A 'New' Aortic valve. But which one?

[Patrickh]

Hi...I'm a 57-yr-old male with aortic stenosis and after 10 years of being monitored its finally time for me to have surgery. I also have type 2 diabetes, just recently diagnosed, and have Hepatitis B, though I have cleared this so I'm not a carrier. I decided to have surgery recently, following an echocardiogram in April which revealed that the stenosis is severe and that my aortic valve is approx 0.5 sq cm, when in a healthy person it is 1.5 sq cm. Just recently, in the last 6-8 weeks, I have been suffering fairly severe breathlessness when I walk briskly or take the stairs. My valve seems to have deteriorated quickly. I had an Angiogram last November and they doctors say my heart is OK (!) so its just the valve which is a problem.
Now I have to decide whether to have a tissue valve, which may not last me a lifetime, and would mean further surgery, or a mechanical valve, which would mean taking Warfarin, or some future substitute, for the rest of my life. I’m interested to hear from anyone who has had aortic valve replacement, of their own experiences, and any advice they have. It’s a big decision, and I want to make the right one. The Doctors seem keen on a mechanical valve…no future surgery. But I already take a load of meds…not sure I want Warfarin too. I also heard that when you are lying in bed at night, trying to sleep, you can hear the mechanical valve clicking. I’m a bit worried it might bother me. What do you think?

 

[dwhist]

I quess I will be the first to chime in.

This is probably one of the hardest choices you will ever make. The best thing to do is research both options to the max. You can search these forums and find others who have asked and read the responces.

In my case, at my age of 52 I choose the mechanical. I do not want to have to do another surgery. Talk is they may have a way to do replacements in a few years without surgury going through groin, but I would rather not go through any of this process again. I am active and had read that people who doing running ect tend to lean towards the mechanical. My father had his valve replaced 18 years ago and has been on warfarin for all of those years with no issues. So, I felt comfortable going that direction. I have been on it for 8 months now and do the weekly home testing that takes maybe 5 minutes of my time and have had no issues staying in range. I have taken the adjust medicine to the diet approach, so eat whatever I want.

As to ticking, yes you may hear it. My wife even hears it when we go to bed. She said it is louder when I lay on my left side. Does not bother me and I have gotten used to it. When my dad and I are going someplace in the same car we can hear each others. His has not gotten quieter over the years as they say should happen.

So, do lots of research and no matter which one you decide to go with, it will be a good decision.

 

[Superman]

Patrickh,

Welcome to the forum. All of us who have been through this have our own reasons for making the choice that is right for us. I've got mechanical. My reasons were that in 1990 at 17 years old, it's all I was offered and in retrospect, made the most sense due to my age. When I was 36, due to an aortic aneurysm, I had it replaced again - so mechanical was no a guarantee against re-op. Still don't regret it though. 1st one lasted 19 years and actually the valve itself was just fine. It was other issues that triggered the re-op. I stuck with mechanical the second time around.

Honestly I can only recall seeing a couple posts where people say they regretted their choice - but those are all outcome driven and seem apply to both tissue and mechanical. Somebody couldn't get their INR under control, somebody who's tissue valve didn't last nearly as long as expected/hoped, somebody might have panus growth and need an early re-op with mechanical, etc. The vast majority of us are happy with our decisions (whether tissue or mechanical) and will likely state the positive reasons why to you in this thread.

Ticking doesn't bother me, I sleep through anything.
Warfarin has not been an issue for me. It's just one pill a day and my level has been pretty steady with little effort on my part for years now. I've been on Warfarin for almost 22 years already.
I'd rather minimize re-ops.

I'd also add, with my being so young at my 1st and really even my second OHS - my decision was a little easier.

Good luck with yours. Pick whichever helps you sleep at night (not because of ticking, but for peace of mind).

 

[Rachel]

Really great responses here to your question! I also think this is such a personal decision, you really do need to do your research (and IMO follow your gut somewhat) to find out the best fit for you.

In my case I went with a tissue valve, I'm 46 and I've had it for one year now and I am very happy so far. Although it is my understanding that people who have mechanical valves do really well and lead very active lifestyles while on anticoagulation meds, it was my surgeon's opinion that as a runner, I would do better with a tissue valve, so I went with that.

For me another surgery just doesn't bother me, but the idea of hearing the valve ticking does (we are all just so very different). Although I've heard that the ticking sound from a mechanical valve is a great comfort to some.

