Artificial Valve VS Tissue Valve benefits & negatives

[bassadict69]

My dad met with the surgeon yesterday that will be doing his Mitral valve replacement. Dad is 65 & once he heard about the chance of a resurgery with the tissue valve, he decided on the artificial valve & Coumadin for the rest of his life.

First of all, I know there are posts everywhere on this in a couple of different sections, but I would like to get positives & negatives of going each route here in one thread so I can make sure dad makes the correct decision. Reading through here, it almost sounds like a tissue valve would be better for his age than dealing with Coumadin effects.

Help me out...what are your thoughts on this?

 

[Mary]

My dad met with the surgeon yesterday that will be doing his Mitral valve replacement. Dad is 65 & once he heard about the chance of a resurgery with the tissue valve, he decided on the artificial valve & Coumadin for the rest of his life.

First of all, I know there are posts everywhere on this in a couple of different sections, but I would like to get positives & negatives of going each route here in one thread so I can make sure dad makes the correct decision. Reading through here, it almost sounds like a tissue valve would be better for his age than dealing with Coumadin effects.

Help me out...what are your thoughts on this?

I suggest you read Tobagotwo's "sticky" thread in the Valve Selection forum. That outlines the positive and negatives of both types very well.

 

[Cooker]

Welcome to VR ?. The first thing I will say is that the valve that your dad is most comfortable with is the best valve for him ?. That being said, coumadin is not the bogyman ? I have had absolutely no problems with it ? we have a member who just celebrated 28 years with mechanical valves and being on coumadin ?. If your dad is in good health he should do just fine with the surgery ? I went mechanical to avoid, if possible a second surgery ? Valve choice is very personal and if his cardiologist and surgeon are onboard with his choice then you should be too ? Again, welcome and please keep us posted ? we are here for you!

 

[bassadict69]

The surgeon was leaning more towards the mechanical also...

I have read the stickies & actually have them printed out for him to read. I would just like to see some personal experiences from some of you...

 

[dick0236]

Help me out...what are your thoughts on this?

I have had a mechanical aortic valve a long time. I have never "second guessed" that choice since it has allowed me to live a pretty normal life with few, if any, restrictions. Warfarin usage is doable even tho it can be a "pain in the A--" sometimes.

Having said the above, should I need to have my mechanical valve replaced at my age, I would consider a tissue valve if it were feasible. I know this sounds like heresy coming from a "dyed in the wool" mechanical owner. What's good for the "goose"(younger patient) may not be that good for the "gander"(older patient). I am beginning to see signs that ACT will become more difficult to manage as I get older due to changing life style, drug interactions, etc.

This choice would be easier for me since I am almost 73 years old. Your Dad, at 65, is kinda at a "crossroad" age. A mechanical valve would almost certainly last his lifetime, but ACT may, or may not, become a problem. A tissue valve, may last his lifetime due to a less demanding life style, etc. However, a re-op at age 80, if necesary, would be NO fun.

 

[Bina]

I agree with Dick0236, and would only like to add that sometimes (probably rarely), tissue valvers end up on Coumadin for A-Fib.

 

[Eva]

Welcome to VR ?. If your dad is in good health he should do just fine with the surgery ? I went mechanical to avoid, if possible, a second surgery ? Valve choice is very personal and if his cardiologist and surgeon are onboard with his choice then you should be too ?

I agree with Cooker.
I also went mechanical to avoid, if possible, another surgery
Up todate, tissue valves' maximum life as claimed is 15-20 years. If your dad is in good health and may live over 90, does he want another surgery at 80 or 85...You spoke highly of your dad's surgeon and thus I would trust her. I am 57, my surgeon opted for mechanical right away, my fears of anti-coagulants let me towards valve tissue, but my fear to have another surgery was stronger especially when I learned that some tissue valve recipients has to take coumadin, as Bina said, and coumadin is not that bad as we before surgery imagine.
Keep us posted and keep coming whenever you like to share any thoughts.

With my prayers,

 

[tobagotwo]

Please be aware that those were written for people younger than your dad (I believe ages 40 and 50). The benefits of a tissue valve from age 65 do slightly outweigh those of a mechanical valve.

