52 year old choosing between mechanical and bioprosthetic valve

[cldlhd]

Well obviously you'll have to decide which valve before surgery but the surgeon may end up repairing it. Did he give you any sort of indication if he thought a repair is a likely possibility? I was told that my valve should be "easily repairable but we won't know until we get in there" so I had to choose a valve for a backup plan and I chose mechanical . I guess somebody else got that valve as mine was repaired earlier this year . I was 45 at the time of my surgery. Does your surgeon specialize in repair? I know some people out here who had surgeons who weren't experienced in repair so were iffy on it and leaned towards replacement. Being a few hours outside Boston I'm sure you'll be able to find a top notch surgeon.

 

[nohohamp]

Well obviously you'll have to decide which valve before surgery but the surgeon may end up repairing it. Did he give you any sort of indication if he thought a repair is a likely possibility. ... Does your surgeon specialize in repair? I know some people out here who had surgeons who weren't experienced in repair so were iffy on it and leaned towards replacement.

My surgeon's guess was somewhere around a 70% chance of repair, though I think that was a somewhat off the cuff estimate. He's done about 100 repairs over the past 10 years, which my cardiologist says is a good number. As you say, my job is to decide which valve is plan B.

 

[W. Carter]

Mechanical. Don't be scared of warfarin, it won't bite. With tissue at your age you might need 2 additional ohs's.

 

[pellicle]

Hi

I am quite curious.

Mechanical. Don't be scared of warfarin, it won't bite. With tissue at your age you might need 2 additional ohs's.

While it is laudable that you are able to abstract your decisions from the advice you give I would be interested to read why you give the exact opposite advice to your own views just 2 posts above

For me my final choice of a tissue valve had a few reasons. Warfarin being the the major one, however most people in here don't have a problem with that but I felt I didn't want surgery to correct one problem whilst creating another that needed ongoing attention.

Especially since a tissue valve does exactly that: create an ongoing problem that needs ongoing attention.

 

[nohohamp]

Hi
I would be interested to read why you give the exact opposite advice to your own views just 2 posts above

The two posts you quote don't appear to be from the same person.

 

[cldlhd]

My surgeon's guess was somewhere around a 70% chance of repair, though I think that was a somewhat off the cuff estimate. He's done about 100 repairs over the past 10 years, which my cardiologist says is a good number. As you say, my job is to decide which valve is plan B.

From what I've read experience is very important when it comes to repairs and 100 sounds like a good bit to me. I didn't go with the first surgeon I was assigned, he was highly rated but I pushed for the guy who trained him. When I asked to switch my cardiologist seemed to imply I was asking a bit much . The surgeon I went with does ,on average ,over 200 OHS a year and specializes in repairs so I assumed they make up a good % of his surgeries. He's been using a technique he helped develop since 2004 so going by rudimentary math that's...um..a hell of a lot. More important to me was the fact he has no reops due to valve failure over that 11 yr period. I only wanted repair if it's likely to last.
I was 45 when I had my surgery ( February this yr ) and my backup choice was mechanical.

 

[David W]

Especially since a tissue valve does exactly that: create an ongoing problem that needs ongoing attention.[/QUOTE]

That's a bit insensitive mate. The reason for writing that post was to convey that currently for me, I am in a much better position than I was a month ago, so my reasons for side stepping warfarin related to me not wanting myself to be in a position where I needed to look after my blood INR levels. To me that's a problem and I respect that it's not for others. From what I have discovered, either valve can (potentially) create problems and "ongoing attention" that's the hand we have all been dealt. Additionally on the clinical advice I have been given I would not have wanted to be given a mechanical valve when the near future points to better tissue valves and choice. So we know the pros and cons and we make the choice that is relative to our frame of reference. I made mine and I'm sure you will make yours which will be right for you.

 

[David W]

If you get the chance have a listen to this YouTube webinar. It kind of settled it for me as my mind was leaning this way prior to hearing it.

https://www.youtube.com/watch?feature=player_detailpage&v=3RU9bIzBIM0#t=2929

 

[ALLBETTERNOW!]

Right you are, epstns. What's your connection to Northampton?

Good food, great music and Baystate just down the Road, what's not to like? Say hello to dr flack, he's the best!!!

 

[pellicle]

Hi

That's a bit insensitive mate.

