62 years old and meeting surgeon in 10 days to decide on valve type

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PeterII

Liborio
Joined
Sep 20, 2015
Messages
285
Location
Toronto
Hi !, before all, would like to thank all the people that share here their concerns and thoughts about this event that has crossed our lives taking us to surgery room to have a heart valve replaced.

currently am 62, and every where hear "recommendations" for tissue valves because they will last 20 years, or 17 at least, and on the other side hear that currnet st jude and on-x valves will for sure last 20+ years and warfarin is just a matter of learning how to manage it....

reading and talking have to say a question comes to my mind "if there is no one walking around with a pericardial valve" x 20 years, how can the industry promiss so ?, statistics can say what ever you push the to say, mathematics tell you is all about the sample and the population selected,
so "science papers" mean certain thing but they are just a "reflection" of the reality,..... but there are people walking around with mechanical valves x 20+ years ...

all of that said, still have doubts, will a pericardial valve last 20 years on a 62 years old ?
is taking warfaring the boogie man that will fix one thing and destroy 3 more ?
what about the noise of the mechanical valves ?, st jude or on-x ?

my heart tells me to get a bio, my mind tells me to get a robot l.o.l...

just need to share.....


thank you
 
My Surgeon asked me yesterday have l ever seen a 50 year old cow ? And secondly if you can't hear the ticking you've got a problem. 😕
He will be using 2 mechanical on aorta and mitral and whatever is on his shelf. He would never use OnX while replacement of 2 valves.
Also take about increase my med list by double possibly triple including rat poison for life (Cumiden)
I am a 55 yr old female.
I'm going to take his advice!
Best if luck in your decision.
 
Welcome to the forum jlcsn2015 ! I was 60 years old when I got my valve, a pericardial Carpenter Edwards Magna Ease aortic valve. My cardiologist and cardiac surgeon didn't even question me wanting a tissue valve, they were both perfectly happy with my preference. The reason you don't see people walking round with that particular valve from 20 years ago is that those particular valves weren't developed until more recently. Yes they made pericardial valves 20 years ago but they have refined them every few years and now they last longer than they did when they were first invented. I do not mind having a 're-do' though which is surely on the cards for me. The fact that I do not hear ticking in my chest and do not have to take warfarin every day more than compensates for the pain and stress of a 're-do' (and I didn't have it particularly easy when I had my surgery). Right now the only thing that tells me I've got a bio valve is seeing my incision scar and memories of the surgery and ongoing check ups with the cardiologist - I liken it to having a crown on a tooth, it feels your own as you can't notice the difference between it and the natural one.

Harriet - I would hate to hear the ticking of a mechanical valve - it would be no joke to me. I know for some people hearing the ticking is reassuring but for others that would be quite the opposite.
 
Welcome jlcsn. I understand your need to share. It is a life-changing decision either way, isn't it?

My backstory is very similar to that of Paleogirl. In fact, I communicated with her privately to help in my decision to go with a tissue valve. I just turned 61 and though the thought of a re-do (very likley) is not a pleasant one, the deciding factor for me was the ticking of a mechanical valve. I'd made up my mind to deal with the warfarin when I read a post about potential ticking and, like Paleogirl, I would find that very difficult to live with. My surgeon was good with either type at my age.

Regarding the longevity of tissue valves; like you I've seen stats that state up to 20 years. However, from posts I've read on this forum, 10 years seems to be closer to the norm. Another point to consider (and pellicle can verify this for you), it is possible that even with a tissue valve I may need to take warfarin. It's not a strong possibility but it is a possibility.

My surgery is less than a week away (9/30/15). Last week, following my heart cath, I was invited to particpate in a clinical study for a new type of Edwards tissue valve that will require less time on the heart-lung machine. I'm pretty excited about that.

I'm confident you will find the folks on this forum as helpful as I did. IMO, no amount of research can compare with talking to others who have been down this road.
 
jlcsn - Some of the valve lifespan expectancies are extrapolations from data regarding the previous generations of tissue valves. IIRC, the current batch of tissue valves are thought of as "third-generation" valves. The scientists have a lot of data on the "second-generation" valves that were in use some years ago. They also have predictions as to how the third-generation valves are superior to the second. They then calculate how long the third generation valves should last, given what they know about second generation and what they think they know about the third generation valves. We know and are told by the docs that there are no guarantees as to valve life, but they do tell us that their best prediction is that the third-generation valves will last longer than the second gen. They have a lot of data about what percentage of second generation valves are still OK at 10, 12, 15 or more years, and they expect that the newest ones will last longer.

They are also sure that the older the patient at time of implant, the longer it will take for calcification to form on the prosthetic valve. That is because the immune system is what causes calcification, and the immune systems of younger patients are more active than those of older patients.

I was 63 when my Edwards tissue valve was implanted. At 4 1/2 years all is just fine. I'm betting that it will be a close race as to which lasts longer -- me or my valve. (And yes, I DO buy green bananas. . . )
 
jlcsn2015;n858606 said:
,..... but there are people walking around with mechanical valves x 20+ years ...

all of that said, still have doubts, will a pericardial valve last 20 years on a 62 years old ?
is taking warfaring the boogie man that will fix one thing and destroy 3 more ?
what about the noise of the mechanical valves ?, st jude or on-x ?
thank you

Hi, welcome to this forum. You'll get a lot of good info here. From what I've read you at at the crossroad of valve choice......so I'll give you my thoughts.