It is also my understanding that going with a tissue does not necessarily mean you will never have to be on an anticoagulant (I’m not on any, but I think it does happen in some cases). Also, going with a mechanical does not necessarily mean you will only have one OHS in your life time, as the person who posted here has stated that some people have had to go in for more surgeries after the valve was put it due to aortic aneurysms that can develop if you have a connective tissue disorder.

I completely agree with Superman, make your decision on whichever helps you sleep at night, that's well put!

Good luck to you!

Rachel

 

[dick0236]

Now I have to decide whether to have a tissue valve, which may not last me a lifetime, and would mean further surgery, or a mechanical valve, which would mean taking Warfarin, or some future substitute, for the rest of my life. I’m interested to hear from anyone who has had aortic valve replacement, of their own experiences, and any advice they have. It’s a big decision, and I want to make the right one. The Doctors seem keen on a mechanical valve…no future surgery. But I already take a load of meds…not sure I want Warfarin too. I also heard that when you are lying in bed at night, trying to sleep, you can hear the mechanical valve clicking. I’m a bit worried it might bother me. What do you think?

Your heart situation seems similar to mine....no problems other than a "bad" valve and either valve should fix your problem. A tissue valve will, almost certainly, require a re-op and a mechanical valve will require warfarin, although the newer valve designs hold the promise of reduced need for warfarin.

A re-op, in a "senior", can carry a bunch of problems and is something I would want to avoid, if possible. Warfarin, generally is not a problem, although it does require following a regimen(take it as prescribed and test routinely)....or it can cause problems.

I have a diabetic friend who has a mechanical valve. He seems to handle his meds, including insulin and warfarin, with few problems. He had a tissue valve implanted in his 40s that was replaced with a mechanical valve in his late 50s. He is now 78 and enjoys a normal life.

My valve, long ago, stopped its loud ticking and can not be heard by anyone, including me, and my docs, without a stethoscope, although I sometimes become aware of my heart beating when I lay down.

 

[DanielB]

A very personal decision for sure. For me, needing a valve at age 53, I was leaning toward mechanical as I too did not like the idea of re-op 7-10 years down the road. My surgeon reccomended the On-x valve, saying, though I cannot plan on (and do not) things that 'might' happen, there is great promise in that valve in not needing Warfarin in the furute as clinical trials are about halfway though to prove their theory out that their newer valve does not have as great a risk as older mechanical valves in throwing off clots. That was enough to tilt the scales for me and I have been happy with the decision. I know there is the hope of transcatater replacement in the future for some, but, as I said, I personally don't make health decisions now based on what may come in the future. As far as 'ticking' sounds, that's anoher personal thing. I rarely hear mine, others do and think it's a watch ticking. I personally not only like hearing my ticking, but love it! Having moderate to severe Aortic reguitation prior to surgery, at night I could hear my heart literally 'slushing' at each beat, To hear clean, crisp tick every now and then still brings a smile to my face -- tells me all is well.

All options have drawbacks, the good news is all work well and are very sucessfully done all the time. Best of luck to you.

 

[Mentu]

Patrick, as you know by now, this is probably the most frequently discusses issue for people joining our community. Both types of valves have their issues but either will be tremendously better than your failing valve. By the way, an adult male should have an area close to 2.5 cm2. An area of 1.5 cm2 is indicitive of stenosis (functional but bears watching).

It really comes down to which future you are more comfortable thinking about. Mechanical valves can require replacement, although not very often, and tissue valves can last and not need replacement. There are no certainties with either path because as an individual you bring your own body to the equation. Think about the way you live and how the new valve will best fit with your desires for the future. Take care.

Larry

 

[Lynlw]

I quess I will be the first to chime in.

This is probably one of the hardest choices you will ever make. The best thing to do is research both options to the max. You can search these forums and find others who have asked and read the responces.

In my case, at my age of 52 I choose the mechanical. I do not want to have to do another surgery. Talk is they may have a way to do replacements in a few years without surgury going through groin, but I would rather not go through any of this process again. I am active and had read that people who doing running ect tend to lean towards the mechanical. My father had his valve replaced 18 years ago and has been on warfarin for all of those years with no issues. So, I felt comfortable going that direction. I have been on it for 8 months now and do the weekly home testing that takes maybe 5 minutes of my time and have had no issues staying in range. I have taken the adjust medicine to the diet approach, so eat whatever I want.

