Need to make decision quickly for AVR please help

[MoAVR]

Hi I have just joined this fine community and pleased to say hello to you all

I am currently in hospital in Manchester UK, awaiting AVR and CABGs. 3 weeks ago I suffered a heart attack with raised troponins 60 to 600
Further Angiogram test revealed I had many severly blocked Arteries and my Aortic Stenosis had progressed from Moderate to Severe.

I have been told that wihtin a few a few days I will have OHS to replace the Aortic Valve and to also bypass the various arteries.

My doctors have recommended A tissue valve as I am over 55.

I am 55 years of age, I was diagnosed as moderate AV stenosis, this year has been very limiting as my condition has progressed to severe

I want to go for a Mechanical Valve as I do not want to experiance the last year of failing health again in say 10 years and face another op then.
I also like to cycle to which the consultant mentioned the risk to head damage from falling off my bike is more serious if on anti coagulants for mechanical valve

I have hours to decide which type valve type I chose and want to make an informed decision based on other peoples experiance and knowledge

Can you please help.

 

[pellicle]

Hi and welcome

Can you please help.

So, just tell them as you have expressed it here. The injury issues aren't significant with a well manager INR

Best wishes

 

[Paleowoman]

Hi @MoAVR - what a pickle you are in with so little time. You need some more information from the consultant, for example what kind of tissue valve would the consultant cardiac surgeon use because the latest tissue valve, the Inspiris Resilia is given to people your age and younger and that valve is designed to last longer than the previous generation of tissue valves. I have a tissue valve of the previous generation and mine is now 10 years old and still going strong. Recently someone on the forum with a tissue valve reported that he is 18 years strong with his....but there are no guarantees. On the other hand the cardiac surgeon should take into account the fact that you want a mechanical valve and that you're willing to take the risk with an anticoagulant. Even people with tissue valves can end up on an anticoagulant for various reasons....so no guarantees there.

 

[Paleowoman]

PS - do you know if your failing health is due to your severely blocked arteries or to your aortic valve stenosis ?

 

[LondonAndy]

Hi @MoAVR . I had my aortic valve (mechanical) and one CABG done in 2013, when I was 48. Is it only your age that leads them to recommend a tissue valve, or are there other factors? If no other factors, I would be inclined to agree with you: "one-and-done" seems preferable. That was my view when mine was done, and still is.

As @Paleowoman says, a well managed INR is important. This means regularly (preferably weekly) doing a blood test to check it is in range. The National Institute of Clinical Excellence, which advises the NHS, recommends home testing using a CoaguChek meter, which is very similar to the blood glucose meters used by diabetics, but bigger. See this document for how much better life expectancy is when you do that.

Incidentally, are you diabetic? On statins too? My surgeon said they now think this combination CAUSES the calcification! Joy.

 

[3mm]

risk to head damage from falling off my bike is more serious if on anti coagulants

MoAVR - First, either valve choice is reasonable because either valve will significantly improve your life. You have some work ahead of you as you heal from surgery, but you can do this! Everyone on this forum is here to help you.

Second, if you choose a mechanical valve: with properly managed INR and a GOOD HELMET, a bike accident is not much worse for you than it is for someone who is not taking warfarin. For example, you can carry a medical kit on your bike with bandages, etc., in case of an accident. Also, wear leather palm gloves while biking, so if you fall your hands are protected from abrasion. These issues can be managed.

I pray everything goes well for you! Please stay in touch with the forum as you travel your recovery path.

 

[Martin1962]

Hi MoAVR, I'm in the UK and had my mitral valve replaced last year at age 59. My surgeon at Papworth left the choice of valve entirely to me, thinking that either would be good at my age. I went with mechanical mainly for the same reasons as you. For me I preferred the greater certainty of hopefully a "one and done" surgery. Warfarin hasn't been too bad, would recommend getting your own meter and testing INR weekly or every 2 weeks.

 

[dick0236]

I am 55 years of age, I was diagnosed as moderate AV stenosis, this year has been very limiting as my condition has progressed to severe

I want to go for a Mechanical Valve as I do not want to experiance the last year of failing health again in say 10 years and face another op then.
I also like to cycle to which the consultant mentioned the risk to head damage from falling off my bike is more serious if on anti coagulants for mechanical valve

At 55 I would go mechanical valve and, hopefully, it will be a one-and-done surgery. Doctors are used to treating "senior" patients for valve surgeries.......not young people, like yourself.......and do not see a patient as having a long life in front of them......and having a need for a valve that will last well into the future.

Using "falling and hitting your head" as a primary reason to opt for a short-term fix (biological valve) seems a little silly to me. I can't count the times I have fallen, or been hit on my head over the years with my valve........that's why you wear a helmet. At 55 you have 30-35+ years ahead of you....and you do not want to have heart procedures done when you are my age.

