Choosing valve with active lifestyle and being 21

[Soilman]

Just wanted to put my .02 cent in. I has surgery in Aug. and got the On-X in the aortic position. The coumadin thing was an issue for me, because I was an extremely active 43 year old. My job is outdoors doing manual labor. I hunt, fish, woodwork, garden, mechanic, and do-it-yourself all the time, as well as run and workout with wieghts (light). I'm constantly getting cut, scratched, bumped and scraped. This is why the coumadin would be an issue. However, I've found that the cuts and scratches don't bleed much, if any, worse than before and I don't seem to bruise any worse either. In corresponding with others, it appears that if you didn't bruise/bleed easily before coumadin, you won't after either. If you did before, then it might be worse after.

My point is, coumadin isn't necessarily a death sentence to an extremely active life style. I'm doing everything I want too, just like before surgery. I didn't have the surgery just to sit on the sidelines, I'm in the game!

 

[T-Money]

Myopia

Myopia

Hi.
I have read through everything here and I have to say I think your surgeon and cardio. are telling you what you want to hear. The coumadin is not that big a deal. Also, anyone who suggests that you should voluntarily set yourself up for a re-run in the cardiac intensive care unit only says so because they have never had OHS. Your risk of dying from an internal bleed while leading an active lifestyle on coumadin is at least equivalent if not less than the risk of death from a 2nd or 3rd OHS. My surgery was performed by a guy that had done more than 20,000 OHSs at a top 10 facility and specialized in valve replacements and he never even mentioned the option of letting me have a biological valve of any sort. I thought the same things you did. But, take a minute and fast forward to what your life (statistically speaking) will probably look like in 10-15 years. 50-60 hours a week of nursing for 5-10 years will slow you down your active lifestyle considerably, not to mention kids if you choose to have them. Go talk to someone who is 30 and I think you'll realize that planning as if you will be 21 for the next decade is myopic.
Dr. T

 

[Natanni]

Oak tree,

both my cardiologist and surgeon have both predicted the porcine valve would last 10-15+ years, I know there is a lot of skepticism about that number especially given my age and everything, but I do know the advancments have vastly increased in the past couple years so someone who had a tissue valve put in ten years ago and it went bad in eight had a much different experience than im hoping to have.

If my surgeon repaired the valve, he gave it 8 years top, because the inflammation would settle in and be a culture for calcification to start immmediately. I just can't see myself getting a mechanical at this stage and setting my limitations for the rest of my life just yet. I feel like im planning the rest of my life at age 21, and honestly Im too young for that, I recognize this and still want to be like the rest of the herd and do what 20 something year olds do.

And i more than appreciate everyones imput and still will take any advice and stories because the most informed decision is always the easiest.

Another question, best vacation spot? a place that you have been to

Best Vacation SPOT? St Thomas USVI Secret Harbor March 19, 2008 Wow...is all I can say

Make sure you talk with your surgeon about your future careers. If I read through this all, you are with UPS now (hubby is with UPS 18 years) and are in nursing school? Make sure you discuss repetitive heavy lifting and valve life. That said, your social life and active lifestyle need to be all be balanced out. Good luck and wishing all the best.

Ann, the wife

 

[Bad Mad]

Hi.
I have read through everything here and I have to say I think your surgeon and cardio. are telling you what you want to hear. The coumadin is not that big a deal. Also, anyone who suggests that you should voluntarily set yourself up for a re-run in the cardiac intensive care unit only says so because they have never had OHS. Your risk of dying from an internal bleed while leading an active lifestyle on coumadin is at least equivalent if not less than the risk of death from a 2nd or 3rd OHS. My surgery was performed by a guy that had done more than 20,000 OHSs at a top 10 facility and specialized in valve replacements and he never even mentioned the option of letting me have a biological valve of any sort. I thought the same things you did. But, take a minute and fast forward to what your life (statistically speaking) will probably look like in 10-15 years. 50-60 hours a week of nursing for 5-10 years will slow you down your active lifestyle considerably, not to mention kids if you choose to have them. Go talk to someone who is 30 and I think you'll realize that planning as if you will be 21 for the next decade is myopic.
Dr. T

Ok. Based on this post, once again I'm going to add my tupence worth, not beacause I am an expert, but rather due to the facts that I am that person referred to in the quote above because:

1. I had an AVR with a Tissue Valve when I was 23, which only lasted 6/7 years - My reasoning was to continue with contact sport.

