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

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Not sure if this the correct section to ask this question but.... Please say taking the anti col drugs happen everyday and the levels have to be maintained.... How do you maintain it...?? Do you test it yourself like people with diabetes have to do?? As on with a machine and you prick ya finger??
 
BIG SNIP

At the end, I would suggest you read here; read literature enough to understand the trade-offs and most importantly, select an experienced surgeon who performs what you need very often (you may need to see a few for this before you find your surgeon).

Rick

AMEN!

I strongly concur that it is wise to select a Surgeon who has a lot of experience performing the procedure you will need,
and preferably with the valve you desire.

That said, it is important to know that Not All Surgeons are intimately familiar with all valves or procedures.
IMO, Cardiologists are even less so
(e.g. I know Cardiologists who have told me that they have not examined the literature on my primary 'valve of interest').

Cardiologists identify and diagnose Heart Problems.
Surgeons FIX them.
Many Surgeons (and Hospitals) limit their offerings to only a small fraction of the ones available.

And only a small percentage of surgeons see many of the more Complex Heart Surgery Cases
such as Aorta Repair / Replacement or Ross Procedures (which have fallen from favor by most Surgeons and Hospitals for older patients)
 
@ Neil.........
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where where
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Ah yes, "the chance of mechanical valve re-op".

It would he helpful if someone could find some Numbers comparing Re-op Rates for Tissue vs. Mechanical Valves.
I expect the numbers are no-where near being close.

In all the years I've been reading the VR Forums, I DO NOT recall reading of a Mechanical Valve Failure.
Yes, I have read about mechanical valve replacements for Pannus Tissue Growth and Endocarditis,
but those causes for re-ops have little to do with Valve Type and can happen to BOTH types of valves.

'AL Capshaw'

Of course the rates of re-ops for tissue are higher than mechanical valves
It would be more interesting/ important to ME to see the rates of BAD outcomes from the REDOs in tissue valves compared to the Bad outcomes of Mechanical valves and coumadin. Since pretty much that is what the choice boils down to, which you feel more comfortable living with.

FWIW most studies or articles show about 10% of mech valves need REDOs in the first 5-10 years Others show about 10% have reoperation in 20 years or less depending on the article.
I remember from an earlier thread, many of the people here, who've had a mechanical valve for a very long time (20 plus years) where on their 2nd mechanical valve or they had their valve repaired, anything from sewing a popped stich or cleaning up the valve. One of the concerns w/ REDOs that make them riskier is if they are ER surgeries and not planned "elective" surgeries, I believe a larger percentage of mechanical valve REDOs are emergencies (mainly clots would be ERs) compared to the percentage of Tissue valve REDOs. I am NOT in any way saying or implying theire are MORE mechanical valves needing REDOs than tissue valves..what I am saying is out of all the REDOs needed for either type, the % of those surgeries being an emergency are higher for mechanical valves.


As for why a person with a mechanical valve needs a REDOs, wether it is because of BE, Pannus, clots, popped stitch or need a repair I don't think it matters to them as much as the fact they need to go thru a surgery and recovery (at least in my family's personal experience) on a part that should have lasted a "lifetime".

Of course Tissue valves will also need REDOs and pretty much if you live long enough you will probably need a REDO. Since it is surgery there ARE risks, less in the centers that have alot of experience with REDOS. Hospitals that do several REDOs a week will have better stats than ones that do a couple a month. For the most part the hospitals /surgeons with the most experience in REDOs are the ones that take care of Congenital Heart defect patients, children and adults.
Which since there are about 50,000 REDOs of all types of heart surgery each year (in the US), quite a few hospitals are becoming pretty experienced in them.


I don't know how to quote 2 post so I'm copying part of duffs

"Even if pradaxa ends up being a good replacement treatment for A-fib or VTE - which really the jury is still out on - if you're lifelong anticoagulated on pradaxa, it stands to reason that, if doses are properly managed, it's similar in bleeding risk to being anticoagulated with coumadin except you don't have the 50 years of knowledge of the drug to provide insight in to how it works. What i mean to say is, we can't possibly know as much about Pradaxa as we do about Coumadin right now... at least not in my opinion. The lack of familiarity in the medical community about Pradaxa seems a risk in itself. The lack of reversal agent (that I'm aware of) is also concerning. From my perspective and to my personal situation, the only clear benefit to Pradaxa is convenience."

I don't know if this would interest you, but if you have a spare 1/2 hour, There is a pretty interesting (IMO) webcast panel discussion on the different clinical trials going on for the new anticoagulants http://www.theheart.org/article/115...edium=email&utm_source=20110128_TopStories_EN
hopefully this goes to a page describing the discussion and you can click on "view conference" if it doesn't work , let me know and i'll try a different way.