 

[slipkid]

I had a major heart attack at 58. Rushed to hospital by ambulance. Led to almost immediate OHS for double-bypass & at same time they replaced my aortic valve due to what they called "moderate calcification". I don't recall/know my status was with aortic stenosis or not.

This was an emergency situation & I was dying. There really wasn't any time for discussion/research/questions (which you do have a little of) in order to make an informed decision. In the 2 minutes or whatever it was that I had in "discussion" with the surgeon I said I did not want to go on warfarin so give me the other choice he mentioned. He balked. Said "we don't do tissue valves on people your age" (58! and yer "only" 55). More to the story but I awoke with a new mechanical valve.

Seems odd to me that your doctors are using 55 or over as a cutoff for going with a tissue valve whereas with my doctors/surgeon it was kind of the opposite (they didn't mention a distinct cutoff age range but felt 58 was TOO young to go with a tissue valve, that it would fail b4 I died of other conditions). I suppose things may have changed since then (this was in 2014) but I still find it odd. Not wanting to risk another OHS is a huge reason for going with a mechanical valve and if that is your wish I would think they should honor that.

As far as head injuries go, I've had at least 2 very serious ones while on warfarin. No problems (YMMV).

Regardless, one thing to consider in all this is that YOU SHOULD BE FINE once this is all said & done. Don't worry about anything. If I survived OK so can you!!!!!!

 

[Chuck C]

Hi.

I bike, run, box and do Brazlilian Jiu Jitsu and I'm on warfarin with a mechanical valve.

I'm not sure if the UK changed their guidelines, but last I heard they called for people under 60 to get a mechancal valve, so as to keep repeat surgeries at a minimum and to have the best chance at a normal lifespan. It is your choice to make. Your cardiologist and surgeon will not be the ones who have to get a future procedure.

Sorry that you don't have more time to do your homework, but it is a myth that people with a mechanical valve can't live an active life.

Best of luck to you for which ever valve you choose. Please keep us posted.

 

[Chuck C]

On a separate issue, in that you have had a heart attack at a young age and valve disease at a young age, have you had your Lp(a) tested? Lp(a) is causal for early heart disease and is also strongly correlated, and likely causal, for early valve disease. They will be taking daily blood samples while you are in the hospital in recovery. Perhaps you can have them test your Lp(a) at that time or in a follow up visit with your cardiologist.

I doubt you will have the test results back in time before your valve choice, but having elevated Lp(a) is believed, by many who study this field, to lead to faster progression of SVD for bioprosthetic (tissue) valves.

 

[carolinemc]

Hi I have just joined this fine community and pleased to say hello to you all

I am currently in hospital in Manchester UK, awaiting AVR and CABGs. 3 weeks ago I suffered a heart attack with raised troponins 60 to 600
Further Angiogram test revealed I had many severly blocked Arteries and my Aortic Stenosis had progressed from Moderate to Severe.

I have been told that wihtin a few a few days I will have OHS to replace the Aortic Valve and to also bypass the various arteries.

My doctors have recommended A tissue valve as I am over 55.

I am 55 years of age, I was diagnosed as moderate AV stenosis, this year has been very limiting as my condition has progressed to severe

I want to go for a Mechanical Valve as I do not want to experiance the last year of failing health again in say 10 years and face another op then.
I also like to cycle to which the consultant mentioned the risk to head damage from falling off my bike is more serious if on anti coagulants for mechanical valve

I have hours to decide which type valve type I chose and want to make an informed decision based on other peoples experiance and knowledge

Can you please help.

I have a St., Jude's Leaflet and on Warfarin. I live an active life. Nothing slows me down.

 

[MoAVR]

Thank you all for the caring, considered replies

My operation has been delayed, tentavely by 2 days

After more consideration and research I have flip flopped and I am now considering a Tissue Valve!

The main reason for this as well as possile bleeding, I think the chance of a stroke or mini stroke (about 1%) with the mechanical valve out weighs the need for TAVI in say 10 to 15 years with tissue valve replacement.

About 10 years ago as self medication I used to take a table spoon of the spice Turmeric a day , this is also anticoagulant much like Wafarin. We Indians sometimes have a teaspoon! in milk at night before sleep. I had got the dosage wrong but had been taking it for months.
Until one day, I was driving to my house and noticed I started losing sight in one eye! fortunately by the time i had driven straight to the A&E hospital the sight came back. Suffice to say I stopped the self medication of tumeric that day. One of the Dr then mentioned it "could" have been a TIA (mini stroke) that caused this. A scan of the carotid artery showed that the artery was normal.