As to ticking, yes you may hear it. My wife even hears it when we go to bed. She said it is louder when I lay on my left side. Does not bother me and I have gotten used to it. When my dad and I are going someplace in the same car we can hear each others. His has not gotten quieter over the years as they say should happen.

So, do lots of research and no matter which one you decide to go with, it will be a good decision.

I'm glad you are very happy with your decision, that is all anyone could hope for and it had to be helpful making your decision having you father live with his mechanical valve so many years and doing great.
But I wanted to comment on a couple things you've said. First is about "I am active and had read that people who doing running ect tend to lean towards the mechanical" I guess that is possible, but usually it is more common for "active' people to get a tissue valve, there are several reasons, including coumadin for those who are the most active, but also im pretty sure in general tissue valve have better hemodynamics than mechanical valves, partly because they are closer to what a "normal" valve looks and acts lie. MAYBE it seems that many active people choose mechanical, but m guess is part of that might be just because in general the active people are usually younger and fall into the age group that most everyone reccomends mechanical valve for.

The other thing is about "Talk is they may have a way to do replacements in a few years without surgury going through groin" They already have been doing valve replacemnts by cath for quite a few years now.
For first time Aorti valve replacements even in the US percutaneous Aortic valves have been approved for the higher surgical risk patients and current trials (Sapien PARTNER Trials) include replacing older tissue valves by cath. Pulmonary valves have been used for about a decade and approved for the past few years in the US and they are (lmost?) always to replace older tissue valves in young very active patients with great results so far.
So even tho it isnt guarenteed that someone getting a tissue valve NOW in their fifties wont need OHS to replace that valve when it needs replaced, at this point in time chances look pretty good that by the time this valve needs replaced having it done by cath will be pretty common.

 

[tom in MO]

Even if you remove warfarin from the equation, I believe you will find that a tissue valve is a "better" valve than mechanical when compared to a good "god-given" normal human valve, just because the blood passes through a tissue valve with less or no damage.

However, even if your valve is replaced by catheritization, it's still surgery and it's still your heart. For some people, myself included, any resurgery is something we wish to avoid. Avoiding resurgery can be attributed to a variety of different reasons, including life disruption, fear of death and complications, lack of good insurance, lack of access to health care, poor family support, etc.

It's your choice and there is no wrong one, since at the end of the operation you live

 

[neil]

i had tissue at 51 and that was the right decision for me, i didnt want to be on warfarin and the problems that may occur with it, do your homework listen to what your cardio and surgeon have to say and take your pick, either choice is a good choice,

 

[scott.eitman]

I had a tissue at 34, and that was the right decision for me at the time. I was lucky to be able to be very active, including wrestling and wrecking on a bicycle. I recommend not looking back once a decision is made, a person could drive themselves crazy if they do. With that said, I am very happy with my mechanical because the thought of another surgery would be devastating. I have found that after the 2nd surgery, I will never me the 100% that I once was, but I am alive! This is not like changing spark plugs, which is kinda what I calculated at 34.

I recommend gather as much information as possible and then making and keeping your decision. You are at the right place to get many arguments for and against any of the choices. Weed through this and make the right decision for YOU.

Stay Well,
Scott

 

[ElectLive]

Patrick - Being asked to choose a valve is quite an amazing thing. It feels at times a blessing and yes at other times a curse. The pros and cons of each not only tend to balance out but they are also so very personal and inevitably indeterminate.

Now, adding diabetes to the mix might seem to potentially tip the scales one way or the other, but in many ways it mirrors the effect with additional pros and cons on each side. Hopefully your diabetes has been diagnosed prior to complications. With so many controllable risk factors for diabetes related complications in play, you will be be able to minimize the impact on your valve situation either way simply by continued monitoring and living a healthy lifestyle.

You may have already done so, but if not, I would recommend that you have a good discussion of all the diabetes related factors (stroke, retinopathy, kidney issues as examples) on both sides of the equation prior to deciding. Unfortunately, you may have to consult several types of medical professionals (such as surgeon, endocrinologist, and ophthalmologist - with generalized primary care oversight) to get the full picture though. It may not make the decision easier, but obviously better to be informed up front than to be surprised by an unexpected consideration later on.

Just remember your decision is tough only because you have two very good options. Educate yourself as best you can as time allows and you should be very confident that your outcome will be very successful whatever you decide. Welcome aboard and best wishes moving forward.

