Facing AVR Surgery- Which Valve?

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J

jeffreyjl

Hi Folks,

I'm new to the forum and have started to read the postings to this thread.

I'm a 57yr male just recently diagnosed with a congential bi-cuspid aortic valve. The heart has started to enlarge, so my cardiologist has recommended the replacement be done within the next few months. He recommended a mechanical heart because of my age and its durability. I received a second opinion and he recommended that I look at the tissue valves also. I'm in excellent health with no symptons but a murmur was detected at my recent checkup. This was confirmed with the echocardiogram.

I'm leaning toward the bovine biologic valve since I am pretty active but the prospect of a second surgery, even 15 years from now has to be considered.

I'm currently being treated at Kaiser Permanente in San Francisco, where they do most of the cardiovascular surgery for Kaiser in Northern California.

I have only spoken to 2 cardiologists so far. I have not talked to any surgeons yet. I will let folks know of my progress after my next meeting with my doctor on Monday.

Cheers,

Jeff
 
Welcome!

Welcome!

Hi Jeffery,

Welcome to this increidable forum and the wealth of Knowledge that comes with. I to have been diagnosed with a bicuspid aortic valve and will need to have it replaced soon. The people you will meet in VR.com are absoultly the best and will help you with all your questions and concerns. It is truley like a family.

I have sent you a Private message but wanted to welcome you to the group.

WE are all in this together.

Regards,
Jay
 
Welcome to the forum, Jeff. You will probably want to read the threads on valve selection before you discuss which valve with your cardio or a surgeon. You are at that age where the choice is difficult, but we like to say that once you make decision, it is always the right decision. Best wishes to you as you make this journey and I hope you find lots of support and help here.
 
Jeff - don't be surprised if the opinions of surgeon and cardio differ greatly. I think (I could be wrong) that most surgeons will recommend the tissue valve. Especially if you are pretty active. I remember watching a lengthy video that someone presented here on the forum that covered the operation in graphic detail -- done at one of the better known hospitals in Texas. And I think the surgeon who was discussing the operation was quite well known. Anyway, he made no bones about it -- go with the tissue valve.
 
Aortic valve Repair

Aortic valve Repair

Hi all,

I just found this site,wow what a wonderful site! I am a 33 year old male and i just had the aortic valve repair by Dr.cosgrove at the Cleveland Clinic
in june of this year. Surgery went great and the recovery time was remarkable. Goodluck to all that has to have any type of open heart surgery! My 8 yr.old son is so happy to have his dad back playing ball with him again too :)

Bobby
 
Which Valve?

Which Valve?

Hi Bobby,

Glad to hear that it went well. What type of valve did you choose? How did you decide?

Thanks,

Jeff
 
Welcome Jeff!

I too, along with several others on this site had (some may still have) a
congential bi-cuspid aortic valve, I was not having symptoms. However, I was being monitored every 6 months. It was inbetween those checks when I found out my valve had gotten to so bad that is was time for it to be replaced.

Karl
 
Welcome! I am 7 months post-op, 52 year old female. I chose tissue for many reasons, and my surgeon who was the same age said it was the exact valve that he would go with were he on the table. I have no other known health issues and was willing to take the gamble that this heart may well last me my lifetime. But truly.....it is a gamble.

You really have to look into yourself and decide what your choice will mean for your life and lifestyle. Going mechanical definitely has its advantages as no one wants to line up for another OHS real soon!! Tissue has advantages, too, but for many.....just not enough.

I think it is important to find a surgeon who is very familar with your procedure, and is very familiar with the valve you are choosing. SFO has state of the art hospitals, so I'm sure you will be in excellent care.

I hope you will take some time to peruse the many, many threads here on valve choice. There is a lot of good info and tons of emotion!! :) Good luck in your decision making and keep us posted.

Marguerite
 
Welcome to the Forum, Jeff.

My surgeon presented me a range of options for a replacement valve, but left the choice entirely to me. My cardiologist didn't make a valve recommendation; his chief concern was that I have the Bentall's done promptly because my heart was enlarging at a scary rate.

The valve was a tough decision for me. I was 63 at the time of the operation. I wound up going tissue (porcine) for a variety of lifestyle reasons but I certainly respect the views of those who argue for going mechanical and thereby lessening the chances of a re-op.

I think you'll get a good sense of the pros and cons if you read the past threads on valve choice. Ultimately, it'll come down to what you are comfortable with. Go with that, and don't look back. Any decision you make will be better than the status quo.

