Kathy McCain
Well-known member
Ross,
I do prefer wine, but I'll settle for the Select 55, from Bud.
I do prefer wine, but I'll settle for the Select 55, from Bud.
Guess what ? That's right mechanical -v- tissue (with a hint of Ross)
- Thread starter andyabernethy
- Start date
Help Support Valve Replacement Forums:
Thanks Kristen. It was extremely helpful to hear about your experiences. It's incredible that you went two surgeries in the space of a week. I'm really moved by the courage of people on ths site. I will keep you updated how I get on. Lots to decide at the moment and this site is proving invaluable.
hook
Well-known member
I am a newb to this forum, and your avitar is one I love to see pop up. I love the fact that you say it the way you see it. I appreciate your direct approach and honesty. Please keep talking,,,,,, I dig it brother!!! All kidding aside, I can tell you are a leader; your presepctive is honest.
As for the topic; I have a mechanical mitral valve. There is no way I want to do that surgery again; I can tell you those things age you, I don't care what anyone says. This pill is no big deal; just make sure you get set up for a home testing device.
well am sat here beer in the fridge....pizza in oven...so where is everbody?
Ross
Well-known member
My Learjet is down for it's annual inspection.
lame excuse ross.....use your other jet then
Ross
Well-known member
Well ok, but don't laugh at my ride!
Attachments
MarkU
Well-known member
MarkU
Well-known member
This debate of biological vs. mechanical will go on till the end of time.
In simple terms my view is AGE of a patient figures strongly in a decision/recommendation for a mechanical valve in a young fully grown adult....(20-55 years of age would be my reading as little requirement for debate) and I would think that most surgeons would highly recommend mechanical valve in most of those cases, with some few exceptions such as:
underlying other medical condition
chosen profession
bearing children
the decision for mechanical vs. biological does not have to be overly complicated in my view, but will be debated at infinitytum...vive la difference
Gil
In simple terms my view is AGE of a patient figures strongly in a decision/recommendation for a mechanical valve in a young fully grown adult....(20-55 years of age would be my reading as little requirement for debate) and I would think that most surgeons would highly recommend mechanical valve in most of those cases, with some few exceptions such as:
underlying other medical condition
chosen profession
bearing children
the decision for mechanical vs. biological does not have to be overly complicated in my view, but will be debated at infinitytum...vive la difference
Gil
The age is not quite as cut and dry anymore. Many of the leading centers and surgeons, recomend tissue valves for younger (40? and up) it isn't the fact that they only advise tissue valves for older people who will most likely out live the valve any more, like it used to be. Part of the decisions takes into considerration of the risks of REDO compared to the risk of being on Coumadin. Since the success rates of 1st time REDO have improved in the past decade, that plays a role in why many centers are recomending tissue valves now in people younger than 60. (along with longer last tissue valves since they started treating with the anti-calcification ect) That's why many of the people here trying to decide which valve to get are often in the under 60 age group. Since most of the studies show there is no difference in how long you will live wether you choose a tissue valve and REDOs or choose a mechanical valve and coumadin, thats why the decision can be tough for people not very Old or very young.
Ross
Well-known member
They are only just now, beginning to figure out that Coumadin isn't the big ugly monster that they were taught in med school. It's going to take another generation of doctors and surgeons to pass by before anticoagulation is put into it's proper prospective. The world would be a lovely place if our physicians were all on the same page, but they are not. It's disheartening to know that you live in one of the greatest nations for health care, yet there is so much misunderstanding between physicians.
Lyn,
+60 years for biological is the rule of thumb in our region for consideration of biological as recommended by cardiologist and surgeon.
My concern is that there aer folks on the forum in the 20-40 age group considering biological vs. mechanical, because of concern with coumadin and i believe this is just wrong as coumadin and the long term use when appropriately controlled is a lesser compromise than addtionsl replacement surgeries.
That being said, at 57 i am ok with the possibility of an additional surgery if required and only time will tell if my metabolism at my age and with my activities will shorten the time to redo in my lifetime....that part is a crapshoot.
At 57, the 1st recommendation from cardiologist and surgeon both, initially recommended mechanical for me because of age and general fitness and the possiblr likehood of a few more decades of active life...all else permitting.
But if I had been 20 to 50 years of age, my valve preference would likely not have been the same and this is before factoring the economies of a costly surgical intervention...many $, plus loss of income + risk....wow that is a lot of consideration vs. anti-coaulation therapy....especially when home monitoring can be done.
