Surgery date set for my 2nd OHS, going mechanical this time

[cewilk]

Met last week with my surgeon and we agreed on a surgery date of 15 January 2015. I had a Ross Procedure in July 2012 which didn't hold up and now I feel the right thing to do this time is go mechanical due to my age (26) and making the best potentially 'long-term' choice. I am also getting my ascending aortic anuerysm fixed.

The mech valves he uses are the St. Jude's and ATS. I've read some very positive things about St. Jude's but haven't seen much on here about ATS. According to my understanding they are all fairly similar.

Anyone have any advice for the second time around? Was it easier the second time, about the same, or worse? Also, anyone have a St. Jude's or ATS mech valve and if so how's it treating you?

I'm not happy about having to be on anti-coagulants, but I am ready to get this over with and hopefully never have another OHS again.

 

[mainframe]

Hi Cewilk

St. Judes is probably the most popular mechanical valve there is. Well proven and used extensively. For my second, my surgeon suggested a Carbomedics for me, so that's what I went with. At the time I was more concerned with choosing the right surgeon and letting him decide what to use.

I think experiences for the second surgery vary widely from "it was easier than the first" to "it was touch and go and I was in the hospital for months". O.K. just two :<)
If you go into the surgery relatively healthy most people don't have any more compilications than the first.

For me anticoagulation hasn't been a big deal, but then I was 53 when I had my second surgery. I hope you find it a non issue like I have.

Good luck with your surgery.

 

[tom in MO]

I have a St. Jude. No problems within the last two years. My INR range is 2-2.5 it was originally 2-3 for this valve, but has been tightened based upon experience. I did some research on my model, 23AGFN-756, at the FDA website and found only one reported failure.

 

[IronmaninTraining]

cewilk,

just curious....what happened with your initial ross. Was the root not wrapped during the first OHS?

 

[pellicle]

Hi

Met last week with my surgeon and we agreed on a surgery date of 15 January 2015..... I am also getting my ascending aortic anuerysm fixed.

that's a good point to have fixed. I was going to ask when I read your title if you were looking into this as aneuysm is one of the causes for need for reop - and as far as I know common in Bicuspid Aortic Valve patients (I don't know if thats genetically related or just hydraulicly related)

The mech valves he uses are the St. Jude's and ATS. I've read some very positive things about St. Jude's but haven't seen much on here about ATS. According to my understanding they are all fairly similar.

I have the ATS and knew little about them and I'd read here about the On-X. My surgeon had a preference for the ATS valve as that was approved for use in Australia with a pre-attached aortic artery tube simplifying surgery. The differences as I understand it between (ATS On-X and St Jude) is in the details like hinge system pivots, sewing rings and (so called) pannus inhibition strategies.

I have read there are some subtle differences in the haemodynamics of the opening and closing of the valves. Just like some tap spigots which you turn off there is a small high speed jet created at the moment of opening and closing (due to the pressures). I have read some tests which suggest that one valve works better on opening and the other on closing. You may wish to read "Comparison of the Hemodynamic and Thrombogenic Performance of Two Bileaflet Mechanical Heart Valves Using a CFD/FSI Model"

However I suspect that the advantages are minor. The ATS valve is in name no more as it was acquired by Medtronics. So you may wish to google that. Your surgeon is probably calling it by the old name out of habit.

Was it easier the second time, about the same, or worse?

My experience of my 2nd time round was when I was 28. I recall that it wasn't too bad and in fact that I remember so little about it suggests that it went pretty well. My biggest issue was in restoring my fitness which I did gradually after surgery to at 2 years after surgery was able to "climb hills" on my bike (long ones) to be fitter than I ever was personally before.

When you are on AC for a while you may wish to poke around my blog posts on warfarin management strategies :
http://cjeastwd.blogspot.com/2014/05/inr-management-goldilocks-dose.html
http://cjeastwd.blogspot.com/2014/09/managing-my-inr.html

don't be surprised if it takes you a few months to get comfortable with it all. Its what I call the "Rachel Hunter Principle" it won't happen overnight, but it will heppin. (she's a Kiwi and that's an Aussie joke)


Best Wishes and I hope you have a smooth recovery.

 

[cewilk]

cewilk,
just curious....what happened with your initial ross. Was the root not wrapped during the first OHS?

So when I had the Ross Procedure in July 2012 I had a follow up echo with the surgeon about a month after which had pretty normal results for a one month post op patient. Around October 2012 I was pretty much back to easing in to all my normal activities which included moderate to heavy weight lifting, running (minimum 3 miles), sprints, and helped several people move so lots of heavy furniture lifting. In January 2013 I began a pre-deployment training workup in preparation for Afghanistan so I was pretty busy with 6-7 months worth of training exercises. Then in July 2013 I deployed and came back shortly after the New Year 2014. The entire year of 2013 I was away from my cardiologist, but I never was having any major issues (or at least that's what I mentally convinced myself).

I saw my cardiologist for an echo one month after arriving back in the US in February 2014. Echo still showed some LV enlargement, moderate aortic regurg, and an even larger ascending aortic anuerysm. He obviously was surprised that the echo wasn't too good and said to come back in 6 months and do another one. So my last echo this past October was even worse. Now back to severe aortic regurg and a slightly larger LV and aortic anuerysm. So that is when he determined that my Ross Procedure was not effective. Apparently my pulmonic valve(now in my aortic position), has a leaflet that prolapsed and is allowing worse aortic regurg, which of course is effecting the LV and my aortic anuerysm.

 

[TheGymGuy]

Hey cewilk,
This sucks a little about Ross not taking, but thats the hand we are dealt sometimes. Man, it did allow you to be deployed and train hard, etc., so its a big plus.
From what I recall, ATS, St Jude, and On-x are all byleaflet with very similar properties. My surgeon wanted to use St. Jude as he was used to using those. Really, most byleaflets appear the same to me.

Good luck with 2nd OHS, it will be just fine. Also, life on coumadin is basically same as life not on it, at least for me. I take Vit. K in the AM and PM to keep K supplies topped off and variations in K intake from natural sources does not seem to affect me much. Of course I stay away from super dark leafy greens, but thats ok with me.

 

[Leah]

I have an ATS & I am very happy with it. I can hear it tick, but its pretty quiet & doesn't really bother me. The only time I have had issues w/ Coumadin is when I am sick...it always seems my levels are off if I have not been feeling well. I have 2 little boys & my immune system sucks. I just take my meds, test once a week, adjust my dose if I need to & go about my business