Age 43 - Active person - No health issues - Any reason NOT to go mechanical?

[clement]

Hello all,

I have read lots of blogs.
Need surgery for bicuspid condition in 2 months.
Like you, I must choose a valve type.

Please give one good reason why at my age (43) I should not choose a mechanical valve.

Thank you for your help,
Clement

 

[JimL]

Hi Clement. Your situation sounds like that of so many others. I was three years older, and my surgeon said mechanical, and I agreed. I have never regreted that. But since you have two months yet, keep an open mind.

 

[Lynlw]

Chances are you won't get many replies that directly answer your question, rarely will anyone say what you or anyone should or shouldn't do, except to have surgery if your doctor recomends it.
You proably would get more info reading the other valve choice threads where people discussed why they WERE getting what ever valve they chose.

When you say you are very active, what do you do that there might be some concerns about as far a valve choice?

 

[ALCapshaw2]

Have you looked over the Bicuspid Aortic Valve and Connective Tissue Disorder Forum?

If not, I recommend that you do so that you understand the connection between those often related conditions and are checked for possible Connective Tissue Disorders (e.g. Aneurysms) BEFORE surgery.

Note that the Gold Standard for looking for aneurysms are either a Chest CT or MRI.

IF you have a connective tissue disorder, it would be wise to find a Surgeon with considerable EXPERIENCE recognizing and dealing with those conditions.

Have you looked over the Active Lifestyle Forum?
There are several Very Active Members there who have mechanical valves and participate in High Level Activities such as Bicycling and Tri-Athelons.

'AL Capshaw'

 

[clement]

Hello all,

Very active for me is:
20 downhill ski days / year
gym
running
yoga

Just talked to my surgeon and his only objection was aggressive downhill skiing.

At this point of my life, I am willing to stop downhill for cross-country if it means going with a mechanical valve.

Very tough decision but better for me than having my chestbone cut open again in the future.

Cheers,
Clement

 

[tprice54]

Welcome, and I will take a stab at your question! Don't get a mechanical IF you are dead set against it an have grave concerns about having one in your chest. Now, notice I cannot give any medical reason, because there isn't one!

 

[scott.eitman]

Reason 1: Surgery is fun!
Reason 2: A quiet heart is more important than risking your life with future surgeries.
Reason 3: I just can't get out of bed to go to the Coumadin clinic.
Reason 4: Recovery beats going to work.

How's that? Seriously, At 34 I could not figure out why I would want a mechanical. At 46, I had trouble with this decision again. It all boiled down to Reason 1: It really wasn't all that fun. I find none of the reasons I listed to be so important that I would want to go through this again.

 

[Lynlw]

Reason 1: Surgery is fun!
Reason 2: A quiet heart is more important than risking your life with future surgeries.
Reason 3: I just can't get out of bed to go to the Coumadin clinic.
Reason 4: Recovery beats going to work.

How's that? Seriously, At 34 I could not figure out why I would want a mechanical. At 46, I had trouble with this decision again. It all boiled down to Reason 1: It really wasn't all that fun. I find none of the reasons I listed to be so important that I would want to go through this again.

I don't really find your answers that helpful, you were probably trying to be funny, but lots of people choose Tissue valves for VERY good reasons

 

[scott.eitman]

As did I when I chose my Homograft. There are many great reasons for each and every different valve.

Having gone through this decision process in the last 6 months. I am accutely aware of the choices we are faced with. When it comes down to it, funny or not, these are very serious struggles one needs to come to grips with.

 

[Lynlw]

As did I when I chose my Homograft. There are many great reasons for each and every different valve.

Having gone through this decision process in the last 6 months. I am accutely aware of the choices we are faced with. When it comes down to it, funny or not, these are very serious struggles one needs to come to grips with.

True, but I wouldn't find it helpful either if people made light of the all the problems you can have with a mechanical valve and or joked about the risks of coumadin, stroke bleeds ect. to make it seem that a Tissue valve would be the better choice.

 

[Bob in Colorado]

Scott, we have almost the same history

Scott, we have almost the same history

As did I when I chose my Homograft. There are many great reasons for each and every different valve.

