Valve Decision - Mechanical or Tissue

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johnnycake23

johnnycake23

Two-time AVR Vet
Joined
Nov 19, 2003
Messages
190
Location
Chicago
Hello,

I posted in another thread that my blurry eye was really a mild stroke. Well, the results are back and I need to get the valve (bicuspid aortic) replaced. Repair job is out this time, doc said. So now the decisions to be made are:

1) Mechanical or tissue? Doc told me the upside and downside for both. I would like to not have to take Coumadin but then again I am not looking forward to going through this yet again in 10 years.

2) Which hospital? I went in 1993 to Cleveland Clinic to get aortic valve repaired. Now I am also looking in Chicago at Loyola ( Dr. Jefferey Schwartz) and Northwestern Hospital (Dr. Edwin McGee). If anyone has some personal knowledge of either I'd love to hear it. Both biographies are great.

It needs to get done soon cuz Cardio said my valve is "leaking like crazy." Gee, I am just giddy with anticipation.

I've read the posts of others who were recently in similar situations and it's helped.Any other words of encouragement or insight are always welcome. Thanks to all.
 
If I were going for a replacement tomorrow, I would go to Cleveland and get a St. Jude or an On-X valve. Just my personal opinion tho. The important think is to find a surgeon you trust and allow him/her to make the final decision once they have you open.
 
I don't think you can go wrong with any of those hospital choices. I had my mitral valve replaced 16 years ago (this last week) at Northwestern, so I'm partial:eek:, but they do have McCarthy on staff there now. (Much to Ross' distress!)

This will be your 2nd OHS so I tend to agree with Gina, I'd go St. Jude or On-X and not sign myself up for a guaranteed 3rd surgery.

You probably have already done this, but if not, go read the stickies at the top of the anticoagulation forum.
 
Just one note. You mentioned not wanting another ohs in ~10 years if you got a tissue valve. The latest tissues are projected to last ~20 years, plus or minus. If I was in my 60's I probably would have gotten a tissue. But at my current age I'm happy with the mechanical.
 
Isis said:
Just one note. You mentioned not wanting another ohs in ~10 years if you got a tissue valve. The latest tissues are projected to last ~20 years, plus or minus. If I was in my 60's I probably would have gotten a tissue. But at my current age I'm happy with the mechanical.
Click to expand...
Good point but Johnny is only 41 so he would be guaranteed another surgery even if a tissue lasted 20 years.
 
I read your other post about a stroke. Are you being told it is from your valve, and if so, how did it happen?

I am not sure how old you are, but you might investigate the bovine pericardial valve's proven track record.

If you look at my husband's experience listed below my name, you will see that there are no guarantees. There are important things about your valve now - how heavily calcified is it, and will they remove the calcification in the area around it if it is there? If so, what is the risk of stroke during that procedure?

You need someone to evaluate your aorta - is it enlarged - do you have an aneurysm?

The bottom line is to know all you can about your current valve, the one you will get, and your aorta. It's a lot to think about, but can make a huge difference regarding what is best for you now as well as avoiding future surgeries or emergencies....

Best wishes,
Arlyss
 
geebee said:
If I were going for a replacement tomorrow, I would go to Cleveland and get a St. Jude or an On-X valve. Just my personal opinion tho. The important think is to find a surgeon you trust and allow him/her to make the final decision once they have you open.
Click to expand...

Those are my choices also (On-X first, St. Jude second).

I seem to recall that the On-X valves have recently been added to the option choice at Cleveland Clinic. I recommend verifying that, either through CC or On-X. There have been cases at CC where surgeons have agreed to use On-X, only to rescind that arrangement at the last moment so if you choose On-X I would want a more firm commitment beforehand.

I believe Northwestern recruited Dr. McGee from CC. Ross speaks very highly of Dr. McGee and regrets his 'loss' (from CC).

'AL Capshaw'
 
I've not heard of the On-x procedure. Would someone please post a link, either from this site or CC or wherever, about it? Thank you.

BTW, I am 41 years old, for whatever that's worth in determining which valve. I so appreciate the input. Please keep it coming.
 
You had your BAV repair about 14 years ago, and if I did the math correctly, you were only 27 at the time. I'm glad the repair lasted as long as it has.

I know this thread is about the valve, but I want to emphasize that the valve is just one part - a very important part - of the picture for those with BAVD.

BAV regurgitation in someone young - where the tissue is not strong enough to hold its form and close properly - is and indicator that the tissue is failing after not that many years of life and there may be an associated progression of failure of the tissue of the aorta also.

No matter where you go, and who you speak with, if they do not address your aorta along with your valve, get another opinion from someone who will. In many ways, although it can have its complications also, valve surgery is done routinely by many. The aorta is another story. There are centers that have established aortic surgery practices handling both the valve and the aorta. Searching them out - and getting opinions from more than one if you are able to do it - will give you the best odds of receiving state-of-the-art treatment.

