I'm new to the site and having AVR surgery May 30th at Brigham and Women's Hospital in Boston, MA and my surgeon is leaving the valve choice up to me. One minute I'm positive I want a mechanical and the next minute I want a tissue valve. It's the coumadin that is making this so hard for me. I hate taking medication and I also hate the thought of hearing my valve tick all the time. Is it that loud that you can hear it all the time? On the other hand, I don't want another surgery in ten years. It's such a hard choice, thank you to everyone who has posted their thoughts and reasons for selection.
Valve Selection
- Thread starter Kristen
- Start date
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Boston Tiger
Well-known member
I went through the same process (and at the same hospital) about two years ago. I kept changing my mind all the way up until I was admitted, and chose to go with tissue if a replacement was needed (it wasn't). Like you, I was really concerned about taking the coumadin for life, but it really doesn't seem to be that much of a problem for the people on the site who have to take it. I've been taking another set of medicine (the beta blocker toprol) daily since my operation even though I had a repair, so there's no guarantee that you won't have a medicine regimen if you choose tissue.
Feel free to PM me if you have any questions about the Brigham. The care I received there was fantastic!
Feel free to PM me if you have any questions about the Brigham. The care I received there was fantastic!
Hi Kristen. You will find this forum very useful in helping you come thru this surgery. There will be many who have recently gone thru the surgery and they will come along to give you their input. I went thru it a long time ago and a lot of my experience may be of little help to you. However, FWIW, coumadin/warfarin for me has not been a big deal. It interferes little with my life or lifestyle. It does require a simple dosing regimen which most people handle with little difficulty. The ticking of the newer valves is something I know little about...but I have a 2nd generation mechanical valve that I have not heard in years....and years. Peopl standing next to me can't hear it either. From what I have heard, the ticking of the newer valves is an annoyance that goes away not long after surgery. Unfortunately, mechanical and tissue valves have their pluses and minisus. All you can do is educate yourself and make the decision that best suits your life and lifestyle.
TheGymGuy
Well-known member
It ticks, but not too loud. I can hear it in complete silence, but I enjoy the soft tick and make it a game to count heartbeats sometimes. People say it gets quiter over time, I can only hear mine when go to sleep and wake up. Most other time any other noise drowns it out.
Kristen,
Welcome aboard! It is normal to keep changing your mind from one minute to another. I made my decision only four days before my surgery!
As for Coumadin, I got used to taking it and to adjusting the dose (very rarely) the same way I got used to taking and adjusting my Synthroid!
Though I am a very sensitive person to noise, and although the ticking was a big concern to me, I decided to take the chance on the ticking! Luckily, I hardly hear my valves' ticking, and whenever I do (which is very rare and mostly after a long tiring day), the ticking is not a *noise* ... It is soothing and a pleasantly reassuring *companion*!
Good luck with your choice.
hi and welcome aboard, how old are you kristen? its a tough choice but for me tissue was the way to go, didnt fancy anti coags and the problems that may occur with them, new tissue valves can last 15 to 20 yrs so there say and even mechs have no quanantee with them, saying all that some people love there mechs and have no problems at all, do your homework and pick your choice, and remember it will be the right choice for YOU,
I'm deep in the mental anguish of choosing the material for my AVR scheduled for June 6th. After reviewing (almost DAILY) everything I have read about this issue on this forum and other sources I am convinced that mechanical is a no brainer - it doesn't wear out and the biological valve is guaranteed to slowly degrade until it requires another OHS to replace. Then I start reading the zillions of opinions on the anticoagulation section of this forum and they go on and on and on about all their worries, and costs, and inconvenience of frequent blood tests, and are the tests too infrequent, and are home testing devices accurate, and is the blood letting technician competent and on and on and on and I decide to go biological....then I wake up in the morning an decide that I don't want to go through breast bone cutting, rib splitting surgery more than once!
I've also read where 50% of people who choose biological valve jobs end up on lifetime warfarin!!! AAAGGGGggghhhh!! :eek2:
Tom
MarkU
Well-known member
Valve selection is very much an individual decision; you have to do what you think is right for you. You're doing the right thing in researching the issues and asking for opinions.
Personally, I chose a mechanical valve in order to minimize the need for future surgeries. I've been fortunate that Coumadin has not been a big issue for me.
Looking back, I have no regrets. I think I made the the right choice for me at the time.
I do think that my decision might be tougher today than it was 11-1/2 years ago due to the advances in tissue valves in that time.
At the end of the day either choice is a good decision if it extends and improves the quality of your life.
Good luck to you.
Mark
Personally, I chose a mechanical valve in order to minimize the need for future surgeries. I've been fortunate that Coumadin has not been a big issue for me.
Looking back, I have no regrets. I think I made the the right choice for me at the time.
I do think that my decision might be tougher today than it was 11-1/2 years ago due to the advances in tissue valves in that time.
At the end of the day either choice is a good decision if it extends and improves the quality of your life.
Good luck to you.
Mark
Thanks for the confidence builder Mark. But even with the advances in tissue valves they still do not last, they all must be replaced!! This is why I'm leaning mechanical. It just grinds me that my OEM valve lasted nearly 63 years but a new tissue valve will only last 5 - 15 years before it is guaranteed to start degrading and must be replaced.