All best wishes to you,
 
I am 52, about 3 1/2 months removed from Aortic valve replacement. I also had most of my ascending aorta replaced. This was my second surgery, as I had the bicuspid valve repaired 47 years ago. My cardiologist never even mentioned a tissue valve, my surgeon talked mainly about the tissue valve. In the end it was my choice to make. I decided that some of the things that go with a mechanical vavle were things I did not want to deal with, such as coumadin, and the noise issue. Added to that the fact that the new generation of tissue valves are showing them to be still going at 20 years. I figure the technology in 20 years or 25 or when ever the tissue valve might have to be replaced will make replacement a much easier thing in the future. Its a gamble sure, but I went with the Metronics Freestyle valve. That valve is stentless which should make replacement easier in the future.
No guarantees on either type of valve not having to have future surgery. Read all you can, decide which is right for you then relax and get ready for surgery and life after. Once you make the decision on the valve you will feel a ton of weight off your shoulders. I can say I feel as though I have come through with flying colors. This week I raked, hauled and burn leaves, and I am talking a BUNCH of leaves (3/4 acre wooded lot) by myself. I can walk 3-4 miles and not get winded.
 
Welcome

Welcome

Hi Jeff -

You've come to the right place for support and counsel as you make a decision about your valve.

Six months ago I was faced with the same choice. Like you, I had no symptoms, was in good shape and my heart issues were originally detected last March with a murmur (congenital BAV). My doctor laid out all of the options and then asked me to make the choice (by the way, I'm 43). I was so torn...both the mechanical and tissue options present significant pros and cons. However, this site provided so much good information, after a month I felt that I could make a clear-eyed choice.

I chose The Medtronics Freestyle valve -- although the Carpentier-Edwards Perimount was a very close second. I've had a terrific recovery and now I just take an aspirin a day. (Frankly, I felt pretty much back to normal after a couple of months and have been back to 100% for at least a month.) Obviously, I'm very happy with my choice.

Read all that you can, Jeff, and don't be afraid to ask any sort of question. This is a tremendous forum that can be so very empowering.

Best regards,

Kristine
 
Hi and welcome.

I was 42 three years ago when I went with a porcine valve. I do not want to be on Coumadin, for many reasons. That said, however, choosing a tissue valve does not guarantee you can avoid Coumadin. I went into a very strong A-fib a week after getting my new valve and I was on Coumadin for three months post-op. Had the A-fib not stopped (from additional medication) I would probably still be on the Coumadin. But happily, now I can get by with just a couple of baby aspirin each day.
 
Tough Choice

Tough Choice

I had my bicuspid Aorta valve replaced with a St Judes mechanical last year at age 59. It is a hard choice because you can't really know what it will be like for you until it is over.

Even then, I don't believe you will ever know whether you made the best choice or not, because the path you declined will always remain a great unknown. Talking to people who have had their surgery is of limited benefit in my opinion. When humans are forced to make a difficult and irreversible choice with insufficient information, they have a strong motivation to ultimately be convinced that their particular choice was the best option.

The consolation is that we have a choice, and every reason to expect that, no matter what we choose, we have a high likelihood of many productive and enjoyable years to come.
 
Tough choice but in the end your call!

Tough choice but in the end your call!

My first post but have been a regular reader over the last 10 weeks. Like Dennis above I had bicuspid Aorta valve replaced with a St Judes mechanical 7 weeks ago.

My surgeon recommended the mechanical valve due to my age (55) activity levels and possible need for tissue valve replacement in 10+ years. I was so taken a back needing any surgery I went with the 'flow' and recommendation.

I have had a great recovery and feel fantastic and a return to work beckons. Taking the warfarin is not really a problem and has certainly caused me to be drinking far less alchohol! I have had a couple of days with a small problem with some blood in my urine but an adjustment on the tablets and it was sorted.

I am slowly getting used to the 'ticking' of my mecahnical valve and am comforted by my wife who 'likes it'.

The big thing is what ever you go with, if you are like me and many other posters you will feel so much better than you do now. I am only 7 weeks on but now realise how rough I felt before the op.

regards
 
cjwinthesun said:
My first post but have been a regular reader over the last 10 weeks... The big thing is what ever you go with, if you are like me and many other posters you will feel so much better than you do now. I am only 7 weeks on but now realise how rough I felt before the op...
Click to expand...

"The big thing..." -- That's the truth! The new valve was nearly like a resurrection for me; I was so ill pre-op!

And, WELCOME:), Chris!
 
Good Luck

Good Luck

Jeff,

we have been in your shoes and it is not an easy decision. I am 10 months post op and am doing great. I went with a bovine tissue valve, at age 48. I agonized over the decision. You go back and forth of the pros and cons for each choice. Like everyone has said, it comes down to your decision. I remember reading that and thinking, well, that does not help. I think Dennis said it best, we are trying to get people to validate our decision and and have someone tell you "this is the best choice", "go with this valve". That never comes. Do the research, look deep into your self and what you want for your lifestyle, talk to your cardiologist who will be the person taking of you after the surgeon is gone, talk to your family, then make the call. It will be a relief once you make the decision. You will feel so much better once it is over.

Take care,

George
 
Welcome jeff,

When I was 58 I requested the Bovine Pericardial Valve as my first choice. Unfortunagely, extensive damage from Radiation Therapy dictated going with a Mechanical Valve to avoid a (difficult) repeat surgery.

To me the most interesting choice among the Mechanical Valves is the On-X made by MCRI (see their website and do a VR.com SEARCH to find considerable information / discussion of this valve).