2. I am now 30 (years) and have a mechanical valve and do the comaudin/warfarin thing, so far with no trouble and little restrictions

3. Therefore, I can see things and have experienced them from both sides.

Ok I'll try and make this short
Did/Do I regret going tissue and having to face a 2nd OHS, given the fact my valve only lasted 6/7 years?
Absolutely not. If you had asked me this, the day before my 2nd surgery, the answer was exactly the same. Tissue was my only option if I was to continue with my sport.

If my 2nd OHS had of been my 1st (i.e. At 30 years old) would my age have influenced me to choose mechanical to avoid a 2nd OHS at the expense of continuing my sport?
No. To make a prediction on what an idividual might desire (in 10 years time), or be capable of, for that matter is unfair. I still retain the desire to continue playing my sport, but an aortic aneurysm and the prospect of a definitive 3rd OHS persuaded me to give it up. Had my 1st surgery of been 3/4 months ago (at age 30) I would have still went tissue.

I continue to be very active, work 40 hours per week, coach an additional 15-20 hours, getting married next year, but believe me still retain that same desire to play as I did at 23.

The flip side. If I had of been active at 23 but not interested in contact sport, (based on my limited experience so far) would I have went tissue to avoid warfarin?

No. While with-in my range 2.0-2.5, I can honestly say it isn't an issue.
Just my tupence worth from both sides of the fence

 

[Ross]

Hi.
I have read through everything here and I have to say I think your surgeon and cardio. are telling you what you want to hear. The coumadin is not that big a deal. Also, anyone who suggests that you should voluntarily set yourself up for a re-run in the cardiac intensive care unit only says so because they have never had OHS. Your risk of dying from an internal bleed while leading an active lifestyle on coumadin is at least equivalent if not less than the risk of death from a 2nd or 3rd OHS. My surgery was performed by a guy that had done more than 20,000 OHSs at a top 10 facility and specialized in valve replacements and he never even mentioned the option of letting me have a biological valve of any sort. I thought the same things you did. But, take a minute and fast forward to what your life (statistically speaking) will probably look like in 10-15 years. 50-60 hours a week of nursing for 5-10 years will slow you down your active lifestyle considerably, not to mention kids if you choose to have them. Go talk to someone who is 30 and I think you'll realize that planning as if you will be 21 for the next decade is myopic.
Dr. T

T Money this post is unnecessary. It's highly opinionated and lacks facts to back it all up. Your trying to force someone to see things your way and this is not what we want to do. We want to present a person with all of their choices, as we know them, and let the person decide for themselves and with their surgeons. I know I feel like you do, but it's not up to me and cool kid has been presented with choices and he still choses what he wants. That's fine. You or I would not elect it, but it's not our choice. In the future, please find a way to convey your message without it sounding contesting and calling others out on it. We don't need the headaches that these things cause. In the past, I've been as guilty as you are here. I'm trying to bring about peaceful change and how we present our opinions is a very large part of keeping the peace.

 

[MikeHeim]

Hi.
I have read through everything here and I have to say I think your surgeon and cardio. are telling you what you want to hear. The coumadin is not that big a deal. Also, anyone who suggests that you should voluntarily set yourself up for a re-run in the cardiac intensive care unit only says so because they have never had OHS. Your risk of dying from an internal bleed while leading an active lifestyle on coumadin is at least equivalent if not less than the risk of death from a 2nd or 3rd OHS. My surgery was performed by a guy that had done more than 20,000 OHSs at a top 10 facility and specialized in valve replacements and he never even mentioned the option of letting me have a biological valve of any sort. I thought the same things you did. But, take a minute and fast forward to what your life (statistically speaking) will probably look like in 10-15 years. 50-60 hours a week of nursing for 5-10 years will slow you down your active lifestyle considerably, not to mention kids if you choose to have them. Go talk to someone who is 30 and I think you'll realize that planning as if you will be 21 for the next decade is myopic.
Dr. T

20,000 OHS's. That's very impressive. Works out to one per day for a little over 54 years. Assuming, of course, that he has never taken a weekend off or gone on a vacation.