Gil
+60 years for biological is the rule of thumb in our region for consideration of biological as recommended by cardiologist and surgeon.
My concern is that there aer folks on the forum in the 20-40 age group considering biological vs. mechanical, because of concern with coumadin and i believe this is just wrong as coumadin and the long term use when appropriately controlled is a lesser compromise than addtionsl replacement surgeries.
That being said, at 57 i am ok with the possibility of an additional surgery if required and only time will tell if my metabolism at my age and with my activities will shorten the time to redo in my lifetime....that part is a crapshoot.
At 57, the 1st recommendation from cardiologist and surgeon both, initially recommended mechanical for me because of age and general fitness and the possiblr likehood of a few more decades of active life...all else permitting.
But if I had been 20 to 50 years of age, my valve preference would likely not have been the same and this is before factoring the economies of a costly surgical intervention...many $, plus loss of income + risk....wow that is a lot of consideration vs. anti-coaulation therapy....especially when home monitoring can be done.
Gil
For what its worth...i was a newbie here 6 weeks or so ago. The people here gave me invaluable information and it was based on personal experience, not just what the medical textbooks said heart surgery would be like. I thought long and hard as to what valve i wanted to receive. I chose a St Jude valve and have never looked back or second guessed myself. I agree with Ross that this is a surgery I would only want to go through once. I take 2.5 mg of coumadin a day and do not notice ANY difference in how i feel....How i live or how i eat. Having one extra pill to take in my daily regimen is a minuscule addition. My INR is very stable and knowing that with the mechanical valve I have low odds of ever needing it replaced, I feel very happy I chose my St Jude valve. As far as the sound, I was very concerned because i need a quiet environment to fall asleep. I can hear my valve at times but night time is never a problem. Especially when I sleep on my left side, I don't hear even a hint of my valve. Valve choice is very personal as it was to me also. It did help me to hear from people who had already gone through their valve replacements and know what their concerns were. I would never presume to know what was best for another person, but if I was asked, in regards to choice of valve, associated sound and living on coumadin, I would highly recommend a mechanical valve. But that's just my opinion. I pray for all those yet to go through their surgery that they will make the right choice for themselves. After all, we are all just here to help and support each other. Lots of heartfelt hugs.....Michael
Gil, thanks for this post and obviously, I agree. When I first joined this Forum a couple years ago, I was puzzled over some of the reasons for dismissing mechanical valves as a viable valve choice, such as the "noise:confused2: factor and an unreasonable fear of the drug warfarin. If I had to have my valve replaced today, and it is becoming increasingly unlikely, I probably would choose a tissue valve, in order to not fool with warfarin as a senile senior:tongue2:. That said, I very happy that I've lived my life knowing I was not facing OHS multiple times. Mechanical valves do not guarantee no further surgery, but it has been comforting over the years knowing that future surgeries would not be a certainty. This Forum has been good at debunking many of the "old wives tales". Valve choice is a BIG deal and should be made after considering all the relevant issues but none of BS reasons.
BTW, from what I read here, surgical and hospital procedures seem not to have change all that dramatically since I had this done, so the chance that it will become an "outpatient type" :wink2:
procedure in the next few years seems unlikely:tongue2:.
Dick, if I am reading your case appropriately, you have had 43 years on your mechanical valve + as a further consideration, when your surgery was done in 1967, you would have been an early adopter, at the ripe old age of 31 in 1967.
For the young age newbies, your case study kind of says it all and to top it off, if a valve redo was required you would do mechanical all over again at age 74...now that is an attestation.
From what i have read on the forum and to my knowledge, i have seen 2nd AVR replacing a bio with a bio or replacing a bio with a mech.....I have not seen or heard of a mechanical valve replaced with a bio valve.
Has anyone heard of the last, where a defective mechanical valve was replaced with a biological valve in a 2nd or 3rd AVR or MVR surgery?
As an add on, i have been on a 5mg daily coumadin dose daily, since surgery, which has produced an INR varying between 2.3-2.8 including my binging on greens and vitK foods and such. Coumadin program is therefore a non issue in my case and this would have been nice to know better before surgery...so my fear of coumadin is gone, but in my case coumadin will likely be replaced with a baby aspirin in next few weeks. What i mean to say is that if a coumadin regime was required for life for me, it would not be a big deal either, especially with home testing capability.
Gil
Gil about this part.
Dick, if I am reading your case appropriately, you have had 43 years on your mechanical valve + as a further consideration, when your surgery was done in 1967, you would have been an early adopter, at the ripe old age of 31 in 1967.