Here is the MCRI contact information provided by another member recently:

Customer Service: [email protected]
phone: (888) 339-8000 extension 261 Toll free US and Canada
phone: (512) 339-8000 extension 261
fax: (888) 339-3636 Toll free US and Canada
fax: (512) 339-3636

Marketing: [email protected]

Heart Valve Sales:
USA Sales: Clyde Baker [email protected]
European Sales: Scott Peters [email protected]
Rest Of The World Sales: Regina Creekmore [email protected]

Carbon Coating Services: Jonathan Stupka [email protected]

Investor Relations and Corporate:
President: Clyde Baker [email protected]
Chief Financial Officer: Bill McClellan [email protected]

Other Inquiries: [email protected]

MCRI Web Site: http://www.mcritx.com

Mailing Address:
Medical Carbon Research Institute
8200 Cameron Road, Suite A-196
Austin, Texas 78754-3832
__________________

I've been communicating with Catharan Burnett at (888) 339-8000 extension 265. She is their Education / Promotion Manager and is a former Surgical Nurse so she has a VERY GOOD understanding of Valves, Replacement Valve Products, and how they compare.

'AL Capshaw'
 
"When I was 58 I requested the Bovine Pericardial Valve as my first choice. Unfortunagely, extensive damage from Radiation Therapy dictated going with a Mechanical Valve to avoid a (difficult) repeat surgery.

To me the most interesting choice among the Mechanical Valves is the On-X..."

AL,

My understanding, and please correct me if I am wrong, is that the On-x is currently undergoing a clinical trial to determine or at least confirm, that that there is indeed significantly less need of anti-coagulant or even only aspirin. But as of now it is not a fact. If it were wouldn't that be almost everyone's (both patients and surgeons) choice? If you were having your surgery today, would the On-x be your first choice (over the bovine)?

I am 58 now. My aortic regurgitation was diagnosed 11 years ago as moderate to severe. A year and a half ago it became severe, but my cardio says an op is not yet required. I have no symtoms at all. When an op is needed he strongly recommends a mech valve but is not familiar with the On-x. When I told him about it he said he would not recommend it unless the claim about the lower need for coumadin is proven. I hope I can hold out long enough to see that day.
 
Hello! I wanted to join everyone in welcoming you to the board. I'm 41, and am 5 months post-op from having a St. Jude's mechanical valve installed. Like you I was born with a BAV. I also had my ascending aorta repaired. I take 5mg of Coumadin daily. I go to the gym three times a week and, though I've feared saying so (for fear it'll change!) I'm feeling really really good. Probably the best I've felt in a long time. I do not get terribly winded, even working out and can easily walk 2 miles and can walk much more if I push myself. Due to the surgery I do have complete heart block however, and while I was aware that it does happen, I didn't really think I'd need a permanent pacemaker. It's certainly not a problem at ALL but it's something else to be aware of. Taking the coumadin is simply not a problem and my INR has been very constant. I'm aware everyone's mileage varies of course....especially when it comes to getting your blood levels checked.

If you (or anyone else reading) wants to contact me about this, they're welcome to. My email = [email protected]. Best of luck!

Chris
 
starfish11040 said:
To me the most interesting choice among the Mechanical Valves is the On-X..."

AL,

My understanding, and please correct me if I am wrong, is that the On-x is currently undergoing a clinical trial to determine or at least confirm, that that there is indeed significantly less need of anti-coagulant or even only aspirin. But as of now it is not a fact. If it were wouldn't that be almost everyone's (both patients and surgeons) choice? If you were having your surgery today, would the On-x be your first choice (over the bovine)?

I am 58 now. My aortic regurgitation was diagnosed 11 years ago as moderate to severe. A year and a half ago it became severe, but my cardio says an op is not yet required. I have no symtoms at all. When an op is needed he strongly recommends a mech valve but is not familiar with the On-x. When I told him about it he said he would not recommend it unless the claim about the lower need for coumadin is proven. I hope I can hold out long enough to see that day.
Click to expand...

Starfish -

There are WAY MORE advantages to the On-X than just lower anti-coagulation. Check out their Very Informative Website www.onxvalves.com Be sure to click on Valve Info, Patients and Family, AND Medical Professionals. Then read ALL the reports. If you want more info, call Catheran Burnette (Education and Promotion Manager) at 888-539-8000 X265 She will be out of the office for the last 3 weeks of December but I expect someone else should be available. Catheran is a former Surgical Nurse and has worked with valves for the last 10 years, including a stint at St. Jude. She KNOWS her stuff!

Someone posted a paper from South Africa with results of On-X valve studies in a very low to non-compliant population and there was an extremely LOW Mobidity Rate, even with patients who did NOT take Warfarin. Rates were MUCH higher for other valves in similar populations as I recall.

Studies for Low AC and Aspirin Only therapy (for Low Risk Patients ONLY - i.e. Aortic Position, NO other Heart Issues) have been under way in Europe and recently were begun in the USA.

FWIW, I asked my surgeon to look into the On-X Valve for my MVR when that time comes.

'AL Capshaw'
 
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