Thinking back on this I want to avoid TIAs. This is my latest panicy thinking, your thoughts on this will help me.

I know whichever valve they use. I will be in a significantly better situations then now.


Again Thank you all


To answer questions I have been asked earlier:

Incidentally, are you diabetic? On statins too? My surgeon said they now think this combination CAUSES the calcification! Joy.

Just turned diabetic, the GP asked if i wanted the meds as I was borderline I chose yes.
I have been on statins for almost 25 years

PS - do you know if your failing health is due to your severely blocked arteries or to your aortic valve stenosis ?

The Drs have said The reason for the HA was probably blocked arteries, however the reason for feeling weak and exhaustion was probably the severe AV stenosis

 

[MoAVR]

Hi @MoAVR - what a pickle you are in with so little time. You need some more information from the consultant, for example what kind of tissue valve would the consultant cardiac surgeon use because the latest tissue valve, the Inspiris Resilia is given to people your age and younger and that valve is designed to last longer than the previous generation of tissue valves. I have a tissue valve of the previous generation and mine is now 10 years old and still going strong. Recently someone on the forum with a tissue valve reported that he is 18 years strong with his....but there are no guarantees. On the other hand the cardiac surgeon should take into account the fact that you want a mechanical valve and that you're willing to take the risk with an anticoagulant. Even people with tissue valves can end up on an anticoagulant for various reasons....so no guarantees there.

Many thanks Paleo
How do they measure your current valves deteriotion over time? Is there a specific measure for this, i could ask for?

 

[MoAVR]

Hi and welcome

So, just tell them as you have expressed it here. The injury issues aren't significant with a well manager INR

Best wishes

Many thanks this forum is great

 

[MoAVR]

MoAVR - First, either valve choice is reasonable because either valve will significantly improve your life. You have some work ahead of you as you heal from surgery, but you can do this! Everyone on this forum is here to help you.

Second, if you choose a mechanical valve: with properly managed INR and a GOOD HELMET, a bike accident is not much worse for you than it is for someone who is not taking warfarin. For example, you can carry a medical kit on your bike with bandages, etc., in case of an accident. Also, wear leather palm gloves while biking, so if you fall your hands are protected from abrasion. These issues can be managed.

I pray everything goes well for you! Please stay in touch with the forum as you travel your recovery path.

 

[carolinemc]

Thank you all for the caring, considered replies

My operation has been delayed, tentavely by 2 days

After more consideration and research I have flip flopped and I am now considering a Tissue Valve!

The main reason for this as well as possile bleeding, I think the chance of a stroke or mini stroke (about 1%) with the mechanical valve out weighs the need for TAVI in say 10 to 15 years with tissue valve replacement.

About 10 years ago as self medication I used to take a table spoon of the spice Turmeric a day , this is also anticoagulant much like Wafarin. We Indians sometimes have a teaspoon! in milk at night before sleep. I had got the dosage wrong but had been taking it for months.
Until one day, I was driving to my house and noticed I started losing sight in one eye! fortunately by the time i had driven straight to the A&E hospital the sight came back. Suffice to say I stopped the self medication of tumeric that day. One of the Dr then mentioned it "could" have been a TIA (mini stroke) that caused this. A scan of the carotid artery showed that the artery was normal.

Thinking back on this I want to avoid TIAs. This is my latest panicy thinking, your thoughts on this will help me.

I know whichever valve they use. I will be in a significantly better situations then now.


Again Thank you all


To answer questions I have been asked earlier:



Just turned diabetic, the GP asked if i wanted the meds as I was borderline I chose yes.
I have been on statins for almost 25 years





The Drs have said The reason for the HA was probably blocked arteries, however the reason for feeling weak and exhaustion was probably the severe AV stenosis

And as you will learn, many heart issues are genetic and cannot always be prevented, we just live with it and do what we can to survive. Turmeric is good for many things, but not prevent heart issues. So just do as the doctors tell you to survive. You will do fine. And welcome to the club, for we are in the millions worldwide.

 

[Paleowoman]

Many thanks Paleo
How do they measure your current valves deteriotion over time? Is there a specific measure for this, i could ask for?

Hi @MoAVR - they do annual echocardiograms which tell them the pressure gradients of the flow of blood across the valve and check how the valve looks and how heart is doing, the left ventricular ejection fraction and other things.

I was born with a bicuspid aortic valve like many here, at a certain stage I started having regular echocardiograms and they could tell when my valve was deteriorating and needed replacing - I didn't have any symptoms. It's the same with the replacement tissue valve I now have - I have echocardiograms once every year since surgery, and again they are plotting the pressure gradients and also looking to see if the valve is functioning okay...the cardiologist can see the leaflets of the tissue valve, and can also see how my heart is coping.