Opinions on tissue vs mechanical aortic valves

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K

klynnc

Well I made it to Cleveland with my husband and 2 kids and tomorrow I have a 9am pre-op appt followed by many other appts at the Cleveland Clinic.
I have been reading the forum a little for the past half hour and I'm getting nervous if I made the right choice on valves.
My consultation appt with my surgeon 2 weeks ago was a little strange and I really felt out of sorts b/c I was supposed to meet with him the previous day after I met my cardiologist, but he decided to do a TEE (2nd one I've had at 2 diff places). They gave me versed (1st time) and then kept me on 23 hr observation b/c I was in Cleveland alone. I was awakened at 4am by the nurse and anyway by the time I met with the surgeon later that afternoon, I was not exactly the sharpest tool in the shed and I didn't ask hardly ANY of the list of questions I had pre-written - I felt like the appt was really nothing but me sitting there trying to express what I had been studying up on, but nothing really came out and I wasn't getting much feedback from the surgeon about his opinion.
I had already kind of decided on a tissue valve even though I am only 40 years b/c I just hate taking coumadin and I am very active, yet a little clutzy (tend to hit my head a little too often!). I have been on coumadin for the past 7 months b/c of TIA's (we think) caused by my heart problem.

Sorry for babbling.....I am so nervous and anxious right now and just mad at myself for "failing" on my consultation appt and not getting in my questions. I am supposed to be meeting with the surgeon again tomorrow if he doesn't get tied up in surgery, so hopefully I'll get a 2nd shot.

Bottom line: Is there anyone else out there that chose a tissue valve over mechanical at my age?

Oh, by the way, I may be stressing out for no reason b/c he is going to try and repair my BAV, but if the tissue is too friable, then he will replace it.

Thanks for any input and for reading my neurotic babbling.....Just a bit nervous!
 
Your best bet here is to read back on the threads in the Valve Selection Forums.
There is alot of very lively discussion...and yes, many 40-ish patients have opted for tissue valves.
Good Luck with your decision. :)
 
I had a tissue valve put in on my 37th birthday. Because I had to have a pulmonary valve replaced, I didn't have the option of mechanical, but I think I would have chosen a tissue valve anyway. Personally I struggle to remember my BC pills everday, so having to monitor and medicate daily would just be more hassle than I could be bothered with. Now that might seem a small price to pay to avoid further OHS... but I'd rather face a few months of discomfort and recovery every decade or more, than have my day-to-day life affected.

But again, that's just me.

At the end of the day you need to assess your own life and lifestyle and choose what feels best for you! Hope you get to chat the surgeon again before you go in.


A : )
 
Thanks, I realize now I posted under the wrong forum probably....oops
Abbanabba - I hear ya! I hate the daily pill thing and wondering if my INR is in range and God forbid I hit my head and the fear of a slow bleed. And there seem to be some side effects that doctors don't know about...
Maybe it's a blessing in disguise that I was put on coumadin for the short term so I can get a taste of it.
That being said, it is a small inconvenience if it were to keep me alive and I could deal with it.
 
My first and foremost consideration is keeping you from having more surgeries down the road. I believe that should be everyones prime consideration, but many disagree with me. I'll never get over how people subject themselves to repeated surgeries to avoid ACT. It's just not logical in my mind. This surgery, one time around, is enough for anyone. This is my opinion and it usually stirs a big bee hive up, so I'll just leave it right here.
 
I have a tissue valve at 45. I know I'll need more surgeries in my life. I'm ok with that. I would also be ok if I had a mechanical and had to take coumadin everyday. I personally think that it is too late in the game to be posting this question on here. You are going to get a lot of arguments trying to "sway" you one way or the other. I know that would confuse me and scare me at this point if I were you.

I would have a talk with your surgeon and with your husband and make a final decision that is best for you (none of us know what that is) and then make peace with it and don't look back.

I wish you the best of luck. Everything will be fine. I hope your husband can post for you and let us know how you are doing.

Kim
 
Many surgeons are open to you changing your mind on Valve selection right up to the point of when you enter the O.R. (assuming you haven't been sedated before that time).

Cleveland Clinic uses a lot of the Bovine Pericardial Tissue Valves and recently added the On-X Mechanical Valve to their 'option list'. See www.heartvalvechoice.com and www.onxvalves.com for details on the advancements these valves offer vs. older mechanical valve designs.

As has been said, there has been a LOT of 'discussion / debate' on this topic in the Valve Selection Forum.