Having gone through this decision process in the last 6 months. I am accutely aware of the choices we are faced with. When it comes down to it, funny or not, these are very serious struggles one needs to come to grips with.

Except my homograft lasted only 9 years -- and the last two I was quite compromised. now with a mechanical valve I seem to have much better heart function even though I am 10 years older.

To Clement - these are personal choices as everyone has said. But having experienced both I would tell you that a second surgery is not something to look forward to, and that the tricky part that many don't think about is that before the second surgery your heart can be under quite a bit of stress as it attempts to compensate for a compromised valve a second time.

 

[mntbiker]

OK, here you go, you want someone to talk you out of the choice you are currently leaning towards.
Mechanical valve
1) you can have issues with warfarin
2) Pannus (sp?) growth causes the valve to fail early

Lots more if you want them, but wait, let's look at tissue

1) Fails prematurely
2) Less longevity

Lots more with this one also.

hmm...

The simple fact is there are way too many unknown variables, if you are happy with the choice and the surgeon feels it's right for you then go for it. Don't worry about the activities you are interested in, they most likely will not be impacted by your choice of valve. Don't worry about what other people say, much of it will be irrelevant to you and only make you worry about extraneous issues.

I have plenty of reasons for going tissue, but they are specific to me, many people chose mechanical, those reasons are specific to them. There is no easy choice but the only wrong choice is to not get the valve replaced when needed.

 

[epstns]

I am currently making the same evaluation. I think it is easiest to think it through if you stay with the "big picture."

First, consider your age. Research the typical service life span of a tissue valve. You might very likely need a second replacement within your projected lifetime. Decide if that would be acceptable to you. The service life span of most mechanical valves is longer than the expected life span of the patient (as long as there are no complications after implantation), so MOST patients who have mechanical valves implanted do not risk a second surgery.

On the other hand, research the potential impact coumadin may have on YOUR life. Some find it not to be an issue, others dread it forever. Only you can decide if it is a problem.

At your age, this is a somewhat complicated decision and only you can make all the necessary value judgements to conclude which type of valve is right for you. (At my age of 63 -- somewhat easier as most surgeons seem to lean toward tissue valves.) Remember. . . whichever valve you choose, it is the right one for you. I feel that in this game, the only wrong decision is to choose not to move ahead with replacement.

 

[ejc61]

Hello all,

Very active for me is:
20 downhill ski days / year
gym
running
yoga

Just talked to my surgeon and his only objection was aggressive downhill skiing.

At this point of my life, I am willing to stop downhill for cross-country if it means going with a mechanical valve.

Very tough decision but better for me than having my chestbone cut open again in the future.

Cheers,
Clement

I was 47 and liked to ski as well and am probably intermediate at best. My cardiologist had no objections to me skiing if I went with the mechanical. He did suggest a helmet which I have incorporated and to not be wreckless. I'm too old for the Warren Miller stuff anyway. My intention was to continue with my skiing and cycling even with a mechanical. Check out the "Lifestyles" section of this board. I found it helpful to hear other people talk about their experiences with a mechanical valve.

 

[Bean Counter]

I am not going to try to persuade you either way, but here is why I went with a tissue valve.

At first, I decided that I wanted to have a mechanical valve (I was 37 at the time and only wanted to go through the surgery once). My main goal was to continue my lifestyle as much as possible post-op. I was a competitive runner and wanted to continue that. I met with 3 surgeons and asked them all the same question if I would be able to continue my level of running and they all said yes. Dr. McCarthy out. of Northwestern (Chicago, IL), answered that question by stating that with a tissue valve I would be able to continue that level of running, but did not necessarily come out and say that a mechanical would prevent that. That got me thinking of a tissue valve. I had another friend that was put on coumadin earler this year and he has not had good experiences with it. That sort of persuaded me to move to the tissue valve. These reasons would probably not persuade others in the same direction..it is purely personal.