This is because if your father can avoid coumadin at age sixty-five, it is a mild statistical plus. Coumadin use at increased age can increase the likelihood of an intracranial bleed to some extent, if he's prone to it. It would be interesting to see the stats on what is gained in avoiding strokes vs. what is risked in the general population.

However, in the overall scheme of things, it's a small risk factor, and he may wind up on Coumadin or Plavix from some other issue anyway.

If he's satisfied and feels confident with his decision, my personal bent would be to leave him alone. He lives with his choice, not you. Let him be content and confident in his path forward. There's not enough difference for that choice to be undermined, even with thoroughly good intentions.

Best wishes,

 

[Jkm7]

I am younger than your father and just about into the range of surgeon's saying a comfortable 'yes' to tissue valves.

My valve replacement was February 2008 and was my second OHS in four years. I knew full well what I was going into and would experience. Of course, facing a second OHS was very stressful and the thought of a third sends my head spinning.

However, I very strongly preferred getting tissue vs mechanical valve.

I had a number of reasons and won't go into all of them but the two strongest were the high likelihood (though no guarantee) that I would not have to take coumadin longer than a brief time post op and to avoid the potential my valve could tick louder than I could tolerate. I cannot stand the sound of a ticking clock and really have to leave the room if I hear one. It was a high risk for me to get a mechanical. My surgeon at Mass General and my cardio both advised me they can never be absolutely sure who will have a loud vs not so loud valve as it does not necessarily depend upon body structure. A barrel chested, large man might have a highly audible, loud sound to his valve and a petite, small structured woman could have a relatively quiet one.

I am now 8 months post op and so very happy I made the choice for tissue valve FOR ME. For me, it was the absolute right choice. The right choice for everyone else is the one they chose.

My surgeon feels very strongly my valve can last me 18-20 years and he also feels that in the event I should need more 'valve work', by the time he expects that could be necessary, they will no longer be cracking open chests to repair/replace heart valves. He says Mass General (and many other heart centers) are currently doing a great deal of study and he has confidence their work will be successful. I have a very healthy lifestyle, eat heart healthy, exercise regularly, don't smoke, am otherwise healthy and only drink moderate amount of wine per week.

None of us get any guarantees but at your dad's age....... he certainly should learn the differences and make an informed choice. For him to just 'accept' a mechanical because his doctor suggested it, just isn't right. IMO For him to choose mechanical after learning the differences, THAT is right. But he would be cheated if he did not learn what he can before making the choice. How awful for him to regret his choice later and say, "I wish I had known."

 

[neil]

see above

see above

jkm 7 fully agree mate, couldnt have put it better myself, its a very very personnal choice,so think long and hard look into it all then pick,am sure you will make the right choice

 

[ALCapshaw2]

Your question / comment is a bit confusing because of the wording "artificial valve".

In the medical world, an "artificial valve" is any valve that is NOT human.

The Broad Categories are Mechanical and Tissue.

In the USA there are 4 common Mechanical Valves made by ATS, Carbomedics, On-X, and St. Jude.

In the Tissue Valve category there are Porcine (from a Pig), Bovine (Cow's Pericardium formed to resemble the natural human valve), Cadaver or Homograft Valve from a deceased Human Body.

Which "artifical valve" was your dad interested in?

I'm not trying to be flippant, but I have NO idea what valve(s) you want to hear about.

'AL Capshaw'

 

[bassadict69]

artificial = mechanical...I am new at this so thanks for the explanation.

No one in particular, we did not go into the choices of mechanical valves...should we have?

 

[ALCapshaw2]

In the Mechanical Valve arena, the Standard St. Jude Master's Series Valves hold the record for durability at 30 years and counting. (See www.sjm.com for more info).

Note that Mechanical Valves require some sort of Anti-Coagulation Medication for Life to prevent Clot Formation. (The downside of Tissue Valves is that they eventually wear out and need to be replaced).

ALL of the Mechanical Valves were designed (at least in part) by Jack Bokros, Ph.D., who was involved in the creation of the Pyrolytic Carbon used in the leaflets of the first Bi-Leaflet St. Jude valves.

