Fundy
Well-known member
I just went through the tissue vs mechanical process decision as you are now doing. Its definitely a decision to be made on a per person and a personal weightings decision. In case it helps, I'll share a bit of my decision.
My story in brief I was basically just short of being severe aortic stenosis from about April 2007(first knowledge) until early October 2011(poor stress echo results) and decision was made to get this fixed sometime in November.(Done on the 16th-home on 21st-yesterday)
First, your never going to get a clear consensus on almost anything, including tissue longevity. My own thoughts from what I gathered from reading forums and websites was that a mechanical would last forever,warfarin wouldn't be that bad, and increased risk from bleeding and stroke is probably not much of a problem. Regarding tissue it seemed that most were only lasting well for 5-7 years if that. Most of those that did go tissue seemed to go mechanical on the reop anyway. And me being 40ish would mean , many many operations in future with increasing operation mortality risk.
So my decision was always a mechanical, with a preference for On-X or St. Jude. However, I basically changed my mind within a week or so of knowing that surgery was definitely coming. I changed it to I think I want tissue but I'm not sure. So I read more posts and sites, asked more questions online, to my cardiologist, and to my surgeon.
The quick reasons why was that I changed my opinion about whether I could handle emotionally and physically, at least two operations. I also changed my opinion of tissue valve durability from about 5 to better than twelve. I feel confident that if twelve for durability than a transcatheter installed valve should be available and at least bridge me for 5-10 years. At that point I would be 65, and another tissue valve may last me the rest of my life. It may be possible that I will never need to use warfarin. ( I screw things up a lot often, so I'm definetely in for at least a few bouts yearly of increased stroke risk with a mechanical). I felt stroke risk for me was a lot higher than total reop risk.
I had the wrong impression that a tissue valve needed warfarin at first anyway. I'm about a week post surgery now and have never taken warfarin yet in my life. My surgeon says with my tissue valve I may not need to, just an 8mg aspirin a day. However, his opinion was that a tissue for me at 45 years old may only last 6 or 7 years. My cardiologist's estimate, if I understand what she told me; is about 15-20, with a good possibilty of trancatheter valve before ever needing another reop. A surgeon from Cleveland Clinic interviewed on Adam Picks site mentions a 44 year old having a 40% reop at 12 years with a tissue valve. So there's quite a range of opinions on how long a tissue valve lasts.
However, immediately after surgery it turns out I had lazy bowel which may have been caused by morphine drugs, and if not it intensified the suffering for the day and a half before they knew what was happening. During this I not only changed my mind back from thinking I could do two or more operations; but I was thinking if this suffering and pain doesn't stop now I'd rather just die. However, things turned around slowly within a day. Then by the time I was off IV and eating solid food, I was feeling quite well. And once again very happy with the choice I made. Considering I was a pack a day smoker right up to the night before operation, things have so far turned out well.
The tissue valve my surgeon actually chose to use was a 23mm St Jude Medical Trifecta. Hope this info can help you out a little in the tough choice you have to make.
So to sum everything up again. i went from early 2007 to Oct 2011 knowing for sure I wanted a mechanical, Oct 2011 to two days before operation thinking I wanted tissue, then chose bovine tissue valve of surgeon's choice. At lazy bowel morphine problem I wished I had chosen not to do operation at all. Within two days, glad I choose bovine tissue of surgeon's choice.
My story in brief I was basically just short of being severe aortic stenosis from about April 2007(first knowledge) until early October 2011(poor stress echo results) and decision was made to get this fixed sometime in November.(Done on the 16th-home on 21st-yesterday)
First, your never going to get a clear consensus on almost anything, including tissue longevity. My own thoughts from what I gathered from reading forums and websites was that a mechanical would last forever,warfarin wouldn't be that bad, and increased risk from bleeding and stroke is probably not much of a problem. Regarding tissue it seemed that most were only lasting well for 5-7 years if that. Most of those that did go tissue seemed to go mechanical on the reop anyway. And me being 40ish would mean , many many operations in future with increasing operation mortality risk.
So my decision was always a mechanical, with a preference for On-X or St. Jude. However, I basically changed my mind within a week or so of knowing that surgery was definitely coming. I changed it to I think I want tissue but I'm not sure. So I read more posts and sites, asked more questions online, to my cardiologist, and to my surgeon.
The quick reasons why was that I changed my opinion about whether I could handle emotionally and physically, at least two operations. I also changed my opinion of tissue valve durability from about 5 to better than twelve. I feel confident that if twelve for durability than a transcatheter installed valve should be available and at least bridge me for 5-10 years. At that point I would be 65, and another tissue valve may last me the rest of my life. It may be possible that I will never need to use warfarin. ( I screw things up a lot often, so I'm definetely in for at least a few bouts yearly of increased stroke risk with a mechanical). I felt stroke risk for me was a lot higher than total reop risk.
I had the wrong impression that a tissue valve needed warfarin at first anyway. I'm about a week post surgery now and have never taken warfarin yet in my life. My surgeon says with my tissue valve I may not need to, just an 8mg aspirin a day. However, his opinion was that a tissue for me at 45 years old may only last 6 or 7 years. My cardiologist's estimate, if I understand what she told me; is about 15-20, with a good possibilty of trancatheter valve before ever needing another reop. A surgeon from Cleveland Clinic interviewed on Adam Picks site mentions a 44 year old having a 40% reop at 12 years with a tissue valve. So there's quite a range of opinions on how long a tissue valve lasts.
However, immediately after surgery it turns out I had lazy bowel which may have been caused by morphine drugs, and if not it intensified the suffering for the day and a half before they knew what was happening. During this I not only changed my mind back from thinking I could do two or more operations; but I was thinking if this suffering and pain doesn't stop now I'd rather just die. However, things turned around slowly within a day. Then by the time I was off IV and eating solid food, I was feeling quite well. And once again very happy with the choice I made. Considering I was a pack a day smoker right up to the night before operation, things have so far turned out well.
The tissue valve my surgeon actually chose to use was a 23mm St Jude Medical Trifecta. Hope this info can help you out a little in the tough choice you have to make.
So to sum everything up again. i went from early 2007 to Oct 2011 knowing for sure I wanted a mechanical, Oct 2011 to two days before operation thinking I wanted tissue, then chose bovine tissue valve of surgeon's choice. At lazy bowel morphine problem I wished I had chosen not to do operation at all. Within two days, glad I choose bovine tissue of surgeon's choice.
