Trending toward tissue?

[pamela]

Before you delete this post out of hand, m'sieu le Mod, please keep in mind I'm merely addressing the other side of your argument regarding the risk of re-op. I am not trying to be argumentative since I agree with you that each anesthetic increases risk exponentially.

Going tissue lessens the chance of needing coumadin therapy significantly.The following is paraphrased from this article Warfarin side effects at the Mayo clinic site. Anti-coagulant use means your blood won't clot as easily. If you accidentally cut yourself while anticoagulated, you may bleed heavily. You're more likely to have bleeding problems if you're older than 75 or take other medications that can further increase your bleeding risk.

Notify your doctor right away if you experience any of these warfarin side effects:

Severe bleeding
Bleeding from the rectum or black stool
Skin conditions such as hives, a rash or itching
Swelling of the face, throat, mouth, legs, feet or hands
Bruising that comes about without an injury you remember
Chest pain or pressure
Nausea or vomiting
Fever or flu-like symptoms
Joint or muscle aches
Diarrhea
Difficulty moving
Numbness of tingling in any part of your body
Painful erection lasting four hours or longer

Other less serious ACT side effects that you should tell your doctor about include:

Gas
Feeling cold
Fatigue
Pale skin
Changes in the way foods taste
Hair loss

 

[neil]

just proves theres fors and against whatever you choose me thinks,as i say there really isnt a easy decision in choosing,or else there wouldnt be a choice would there,it comes down to the old chesnut,personnel pick, just wish people who have had mech or tissue would back everbody, get fed up of reading people saying if you choose tissue you must be mad to take warferin,and mech saying you must be mad to go through another op,i think we have all been through a lot and bugger the choice we make,whoops sorry for the language lol,........anyway hows everbody easter goin? plenty of eggs?

 

[Old clicker]

Other less serious ACT side effects that you should tell your doctor about include:

Hair loss

I don't think this should be on the less serious side!

 

[Lisa in Katy]

Pamela, Every medicine has potential side effects and warnings. If one person on the medicine experiences something and they can't rule out that it's linked to the drug, they have to list it as a potential side effect. Here's Advil, which most of us on ACT never take:

Warnings

Allergy alert: Ibuprofen may cause a severe allergic reaction, especially in people allergic to aspirin. Symptoms may include:

hives
facial swelling
asthma (wheezing)
shock
skin reddening
rash
blisters

If an allergic reaction occurs, stop use and seek medical help right away.

Stomach bleeding warning: This product contains a nonsteroidal anti-inflammatory drug (NSAID), which may cause stomach bleeding. The chance is higher if you:

are age 60 or older
have had stomach ulcers or bleeding problems
take a blood thinning (anticoagulant) or steroid drug
take other drugs containing an NSAID [aspirin, ibuprofen, naproxen, or others]
have 3 or more alcoholic drinks every day while using this product
take more or for a longer time than directed

Do not use:

if you have ever had an allergic reaction to any other pain reliever/fever reducer
right before or after heart surgery

Ask a doctor before use if you have:

problems or serious side effects from taking pain relievers or fever reducers
stomach problems that last or come back, such as heartburn, upset stomach, or stomach pain
ulcers
bleeding problems
high blood pressure
heart or kidney disease
asthma
taken a diuretic
reached age 60 or older

Ask a doctor or pharmacist before use if you are:

taking any other drug containing an NSAID (prescription or nonprescription)
taking a blood thinning (anticoagulant) or steroid drug
under a doctor's care for any serious condition
taking aspirin for heart attack or stroke, because ibuprofen may decrease this benefit of aspirin
taking any other drug

When using this product

take with food or milk if stomach upset occurs
the risk of heart attack or stroke may increase if you use more than directed or for longer than directed

Stop use and ask a doctor if

you feel faint, vomit blood, or have bloody or black stools. These are signs of stomach bleeding.
pain gets worse or lasts more than 10 days
fever gets worse or lasts more than 3 days
stomach pain or upset gets worse or lasts
redness or swelling is present in the painful area
any new symptoms appear

If pregnant or breast-feeding, ask a health professional before use. It is especially important not to use ibuprofen during the last 3 months of pregnancy unless definitely directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.

 

[zipper2]

Well mechanical and or tissue your all great and hey
i did sign for 2 tissues for my 2nd surgery on jan22nd
my biggest fear was giving up warfarin if i needed to
cus already was on it from 1st surgery 17 years ago.
Ended up i couldn't have the tissue and to me then
and now it wouldn't have mattered which i ended up
with tissue or mechanical........I tried and reason i was
going tissue was because understanding was i couldn't
catch endiocarditios again.......BUT YOU CAN WITH TISSUE.
The warfarin aspect of it has been great to me for all 17 years
stabbed in the butt cheek,stuck biggest len thompson fish hook
in my head .....stitches,stitches i luv painbut never bled
hardly at all and lived through it all to tell you.i'm a warfarin junkie
Whatever decision you make is fine for you and i wish you all
the best with your surgery.

zipper2 (DEB)

 

[Ross]

Before you delete this post out of hand, m'sieu le Mod, please keep in mind I'm merely addressing the other side of your argument regarding the risk of re-op. I am not trying to be argumentative since I agree with you that each anesthetic increases risk exponentially.

Going tissue lessens the chance of needing coumadin therapy significantly.The following is paraphrased from this article Warfarin side effects at the Mayo clinic site. Anti-coagulant use means your blood won't clot as easily. If you accidentally cut yourself while anticoagulated, you may bleed heavily. You're more likely to have bleeding problems if you're older than 75 or take other medications that can further increase your bleeding risk.

Notify your doctor right away if you experience any of these warfarin side effects:

Severe bleeding
Bleeding from the rectum or black stool
Skin conditions such as hives, a rash or itching
Swelling of the face, throat, mouth, legs, feet or hands
Bruising that comes about without an injury you remember
Chest pain or pressure
Nausea or vomiting
Fever or flu-like symptoms
Joint or muscle aches
Diarrhea
Difficulty moving
Numbness of tingling in any part of your body
Painful erection lasting four hours or longer

Other less serious ACT side effects that you should tell your doctor about include:

Gas
Feeling cold
Fatigue
Pale skin
Changes in the way foods taste
Hair loss

I realize your not argumentative about it and I'm not trying to be either. I just want people to really stop and think before they jump headlong into a lifetime of possibilities, however long that life may be. The original poster has already had surgery, so this is more informative for others reading then anything.

Ok let me put it this way then. Surgery in itself is a risk of death. Now tell me, how much is your life worth to you? Is it worth risking over and over again or wouldn't be easier to take a pill, that so many that aren't on it, know so much about? I don't give a hoot what anyone says, each time surgery is done, a little bit more of you ends up dysfunctioning, expenses are incurred, anxiety for patient and family over the entire thing and best of all, no guarantees!

To me, surgery is far more risky then taking a pill that you may end having to take anyhow. Oh yes, I'm well aware of those nice 2nd and 3rd and 4th reop stats, but if your one of the unlucky ones, those stats don't mean jack.

Maybe I was lucky that my first nearly killed me as well as my second. It certainly put things in perspective for me.

Oh yeah, the don't cut yourself, you'll bleed to death thing is just CYA. All of us have cut ourselves pretty good and you stop bleeding just like you always do. If a cut is big enough to be a worry, it would be a worry whether or not your on Coumadin. Even those who aren't on it would be in serious need of help.

 

[halleyg]

Oh yeah, the don't cut yourself, you'll bleed to death thing is just CYA. All of us have cut ourselves pretty good and you stop bleeding just like you always do. If a cut is big enough to be a worry, it would be a worry whether or not your on Coumadin. Even those who aren't on it would be in serious need of help.

I can vouch for this, I cut myself good with a kitchen knife a few months after being on warfarin and it bled a lot and for a long time, but eventually stopped. I went to the ER with it, but would have gone to the ER regardless.. they wrapped it up good for me.. I'm still here

 

[neil]

guys guys,time out,think we agree to disagree on this one lol,look people who have a bad time during ohs sure aint wanna go through it again,i had it fairly easy compared to others on here,and im not exactly looking forward to it again, but also i know of plenty of people who have had 2 or 3 reops and are doing fine,my cardio and surgeon seemed at ease with re ops,to be honest there also seemed fine with going mech,whichever path you take can lead to complications we all know that,lets be honest we are bound to be a touch biased towards whatever valve we pick arnt we lol,or else we wouldnt have picked it,i also know sum people havnt a choice, i think we all take a lot of thought over which valve we pick,it isnt easy,sometimes it maddening to then hear people say you must be mad to pick that one,whichever it is mech or tissue,fancy opting to have a re op done,or go on warferin the rest of your life,well guys at least due to the fantastic cardio and surgeons we have that choice,........right wheres my choclate egg yum yum

 

[Karlynn]

I thought the "Painful erection lasting 4 hours or longer" was a Viagra side-effect?

What's with that? And if it wasn't painful - would that be okay????

With over 17 years on the "stuff" - I can honestly say I haven't had any of the side-effects listed. (Particularly not the painful erection )

My BIL (who is a PhD and taught pharmacology at a prominent local med school here for 15 years) told me years ago that regular use of Tylenol was much more concerning to him than warfarin.

 

[neil]

painfull erection where is this thread goin lol

 

[ChouDoufu]

And if it wasn't painful - would that be okay????

they said 'painful' but neglected to say for whom. your significant other suffers.

 

[tobagotwo]

Surgery in itself is a risk of death. Now tell me, how much is your life worth to you? Is it worth risking over and over again or wouldn't be easier to take a pill, that so many that aren't on it, know so much about?

The point remains that the safety of tissue valves over equal time, including the risks from resurgeries, matches the safety of mechanical valves, including the risks from ACT. The difference is in how you care to take your risks: daily, in small doses, or periodically, all at once. Other than in specific or exceptional circumstances, there is no safety "edge" to either choice.

the surgeon who replaced my valve maintained that laboratory tests of valve function and life only prove the valve can perform as such in a laboratory; its performance when implanted in a human could be quite diferent. so the jury is still out on the new generation tissue valves.

If this were actually a reason not to go with the improved tissue valve which has only been on the market for a few years, it would have been just as valid a reason not to go with the improved mechanical valve (On-X, which that surgeon implanted after making this observation), which has also only been on the market for a few years. Both are supported by lab results and the long-term result of very similar products, and are proving themselves well over time. In fact, lab results and current life results are excellent for both - and the jury is still out for both.

What a person decides to go with (when a choice is available) needs to reflect their view of how they accept risk and whether it is more concerning to them to have later operations and times of decreased ability looming over them, or to deal with the issues that ACT causes on a daily basis in terms of maintaining proper levels, the warfarin ignorance of many practicing medical professionals, and the risks of bridging or witholding for even simple procedures, standard medical tests, or dental work.

Sadly, it's a crapshoot what's going to work best for an individual. Some people sail through surgery. Some even say the second was easier than the first. Some say it was much harder than the first. Some are miserable from surgery, and go through a series of painful reactions, such as pericardial inflammation and fluid, or surgery-caused AFib. You don't know until you do it. And then, of course, it's a bit late to change your mind.

Some people resent the daily routine and requirements of warfarin dosing. Some feel it gives them some control over their heart issues. Some have no trouble at all maintaining an INR, others are all over the map with it, and post for help with an INR of 1.2 or 9. Most have no side effects from warfarin. Some get Purple Toe, constant bruising, or other issues. Some aren't worried about future surgeries, but feel the daily warfarin would always remind them of their heart issue. Some feel instead that the prospect of future surgeries would be looming over them all the time, reminding them of their heart issues.

Activity levels or work done with sharp objects (minor-medium cuts concerns) are not valid reasons to avoid mechanical valves and ACT. A very few, certain professions that produce head or chest crush injuries, such as professional boxing would likely be excluded.

Because the rate of other ACT requirements is low, because other drugs are now displacing warfarin for many other ACT purposes (and a new, antistroke procedure has been approved for those with untreatable AFib), the notion that you may wind up on Coumadin anyway is no longer a valid argument for not going with tissue (not that you can't, but it's an ever- decreasing risk that was never, ever 30% to begin with). It's also canceled out by the fact that a percentage of mechanical valve users eventually require OHS again due to scar tissue (pannus) interference, perivalvular leaks, failure of other valves, or aneurysm repair.

There is just no "attack" position for either valve type that holds water in the end. Which is why it seems silly to poke each other with imaginary sticks about it. There's no winning to be had, other than the person comparing the pluses and minuses of each choice as he or she sees them, and making a decision that will begin the process of moving on with the renewed life he or she will have after surgery.

You takes your pick and you takes your chances. Relate the things you find out about these options to your own lifestyle, your own habits, your own personal demons and angels. Choose your option, and step forward from there.

Be well,

 

[Lisa in Katy]

Bob, where did you hear that the risks are equivalent over time? I've never heard that and it's certainly not what my doctor says now! I'm happy with my mechanical valve, but I never knew there was an option before surgery. Years later (actually 4-5 years ago when I had my wire removal) I asked my doctor why he never mentioned that I had a choice, and he said that as far as he was concerned, at my age (36 at the time), there was no safe choice, and he would not have implanted tissue. Granted, he may have changed his tune with the newer tissue valves, but I don't know.

