Anyone in here in their mid 40's and what did your surgeon advise on valve type.

[David W]

Hi

I am about to have valve replacement and a 6.1cm aneurysm tinkered with in a couple of weeks. I'm 44, quite active running, cycling and have started
to lean in the direction of a tissue valve. I am so greatful to the members who have responded to my replies to other people's post offering a variety of
information relating to tissue and mechanical. So I'm just seeing who is in here of a similar age wanting to find out what valves your surgeons recommended
for you relating to your age as much of this decision in regard to valve choice seems to be defined by age. I seem to be hedging my bets on technology in the next 10 years which has been endorsed by some in this forum but not many. Irrespective of age all opinions will be greatly appreciated. Thanks in advance. David

 

[MethodAir]

Hi David,

Yes, I turned 44 in May, and underwent emergency AVR and ascending root repair on February 20. The cardiac surgeon (highly regarded) was emphatic that a tissue valve was not an option, considering my age. 10 or 15 years (if that, especially if you are very physically active) has a way of rolling around before you know it.

The post surgery cardiac ward was somewhat like being in a scene from Dawn of the Dead...people moaning, barely shuffling with walkers and tubes sticking out of their stomachs. I could barely take a shower. Compare that to sitting on a beach in Hawaii, popping a Warfarin, and self testing your INR to the sound of the waves...that's my take.

 

[almost_hectic]

44 just got home from surgery this week. Tissue was barely mentioned as an option. Same reasons MethodAir states above. It was almost as if, you could but why, was the attitude. There's flashes of time during my recovery when I wish tissues had been a possibility but only because it I haven't figured out Coumadin therapy yet. I'm sure I will though. Onx valve inside me ticking away for the rest of my days, means I'll need the lowest dose possible.

 

[almost_hectic]

Hi David,

Yes, I turned 44 in May, and underwent emergency AVR and ascending root repair on February 20. The cardiac surgeon (highly regarded) was emphatic that a tissue valve was not an option, considering my age. 10 or 15 years (if that, especially if you are very physically active) has a way of rolling around before you know it.

As grateful as I was for the outstanding care I received, the post surgery cardiac ward was somewhat like being in a scene from Dawn of the Dead...people moaning, barely shuffling with walkers and tubes sticking out of their stomachs. I could barely take a shower. Compare that to sitting on a beach in Hawaii, popping a Warfarin, and self testing your INR to the sound of the waves...that's my take.

You nailed the description of the hospital stay. But you forgot the drug haze. Read my post on DGAF in post surgery

 

[DachsieMom]

I was 41, very active. I have a mechanical St Jude. We never really discussed other options - although I had researched on my own and would not have chosen tissue. My sister had surgery 6 months prior at 44, same for her. We both have a conduit graft (attached to valve).

 

[yotphix]

I was just 39, so outside your 'mid forties' request, but my surgeon would say the same thing to me know at 46. Mechanical. For such a young patient (he uses the word young to describe any patient under 50), the likelihood is that you will outlive two tissue valves, ,and thus need a third surgery. Not only are you likely to have co-morbidities or complicating conditions in your twilight years, but you'll also just be older, and slower to recover. If you could do something today, with minimal downside, that significant;y reduces the possibility of reoperation, would you? If yes, then mechanical is your only choice.

 

[jumpy]

I'm 44 as well. I meet with the surgeon in a few weeks and so far the cardiologist has indicated that the valve selection will be "my choice". To be honest I haven't really considered tissue valves right now however I am looking seriously at the Ross Procedure as an option. For this to be realistic I will have to be a good candidate for it and the surgeon will need to have some convincing arguments as far as his own experiences with this procedure for me to proceed. If the answers are satisfactory then I will proceed with the Ross and hope for a good 15 years with my native valve. I am prepared for the reality that mechanical will be the better choice for me and I will move on and manage this while getting back to an active life.

Good luck....

 

[almost_hectic]

I'm 44 as well. I meet with the surgeon in a few weeks and so far the cardiologist has indicated that the valve selection will be "my choice". To be honest I haven't really considered tissue valves right now however I am looking seriously at the Ross Procedure as an option. For this to be realistic I will have to be a good candidate for it and the surgeon will need to have some convincing arguments as far as his own experiences with this procedure for me to proceed. If the answers are satisfactory then I will proceed with the Ross and hope for a good 15 years with my native valve. I am prepared for the reality that mechanical will be the better choice for me and I will move on and manage this while getting back to an active life.

Good luck....

Sorry for asking, but why would you go through what it takes to survive surgery now, only to have to do it again when you're in your 60's when your not as strong?

 

[big_L]

This is a very personal choice. Gather your information and you'll know in your gut which type you want. I'm 10 years older than you and so my choice (mech) may not be valid for your situation. I would caution you that a lot of the cardiac surgeons are pushing patients toward tissue as they believe that the TAVR will be a viable option for many in the years to come. Of course, this may be true, maybe not. I found their optimism to be a bit off-putting and simplistic, frankly. I hate to accuse anyone of this, but if you go mechanical, then there's no more business for the surgeon.

