere between ~6 hours and 48 hours following the surgery, depending on the Surgeons assessment of Bleeding Risk versus Stroke Risk.

It is wise to have your Cardiologist confer with the surgeon about the Bridging Protocol, regardless of which one is chosen. Whoever manages your anticoagulation would likely be the person to set up the Bridging Schedule and teach you how to do the injections (to your fatty abdomen area).

'AL Capshaw'

 

[LeakyUK]

Thanks Al, I had not realised what bridging meant.

Only just starting to come to terms with the surgery, but The support on this forum is amazing!

 

[Lily]

Hi all,

As you may have read in my previous post, I am a healthy 41 yo male weight 80kg. I enjoy snow skiing (just cruising), water skiing and bike riding and other normal everyday activities. I have two children boy 11 and girl 13 and of course my ball and chain... Umm I mean my lovely wife.
I was diagnosed with a bicuspid AV when I was 1 yo but was not leaking so no replacement was necessary. Now at 41 the ascending aorta is now 49mm at the root and am waiting for MRI on 4th Feb to confirm the size. Cardio said if it's 49mm we will talk to a surgeon.

He said that if we need to get in there to fix aorta that they would replace the valve while they are there..... So I need to think about my choices .... The thought of going through all of this in maybe another 5 - 9 years with a tissue valve scares the hell out of me..... But in saying that I don't really want to be thinking that a stroke could just be around the corner. Wouldn't stem cell research be excellent as they could just grow another valve which is exactly the same as yours but would be tricuspid.

Anyone have any information of suggestions that I could think about ?

Thanks again..... This forum has really helped me

Dave

Hi Dave - I joined this forum in 2003, shortly before I had to have my bicuspid valve replaced. I was 42 and my personal choice, which I understand wouldn't be and isn't everyone's choice, was a tissue valve. I ignored the criticism :biggrin2:

One reason I chose a tissue valve was because of a thread I read here at the time (entitled "One Valve For Life?") which presented new information to me, stating that mechanical valves don't last in people forever; in fact from what I've read -- and don't just take my word for it but research it -- they usually last about 20-30 years. Tissue valves don't usually last that long.

You can make the best of whatever valve you choose; so take in FACTUAL information, consult with EXPERT surgeons, and don't look back. Best wishes

 

[Lily]

Attention:

Attention:

The 'easy' answer to your question about other surgeries would be to suggest doing a Search on VR for keyword "bridging".

Most Surgeons will want their patients to go OFF Coumadin / Warfarin several days before the procedure. I asked 3 CardioThoracic Surgeons about their Bridging Protocol and got 3 different answers.

1 - NO Bridging, just go off X days before (typically 3 to 5) and resume the same night as the surgery.

2 - Stop Coumadin X days before, Start Lovenox (Low Molecular Weight Heparin) Injections 1 day later, every 12 hours, until 24 hours before the surgery. Then Stop the Lovenox. Resume Coumadin the same night after surgery, knowing that it takes 3 to 4 days to become fully effective. Do NOT resume Lovenox Briding.

3 - Stop Coumadin X days before, Start Lovenox Injections 1 day later, every 12 hours, until 24 hours before the surgery. Then Stop the Lovenox. Resume Coumadin the same night after surgery. Resume Lovenox Injections somewhere between ~6 hours and 48 hours following the surgery, depending on the Surgeons assessment of Bleeding Risk versus Stroke Risk.

It is wise to have your Cardiologist confer with the surgeon about the Bridging Protocol, regardless of which one is chosen. Whoever manages your anticoagulation would likely be the person to set up the Bridging Schedule and teach you how to do the injections (to your fatty abdomen area).

'AL Capshaw'

You are likely not aware, and will no doubt be glad to be informed, that the official Coumadin.com website has an official "message from webpage," which you must click on and acknowledge before entering, and it reads as follows:

"The health information contained herein is provided for general education purposes only. Your healthcare professional is the single best source of information regarding your health. Please consult your healthcare professional if you have any questions about your health or treatment. The information on this site is intended for residents of the United States."