2nd time around avrl

[Guest]

Back again from years ago. time for my second avr surgery. first replaced at age 50, 59 plus now. went with bovine Edwards magna 3000 23mm. Also a small aortic prothesis. Valve is shot and I am now in the process of selecting who and where.. my cardiogist says this one will be a bit more difficult due to the prothesis.. and for some reason likes the mechanical valve... I do not want the mechanical valve as I am still very active surfing, other water sports and just all around adventures. I am in excellent shape expect for the valve... I don't understand where the additional difficulty just because of the dacron sleeve patch. Anybody have feedback... and or why this next one will be more difficult.. we can go to anywhere in the nation we want and now that he has said that we are looking for the best valve guy at the best hospital we can find. over reacting ? Input please... seems to me that this replace is done quite a bit with a prothesis ? sfc1981

 

[pellicle]

Hi

well at 59 I'd say go with what you prefer. I would wonder at the duration of 9 years and observe that for some people they decay tissue valves faster than others. I can only say that I'm quite active and have a mechanical. Just the other day at the dentist it was observed (during a sub gingival clean) that I am not bleeding as much as they expected given I'm on warfarin.

I put that down to my accurate management of INR and that many others on warfarin are probably higher in INR than they know / need to be. Recently the INR required for modern bi-leaflet valves is being revised down, with recent observations being that it can be under 2 without observed issues.


The reasons it will be more difficult (and the next one even more) is that scar tissue builds and obscures the views of the surgeon. They can accidentally cut into what they can not see and damage something (like the AV nerve https://en.wikipedia.org/wiki/Atrioventricular_node) which may lead to problems (such as you requiring a pacemaker.

If you happen to develop atrial fib after your surgery then irrespective of the valve chosen you'll find yourself on warfarin anyway. So the question you need to ask yourself is: do you feel that its possible that your metabolism calcifies valves faster and thus lead you to a third surgery in your late 60's or do you wish to accept a mechanical.

I'm not sure what your reasons for not wanting the mechanical (there are of course many personal reasons) and those reasons are not my business, however if its due to fear of warfarin, then that fear is relatively unfounded. I still travel from Australia to Europe, I have no problems with sourcing durgs or test strips and I cross country ski and hunt. The effect of warfarin on my life has been a total of 10min on Saturday to test and document and then filling my pillbox and taking a pill once a day.

Best Wishes

 

[pellicle]

http://www.hindawi.com/journals/isrn/2013/956252/
4.5. AV Block

[FONT=Minion W08 Regular_1167271]An atrioventricular (AV) block requiring a permanent pacemaker (PPM) implantation occurs in 10 - –50% of patients following TAVI [85, 86].[/FONT]

 

[dick0236]

Hi

well at 59 I'd say go with what you prefer..........

I'm not sure what your reasons for not wanting the mechanical (there are of course many personal reasons) and those reasons are not my business, however if its due to fear of warfarin, then that fear is relatively unfounded.

I agree with Pellicle.

I had the benefit of living most of my active life before the Internet and computers.......so I never knew what I should or shouldn't do while on warfarin....so I just did what I wanted......water skiing, white water rafting, "heavy duty carpentry"(with associated cuts), drinking, etc., etc. When I joined this site 9 years ago I was amazed at the fear generated when warfarin was mentioned. Take a pill a day and test routinely and live your life. Warfarin hasn't even been a distraction when compared to the number of replacement surgeries I have not had to have. Like the old Timex watch commercials......my mechanical valve has taken a lickin' but keeps on tichin". Do the homework and make your choice.....but remember that a third surgery in your 70s/80s ain't gonna be a easy.

 

[Boomanchu]

I've got a mechanical mitral valve and one of my most common statements since surgery is " my new valve and heart are working better than ever but everything else went to ****". Warfarin is nothing to deal with and I'm new to all this but surgery and the meds during the recovery period kicked my ass at times. People always remark at how fast I recovered and how I seemed to have been entirely unfazed by the surgery. It went better than I expected but I never ever want to do that again. It was pretty tough on me at 55, no thanks on the redo