It is too early to see if there are any problems from longtern pradaxa and it, BUT the RELY trials for Pradaxa w/ AFib (18 thousand patients) showed over a 30% DECREASE in stroke and systemic embolism and a signifigant decrease in hemoragic stroke /cerebral bleed. There was lightly less bleeding in the 150 2 times a day group and a signficant reduction in "life threatning" bleeds compared to Coumadin.

I haven't read or heard anything about this, BUT I was thinking since there seems to be a relation between BAV and brain annuerysms that might be even more helpful for those patients, but maybe it wouldn't matter, it might be something interesting to ask about.

Another benefit could be Since Pradaxa doesn't have anything to do with Vitamin K, there wouldn't be the same worry about reduced bone density as it looks like there is with Coumadin.
The not having a reversal agent would be a concern, but since Pradaxa half life is very short 12-17 hours, compared to Coumadin 20-60 hours and you have to take it every 12 hours. For the most part you would only worry about reversal if you you have a trauma or major bleed, Depending how close it was to your last dose, they would probably use charcoal to absorb any left in your stomach and then -like they do for plavix and aspirin that also do not have reversal agents- most likely they would treat the bleed with blood, Fresh frozen Plasma, Cryo, platlets or different clotting factors depending on your bloodwork.
 
Hi...
Having my second valve replacement surgery on Feb. 8 at Duke..Also having an aortic anuerysm repaired. I had a St. Jude mehcanical valve in 1986 at age 37...I am now 62 and trying to decide on whether on having a mechanical valve or a tissue valve. I know all the pros and cons....but being on coumadin for 25 years has definitely got me thinking about the tissue valve. Last year I had 55 protimes at a protime clinic....so you can imagine how many I have done in 25 yers. I also understand the possibility of another surgery (tissue) in 10-15 years. So tough choice and only have another week to make a decision.
 
Hi...
Having my second valve replacement surgery on Feb. 8 at Duke..Also having an aortic anuerysm repaired. I had a St. Jude mehcanical valve in 1986 at age 37...I am now 62 and trying to decide on whether on having a mechanical valve or a tissue valve. I know all the pros and cons....but being on coumadin for 25 years has definitely got me thinking about the tissue valve. Last year I had 55 protimes at a protime clinic....so you can imagine how many I have done in 25 yers. I also understand the possibility of another surgery (tissue) in 10-15 years. So tough choice and only have another week to make a decision.


Hi, I'm glad to meet you. You might want to start a brand new thread so everyone sees your post. Sometimes when thread get this long, people quit reading them :)
 
Welcome ebjlady.

Very happy you have found and joined us.
Please do start a new thread.
We all want to provide support and welcome but your post may not be seen in the midst of this thread.
Very sorry to read you are facing another surgery and understand how difficult your choice of valve.

I had two OHS in four years and can truthfully tell you my second was very much easier on me than my first.
Also, you may be very surprised at the advancements and changes since your last OHS.
Very Best Wishes.
 
I had two OHS in four years and can truthfully tell you my second was very much easier on me than my first.
Also, you may be very surprised at the advancements and changes since your last OHS.

It's funny how circumstances make us looks at things in completely different ways. I had 2 OHS within 8 years and can say I barely survivied my 2nd surgery. I also was surpirsed that my choices we not very different in 2009 than in 2001. Either a tissue valve that would definetely need replaced within ?? number of years or a mechanical and ACT. I was 45 when I had my first AVR (addressing the age thing)
 
Lyn - As you implied, witholding Vitamin K from one's diet can lead to bone loss.
Unfortunately, this was the thinking in the 'Bad Old Days' of anti-coagulation management
and is probably the reason behind the association of bone loss and taking Coumadin as indicated in those OLD studies.

NOW we know that it is NOT necessary to withold Vitamin K containing foods from the diet.
In fact, Studies show that it is easier to maintain a stable INR when consuming a "consistent" level of vitamin K intake
and adjusting the Coumadin dosing accordingly. As Ross and others always say, "Dose the Diet. Don't Diet the Dose."

'AL Capshaw'
 
.......Another benefit could be Since Pradaxa doesn't have anything to do with Vitamin K, there wouldn't be the same worry about reduced bone density as it looks like there is with Coumadin.
.

This has never been a problem with me, although I have been on Warfarin longer than most(43+ years) and I have had more than my share of "tumbles" over the years.....most recently two years ago, at age 73, when I fell off a ladder in my garage....hit the concrete floor hard enough to get seven stitches in an elbow and a headache, but nothing broke....in fact, I have never had a broken bone. I did "crack" a rib a few years ago then I tripped over a "ground under repair" rope on a golf course.... and I do not take calcium supplements like my wife does. FWIW, I have NEVER had a doctor tell me not to eat "green" vegs. Vitamin K green vegs are a "mainstay" in my diet.
I have been "dosing the diet" for years:smile2:.
 