Most people of choose for themselves come down to which negative aspects of artificial valves they can best cope with (i.e. repeat surgery when tissue valves wear out versus lifelong anti-coagulation therapy with mechanical valves). It's your choice. Either way, it's a good idea to have a Plan A and a Plan B, 'just in case' plan A is not viable for some reason once the surgeon gets in there. Several of our members have come home with something other than what they planned / hoped to receive due to incompatibility issues (usually in more complex cases only).

'AL Capshaw'
 
I guess my concern would be whether the TIA's you have been having will most certainly be stopped with the repair/replacement. Is there something going on that may possibly require you to remain on Coumadin regardless of what is done, repair, replacement with tissue or mechanical? Is it a condition that would recommend one valve type over another?
 
I'm 37 and just had an Edwards Lifescieces bovine valve put in, about 2 weeks ago. I chose the tissue valve because I could not go on coumadine right now. I know its tough and you keep second guessing yourself, but you will get through it. Best of luck with your decision.

Nick
 
If you'd asked this same question, and been better prepared a few weeks of even months ago on this forum, you still be none the wiser believe me, i've watched and joined these discussions before, they just go round in circles anyway ! So, dont worry yourself with it. Often, and because it really is such a close call, it's best just to toss a coin, and you've plenty of time to do that still.
My only thought is if you've already been on Warfarin, you might as well go Mechanical, incase you have to continue taking it post op anyway and reduce the chances of further OHS down the line ?
Best of luck with it.
 
Ross said:
My first and foremost consideration is keeping you from having more surgeries down the road. I believe that should be everyones prime consideration, but many disagree with me. I'll never get over how people subject themselves to repeated surgeries to avoid ACT. It's just not logical in my mind. This surgery, one time around, is enough for anyone. This is my opinion and it usually stirs a big bee hive up, so I'll just leave it right here.
Click to expand...

AMEN Ross!
 
Either one is a fine option - pros and cons to both. However, if Coumadin is your only con, you might want to think about it. There is a possibility that you will be on Coumadin with either valve, especially if you are already having TIAs. I haven't heard that BAV causes TIAs, so they could be caused by something that will still be there after surgery.
 
Well I guess you are going thru your testing and consults now so hoping all goes well. and you can come up with a plan B valve choice incase they can't do the repair that you feel at peace with.. As for your question about people in ther 40s getting tissue valves, There are actually quite a few. But I also would ask more questions about why they think your TIA are being caused by your heart condition and IF they think you will be able to stop the coum for them after surgery.
 
Ross said:
My first and foremost consideration is keeping you from having more surgeries down the road. I believe that should be everyones prime consideration, but many disagree with me. I'll never get over how people subject themselves to repeated surgeries to avoid ACT. It's just not logical in my mind. This surgery, one time around, is enough for anyone. This is my opinion and it usually stirs a big bee hive up, so I'll just leave it right here.
Click to expand...


I have to agree with Ross. But you have to decide that for yourself, no one else can. Good luck!
 
i am in a similar position may be able to repair mine , but have to have plan B ,i agree with ross, they say its like being hit by a truck ,and theres always a risk with any surgery ! so i will select the option that gives me the best chance on not being hit by the truck for a second time. beleive the risk gets higher with each OHS so why risk it if its avoidable but its a very personnal thing and what each person has chosen is right for them,
i to would like to avoid pills but at least i have control over that side of it!
best of luck with your desicion making
Dean
 
deano89 said:
....
i to would like to avoid pills but at least i have control over that side of it!
best of luck with your desicion making
Dean
Click to expand...

When I knew I needed surgery, I refused the mechanical because I did not want my life to depend on a pill!! what if this pill is not manufactured anymore? what if I fall and hit my head and there is noone around?! but after I calmed down from the news shock and recollected myself together, I pulled my faith to the surface and realized that I could fall and hit my head and die even with the tissue valve...so, my faith brought me to Dean's realization that with the mechanical I have control over the pill more than conrol over timing of being reopened again. But that is me !
Again as said above, this is a very personal decisioin and only you have to come to peace with it.

Good luck and my advise if you pray, pray for a guidance for what's best for you:).
 
I picked the ST. Jude valve when I go in on the Feb. 23rd. I chose it because I am young (35) and don't want to go back for more fun when I really don't have too. Do your homework and pick what is BEST for you.
 
Just go with your instinct and your surgeon's advice.......unless you are particularly set on one of the two options.
 
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