52 year old choosing between mechanical and bioprosthetic valve

[Fundy]

McBon, was that 80/20 figure for those 55-60 only or did it include the 70+ group that make up the majority of valve operations. That might explain the wide difference.

I checked back at that transcript and it was Dr. Reul talking with Cooley, and not Cooley as I mentioned, But he mentions also that it used to be 65% tissue and 35% mechanical for the aortic valve when it was usual to give anyone over 70 a tissue and everyone else a mechanical with some exceptions like women having future children. That they were giving tissue to younger and younger patients as time went on.

 

[ALLBETTERNOW!]

Precisely. Very different from my lifestyle. How do you know Dr. Flack?

He did my AVR and aneurysm repair in May. quite a guy. I like him, he's confident but not cocky and certainly is very experienced, his outcomes stats are excellent and having a brand new cardiac building at Baystate with a brand new OR and all private specialized rooms and nursing staff is nice too. I haven't seen him since my surgery but will see him next month for my 6 month follow up. Echo stays everything looks good and I am back to work and play now. Mary and Sue and his entire office is excellent. He's a believer of fast track recovery, my breathing tube was out almost as soon as I remember waking up. The other tubes later that day. It's scary stuff but he's the man!

 

[nohohamp]

He did my AVR and aneurysm repair in May. quite a guy. I like him, he's confident but not cocky and certainly is very experienced, his outcomes stats are excellent and having a brand new cardiac building at Baystate with a brand new OR and all private specialized rooms and nursing staff is nice too. I haven't seen him since my surgery but will see him next month for my 6 month follow up. Echo stays everything looks good and I am back to work and play now. Mary and Sue and his entire office is excellent. He's a believer of fast track recovery, my breathing tube was out almost as soon as I remember waking up. The other tubes later that day. It's scary stuff but he's the man!

All great to hear. Scary, yes. Good to also have reason to feel confident.

 

[ALLBETTERNOW!]

All great to hear. Scary, yes. Good to also have reason to feel confident.

Yes and when the nurses see your scar, they will know and perhaps comment about his handiwork, nice and tidy and not too large. A real gem in our part of the world even if Boston and Mass GenEral and Beth Israel are the epicenter

Ps Imwas 49 and went tissue, a little bit of buyers remorse not getting a mech but so happy to be alive and back to life and no Coumadin to deal with. It's common to be on it for 90 days after surgery anyway and bit took my body a long time to get in range....

 

[W. Carter]

I will say this, either way is alright if it's alright with you. I know that for myself I will do it again under emergency if I have to do it to live. 10 mo. post op and my shoulders still hurt from them splitting my chest bone and it took 8 mo. to recover and I was 58 yo for the operation. I can just imagine being 75 or 80 yo and having to do it again.

 

[ALLBETTERNOW!]

A 1 hour video of a valve surgery I watched before my surgery, was fairly informative to me. It kind of touched on various variables one would consider. It seems to have disappeared( I can no longer find it), but a transcript is here:
http://www.or-live.com/transcripts/med_1326_186.pdf

Dr. Cooley mentions that at a then recent surgeon conference(2005), the surgeons were asked which valve (tissue or mechancial) they would choose themselves at 55-60 yrs. He mentioned it was about 50/50.

Also, interesting is the discussion where he states he has had a few mechanical valvers refuse to use warfarin and have no issues even after 30 yrs. Not in that transcript but elsewhere, I noticed he has had several patients with 1st generation pericardial valves lasting over 30 yrs.

they certainly seem to have confidence in tissue valves. hopefully with good reason???

 

[McCbon]

Fundy, my memory is spotty. I've read and heard so many facts and figures and specs that I don't remember exactly where. That said I think it was the overall percentage implanted at CC and then I've seen it externally verified in some reading. It averaged within a recent time-span but not pertaining to a specific age group and was in the context of valve choice. You have a great point though, in that the tissue valves put into the "majority" of geriatric pts (depending on the percentage of that age group to the total number of valvers??) could swing that percentage. It always made me a little anxious because if I do go with mechanical at age 62, as I currently intend, then I am in a distinct minority which makes me second guess my decision, a little bit. Bonbet

 

[pellicle]

Hi

This is the only summary that matters.

I will say this, either way is alright if it's alright with you.