For the young age newbies, your case study kind of says it all and to top it off, if a valve redo was required you would do mechanical all over again at age 74...now that is an attestation."
Dick said "If I had to have my valve replaced today, and it is becoming increasingly unlikely, I probably would choose a tissue valve, in order to not fool with warfarin as a senile senior"
I know a few people who chose mechanical when they were younger, with the thought IF something happened and they needed that valve replaced when they were older, they most likely would get tissue since, Most of the problems with coumadin happen in the "elderly" (over 65 is considerred elderly as far a medical) because they often have frailer arteries/viens, many elderly also have more brittle bones ect and many have other problems that happen more often in people who are older, that can be (not necessarly) complicated by also being on coumadin.
Most people I know of that have a mechanical valve replaced with a tissue valve usually is because they need the valve replaced because of BE. But I know of a few people who had mechanical valves that needed replaced and chose a tissue valve, for various reasons.
Dick, if I am reading your case appropriately, you have had 43 years on your mechanical valve + as a further consideration, when your surgery was done in 1967, you would have been an early adopter, at the ripe old age of 31 in 1967.
For the young age newbies, your case study kind of says it all and to top it off, if a valve redo was required you would do mechanical all over again at age 74...now that is an attestation."
Dick said "If I had to have my valve replaced today, and it is becoming increasingly unlikely, I probably would choose a tissue valve, in order to not fool with warfarin as a senile senior"
I know a few people who chose mechanical when they were younger, with the thought IF something happened and they needed that valve replaced when they were older, they most likely would get tissue since, Most of the problems with coumadin happen in the "elderly" (over 65 is considerred elderly as far a medical) because they often have frailer arteries/viens, many elderly also have more brittle bones ect and many have other problems that happen more often in people who are older, that can be (not necessarly) complicated by also being on coumadin.
Most people I know of that have a mechanical valve replaced with a tissue valve usually is because they need the valve replaced because of BE. But I know of a few people who had mechanical valves that needed replaced and chose a tissue valve, for various reasons.
Received my mech valve a few weeks before I turned 47. Surgeon in Montreal would have given me a tissue if I wanted it, but I knew that my desire to try to limit surgeries was greater than my initial desire for a tissue valve. C'est la vie.
Lyn,
you are absolutely right on the above, I misread the positioning of "unlikely" and therefore misquoted Dick on what he wrote..
My point though: if the patient is less than let's say 50, would mechanical not be the better option in most cases, for the possibility/probability of a single surgery, taking into account that the downside to mechanical is a requirement for a coumadin regime for life, with a life expentancy normally approaching 80 in North America?
Know that the patient survival time overall by studies of biological and mechanical recipients is similar, but the statistics do not take into account the time, stress and expense of multiple surgeries, which is very likely to happen in a young patient when biological valves have a 1 to 2 decade lifespan. Believe studies as well describe a probable more rapid degradation of a biological valave in a young patient, because in simple terms, the immune system is more active when the patient is younger, casuing more rapid wear on the prosthetic biological valve.
A Coumadin regime seems a small tradoff in comparison to the hassle of a probability of multiple surgeries for a young individual, in my view and therefore suggesting biological as the 1st choice for a young patient, may actually be doing them a disservice, if there are none of the other reasons for choosing a biological
Lyn, do we agree to disagree?
Gil
Nancy
Well-known member
As you mentioned Lyn, re: seniors "many have other problems that happen more often in people who are older, that can be (not necessarly) complicated by also being on coumadin"
Those "other" problems which can and often do happen to folks who are older, have the potential to stop further surgeries of any kind dead in their tracks, Coumadin or not.
That was the case with Joe. He had many "other" co-mobidities, and he was told that he would no longer be able to have heart surgery. And he needed to have it done. Coumadin was not the issue here at all. The docs could have handled that very, very well.
We have other members who have been told something similar.
Some of the most difficult problems is with the multiple reops themselves.
And we also have members here who have been told of those difficulties by their surgeon, as was Joe, re: scar tissue and adhesions.
Those "other" problems which can and often do happen to folks who are older, have the potential to stop further surgeries of any kind dead in their tracks, Coumadin or not.
That was the case with Joe. He had many "other" co-mobidities, and he was told that he would no longer be able to have heart surgery. And he needed to have it done. Coumadin was not the issue here at all. The docs could have handled that very, very well.
We have other members who have been told something similar.
Some of the most difficult problems is with the multiple reops themselves.
And we also have members here who have been told of those difficulties by their surgeon, as was Joe, re: scar tissue and adhesions.