 

[Paleowoman]

Arnold Schwarzenegger had his bicuspid aortic valve replaced with a tissue valve when he was 49. That was in 1997. Apparently he knew he would need a re-do at some point. I wonder if he's had it yet ?

 

[jumpy]

Sorry for asking, but why would you go through what it takes to survive surgery now, only to have to do it again when you're in your 60's when your not as strong?

For me personally I look at the Ross as a tissue valve with the possibility of not having to do a re-do until I'm close to retirement age. It offers excellent hemodynamic characteristics which will allow me to return to triathlons and running. Perhaps a regular tissue valve will do the same but the statistics of the rate of re-operations of someone my age is not reassuring. Why not just go mechanical? This on paper would be the more wise choice but if I can delay taking anti-coagulants until closer to retirement age I think that would be the better choice. I am also a pilot so maintaining a medical is another factor in my own personal decision.

 

[jumpy]

Arnold Schwarzenegger had his bicuspid aortic valve replaced with a tissue valve when he was 49. That was in 1997. Apparently he knew he would need a re-do at some point. I wonder if he's had it yet ?

According to this thread he had the Ross and so far he hasn't had to have a re-do.....

http://www.valvereplacement.org/forums/forum/heart-talk/6782-arnold-schwarzenegger-thoughts

 

[Lawdog]

Hi David: I am almost 2 weeks post-op, 41-years-old. Like you, I required an AVR, an ascending anerysium repair, and a hemiarch repair. Also like you, I researched every possible valve combination. I was seen at Mass General and received second opinions at Brigham & Womens and NYU. First, for your age and condition, you should only be seriously considering a mechanical valve, preferably an On-X valve. The thought of warfrain scared the pants off of me, which initially pushed me toward tissue. I am so glad I did not get that done. One surgery is enough for one life, especially with the excellent mechanical valves avaliable. I have been told that within 5-years, those of us with the newset generations of mechanical valves will have choices other than warafrain.

As for the guy who keeps pushing the Ross, I looked into that procedure as well. I spoke with a surgeion at NYU who frequently performs the Ross on children and young adults. He stated that the Ross is perfect for a child or teen, who requires an aortic valve that will grow with them until they are candidates for a long-term solution like a mechanical valve. I was also told that the length of surgery for the Ross is much longer ( as is the recovery), that the risks of complications are much higher, and that one risks needing to replace two valves sometime in the futrue. Finally, I was told that, in the U.S., a Ross procedure is not the standard of care for a 40+ person.

Having just lived through this process, I suggest you ask your surgeon what he would recommend to his little brother if he came to him looking for advice. Once you get past the "doublespeak" of tissue v. mechanical being "your choice," you will quickly learn that for a healthy, active 40+ man, the only sane choice is a mechanical valve.

 

[MrsBray]

Hello. I was 42 when I had my BAV replaced 18 months ago. Since then I've ridden a ton of rollercoasters, climbed mountains, ridden horses, gone snorkeling, kayaking, joined a pool, played with box cutters at work, sliced my finger cutting veggies for dinner, been pecked by chickens... all things I never gave a second thought to years before surgery.
My cardiologist suggested a tissue valve, "because I'm too young and active for coumidin, and I might want babies some day." My surgeon recommended mechanical because I'm so young. Then we talked about slicing feet on oyster beds and riding thrill rides.
Once I decided on mechanical, we talked about On-X and the optimistic outlook (then) for reduced INR levels compared to other valves. I've been given the ok by the FDA and my coumidin nurse to maintain a lower INR now. We haven't reduced my dose, but I don't worry about being too low.

It's a personal choice, and whatever you choose will be the perfect fit for you.

-Meredith
Clearwater, FL

 

[jumpy]

Hi David: I am almost 2 weeks post-op, 41-years-old. Like you, I required an AVR, an ascending anerysium repair, and a hemiarch repair. Also like you, I researched every possible valve combination. I was seen at Mass General and received second opinions at Brigham & Womens and NYU. First, for your age and condition, you should only be seriously considering a mechanical valve, preferably an On-X valve. The thought of warfrain scared the pants off of me, which initially pushed me toward tissue. I am so glad I did not get that done. One surgery is enough for one life, especially with the excellent mechanical valves avaliable. I have been told that within 5-years, those of us with the newset generations of mechanical valves will have choices other than warafrain.

As for the guy who keeps pushing the Ross, I looked into that procedure as well. I spoke with a surgeion at NYU who frequently performs the Ross on children and young adults. He stated that the Ross is perfect for a child or teen, who requires an aortic valve that will grow with them until they are candidates for a long-term solution like a mechanical valve. I was also told that the length of surgery for the Ross is much longer ( as is the recovery), that the risks of complications are much higher, and that one risks needing to replace two valves sometime in the futrue. Finally, I was told that, in the U.S., a Ross procedure is not the standard of care for a 40+ person.

Having just lived through this process, I suggest you ask your surgeon what he would recommend to his little brother if he came to him looking for advice. Once you get past the "doublespeak" of tissue v. mechanical being "your choice," you will quickly learn that for a healthy, active 40+ man, the only sane choice is a mechanical valve.

Sorry if it appears that I'm "pushing the Ross". For every one of us this is a personal decision and I've simply detailed the reasons for me to look at all options. As a 44 year old in the same situation as the original poster I am describing my own situation, not transposing that onto someone else's situation.

The arguments against the long term use of blood thinners has been pushed on me by everyone from my cardiologist to my family doctor. The medical establishment seems to have a much stronger belief in this than the general public on forums such as this. Why is that?

As such many of us are looking at all options and hope for new technologies to make the best of this condition. There are NO perfect solutions. Each has it's own negatives. The common positive is that whatever we choose, we just hope to be healthier than we are today.

 

[Fundy]

I was 45, my surgeon told me if it was him making the choice for himself in my position he said it would be about 50/50 tissue/mechanical. He mentioned for certain if my age was 35 he would go mechanical 100 %. If I were 55 he would choose tissue 100%. Basically said the risks that would take place were about the same at about age 45 for my situation.

He mentioned most of the risks regarding the warfarin were more substantial after 70 or so. But the benefits of going tissue to avoid the added risks then were equally offset by the future surgeries with regards to the tissue for someone aged 45. Thus his reasoning for 50/50.

He did however stress going tissue that I could very well be doing this all over again in just 6-8 years and that was his hunch at about how long the tissue valve may last given what he knew about me.

My cardiologist mentioned she was certain she would choose tissue if she were in my position.

The staff doctor I was talking to after admission the day before scheduled surgery was 100% certain he would choose mechanical. His reasoning was there was no way he would want to go through this brutal of an operation any more than this first time if he could avoid it.

 

[pellicle]

Hi Jumpy

Sorry if it appears that I'm "pushing the Ross".

personally I don't feel like you're pushing anything, just expressing ... I suspect its one of the reasons there has been conflict here in the past over valve choice. I think its perfectly appropriate for you to voice you justifications for 1) your own sounding board 2) the benefit of other readers.

The arguments against the long term use of blood thinners has been pushed on me by everyone from my cardiologist to my family doctor. The medical establishment seems to have a much stronger belief in this than the general public on forums such as this. Why is that?

I suspect that its based on the following points:
* ignorance of current practice
* no motivation to really examine current practice (because its not about them, its about someone else)
* opinions based on the horrendous (really - horrendous) practices and misunderstandings of the past)
* people do NOT like to admit they are wrong (its as if its a football team)
* the naysayers are more vocal than the "its-ok-ers"
* bad news spreads faster than good news
* kicking the can down the road is attractive

from an old blog post of mine:
http://cjeastwd.blogspot.com.au/2011...s-nowhere.html

the ABC interview linked to on that is very interesting.
http://www.abc.net.au/worldtoday/con...0/s2960916.htm

JASON REIFLER: Well we're certainly susceptible to misinformation in that once we believe something that is wrong then it's really difficult to correct people.

ELEANOR HALL: So we know that our ignorance about certain issues makes it easy for us to be misled but your research shows that we don't necessarily change our minds even when we have the facts.

JASON REIFLER: Exactly. And it also shows that there's an important difference between simply being ignorant and being misinformed, that is, believing that you know something but in fact being wrong.
...
JASON REIFLER: The downside of the research that my co-author and I have done to date is that it's very depressing. We don't have a terribly good understanding yet of ways to try and improve public debate, to try and improve political dialogue.

PS when you said:

The arguments against the long term use of blood thinners has been pushed on me by everyone from my cardiologist to my family doctor.

I would be interested in knowing what those arguments actually were.

 

[Agian]

Arnold Schwarzenegger had his bicuspid aortic valve replaced with a tissue valve when he was 49. That was in 1997. Apparently he knew he would need a re-do at some point. I wonder if he's had it yet ?

There's not a lot of info about his heart journey, is there?
His sense of humour has really blossomed as he's gotten older.

 

[Freddie]

Hi David, I was 47 at the time of surgery.
When I met my surgeon (I'll never forget his words); "I'll fix it if I can, but if I can't, I'll be using a mechanical valve......cause I don't think you'd want to go through this type of surgery again".
A little background on myself/surgery - I was an emergency case, unbeknown to me, didn't know I had a heart problem. Surgery was said and done in 4 days.

 

[David W]

Thank you everyone for sharing their thoughts on this topic. It would appear that the majority of people in here have plumbed for a mechanical valve and it's something for me to consider especially the ON-X. In spite of this wealth of information and experience, for some reason my gut still tells me a tissue valve. I cannot ignore some of the articles I have read whereby they most certainly explain the advances in TAVI and the development of tissue valves that are being tested to grown in the body rather than deteriorate with time. I also know that these are trials and certainly not approved for use as yet (at least not in the UK). Forum users of my age with my frame of reference seem to be certainly in a minority and that is something for me to think about. But I cannot shake this gut feeling. I keep asking myself how has this type of surgery evolved over the past 10 years? There must have been many advances? I have spoken with a doctor at my surgery here in London who advised against mechanical and warfarin. My own surgeon assured me that a tissue valve could be replaced in the near future with TAVI yet his colleague also said mechanical.......

I am truly hovering on the fence with one foot in the minority tissue party.....