I want to add in that I have seen lots of positive experiences with being on Coumadin on this website and I have heard stories of people with mechanical valves going right back to their pre-op level of physical activity (see the website cardiacathletes dot org). Actually there was a lady in her 50s that climbed Mt. Everst with a Mechanical Valve! If you do a google search, you should be able to read up on it. That is why you will see a lot of arguments for both sides...there is no right answer.

 

[clement]

Hi all,

Great input. I guess that the main goal in these forums is to ask questions that will make you think and digest the overwhelming amount of information.

My philosophy at this point is that valve + aorta root replacement is a life altering event no matter what.
And life will never be the same.

Got to admit that and adapt. If I need to give up aggressive (and fun) Mt Hood downhill skiiing, so be it. After all, I have never tried golf...

Cheers,
Clement

 

[NealR]

Why you would NOT want to go mechanical?

Well, please remember, which ever valve you chose,,,there are no gaurantees. Both are good options, just not perfect. If you choose a tissue, for sure, you will need another surgery. No matter what, there are trade-offs for both. A lot of people, myself included, preferred not to deal with coumadin. I figure for me, it is worth the risk of another surgery. If I made it through one, I can make through another. I think 10 years, is typically what they are selling, so who knows what technology will be available over this time period. Usually the changes are small, but do add-up.

For Mechanicals, technology is changing too. I read somewhere about a new Anti-coagulation therapy emerging, without the side effects and long-terms worries as warfarin.

Most important,,,,,and few people discuss this on this forum, is how comfortable and successful is your surgeon in implanting these devices? What is there track record? How about the hospital? There is a large team around this type of surgery. What is their comfort level. This should be as much as the deciding factor as much as the type of valve.

Me, well, I got lucky. I was fully prepared, and new (almost) what to expect. Based on what I went through, I have no issue doing again.

Good luck with your decision.

 

[acr]

I was 41 and went with a mechanical, though I didn't get a choice. Though if I did have a choice I'd have gone with a mechanical. Anyway, I'm pretty active and it's fine for me. I don't downhill ski though, and I guess you'd not want to crash too many times when doing that on Warfarin ? With a tissue you may not get long before a re-op, 10 years give or take. I was told 8 years-ish if I'd have gone tissue, hence the Cardiologist choosing mechanical for me.

Warfarin is a non-issue for me, though everyone is different of course.

All depends how much you want a potential repeat surgery in your early 50's. Let's be honest you only want one heart surgery in your lifetime. Having said that, there are no guarantees either way.

Good luck,

Ade

 

[dick0236]

......I think 10 years(tissue valve life), is typically what they are selling, so who knows what technology will be available over this time period. Usually the changes are small, but do add-up.

For Mechanicals, technology is changing too. I read somewhere about a new Anti-coagulation therapy emerging, without the side effects and long-terms worries as warfarin.

The decision, for most, seems to boil down too two issues. Valve life and technology advances OR lifelong ACT. I'll take lifelong ACT....along with my two blood pressure pills, daily Vitamin, OTC allergy pill....and of course, the antibiotic before dental procedures. For me, that has been a small price to pay too stay away from my SECOND surgery. I live in a small "patio home" community made up of mostly retirees. I have several neighbors currently on warfarin...
...me(43 years with mechanical valve)
...Joe, tissue valve (1976), mech valave (1992) and now Afib. His wife also on warfarin for Afib
...Jim, Afib for about 7 years
...Bob, Afib for about two years
...Al, tissue valve at age 76 (two years ago). I don't think he is on warfarin?

If you go into any "ACT clinic" you will find the vast majority of ACT patients are testing because of issues NOT related to a "mechanical valve"

On the second point(technology advance).....I read your stories and can identify with your surgical experiences, and certainly agree that technology is making this surgery safer....but too say that "in ten years" it will be "a piece of cake", is a "stretch". I've had mine, and sure hope that I do not need another.....as they say, "once is enough".

 

[neil]

hi...i am a porky pig man myself,but as you can see by the above posts we all have different views, it really is a personnal choice,and i would never advise anybody to pick one or other,both have pluses and drawbacks,talk to your cardio and surgeon and also listen to your gut feeling,whatever you pick is right for you,