56 and AVR in April 2020

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GaryMc

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Mar 2, 2020
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Hello and thanks for this great resource. I am a 56 year old male with aortic stenosis. Had an angiogram yesterday and surgery looks like it will be next month. From talking to the surgeon I'm in the grey area as far as tissue vs. mechanical. I'm very active so we are leaning toward tissue with the knowledge that I'll need a second replacement somewhere down the line.
 

dick0236

Eat the elephant one bite at a time
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.............I'm in the grey area as far as tissue vs. mechanical. I'm very active so we are leaning toward tissue........
Welcome to the forum. You will find a lot of info on this site from a bunch of folks who have all been thru this.

From what I understand you are in the so called "grey area" between mechanical and tissue.....but I would not consider a "very active lifestyle" in determining valve choice. I got my "mechanical aortic valve" at 31......lived a very active life.......and still have that first valve at 84 as well as a "pretty active life". These major surgeries get "tuffer" the older you get so consider the "now and then pros and cons" as you make your decision.
 

Astro

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Aug 26, 2019
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Adelaide, Australia
It is a difficult question with no obvious right or wrong. Do you go for a tissue valve that will hopefully last into your 70s and then have a TAVI which will hopefully last to your 90s, or do you go mechanical with hopefully only one intervention?
The US, UK and Australian registry data show that the proportion of mechanical valves is decreasing. People are increasingly picking tissue. However, you can see on the forums that active living with a mechanical valve is also fine.
I chose mechanical but was 11 years younger than you.
Either way is likely to have a good outcome. Whatever you chose, I hope that you feel at peace with your decision.
 

LondonAndy

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Welcome GaryMC! I agree with Astro, that there is no obvious right or wrong answer, and we all place different importance on different factors. I went with mechanical at age 48, nearly 6 years ago. My reasoning was to seek to minimise the risk of having to have it replaced at an older age, with the increased risks of surgery through scar tissue and when weaker. Also, I like technology and have a CoaguChek XS meter, so I keep an eye on my INR level weekly, wherever I am in the world, with a finger-prick blood test. My valve's ticking is trivial, and does not bother me.

I understand that the reason tissue valves are less offered to younger people is because their generally greater level of physical activity means the tissue valves wear out more quickly, and can have a life of only 7 to 15 years depending on this. So although you are older if you are causing your heart rate to rise a lot on a regular basis you would presumably face the same issue.

But whatever you decide, remember that it is much better than not having it done!
 

Penny2003

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Apr 10, 2016
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Northern Illinois
Hello and thanks for this great resource. I am a 56 year old male with aortic stenosis. Had an angiogram yesterday and surgery looks like it will be next month. From talking to the surgeon I'm in the grey area as far as tissue vs. mechanical. I'm very active so we are leaning toward tissue with the knowledge that I'll need a second replacement somewhere down the line.
Hello! I was 55 when I got my Medtronic Mosiac Porcine valve and am doing quite well now at the age of 72. Still going strong and will celebrate 17 years with my “little piggy” this month. It is different for everyone and my choice worked out well for me. My cardiologist says my valve has shown no changes in years and maybe I will set a new record for longevity! The best to you!
Penny
 

tom in MO

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Jan 17, 2012
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MO USA
Hello and thanks for this great resource. I am a 56 year old male with aortic stenosis. Had an angiogram yesterday and surgery looks like it will be next month. From talking to the surgeon I'm in the grey area as far as tissue vs. mechanical. I'm very active so we are leaning toward tissue with the knowledge that I'll need a second replacement somewhere down the line.
Welcome and good luck on your journey to health and continued life.

You didn't ask, but I wouldn't recommended picking your valve based upon just being "very active." I wasn't given that advice and I had my valve replaced at the same age as you. You don't say what "very active" means. For example, if you are an instructor in full contact karate, then being on warfarin may impact your life severely. If being "very active" means fishing, hunting, riding your bike, and going to the gym, warfarin wouldn't be a problem.

Most people going on warfarin see no change in their activity ability. Remember, getting a replacement tissue valve means you will have a deterioration in cardiac performance over time, just like your birth valve. Just like a birth valve, it can be quick (5 years) or slower (20 years) but unlike your birth valve, it won't last 56 years.
 

Bryan B

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Jan 16, 2004
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I agree with the others that there is no need to choose your valve based on how active you plan on being. When I was 43 I wanted my cake and eat it too so to speak. I wanted a permanent (indefinite) fix without having to take anticoagulants so I chose a Ross Procedure. Unfortunately one of the risk factors that come with that procedure is dilation of the aortic root, and that's what happened in my case.

I needed surgery again at the age of 50 which put me kind of on the young side of the grey area. I was truly conflicted between a tissue valve (CE bovine pericardial) and a mechanical valve (Onyx). My surgeon was willing to use either, but he was also on the team at Duke doing clinical trials on the TAVR procedure at the time. He was confident that if I chose tissue and got the average lifespan out of the bovine valve that I would be a perfect candidate for the TAVR procedure when the time came.

I ended up choosing tissue and just recently passed 9 years with my CE bovine valve, and so far so good. At my last checkup he felt that I would probably get another 5-10 years out of it and he would use TAVR to replace it when the time comes.
 

nobog

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Joined
Jun 14, 2019
Messages
75
For thought, I have personally seen a tissue valve last 6 months and I have personally seen a tissue valve last 20 years. No one can tell you how long tissue valve X will last in you.

As far as being active, someone climbed Mt Everest (to the top) with a SJM Mechanical Valve.

You indeed have a big decision, my best,
 
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