The remaining discussions can only be for assisting those in the midst of decision. Sometimes I think these discussions only serve to confuse those deciding.

 

[ALLBETTERNOW!]

Hi

This is the only summary that matters.



The remaining discussions can only be for assisting those in the midst of decision. Sometimes I think these discussions only serve to confuse those deciding.

No doubt.I know I flip flopped about my decision post surgery, I only had 24 hours yo decide heading into surgery. The best news is we are debating the best choice, not the only choice and that it is fixable. I say how with your gut and your surgeon and let this chips fall where they may, or may not....

 

[ALLBETTERNOW!]

Fundy, my memory is spotty. I've read and heard so many facts and figures and specs that I don't remember exactly where. That said I think it was the overall percentage implanted at CC and then I've seen it externally verified in some reading. It averaged within a recent time-span but not pertaining to a specific age group and was in the context of valve choice. You have a great point though, in that the tissue valves put into the "majority" of geriatric pts (depending on the percentage of that age group to the total number of valvers??) could swing that percentage. It always made me a little anxious because if I do go with mechanical at age 62, as I currently intend, then I am in a distinct minority which makes me second guess my decision, a little bit. Bonbet

It's your body, do what you want! I think second guessing will come with the territory, I got it for sure. Tissue at 49....

 

[dreamwarrior13]

I am 24 and just had my operation in January; I went with a mechanical valve (the On-X) in the hopes of avoiding future surgeries. The ticking, I am told, is quieter than with other mechanical valves. It freaked me out a little when I first woke up -- but then, I was so doped up on pain medications that pretty much everything probably freaked me out. Since then, however, I've mostly gotten used to it. I don't actively think about it much unless I'm talking or writing about it (like now, haha). It is kind of handy in that if you're bad at taking your pulse like I have always been, you don't really need to check your wrist or neck. You can just sit and listen for sixty seconds.

I have not experienced any of the bad side effects people usually associate with blood thinners, like nosebleeds or hemorrhaging or anything like that, but then, it hasn't even been a year for me yet. Fingers crossed! I will say blood thinners are a bit of an annoyance though, at least for me. My INR range isn't quite stable yet, though my doctors keep reminding me that it can take a long time for me and my body to get used to the medications and the valve and all that. (Plus I'm still learning, as far as watching my diet and all that.) But it's never been extremely far out of range -- even the one time I accidentally took a double dose, not a good day for me lol -- and I've never experienced any negative symptoms from it being a little too high or a little too low.

Sometimes I wonder if I should have chosen a tissue valve -- as Mike59 said early on in this thread, both tissue and mechanical are good choices for different reasons, and the idea of not ticking and not needing long-term anticoagulation therapy is definitely tempting, particularly on the days when my INR is out of range. But I would still recommend my valve, especially if you're concerned about facing future open-heart surgeries. With a tissue valve, it's highly likely you'll need at least one more operation, possibly more. A mechanical valve usually lasts for decades -- I'm personally betting on mine lasting for the next half a century or so.

 

[Fundy]

Fundy, my memory is spotty. I've read and heard so many facts and figures and specs that I don't remember exactly where. That said I think it was the overall percentage implanted at CC and then I've seen it externally verified in some reading. It averaged within a recent time-span but not pertaining to a specific age group and was in the context of valve choice. You have a great point though, in that the tissue valves put into the "majority" of geriatric pts (depending on the percentage of that age group to the total number of valvers??) could swing that percentage. It always made me a little anxious because if I do go with mechanical at age 62, as I currently intend, then I am in a distinct minority which makes me second guess my decision, a little bit. Bonbet

Yeah I think the 70+ group skews the data, which leads to your belief that at 62 a mechanical valve would be the choice of a small minority. I'd say that informal poll of 50/50 for the age group of 55-60 might be a truer representation of the choices being made. Although in these forums you hear of many people in the 60-65 group saying their surgeon recommends tissue, there are many here saying their surgeon recommends mechanical.

I don't think choosing mechanical at 62 is as unpopular as what you believed. Especially, if avoiding a second valve replacement is a high priority for you.