I'm sorry you took it that way, it was not what I intended. If you consider that many people lurk here and read without posting I'm sure you'll understand that may create some confusion.

Your answer clarified that.

I'm sorry that I offended you. I was not intending to contractict you but to ask why (which I thought was reasonable), as we all share ourselves deeply here. I had the view that people here should be willing to share. People have called me out to demand (in not so nice ways) as to why I feel as I do, and I have simply answered. I feel that if one can not ask questions then the place is diminished in value. Asking questions as I did does not cross my personal line of condeming your decision (which I did not).

Thanks for offering the webinar, I'll listen to it.

 

[nohohamp]

Say hello to dr flack, he's the best!!!

Great to hear about Dr. Flack, who'll be doing my surgery.

 

[W. Carter]

Hi
I am quite curious.
G
While it is laudable that you are able to abstract your decisions from the advice you give I would be interested to read why you give the exact opposite advice to your own views just 2 posts above



Especially since a tissue valve does exactly that: create an ongoing problem that needs ongoing attention.

I made one post. I feel that the mech. valve is the best decision for a 52 yo. I often wonder if Dr.'s are just trying to drum up future business by recommending tissue valves to 30-50 yo patients. JMO.ff
Yf

 

[pellicle]

I made one post.

we all swap one disease for another -> heart valve disease for prosthetic valve disease.

Its always a matter of choosing which symptom set you are willing to live with.

Just for the record I'm not actually expecting to get another valve. After 3 surgeries a 4th (with an aortic graft just to complicate things) would not have desirable outcomes.

I just recently commented that it was good we can discuss these things without heated exchanges. I believe that is predicated on the rule of don't judge others choices who have made them.

Perhaps its a fine line but to me understanding the reasons (without calling them into question) for their choice may help others make their choice.

Best Wishes

 

[Agian]

If you get the chance have a listen to this YouTube webinar. It kind of settled it for me as my mind was leaning this way prior to hearing it.

https://www.youtube.com/watch?feature=player_detailpage&v=3RU9bIzBIM0#t=2929

What an amazing man. He makes it sound so easy.
Thanks for posting Dave.

 

[jumpy]

I made one post. I feel that the mech. valve is the best decision for a 52 yo. I often wonder if Dr.'s are just trying to drum up future business by recommending tissue valves to 30-50 yo patients. JMO.ff
Yf

There are many that are choosing tissue with the "potential" sea change in Heart Valve Replacements which will be much less lucrative to the Hospital Businesses. Trans Catheter replacement in moderate risk patients has shown promise in trials.

http://www.cardiovascularbusiness.c...t/tavr-low-risk-patients-holds-steady-2-years

More data is needed for this to be a viable alternative but the potential cannot be ignored.

As a 44 year old I have made the decision to go tissue and hope to get a decade out of the Valve. If the data doesn't support TAVR at that point I will face the prospect of another surgery in order to get a mechanical valve. I started this with Ross as my preference and mechanical as the backup. As the Ross was eliminated due to surgical risk my views opened to include tissue valves as a viable alternative.

The journey is very individual but I think we will start to see more and more people consider all the present data as well as potential future technologies when making this decision.

 

[almost_hectic]

What an amazing man. He makes it sound so easy.
Thanks for posting Dave.

Well he brings up several interesting what ifs... however, all those what ifs can stil exist when it comes time to have a second OHS. What if youre due for a second heart surgery (because you will be eventually) but your no longer strong enough because you have developed... leukemia, pulmonary disease, immune system disorder. The only certainty is that a tissue valve will most likely not last you for the rest of your life and will require an additional surgery years later. Choosing a mechanical valve is your best bet for NOT having additional heart surgery later in life when things may be more advanced, but your health situation may also be much worse. Especially when they only thing you need to do to back that up with a guarantee is to take a tiny pill every day.

 

[David W]

Hi



I'm sorry you took it that way, it was not what I intended. If you consider that many people lurk here and read without posting I'm sure you'll understand that may create some confusion.

Your answer clarified that.

I'm sorry that I offended you. I was not intending to contractict you but to ask why (which I thought was reasonable), as we all share ourselves deeply here. I had the view that people here should be willing to share. People have called me out to demand (in not so nice ways) as to why I feel as I do, and I have simply answered. I feel that if one can not ask questions then the place is diminished in value. Asking questions as I did does not cross my personal line of condeming your decision (which I did not).

