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

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Chiming in late. I .had a carpentier edwards bovine tissue valves implanted at 45. I spoke extensively with the surgeon and based on a number of factors including going with my gut, tissue was the choice. It's been over 5 years and i have no regrets. I don't look forward to another surgery, but am enjoying the freedom of no anticoagulants. I was never on warfarin after surgery, just regular aspirin and that stopped 3 months later.
Good luck with your choice. Both valve types are offered as both are better choices than what you have. Unfortunately, both has pros and cons and much of it seems to be age dependent as well as what your other health issues are.
 
Roberta;n858036 said:
Chiming in late. I .had a carpentier edwards bovine tissue valves implanted at 45. I spoke extensively with the surgeon and based on a number of factors including going with my gut, tissue was the choice. It's been over 5 years and i have no regrets. I don't look forward to another surgery, but am enjoying the freedom of no anticoagulants. I was never on warfarin after surgery, just regular aspirin and that stopped 3 months later.
Good luck with your choice. Both valve types are offered as both are better choices than what you have. Unfortunately, both has pros and cons and much of it seems to be age dependent as well as what your other health issues are.



Hi Roberta. Thanks for the reply. I'm seeing the surgeon today to discuss all of the research i have done and to also convey many of the opinions in this forum that have been incredibly helpful. It
is my gut feeling that tissue seems the way to go based on what I have read and my own gut feelings. I'll do it and live with it, without the need for blood thinners as i'd hate to have the worry hanging over my head about coping with warfarin which also sounds its been very manageable for many folk in here. I will post in here the feedback from my surgeon if it helps anybody with their decision.

David
 
Roberta;n858036 said:
Chiming in late. I .had a carpentier edwards bovine tissue valves implanted at 45. I spoke extensively with the surgeon and based on a number of factors including going with my gut, tissue was the choice. It's been over 5 years and i have no regrets. I don't look forward to another surgery, but am enjoying the freedom of no anticoagulants. I was never on warfarin after surgery, just regular aspirin and that stopped 3 months later.
Good luck with your choice. Both valve types are offered as both are better choices than what you have. Unfortunately, both has pros and cons and much of it seems to be age dependent as well as what your other health issues are.



Hi Roberta. Thanks for the reply. I'm seeing the surgeon today to discuss all of the research i have done and to also convey many of the opinions in this forum that have been incredibly helpful. It
is my gut feeling that tissue seems the way to go based on what I have read and my own gut feelings. I'll do it and live with it, without the need for blood thinners as i'd hate to have the worry hanging over my head about coping with warfarin which also sounds its been very manageable for many folk in here. I will post in here the feedback from my surgeon if it helps anybody with their decision.

David
 
49 and my surgeon quickly recommended a tissue valve. Went with it and it seems as good as any choice I could have made. In 10 years I may differ. Don't dwell on it, there is no RIGHT choice.
 
Lawdog;n857772 said:
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.

I asked my surgeon that exact question and he told me had just put a tissue valve in his 45 year old best friend! At 49 I took that to heart and got a tissue. maybe it wasn't sane, but there just doesn't seem to be a perfect choice.
 
Last edited:
David W;n857737 said:
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

I should add that I am cynical and if TAVR or TAVI is less expensive I think INsURANCE cos will be pushing for valve in a valve work for redos. Here's hoping Edwards and others keep on advancing the ball in this area
 
I chose a pig valve when I had mitral valve replacement surgery when I was 44. I was told it would last 10-12 years, then I would need another surgery to replace it again.

The pig valve lasted 18 years- BUT there is a catch: the valve presumably started to fail after 10 years from calcification. My decline was slow and I just thought I was getting old and out of shape.

I insisted my HMO give me an echo-cardiogram every year. The last couple of years they were also giving me ct scans to monitor a node in my lung. So, with all that info that they had collected, my Primary Care provider never told me that the valve was getting more and more calcified, and the cardiologists didn't either. In fact, my last cardiologist told me the valve was starting to leak, and said I would not need another echo for 5 years.

So last May I had an episode where I would run out of breath (badly) just walking a few yards. I was no longer with the HMO (thank God) due to a job change, so I got a top-rated cardiologist in San Francisco to see me through my new PPO. He looked at the latest echo and ct scan, and told me he could see major calcification on the pig valve, and recommended me for surgery to replace it, citing me as an urgent case.

The surgeon he recommended was at Stanford Medical Center, and this guy was amazing. My surgery, which was projected as being 6 hours, took nearly 12. He had to cut through a lot of scar tissue, and my heart was such a mess due to the calcification being so bad, that he had to also do a tricuspid valve repair, and the atrium of my heart was "gigantic", as he said in his post-surgery report. He also told me that I had been sick for a long time with the pig valve failing.

I am lucky to be alive. The surgeon was amazed I lived long enough to make it to surgery, and I almost died on the table. He said I was "a miracle". But my main source of luck was that I was no longer with the HMO (won't tell you which one, but I think they may make aluminum foil as well :))

I tell you all this so you know that just accepting the fact that you will need a second surgery down the road with a tissue valve isn't enough. You also need to be aggressively pro-active for yourself with your health care providers, and make sure they are covering all the bases. Other than that, you can pretty much forget that you have a replacement valve in your heart.