Again, you make your choice and you live with it, at least for a while. I was always led to believe that repair was the best option because it was "forever", but there are many on this forum who have shown otherwise. Fortunately, or unfortunately, repair wasn't an option for me. I also read an article recently about reversing the Ross, putting the pulmonary valve back where it came from and installing a mechanical aortic. Apparently this is being done more and more because surgeons have decided what they thought was a great option 10 years ago, really wasn't!

As Neil says, no matter what choice you made, it was the best for you at the time, and we have to support it. Everyone has good reasons, no one is crazy!

 

[neil]

bob well put my freind,you put both points of view forward very well,hopefully this will put an end to as you say...pokeing each other over our choice,i could add about the painfull erection but thought better about it when including the word poke lol,

 

[Lisa in Katy]

One more thing, my brother has a mechanical aortic, and it was certainly not the best choice for him. He refuses to take Warfarin, apparently has a death wish, and even "brags" about the 4 small strokes he's had. Of course, there was no way the surgeon knew that he was this stubborn 15 years ago. He didn't ask me!

 

[Ross]

Because the rate of other ACT requirements is low, because other drugs are now displacing warfarin for many other ACT purposes (and a new, antistroke procedure has been approved for those with untreatable AFib), the notion that you may wind up on Coumadin anyway is no longer a valid argument for not going with tissue (not that you can't, but it's an ever- decreasing risk that was never, ever 30% to begin with). It's also canceled out by the fact that a percentage of mechanical valve users eventually require OHS again due to scar tissue (pannus) interference, perivalvular leaks, failure of other valves, or aneurysm repair.

Did I miss this study? Got a linky?

 

[tobagotwo]

Read it at work. I may have a link, as I sent a mess of stuff home that I haven't had time to go through. Basically, there's a little pouch-like area that causes the trouble with clots for those with afib. They now have a way of closing that, so the blood doesn't get a resting place to coagulate in.


Here's one: http://www.bio-medicine.org/medicine-news-1/New-Device-Treats-Common-Heart-Rhythm-Disorder-40913-1/


Best wishes,

 

[COLLEEN S]

I was allergic (hives all over that itch) to the dye in 5mg warfarin. Scared the crap out of me. Got onto the dye free 10mg, been fine with no hives. Just goes to say that even if you think you have thought everything through, life does throw curveballs.

 

[vprnet]

a linky

a linky

Did I miss this study? Got a linky?

Sorry guys I that I did not provide back up my number so here is a quick link.

http://www.onevalveforlife.com/ovflcontenttmp.aspx?section=1&page=3

I know I've read the 30% in several medical journal articles when I was researching the options and if needed I will dig them out for you soon as I can.The number is the composit of Aortic and Mitral.

I also recall reading that the heart does not like to even be touched and that doing so always raises the risk of one of these post operative complications that require warfarin. As far as I know warfarin or some other type of anticlotting drug is used to treat these disorders if they persist after surgery.

BAVR Dec 2009 ON-X 27mm and dacron conduit Dr. L. Girardi. NYP Weill Cornell

PS. I am not a medical professional or a doctor. My comments in this forum are my own opinion and are not intended to be given as medical or professional advise or a recommendation of any valve choice. Decisions that affect your health and wellbeing are ultimately yours and your doctors. vprnet

 

[Ross]

Read it at work. I may have a link, as I sent a mess of stuff home that I haven't had time to go through. Basically, there's a little pouch-like area that causes the trouble with clots for those with afib. They now have a way of closing that, so the blood doesn't get a resting place to coagulate in.


Here's one: http://www.bio-medicine.org/medicine-news-1/New-Device-Treats-Common-Heart-Rhythm-Disorder-40913-1/


Best wishes,

http://stroke.ahajournals.org/cgi/content/abstract/38/2/624

Although present results suggest that LAA occlusion may reduce the long-term stroke risk, available data are still very limited. At present, percutaneous LAA occlusion may be an acceptable option in selected high-risk patients with AF who are not candidates for OAC. The current understanding of LAA exclusion for the prevention of stroke in patients with nonrheumatic AF is the major focus of this review.

Hey, this is like playing badminton! Got to love the internet. For every + found a - can also be found, which is why I don't trust most studies.