 

[pellicle]

Hi

My INR range isn't quite stable yet... But it's never been extremely far out of range -- even the one time I accidentally took a double dose, not a good day for me lol -- and I've never experienced any negative symptoms from it being a little too high or a little too low.
...not needing long-term anticoagulation therapy is definitely tempting, particularly on the days when my INR is out of range.

well don't worry much, it has to be over by an amount and under for a long time to be an issue. This chart shows from some studies where the INR needs to be for indicents to be more common

Since you are a recent valve recipient and probably new to self testing, I will suggest this blog post of mine to you

http://cjeastwd.blogspot.com/2014/09...ng-my-inr.html

it should help you to make better calls, I've only been at this for 3 or so years now, but I'm learning

A mechanical valve usually lasts for decades -- I'm personally betting on mine lasting for the next half a century or so.

actually I've never read of one wearing out. Dick here has one of the first generation ball and cage types, which IIRC he's had for nearly 40 years. I've read of one St Jude breaking a hinge, but that was extensively studied and StJude revised the design. I've heard of them being clogged by people failing for years at a time in their AC therapy, but even that can now be reversed in many cases with a non surgical treatment. The mechanicals are really tough stuff.

 

[dick0236]

...........-- I'm personally betting on mine lasting for the next half a century or so.

That's a pretty good bet.

 

[dreamwarrior13]

pellicle Thank you so, so much. I'm about to go and get my INR checked again today so this was perfect timing. That blog post of yours is fantastic, very detailed and VERY comforting. I look forward to self monitoring in the near future.

 

[epstns]

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

I have family in the area. My son-in-law is a grad student at UMass - Amherst. We visit once in a while. Sure is different from Chicago!

 

[ALLBETTERNOW!]

I am 24 and just had my operation in January; I went with a mechanical valve (the On-X) in the hopes of avoiding future surgeries. The ticking, I am told, is quieter than with other mechanical valves. It freaked me out a little when I first woke up -- but then, I was so doped up on pain medications that pretty much everything probably freaked me out. Since then, however, I've mostly gotten used to it. I don't actively think about it much unless I'm talking or writing about it (like now, haha). It is kind of handy in that if you're bad at taking your pulse like I have always been, you don't really need to check your wrist or neck. You can just sit and listen for sixty seconds.

I have not experienced any of the bad side effects people usually associate with blood thinners, like nosebleeds or hemorrhaging or anything like that, but then, it hasn't even been a year for me yet. Fingers crossed! I will say blood thinners are a bit of an annoyance though, at least for me. My INR range isn't quite stable yet, though my doctors keep reminding me that it can take a long time for me and my body to get used to the medications and the valve and all that. (Plus I'm still learning, as far as watching my diet and all that.) But it's never been extremely far out of range -- even the one time I accidentally took a double dose, not a good day for me lol -- and I've never experienced any negative symptoms from it being a little too high or a little too low.

Sometimes I wonder if I should have chosen a tissue valve -- as Mike59 said early on in this thread, both tissue and mechanical are good choices for different reasons, and the idea of not ticking and not needing long-term anticoagulation therapy is definitely tempting, particularly on the days when my INR is out of range. But I would still recommend my valve, especially if you're concerned about facing future open-heart surgeries. With a tissue valve, it's highly likely you'll need at least one more operation, possibly more. A mechanical valve usually lasts for decades -- I'm personally betting on mine lasting for the next half a century or so.

At 24 it's hard to think anything but a mechanical valve would make sense.

 

[MethodAir]

At 24 it's hard to think anything but a mechanical valve would make sense.

Tissue is the perfect choice if you don't anticipate having another OHS.

 

[ALLBETTERNOW!]

Tissue is the perfect choice if you don't anticipate having another OHS.

True but I don't know how one would expect to get from 24 to 84 with a tissue valve?

 

[Tank]

I chose tissue at age 44 for whatever reason and my heart beat hard and noisy with the tissue. It would literally shake the whole truck while I was leaning on it to shoot my rifle. well at least it felt like it, causing me to have to squeeze one off between beats. The tissue valve started to cause me problems at about 5 years and got superbad by 10 years almost to the month. I chose mechanical the 2nd go around only because I do not want to go though this ever again if I have anything to say about it. The ticking, clicking and other noise that you may or may not hear are minimal at worst and I thought it was pretty cool that my daughter could hear my heart making noise from 5 feet away. I have a stethoscope at home but have not listened to my heart due to the fact that it would totally freak me out listen to a noise that is not normal