BTW- I chose a mechanical valve this time. I'm now 61, and having to go through this yet again when I am over 70 is just not an option. Obviously, I had to choose the valve prior to surgery, when I didn't really understand just how bad off I was. I just knew how bad I felt. If they had tried to postpone my surgery I would have asked them to just shoot me- I didn't want to keep on living in that condition. So the mechanical valve was the safest option, despite the coumadin issue. I don't regret my choice, even though getting my INR in range had been a pain so far. But my surgery was July 22, so I'm only a month and a half into it.

Hope this helps you make a decision.
 
Down right scary story CameraGuy! Glad you're finally on the right track. HMOs are not in the business of healthcare that for sure. They're part of the problem of what's wrong with health insurance in America!
 
Hi and "welcome aboard"

CameraGuy;n858105 said:
...You also need to be aggressively pro-active for yourself with your health care providers... despite the coumadin issue. I don't regret my choice, even though getting my INR in range had been a pain so far. But my surgery was July 22, so I'm only a month and a half into it.

just a quick bit of thought on the topic of INR stabilisation. It will take a while and right now you probably feel a little anxious (straight after surgery n all) but I wanted to make 2 reassuring points.
1) your INR will take a little while after surgery to settle because of all the disruption to your metabolism, but it will settle

2) your point about agressively pro-active will apply to your INR management too. In my view you are best suited to manage it yourself. Give yourself a bit of time and don't get anxious if its all over the shop at first. Really no harm will come of that. I have a blog post which I hope will be useful reading (mentioned above but here it is again anyway http://cjeastwd.blogspot.com/2014/09...ng-my-inr.html .You will also notice a large amount of camera related stuff on my blog too).

Also, I believe an important part is managing expectations as to what is a stable INR. For many of us (and yes, I've seen a few INR plots of some others over the years) stable is not flatline, stable is to remain within a range. To do this effectively its important to not be fiddling the dose (and provoking change). Here is a portion of my 2015 data.

19985600681_08fa3580ab_b.jpg


The important thing is trends (often best seen in multi week averages, easily done in excel). In this graph you can see my INR trends. The red datapoints are marked so because I took my dose twice one evening and so have marked the following two data points for my own reference. The circled points show the sort of changes that can happen week to week and from the big picture you can see that I am overall "in range" ... which is why I haven't adjusted my dose for some time now.

Anyway, my management of my INR is good and my Dr has observed that he doesn't see as good a result from his patients who are clinic managed. The key numbers in my INR are not the dailys but the average, the standard deviation, thenumber of "over events" and the number of under events. So far this year it is
average2.6
std dev0.3
max3.2
min2.0
over event0
under event1

pretty good and quite likely such numbers will mean I never have risk from my INR

Best Wishes
 
As a 48 year old (at time of surgery, a year ago today), I chose a mechanical valve with a view to hopefully avoiding the future repeat surgery likely with a tissue valve. I am hardly aware of the ticking noise the valve makes, which did surprise me as I refuse to have mechanical clocks or watches because of the ticking noise!). I self-test my INR weekly at home (I am diabetic, so very used to finger-prick testing), and go to an anticoagulation clinic only once every 6 months. As far as I can tell, having a mechanical valve has had no impact on what activities I can do; I am not a runner or otherwise particularly athletic, but can't see why anything other than activities with risks of significant cuts or bruises would be a problem. I wear a Medic Alert bracelet at all times though.

But I agree with other comments: it is your life, your choice, and only you will know the balance of for and against arguments.

----------------------
Mechanical Aortic Valve, CABG and Pacemaker, Sept 2014. Diabetic type 1 since 1996, though now may be reclassified as type 2.
 
I was 36 when i had the aortic vale replace with a St. Jude's aortic leaflet valve. I am now 50, taking warafrin and trying to lose weight, got to get the walking done, LOL! But seriously, have you talk about this with the surgeon. You have a choice if you can make a choice. Some people don't get that chance. Hopefully, talking with the surgeon and you cardio, can help you with the decision and choice. Good luck and hugs for today.
 
So here is my very late chime in and return to this board. I had my valve replaced 10 years and 3 months ago with an Edwards 29mm bovine valve, i was 34 at the time. I decided with the help of my surgeon that technology would be on my side regarding TAVR as long as i hope to get 10 years out of my new tissue valve. 10 years has gone by very quickly and Ive lived just as I had for the prior 34. I went to see my surgeon for my annual check up (echo and 64 slice ct) and he has just given me the bad news that the valve will have to be replaced just as it had to 10 years earlier. TAvr is not an option for me he says at this time and will most definitely be an option when i have to do my third (again 10-15, hoping for 20 years). He said it really is done for high risk patients that cannot stand an open heart procedure so i do not fit that mold. While i am unhappy with that as I recall the toll it took on my body and mind, im still optimistic that this 2nd surgery will be easier and then my third will be a piece of cake done through the groin. I do have thoughts today of maybe going ON-X but would that be a wasted 1st surgery? I have so many unanswered questions running through my mind since i got this news.... i have read through this post and there are so many arguments for and against i am just not sure anymore........