Thanks for offering the webinar, I'll listen to it.

Hi Pellicle

I'm not offended honestly. From my (short experience) of this wonderful forum, it appears that having made a choice about our valves, we can all get a bit emotive when explaining the reasons for our choice. Sometimes it's quite clear (even with the best intent in the world) that we all over emphasise our choice and for some, it comes out in their use of words without them knowing, quite blatantly at times. I would never dismiss or devalue anyone's else’s choice of valve by highlighting some of the reasons why I didn't go for a particular valve (in my case a mechanical valve). To do that would be a bit out of order, so I am very careful with my choice of words when replying to someone's comment about the merits of my tissue valve. That's how your response came across to me, but maybe that's just my interpretation. No offence was taken at all my friend and your input is always valued.

D

 

[Paleowoman]

Hi

I am quite curious.

While it is laudable that you are able to abstract your decisions from the advice you give I would be interested to read why you give the exact opposite advice to your own views just 2 posts above

Especially since a tissue valve does exactly that: create an ongoing problem that needs ongoing attention.

Hi Pell,

You seem to have quoted two different writers thinking they are the same person.

The first person you quoted was W Carter who obviously had a mechanical valve, the second person you quoted was David W who has just had a tissue valve. Here:

Mechanical. Don't be scared of warfarin, it won't bite. With tissue at your age you might need 2 additional ohs's.

For me my final choice of a tissue valve had a few reasons. Warfarin being the the major one, however most people in here don't have a problem with that but I felt I didn't want surgery to correct one problem whilst creating another that needed ongoing attention..

Btw, I will take a little issue here with W Carter: whoever said that those of us who don't want to take warfarin are "scared" of it ? I wouldn't go on warfarin because I don't want to spend the rest of my life having to take it into account when eating or whatever and in testing my INR levels. Having to take warfarin does mean "ongoing attention" as David W says. Goodness there's a whole forum on valvereplacement forum just for those taking warfarin and the issues they get from time to time.

In addition, many of us who have chosen tissue valve have also done so because of the noise. There's no use pretending it doesn't make a noise unless you are hard of hearing (or maybe a tad overweight as the fat buffers the chest). Last Thursday I was a patient n an exam for doctors wishing to move up to specialist level. One of the first things they do when they see a sternotomy scar is listen for a mechanical click WITHOUT using a stethoscope, just by being near.

So a person with a mechnical valve does have to give ongoing attention to their INR levels. Obviously most who choose mechanical do not mind those ongoing issues. (they obviously don't mind the noise - I find a ticking clock irritatting and cannot get used to one). A person with a tissue valve on the other hand does not have ongoing issues and does not need attention until the tissue valve goes wrong. Obviously that means a reoperation which won't be nice.

[FONT=Arial, Helvetica, Verdana, sans-serif]It's swings and roundabouts. There's good and bad in both choices. There's no wrong or right choice.[/FONT]

 

[David W]

Well he brings up several interesting what ifs... however, all those what ifs can stil exist when it comes time to have a second OHS. What if youre due for a second heart surgery (because you will be eventually) but your no longer strong enough because you have developed... leukemia, pulmonary disease, immune system disorder. The only certainty is that a tissue valve will most likely not last you for the rest of your life and will require an additional surgery years later. Choosing a mechanical valve is your best bet for NOT having additional heart surgery later in life when things may be more advanced, but your health situation may also be much worse. Especially when they only thing you need to do to back that up with a guarantee is to take a tiny pill every day.

Your use of the word (maybe) is as liberal as the (what ifs) in the webinar. We all know that none of us can see our health 10 years from now. But that's not to say we will all have lukemia etc. We can't live in a mind that has written us off before we even get to the future. We have every likely hood of getting to our destination as fit and healthy people with no ailments what so ever. I made my choice of valve with this mindset. Had I thought in a more negative capacity then that would have been incredibly limiting. A meteor might wipe us all out next week so what's the point on booking that holiday to Barbados next year, that would not make any rational sense in spite of it being a rational statement if you get my drift.

 

[pellicle]

Hi Pellicle

I'm not offended honestly.
D

That's good, I wasn't sure by what you meant by

That's a bit insensitive mate

, so I wanted to be clear. Its a sensitive subject. I know I stand on toes occasionally but its just because I'm clumsy and don't know everyone's steps.

Shalom