Tom
I too had trouble with my decision. I decided to be positive, assume all would go well and shut out all but the two major issues to me. Mechanical = no redo of valve Tissue = no warfarin. When I boiled it down that way, it was easier to choose...however I had remake the choice about every other day 
Don't worry either choice is for life.
Don't worry either choice is for life.
Tom, I don't think it's accurate to state or guarantee that a tissue valve will degrade in 5-15 years in a 63 year old recipient. I received a tissue aortic valve in 2005, at the age of 53, and seven years later it's going strong. My surgeon at the time said he was confident I would get at least 12 years usage, possibly 15-20. If I were receiving one at the age of 63, I would be pretty confident that it would be my only one.
agree with duffey,and tom where did you get 50 per cent of tissue valves finnish up on anti coags? never heard that one before, its a tough choice for some,for me it was easy,do you homework make your choice and dont look back,
kfay
Well-known member
Tom, Im chiming in with the others about your statics you are quoting, I've never heard 50 percent of us with tissue valves wind up on Coumadin either, although most of us are on it for a short time immediately after surgery, and if at the age of 63 you only got 5 years out of a tissue valve, you have to be an incredibly unlucky person.
Kristen, you didn't say how old you are and if having children is a consideration or not, but if so, that should have a big role in your decision. It is certainly much easier and safer for mother and baby to do that with a tissue valve. If that isn't a consideration, then it truly is a personal choice that should be made with your loved ones and your dr.s who know your medical condition best.
Kristen, you didn't say how old you are and if having children is a consideration or not, but if so, that should have a big role in your decision. It is certainly much easier and safer for mother and baby to do that with a tissue valve. If that isn't a consideration, then it truly is a personal choice that should be made with your loved ones and your dr.s who know your medical condition best.
Les Hazelton
Member
I had not made up my mind even as I went to bed the night before surgery! I woke up realizing that if I chose tissue, that I might start counting the days down to a future surgery. So I decided I can more actively deal with the anti-coag regimen. It's only been 3 weeks tomorrow since surgery (not a bad experience for me) and I am stable and still have a beer or glass of wine when I want. I am at peace with my choice. You will be too. Very best to you.
Kristen, as 45 is young in "valve age", your choice is truly a bit harder. At 52, I had a hard time deciding, but ended up tissue. Your age puts you close to potentially 2 more surgeries with a tissue......maybe. I am working up in Waltham, Mass. often...let me know if you'd like to meet up and talk.
Kristen, the noise of the valve has been a non-issue, as seems to be the case with most with mechanical valves. A soft tapping that I only hear when its real quiet. The Coumadin has been pretty insignificant in terms of side effects. Once I got on home testing it was much simpler and easier. The statistic someone quoted about 50% of tissue valvers going on Coumadin seems high though - think its more in the 25% range or 30% at most. However, I would bet that some of those that got tissue valves to avoid Coumadin and then ended up on Coumadin anyway are regretting their choice.
What I remember about my experience was how close I came to dying and how debilitating the surgery was. As a fitness buff, it took me a year to get back to near 100% of the fitness level that I was at before the surgery. The relative freedom from reops with mechanicals provides a psychological boost. I have good insurance so the cost (mine was $112K) could be a consideration for some, not to mention the downtime during and after the surgery. I think its a lot easier taking Coumadin than it is going through open heart surgery - don't ever want to go through that again.
Good luck whatever you choose.
What I remember about my experience was how close I came to dying and how debilitating the surgery was. As a fitness buff, it took me a year to get back to near 100% of the fitness level that I was at before the surgery. The relative freedom from reops with mechanicals provides a psychological boost. I have good insurance so the cost (mine was $112K) could be a consideration for some, not to mention the downtime during and after the surgery. I think its a lot easier taking Coumadin than it is going through open heart surgery - don't ever want to go through that again.
Good luck whatever you choose.
Jkm7
Well-known member
There is no way to predict who will have a louder ticking vs quieter valve. The shape and size of the body is not a factor. My surgeon told me he had placed mechanical valves in petite, extremely lean ladies and some had very quiet valves whereas he said some large, barrel chested men had loud valves.
I chose tissue valve with very little angyst. I knew that for me, that was the best choice. It has been a little over four years since and each day I am so grateful I chose tissue valve.
In the end, the only bad choice is to not make a choice. Whichever valve you choose, don't look back. It will be the right one for you.
It's very hard for some to make this decision.
Almost all surgeons leave the choice to the patient. It is rare to read of one who does not.
I also disagree with whoever it was that said 50% of tissue valvers end up on coumadin. I question the accuracy of that statement.
I chose tissue valve with very little angyst. I knew that for me, that was the best choice. It has been a little over four years since and each day I am so grateful I chose tissue valve.
In the end, the only bad choice is to not make a choice. Whichever valve you choose, don't look back. It will be the right one for you.
It's very hard for some to make this decision.
Almost all surgeons leave the choice to the patient. It is rare to read of one who does not.
I also disagree with whoever it was that said 50% of tissue valvers end up on coumadin. I question the accuracy of that statement.
TheGymGuy
Well-known member
This is a tough decision indeed. Home testing is not all bad once you get your device. This forum has shown many times that this is not an issue for most. I cannot wait to get my device so that I can test as often as I want. Ideally, once a week, but if I feel like wasting money I could even test twice a week. Staying in range is very easy as there are easy formulas to follow for this.