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Testing your INR levels are for me time consuming and very aggravating. I am now being monitored by the local clinic because of cost and I hate it. I feel like they know much less about coumadin than I do....or most of the people on this forum. I posted recently that my range is 2.5 to 3.5 but if it comes in at 3.1 or above I am told to hold a dose, if it comes back at 1.9 I am told everything is good and stay on the same dose. I REFUSE to hold a dose when I am in my range and it has caused them to question my INR levels. I don't want to tell them I am ignoring them, but I don't know what else to do.....THAT is my major concern with coumadin....
THEN I have the loudest valve in the world! Had my surgery over 17 months ago and not only has it not quieted down, I also have not grown USE to it. There are times that it doesn't bother me.....if I am up and about doing stuff, but when I exercise or even walk up stairs...it can really drive me MAD!

Here is now what I think.....MY opinion....I would go with mechanical again....for ONE reason....all these things (for me!) outweigh the idea of KNOWING I would have to do it again. I am 47. The choice to me is basic...you take all these things and you weigh them.....but when it comes down to another surgery, I would do almost anything to avoid it. I also had a pretty easy surgery with a very quick recovery, not a lot of pain and no problems.....STILL don't want to do it again!

Mileena
 
.....STILL don't want to do it again!
Mileena

Atta Girl:biggrin2:, my thoughts exactly. Keep the faith about ACT managers. You will, over the years, get some good ones and some bad ones. Hopefully, your valve will quieten down and I think it will after a while....I have to hold my hand over my heart, every now and then, to be sure it is still "running":redface2:.

I just came in from the gym:thumbup: and was hoping this thread was still up. On the treadmill, I thought of another "plus" for warfarin. Many people get "botox"(sp?) to reduce
wrinkles. I have NO wrinkles and most people think I am 55....not75. Since both "botox" and "warfarin" are derived from toxic materials, maybe long term use of warfarin keeps you looking young:tongue2:. My brain and muscle reflexes are pretty quick too. Maybe we should get this circulated to go with all of the other rumor and misinformation swirling around Warfarin:cool2:.
 
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?).
 
dick i like you and to me you should be looked up to when it comes to valve longtivity,but to say anti coags and the damage there can do is all rumour? am sorry it doesnt wash, look i believe that most people who go mech and have to take anti coags do absol fine,as are people who choose tissue and have to go down the re op path also, BUT there are risks with both, to say having a re op is just another little op and everthing will be brill is just the same as saying anti coags is just popping a little pill,dick for you having a mech has worked out absol brill and well done,but for some it doesnt and thats a fact,the same as having a tissue might not work out, i truly hope in the future there will be a universal valve made with no re ops and no anti coags,then these threads will no longer excist,until then i suppose the arguments will, and thats a shame as at the end of the day we are all zipper buddies,we are all in the same boat,
 
Lyn - As you implied, witholding Vitamin K from one's diet can lead to bone loss.
Unfortunately, this was the thinking in the 'Bad Old Days' of anti-coagulation management
and is probably the reason behind the association of bone loss and taking Coumadin as indicated in those OLD studies.

NOW we know that it is NOT necessary to withold Vitamin K containing foods from the diet.
In fact, Studies show that it is easier to maintain a stable INR when consuming a "consistent" level of vitamin K intake
and adjusting the Coumadin dosing accordingly. As Ross and others always say, "Dose the Diet. Don't Diet the Dose."

'AL Capshaw'

I didn't mean the problem with bone density and Coumadin having to do with not eating food that have Vitamin K or restricting them. Altho I am sure that played a role in the OLD studies showing a relationship between Coumadin and decreased bone density and probably even some part of the newer studies.

I was talking about Coumadin's effect on Vitamin K's role in the liver related to bone metabolism. Just like Coumadin works to prevent/cut down clot formation by inhibiting vit K from doing it's role in the liver with the different proteins, factors needed for coagulation, it also interfers with the action of Vit K on some of the different proteins that are needed for bone health.

Does that mean everyone who takes coumadin long term will have problems with Bones, of course not just like everything else some people are just luckier or more Blessed than others.

But since I was talking about POSSIBLE benefits of Pradaxa over Coumadin, the fact it works a completely different way (inhibits thrombin needed for clots) than coumadin, and is not a Vitamin K antagonist, most likely it would not effect bones. That might be something some people would want to consider if they have the choice between the 2.
 
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