He has since founded Carbomedics, holds patents on the Carbomedics and ATS Valves, and most recently founded On-X to market his 'latest and greatest' developments in mechanical valves beginning in 1996. See www.heartvalvechoice.com and www.onxvalves.com for the details on how these advancements improve performance.

MY first choice, especially for the Mitral Valve, is the On-X Valve with the St. Jude Master's Series as a backup plan. To my mind, ATS and Carbomedics are spin-offs of the St. Jude Valve so if you are looking for a proven record (vs. new technology), why not go with St. Jude.

In your dad's case, since he is already 65, a good argument can be made for the Bovine Pericardial Tissue Valve if his life expectancy is not expected to be more than another 20 years or so. The Bovine Tissue Valves have a good record of durability approaching 20 years when implanted in patients over 65 for most patients.

The 'new and improved' Bovine tissue valves have an anti-calcification coating that is hoped to extend that durability a few more years. (Carpentier-Edwards is one manufacturer of those valves).

To my mind, ANY of those 3 options would give your father a good extension on life. It becomes a matter of personal preference, often deciding which of the negative aspects of the valve (every valve has some positive and negative attributes) you (he) can best live with.

On-X has the Latest Technology with enhanced performance
St. Jude has the record for durability
C-E Bovine Pericardial Tissue Valve does not require anti-coagulation medication UNLESS the patient also develops Atrial Fibrilation (which can happen even without artificial valves)

Valve choice can get complicated. It helps to understand the trade-offs. The "sticky" posts at the top of the Valve Selection Forum is a good place to begin to learn about the options.

'AL Capshaw'

 

[dtread]

There is also the Medtronic Hall Easy-Fit Heart Valve, which is a mechanical: http://www.medtronic.com/your-healt...ucts/hall-easy-fit-mechanical-valve/index.htm

The Medtronic Hall Easy-Fit Heart Valve is of the "tilting disc" design, which is a different design than the "bileaflet" design of the ATS, Carbomedics, On-X, and St. Jude mechanical heart valves.

Those five are the only mechanical heart valves currently approved for use by the FDA in the U.S. Also, Edwards Lifesciences makes biological valves only (no mechanicals). The complete list of U.S. Heart Valve Manufacturers:

ATS - Mechanical Valves. Headquarters: Minneapolis, MN
www.atsmedical.com

Carbomedics (Sorin Group) - Mechanical Valves & Biological Valves. Headquarters: Austin, TX
www.carbomedics.com

Edwards - Biological Valves. Headquarters: Irvine, CA
www.edwards.com

Medtronics - Mechanical & Biological Valves. Headquarters: Minneapolis, MN
www.medtronic.com

On-X Life Technologies, Inc. - Mechanical Valves. Headquarters: Austin, TX
(formerly Medical Carbon Research Institute)
http://www.onxlti.com/onxlti-heart-valve.html www.heartvalvechoice.com

St. Jude - Mechanical and Biological Valves, also Allografts. Headquarters: Minneapolis, MN
www.sjm.com

Outside of the U.S. (not approved for use in U.S.) there is:
Sorin Biomedica Cardio - Mechanical & Biological Valves. Headquarters: Italy
http://www.sorinbiomedica.com/

 

[Karlynn]

I would have your Dad take a look at the longevity of his family history. If he has parents or other close family relations that have lived, or are living, into their late 80's or 90's, he could be facing another replacement if he got a tissue valve. If you looked at my family history - I'd choose a tissue valve at 65. (No one has lived into their 80's, except 1 uncle.)

Your Dad is lucky to have you looking into this for him. But as someone else said - he needs to be comfortable with the choice. If he make a choice that you want, and he's not comfortable with and something goes wrong, that's a lot of guilt to deal with.

If he does end up choosing a mechanical - encourage him to look into home testing. It will keep him more safe and give him freedom in his life.

Did you read the stickies in the Anticoagulation Forum? There are many of us that have been on Coumadin for years and know it's not the bogey-man many make it out to be. I've been on it 17 years.

 

[bassadict69]

Thanks everyone for your help, info, & suggestions!

I think I have read every sticky in every forum here on the site...LOTS of good info!