Both the valve and the aorta should be part of your decision making process. If you can find a surgeon/center that is current and knowledgeable about BAV disease, you are giving yourself all possible advantages for both the valve and the aorta. You need the best possible solution for them both!

You are still a very young man and I wish you all the best!

Arlyss
 
ALCapshaw2 said:
I believe Northwestern recruited Dr. McGee from CC. Ross speaks very highly of Dr. McGee and regrets his 'loss' (from CC).

'AL Capshaw'
Click to expand...
They stole McCarthy away from Cleveland to run their Cardiac surgery department. I'd say they got one heck of a deal.

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johnnycake23 said:
I've not heard of the On-x procedure. Would someone please post a link, either from this site or CC or wherever, about it? Thank you.

BTW, I am 41 years old, for whatever that's worth in determining which valve. I so appreciate the input. Please keep it coming.
Click to expand...
http://www.mcritx.com/
 
Johnny:

Have you considered the Mayo Clinic there in Arizona? There are a number of CTS surgeons at the AZ location, according to Mayo's website.

I have a St. Jude and would go that route, if not an On-X, again. (Both my grandmothers were 95YO+ when they died and my parents are 78 & 80YO. So, I'm hoping I have inherited their genes!)
 
Life is full of difficult decisions, especially for us heart patients.
Before my OHS I had a chance to meet with 2 valvers:

A man at age 49 had 2 St.Judes put in, they were, and still are, fabulous.
Then 17 years later he needed a second OHS to re-stitch the ring.

A woman at age 42 had the Ross Procedure, within 6 years she had a second OHS because of homograft valve failure, she now has a St.Jude.

This scared me at the time, but we make a decision on what we learn and have to live with it.
And yes, we could be hit by a bus tomorrow, I ain't going there.:D
 
rckrzy1 said:
How do you figure ? Might get run over by a streetcar next year. And mechanical valves come with NO guarantee either.

I took my ross (tissue) @ 43 and am glad I did. Life for me is back to better than normal ever was.
Click to expand...
Yes and the earth might explode tomorrow. This is one of the reasons I have bowed out of valve discussions in the past. I decided to start posting again because some folks have asked me to. Guess it is time to reconsider.

Just to clarify - I did NOT say mechanicals came with guarantees and I did not base my comment on whether or not Johnny would get hit by a streetcar. Kind of silly to even bring that up. I merely stated that, if he went with a tissue valve, he would have to have it replaced. So sorry I did not add, "If he lives another 15 or 20 or 25 years", or whatever the current consensus is about the longevity of tissue valves.
 
rckrzy1 said:
How do you figure ? Might get run over by a streetcar next year. And mechanical valves come with NO guarantee either.
Click to expand...

The only point I find this comment making is that no one should get valve surgery-period-because you just may die anyway.

No option offers any guarantee. No doctor worth his/her salt would offer guarantees. But if you look at statistics, mechanical valves offer much greater hope for no more OHS for a 41 year-old, and tissue valves offer a much better chance of not having to take warfarin for the life of the tissue valve. Neither option is a guarantee. We have mechanical valve members who have had to have valves replaced and we have tissue valve members who have ended up on Coumadin or faced a difficult redo.

So it boils down to 2 points - do you want to avoid more surgery, or do you want to avoid Coumadin? You make your choice based on your life and what the collective information has to say to each individual making the decision.

Opinions and information was asked for and opinions and information are being given. Thank you to those who are doing so respectfully.
 
I NEVER post to a valve question?....But over the past 5 years..have read many...newbies asking which valve?.....So, not for Johnny ...but I am sure there will be others asking the same question? Which valve?........... My thoughts....Will you still be employed with Insurance...if you go tissue now..looking down the road..15-20 years...?..I think there was a thread not long ago..about the cost of VR surgery..Most were well over $100,000......plus meds that one needs....Will you have family to help out..after your surgery..Someone who can stay with you for at least 2 weeks..( most doctors do not want you driving for 6 weeks)......Would your job allow you off that much?...If you are still working?.........Same thing.if one goes tissue..It will..probably start to show up..before you need the next surgery..and need to plan for it?.....Family/job , ect.....I was very lucky that when I had my surgery at age 61..My hubby/family helped out..:) ..so glad I went with mech. valve....due to maybe not having family to help me ..if I live to be .age 81..(if I had the tissue).....Just my thoughts. please don't flame me..:p ..Whatever anyone chooses is better than none at all......Bonnie
 
Well, you have all given me plenty of food for thought. I will let you all know, just for the record, which way I go. Thanks to all.
 
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