I deleted the rest of my post as I am a firm believer that discretion is the better part of valor.

 

[thecoolkid17]

Hi.
My surgery was performed by a guy that had done more than 20,000 OHSs at a top 10 facility and specialized in valve replacements and he never even mentioned the option of letting me have a biological valve of any sort.Dr. T

That is great that your surgeon has done that many, if he has, but that means if he is good that he has 20,000 patients, meaning he didnt do any reops because they were all mechanical, and has NO idea on who they are and probably never sat down with them one on one and got to know their lifestyle and see what they want out of life. I thank you for your opinon and concern but i don't want to tell myself at 21 that when im 30 i can't play contact sports. I will decide that for myself when i get to that age. As for now i want to live like i'm 21.

And thanks Ross for your comment also, i wasnt sure if i was the only one who took it that way

 

[Lynlw]

T Money this post is unnecessary. It's highly opinionated and lacks facts to back it all up. Your trying to force someone to see things your way and this is not what we want to do. We want to present a person with all of their choices, as we know them, and let the person decide for themselves and with their surgeons. I know I feel like you do, but it's not up to me and cool kid has been presented with choices and he still choses what he wants. That's fine. You or I would not elect it, but it's not our choice. In the future, please find a way to convey your message without it sounding contesting and calling others out on it. We don't need the headaches that these things cause. In the past, I've been as guilty as you are here. I'm trying to bring about peaceful change and how we present our opinions is a very large part of keeping the peace.

Thank you Ross, I'm glad I kept reading before I posted, Lyn

 

[Ross]

Thank you Ross, I'm glad I kept reading before I posted, Lyn

With everyones cooperation on this issue, we shouldn't be having this problem. We can be the forum that were meant to be.

 

[Swede]

Hard decision

Hard decision

Hi Luke,
I got my first AVR done when I was 35 and chose a mosaic - pig - it lasted for six and a half years. I chose it due to a very active lifestyle -running weightlifting squash waterskiing - really whatever kind of sport - it was great having a bilogical valve and no coumadin but after replacing it with a st jude regent i already feel flow is better then before and expect to be in even better shape than 2 years ago when I was back to the same shape as my early twenties.
I wanted performance out of my new valve and my first choice was the ON-X 25mm. I wanted to get as big a diameter as possible and put a priority of diameter vs valve type - I ended up with the StJude regent 25mm due to that the ON-X could not be fitted without pushing to hard. Game plan was decided together with the surgeon and he agreed fully that it was the best way to go - I feel afterwards that it was very good and I am very happy with the performance of the StJude - I am looking forward to running for the first time this weekend - it has been the breastbone heling process that has stopped me from running before.
My feeling is that flow performance is probably more dependent on the surgeons skills than performance in a workbench so I would make sure to find a very good surgeon preferably with experience of different kind of valves.
It is very hard to take a decision but take your time gather information and go with your gut feeling then you will feel good about it.
Swede

 

[HeartPart2]

Yo Luke

Yo Luke

Hey man .... Just to drop my thought your way.. Be young. I just had VRS 4 weeks ago and I went for the porcine valve. Ok, longevity isnt really the factor for the valve but it is for your living experience. I'm 37 years old and the Executive Chef of a well known restaurant, that means lots of knives all the time..... I am not risking a cut on blood thinners man. I dont want to live with the "what if I fall or get hurt " song in the back of my head.... but thats just me man.. Lots to consider for you.. GOOD LUCK BROTHER!!

 

[Ross]

Hey man .... Just to drop my thought your way.. Be young. I just had VRS 4 weeks ago and I went for the porcine valve. Ok, longevity isnt really the factor for the valve but it is for your living experience. I'm 37 years old and the Executive Chef of a well known restaurant, that means lots of knives all the time..... I am not risking a cut on blood thinners man. I dont want to live with the "what if I fall or get hurt " song in the back of my head.... but thats just me man.. Lots to consider for you.. GOOD LUCK BROTHER!!

Another one who's falling for the myth of I'll bleed to death. If you cut yourself bad enough to bleed out 2 pints of blood, your going to the hospital regardless. I slice and dice myself on car parts constantly and you stop the bleeding just like any other time, direct pressure until it stops. People need to lose the term "thinner". Coumadin does not thin the blood or change its viscosity in any way. It inhibits it's ability to clot by a mere few seconds. The more proper term would be "Anticoagulant". People contemplating valves should include Coumadin in their studying. You'll find much of what you thinik you know about it to be laughable. See http://www.warfarinfo.com/warfarinfo.com2.htm

Don't tell Hank the founder of this site about falling and getting hurt, he just jumped out of an aircraft! http://youtube.com/watch?v=MGS4DVpi1xY

 

[OldManEmu]

Choice

Choice

While I have a tissue valve, I would say if I had to make the decision on valve type at 21 and wasn't a female that wanted to have a child then mechanical would really be the only choice. Even if you are in good health other than the valve, once you get beyond your third surgery you really are high risk surgery and if you are in your early twenties this may only be 40 years of age.)
Ross while I know our founder Hank has a mechanical valve and water ski's my cardio?s quote was she has "had two patients that water skied on warfarin and have had bad outcomes". She didn't elaborate on this and I didn't push her. She is the director of specialist services at a major public hospital and is on a number of government medical advisory committees.
My uncle is a farmer on warfarin for non valve issues and can attest to not bleeding to death from cuts and scratches, contact sports and other activities that may involve significant impacts to the body or head are another issue again.

 

[Ross]

Well if you water ski and smack into a boat or a dock, whether your on warfarin or not, your gonna have a bad outcome. Just like jumping out of aircraft, if the chute doesn't open, your gonna have a bad outcome.

 

[OldManEmu]

No Offence

No Offence

Ross I didn't want to cause offence , I was just offering my opinion based on my cardios comments. I only see my cardio every second year as my heart function is now normal. I still see my surgeon every year as he will determine when the next surgery is due. He was pleased with my last echo and CT, my heart function was normal. I will see the surgeon in December 2008 and the cardio in Jan 2009.

 

[Ross]

None taken and I can appreciate the cardio's comments. Bad things can and do happen, but not nearly as much as purported by a friend of a friend who heard if from a friend. You can choose to limit your life as much as you wish, however, after you've gone through surgery, I think you'll find that you want to live life to the fullest, Anticoagulated or not. You didnt have this operation to sit on the sidelines and watch life go by.

 

[Ross]

I think so, but hope we hear soon.

 

[Karlynn]

http://circ.ahajournals.org/cgi/content/meeting_abstract/114/18_MeetingAbstracts/II_791-c

There are cumulative risks with re-operations and cumulative risks with coumadin. The reality is that neither valve choice provides a statistically significant survival rate over the other in the long term.

Coumadin risks are not cumulative. It's been discussed here at length and it just isn't true. If someone is using this as a reason for choosing a tissue, they are being misled. People are free to make their own choices, but our task here is to help them glean correct information.

http://www.valvereplacement.com/forums/showthread.php?t=23172&highlight=cumulative

 

[Karlynn]

The only other thing that I would add is that the article (which I believe we've discussed before) that bicuspidboy refers to talks about "younger" valve patients, but only states they are under 50 years of age. A tissue valve is going to last a fair amount longer in a 49 year old than in a 20 year old. A 49 year old will face less surgery throughout the rest of their life than a 20 year old. It sounds good and adds hope to those who are "younger" and receiving tissue valves, but since the exact ages of the 296 under 50 aren't given we don't know if it even applies to someone that is 20 or so.

Methods: Co-morbid, procedural, and yearly follow-up data were available from 4633 patients who underwent left-heart valve or prosthesis replacement at our institution over the last 35 years. Of these, 1512 patients had 20-year follow-up data, of whom 296 were adults under 50 years of age at their first valve operation. Late outcomes were examined with Cox proportional hazards models.

 

[Ross]

I'm too tired to go searching for papers, but the cumulative thing has been debunked repeatedly. If it were true, all of us would have had a few major bleeds by now and some of us would be dead. We've got people with 46 years of experience on down showing otherwise. If everyone were on the same page in the proper dosing and management of the drug, I'm sure that bleeding events would become nearly unheard of.

Studies and articles are fine, but live experience is a more appropriate finding.