I've had my mechanical valve longer(48+ years) than anybody...I think. Even if a tissue valve did last 20 years you would face another surgery at 80+ years of age. Maybe OHS will be an "outpatient procedure", as some predict LOL, but if not it would be a "tuff" operation at age 80+. I am within 6 months of 80 and in very good health....but would not want OHS again. Too many things go wrong with major surgery on seniors.

"is taking warfarin the boogie man that will fix one thing and destroy 3 more" ???? My experience is that if I take the pill as prescribed and test routinely it has caused me NO problem....screw around with it and it will bite you......hard. After all the years I have taken the drug I know of nothing....so far, that it has destroyed if I follow a few simple rules.

The "noise problem" I can't address about the newer valves.....but mine is an old "ball in cage" check valve design(no longer in production) that should be noisy, I guess......but you would not hear it, even if you stood next to me.

Yours is a personal decision. Do your homework and make the decision you think will be right for you.....there are no bad choices. I have literally lived 2X the age I would have lived without the valve replacement.......and, frankly, a lot longer than I thought I would....even with the mechanical valve.
 
Sixty seems to be the age where cardiologists think we're young, but to a lot of the valve recipients we're old. I got a porcine tissue valve at 60 and it lasted 6 years. Another member here got the same valve from the same surgeon two years before me and is still doing well. Now I've had a mechanical valve for two years (so I really am old now). Sadly, statistics and our stories here just don't tell you what YOU should choose. However, I think you should factor in your tolerance for another period of decline as well as second surgery with a tissue valve. I did very well with both surgeries, but I thought a 6-year cycle was not acceptable.
I've found the warfarin experience frustrating, but have finally calmed down about it. I do hear the tick sometimes when it's very quiet, but in AZ we have fans running much of the time, and it's similar to the 'chk-chk-chk' of the fan pull chains. Oddly enough, I don't hear or notice it when I'm ready to sleep or on waking.
 
jlcsn2015 forgive me for not welcoming you. Everyone truly is unique and has very different wants needs and circumstances in which this decision is made. I wasn't even given a choice "he very simply said he would be using two mechanical valves under the circumstances" and Paliogirl l am totally afraid the ticking will send me off the deep end. I can't even stand a fan blowing or the sound of my CPAP MACHINE some nights l want to throw it thru the window. So yes ticking 😕 sigh ! And especially if not in sinc well can you say Crazy. But again lm pretty darn grateful that they can do anything at all.
Honeybunny l am counting the days with you ... think of you and saying my prayers. Xx
 
Welcome .... the best thing to do is to do what YOU feel comfortable with .. I am 52 and opted for Mechanical .. I like the sound of the ticking but accept that not everyone will.
 
Hi, thank you to all the people that have taken their time to write their thoughts, it has really been very useful to read what others feel and think about this event. I spent all day today friday thinking while drinking an Orange juice at a local McDs ( thats all i eat there :) ), and realized that in my feeling i would be happy getting back to a better energy and feel like situation taking a bioprosthesis, but... in my mind , i kept circling around the question, of "do i want to face this again ?", and yes, the warfarin worries me, but have spoken to some people and just read what all are saying here, and was very in tune with me what i hear today from a couple of doctors (non cardiologist , just gp) saying that "today" is not so difficult any more to control the INR levels. So, although have not meet the surgeon yet, appointment is now Oct-1th; i am very sure that "for" me, as for others, the mechanical valve seems to be the way to go, as minimizing the probability of having another surgery is important to me. Valve type i have heard my surgeon uses the st jude and the on-x, not sure which one he will want to use, but hear a lot of good things from the "engineering" point of view regarding the pyrolitic carbon used to build the on-x valve. So, my very sincere thanks to all that have shared their thoughts, and will write again once a decision is made by the surgeon as what it will be. Good night and again, thanks a lot for the sharing !!
 
Had a mechanical valve installed last April. It was an ON-X. My surgeon wouldn't consider any thing put a mechanical valve. He stated that he didn't want to do this again 10 years down the road and neither did I. I only hear the ticking when I lean forward or in certain positions. No a big deal at all. Warfarin isn't a big deal either. INR 1.5 - 2 is easy to maintain.




Born with BAV and at 55 AVR, On-X replacement 4-14-15. Repaired root and Ascending Aorta at Minnesota Heart Institute by Dr. Vibhu Kshettry.
 
Hi dick0236 !
Thank you for your message, 48 years on a mechanical valve !!, i will post message for you on your section, Thank you;
 
Surgeon's office called me today, appointment for thursday canceled due to emergency surgery :(, next date oct-21.
Still strong believer in "one" operation and keep taking my supplements , maybe less than now, and learn how to manage the INR;
and dont have to live with the concern of "when is this going to deteriorate". For what i have heard in the hospital they use the St Jude Mech and the On-X, hoping my surgeon feels the On-X is goot fit. Non only because of the fda 1.5 - 2 inr, but because they claim it has tissue growth protection and good hemodinamics. Thank you for sharing !!!, it matters and it helps me.
 
When you say Thursday, do you mean today?

If so, I'm just wondering how you felt when told you were canceled so close. I was actually washed up, shaved, drugged(valium or something), with an IV needle(not an actual IV yet though) and waiting for the team to come back and wheel me to the OR when mine was canceled. I didn't know what to think. I remember actually thinking wow I should feel either relieved or disappointed. But then again I wasn't relieved or disappointed.
 
DECISION MADE: Met with Surgeon today, we covered all valve types pros and cros, and my surgeon told me "IF you choose a mechanical valve, I will give you an On-X"
Great !!!, that is all i wanted. Op Date set for Nov-4.
 

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