 

[Bill B]

Oh, did I fuss over this...months and months of study...read every valve study on this issue I could find. Made charts of all the valve choices, trying to find something that would tip the scales one way or the other. At the start of this exploration, my surgeon made a very specific and strong recommendation, but as with nearly everyone here, he left the choice to me. About 10 minutes before he called me to finalize this on the night before surgery, I read a paper that seemed to nail the choice for me, basically supporting what my surgeon told me months before. However, that paper may suggest the opposite for you. My main point is that you should weigh heavily the opinion of your surgeon, if it is strong. He knows you and your case better than any of us here. There are some nuances about your health status that he knows that may have influenced this choice.

 

[Greg a]

A heart felt WELCOME,Patrick, to our OHS family glad you found the site , there is a wealth of knowledge here for the future ... and I have listed some links for your research and prep ....WAITING IS THE WORST PART.. many members here are on the NH in the UK and may have ideas not already brought forward

Bob/tobagotwo has up dated a list of acronyms and short forms http://www.valvereplacement.org/foru...4&d=1276042314

what to ask pre surgery http://www.valvereplacement.org/foru...t-of-questions

what to take with you to the hospital http://www.valvereplacement.org/foru...al-a-checklist

Preparing the house for post surgical patients http://www.valvereplacement.org/foru...House&p=218802

These are from various forum stickies as mentioned above and there is plenty more to read as well


And Lynw recently added this PDF on what to expect post op
http://www.sts.org/documents/pdf/whattoexpect.pdf

 

[pgammo]

Get a On-X mechanical valve. The ticking is really soft and comforting in a way and the coumadin management is not bad at all. Get your own home testing machine and you will do awesome!

 

[carolinemc]

I have been in warafin for for than 10 years with no problems. You just have to watch it when taking antibotics, it will lower INR. But you can still lead a very active life. As for the ticking, it only lasts for a short time till you are so used to it, you will not hear it as much or not at all. I never aware of it now and will not let that bother. The ticking will not keep you awake, if that is what you are afraid of. The breathlessness is from the artic valve shutting down. Once you have the replacement surgery done, you can get built back up and bsack to normal. I still walk fairly regularly most days with no problems. You will be fine. On the valve decision, it is only yours to make. We are here to give our experience advice. You will make the right choice for you. Good luck and keep coming in here for advice. We are here for you. Hugs for today.

 

[SusQ]

Hubby just had a tissue valve put in exactly two months ago today. We decided on tissue. He's a butcher by trade, a real honest to goodness one that deals with live animals and between the knives he works with and the potential for him to get kicked, we wanted to steer away from warfarin. We do not regret this choice. He was on warfarin for two weeks after surgery and he suffered a complication that was due to the warfarin. He had an aortic graft as well and was bleeding through the graft into the sack around his heart. Not everyone has this, but it did really help cement the decision for us. Hubby is 47, BTW, and another part of the decision was that mechanical valves don't always mean no further surgery.

 

[Jkm7]

My valve replacement was my second OHS in four years and I certainly knew what to expect. Given that prior experience, I still opted for tissue valve and am very happy I did. This valve is serving me well, thus far. I did not want to risk a loud ticking valve and definitely did not wish a lifetime of coumadin if I could avoid it. This is a personal decision and there is no wrong choice. Only you, in consult with your doctors, can decide the best for you.

All best wishes.

 

[Paleowoman]

Although I may be still a year or more away from surgery I have already discussed whether to have a tissue or mechanical aortic valve when the time comes with my cardiologist and endocrinologist - I too have diabetes as well as osteoporosis. I am 59. I am opting for a tissue valve because of a) complications of medications and diet if I opted for mechanical valve as I already have to follow particular diet and meds with the diabetes and osteoporosis, and b) I deffo don't want any noise from a clicking valve as I already have hypersensitive hearing. I know this will mean a second surgery at some point further on in the future, but my cardiologist is hopeful that transcatherter valve replacement will be an viable option by the time I need the replacement replaced. But it's your choice along with your cardiologist's and surgeon's advice of course.

 

[Duffey]

Gee whiz! We've had so many discussions concerning mechanical/nonmechanical, that when I read the title of the thread, I really thought the question, "But which one?" was going to do with company and model. I guess I'm wrong.:eek2:

Patrick, I'd suggest that you read the valve selection threads and go with the one that seems right for you. At 0.5 sq cm, whatever one you chose will be 1000 times better than what you have now.:smile2: