34 years old - Going tissue...

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neo

Well-known member
Joined
Apr 20, 2013
Messages
128
Location
Nashville, Tennessee
Hey,

I am new to this site and have really enjoyed reading through the posts over the last month. I wanted to share my story as I am having my 3rd AVR tomorrow. After having the Ross Procedure in 1999, and a 2nd procedure to fix a dilated aortic root in 2010, I now have severe regurgitation again. Nobody knows yet why the AR came back, maybe a torn leaflet. I guess the best option now is something NEW, thus my name, ha!

The most common question seems to be tissue vs. mechanical. I have found, through an exhaustive amount of research, that there is no right or wrong option. At first, I was set on the On-X mechanical valve. I like the idea of having something potentially permanent with a good possibility of FDA approved low or no anti-coagulation in the near future.

I changed my mind to tissue reasoning that there is tremendous advancements taking place right now. The SJM Trifecta (porcine & bovine) and the CE Magna Ease (bovine) valves have new calcium treatments which may extend their durability. The current long-term durability studies showing 10-15 years refer to tissue valves that were implanted 15-20 years ago, naturally. Therefore, it could be assumed that these newer valves could last longer. There just are no long-term studies yet to prove either way. However, there are several ongoing studies which can be found at clinicaltrials.gov

TAVR technology is currently being used in high-risk folks, but is certainly capable of being a more mainstream option in the near future. They say that multiple TAVR procedures could be done (valve in valve in valve), just not proven as of yet. Finally, tissue engineered valves (adult stem cells) are currently being tested in sheep, etc. In the next few decades, this "holy grail" of valve replacements could be something that would replace a worn out valve, ascending aorta, etc.

So finally, I was unable to find the perfect option. But with me, this will be my 3rd open-heart procedure, and I think I'm comfortable with another procedure down the road. If I can live a life unrestricted by meds and diet, and have the possibility of an easier/better fix in the future, this seems to be, for me, the best way to go. Any comments would be greatly appreciated! I am going under tomorrow, so would also appreciate your prayers!

Thanks!
 
You've done your research. You make valid points and you seem to have a great outlook.
You'll be in my thoughts tomorrow and I send you all best wishes for a successful surgery and fast, bump free, easy recovery.

Please let us know how it all goes and let us follow your recovery.
Godspeed.....
 

hey back :)

The most common question seems to be tissue vs. mechanical. I have found, through an exhaustive amount of research, that there is no right or wrong option.

it is a very personal thing ...

I changed my mind to tissue reasoning that there is tremendous advancements taking place right now.

which may be available to you ...

...valves have new calcium treatments which may extend their durability. The current long-term durability studies showing 10-15 years refer to tissue valves that were implanted 15-20 years ago..
...
Therefore, it could be assumed that these newer valves could last longer.
...
They say that multiple TAVR procedures could be done (valve in valve in valve), just not proven as of yet. Finally, tissue engineered valves (adult stem cells) are currently being tested in sheep, etc. In the next few decades, this "holy grail" of valve replacements could be something that would replace a worn out valve, ascending aorta, etc.
lots of coulds, ifs buts and maybes in there. Too many for me ...

So finally, I was unable to find the perfect option.

my surgeon when I was younger used to say "only God makes the perfect valve, and even then he doesn't give them out to everyone.

But with me, this will be my 3rd open-heart procedure,

which brings me to why I bothered to reply. I was told that after the third surgery things start becoming more risky. Buildup of scar tissue and other complications.

I was cautioned about selecting a tissue valve because I would be unlikely to have as good a recovery as in this operation and the risks grew significantly.

I concurred and despite being afraid of warfarin I am here now with a mechanical.

and I think I'm comfortable with another procedure down the road.

its easier to say that now than it will be in 20 years I'm sure.

best wishes for your surgery and recovery.
 
Hello Neo,

I am just a newbie. I am just 23 and need a AVR soon. I did my research as well. I had a real detail talk with my surgeon. I opted for the mechanical cause of obvious reasons that it lasts a life time chances of another OHS are low and also about the med and diet, i have spoken to a lot of people including some amazing people here. It is not a serious issue. My surgeon also told me that the blood thining in an AVR is not so strict since the blood flow at the aorta is super fast hence not giving the blood enough time to clot. so basically it is like a precaution more than a serious need. You also must be aware that the risk of OHS increases with every OHS. But yeah i agree that for a young age nothing better than a no restricted life. Decision is yours. All the best. Speedy recovery and an amazing life :)
 
Neo,

I was in the same boat as you 2.5 years ago at the age of 40. To your point, I decided to go with the Magna Ease Mitral in hopes of it lasting 15 years or more due to it's advancements (Thermafix). So far so good! Your in my thoughts and all the best to you tomorrow!

Jason
 
Just read this -- evidently you may be in surgery now. While not going into the pros and cons of valve selection (which you seem to have researched anyway), I just wanted to add my best wishes and prayers for the best possible outcome.
 
Hey everyone,

Thank you so much for your thoughts and prayers! I went into surgery on Wednesday morning and came out with a 29mm SJM Trifecta Aortic valve. I didn't feel much like checking emails etc for a few days, but got released early today, and it feels so much better to be home! 3 nights in the hospital, not bad.

Overall, I am very pleased with the valve. There appears to be no murmur and I had great blood pressures in the hospital. They did go up on a few meds, and I'm taking the diuretic now, which may be the reason some of my pressures are up. I guess other things can factor into increased blood pressure, but will hopefully degress over the next week.

I can hear my heart beat sometimes, mainly the closing of it, up through my neck. I've also heard it is normal to hear things and feel certain things while the heart settles down in there, for lack of better word.

Anyway, I will keep everyone updated. Any questions, feel free to ask! Praise God, and it sure is great to be back home!
 
Hey everyone,

Thank you so much for your thoughts and prayers! I went into surgery on Wednesday morning and came out with a 29mm SJM Trifecta Aortic valve. I didn't feel much like checking emails etc for a few days, but got released early today, and it feels so much better to be home! 3 nights in the hospital, not bad.

Overall, I am very pleased with the valve. There appears to be no murmur and I had great blood pressures in the hospital. They did go up on a few meds, and I'm taking the diuretic now, which may be the reason some of my pressures are up. I guess other things can factor into increased blood pressure, but will hopefully degress over the next week.

I can hear my heart beat sometimes, mainly the closing of it, up through my neck. I've also heard it is normal to hear things and feel certain things while the heart settles down in there, for lack of better word.

Anyway, I will keep everyone updated. Any questions, feel free to ask! Praise God, and it sure is great to be back home!

Amazing! Welcome home.
 
Hello Neo -

I see you live in TN. I'm wondering where you had your Surgery (Hospital and city) and Who was your surgeon?

'AL' in Alabama
 
Thanks everyone, Al, I had the surgery at Vanderbilt with Dr. Bichell. He's a pediatric cardio-thoracic surgeon but also works on adults. I felt like he was the best pick for knowing what he's actually looking at, congenitally speaking. He was listed on the latest USNews top docs report with a star next to his name, top 1% in his speciality. He also worked on my son, who had tetrology. Working on a baby of 4lbs and 9ozs is amazing to me, thus I guess I chose the family doc!

Hey Vegas, how has your experience been over the last 6 months with the Trifecta? Any murmors, etc? What size did you get? Any meds?

I spent 3 nights in the hospital and have been home now for 3 days. It is amazing how fast you recover. Every day, you get so much energy back. It really helps to walk as often as possible and use the lung spirometer (explained to me as basically a yoga device).

The one thing I am battling right now is getting my blood pressure controlled. Right after surgery I had normal 120-140s / 60-80s. They upped my meds at discharge and the last few days the numbers have been pretty high. Stopping the Torodol seemed to help today, and they're changing my lisinopril (acei) over to losartan (arb). I also take atenolol (beta-blocker) and aspirin 325. I'll take lasix for the next few days until my post-op appt.

I guess that's all for now! Thanks.
 
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