I was quite certain that my 2nd AVR would be TAVR and i was NOT going to go through the sternum being broken and mended a 2nd time. I am pretty bummed at this point. Curious what all of you think about this?
 
coryp;n858226 said:
So here is my very late chime in and return to this board. I had my valve replaced 10 years and 3 months ago with an Edwards 29mm bovine valve, i was 34 at the time. I decided with the help of my surgeon that technology would be on my side regarding TAVR as long as i hope to get 10 years out of my new tissue valve. 10 years has gone by very quickly and Ive lived just as I had for the prior 34. I went to see my surgeon for my annual check up (echo and 64 slice ct) and he has just given me the bad news that the valve will have to be replaced just as it had to 10 years earlier. TAvr is not an option for me he says at this time and will most definitely be an option when i have to do my third (again 10-15, hoping for 20 years). He said it really is done for high risk patients that cannot stand an open heart procedure so i do not fit that mold. While i am unhappy with that as I recall the toll it took on my body and mind, im still optimistic that this 2nd surgery will be easier and then my third will be a piece of cake done through the groin. I do have thoughts today of maybe going ON-X but would that be a wasted 1st surgery? I have so many unanswered questions running through my mind since i got this news.... i have read through this post and there are so many arguments for and against i am just not sure anymore........

I was quite certain that my 2nd AVR would be TAVR and i was NOT going to go through the sternum being broken and mended a 2nd time. I am pretty bummed at this point. Curious what all of you think about this?

Sorry to hear you have to go through it all again. In my opinion I wouldn't let yourself think that if you choose the ONX this time that your first surgery was a waste. It's in the past and I would only look to the future. That being said 10 years will go by very quickly, but there's also no guarantee that the second time around you'll get ten years again, it might be less now that your older and your body may not behave the same this time around. It's my understanding that other surgical techniques will advance as quickly or quicker than TAVR will. Even still TAVR valves right now are not made to last a lifetime, so what your talking about would in fact be a gamble again on what the future will bring. I like to gamble, but not when the stakes are so high.
 
Hi

coryp;n858226 said:
I was quite certain that my 2nd AVR would be TAVR and i was NOT going to go through the sternum being broken and mended a 2nd time. I am pretty bummed at this point. Curious what all of you think about this?

tough stuff, but as you ask I will say I wonder why after being sure 10 years ago that TAVI would be the option that you are still of the view that in 10years time TAVI will somehow be the option? To me this sounds like farmers saying "next season will be better" ... Naturally if you choose a tissue valve again for any other reason that's understandable, but to expect TAVI will be the option for you in 10years is to me just like before. People have been saying we'll be on the moon soon since apollo 17 in 1972 ... Still we aren't there ... maybe soon.

Of course we may solve all the issues for TAVI which currently have remained unsolved ... maybe even by the time your next surgery is required. If it was me, I would not be gambling on it. Like my surgeon said to me "no body will be lining up to do your 4th" so I took mechanical for my 3rd operation. If I had been 38 with todays INR monitoring technology I'd have had a mechanical in a flash. The real area of medical development now seems to be the smarter administration of drugs through monitoring. I'm not expecting any magic anticoagulant to appear because quite honestly I find that warfarin is now so well managed that almost anything can be done (even women having pregnancies and deliveries)

you say:

I do have thoughts today of maybe going ON-X but would that be a wasted 1st surgery?

which seems unfair to yourself and perhaps even wrong. I had a repair done on my first surgery, and a homograft done on my 2nd. I don't think either of them as being "wrong" now that I have a mechanical. You made a choice back then based on what you (thought) you knew. It turned out perhaps your expectations of the future (gamble / bet) was incorrect, you now are at a new junction and have to make a choice again. History is history, the future is what you make of it from now...

That's my thoughts.


Best Wishes
 
coryp;n858226 said:
So here is my very late chime in and return to this board. I had my valve replaced 10 years and 3 months ago with an Edwards 29mm bovine valve, i was 34 at the time. I decided with the help of my surgeon that technology would be on my side regarding TAVR as long as i hope to get 10 years out of my new tissue valve. 10 years has gone by very quickly and Ive lived just as I had for the prior 34. I went to see my surgeon for my annual check up (echo and 64 slice ct) and he has just given me the bad news that the valve will have to be replaced just as it had to 10 years earlier. TAvr is not an option for me he says at this time and will most definitely be an option when i have to do my third (again 10-15, hoping for 20 years). He said it really is done for high risk patients that cannot stand an open heart procedure so i do not fit that mold. While i am unhappy with that as I recall the toll it took on my body and mind, im still optimistic that this 2nd surgery will be easier and then my third will be a piece of cake done through the groin. I do have thoughts today of maybe going ON-X but would that be a wasted 1st surgery? I have so many unanswered questions running through my mind since i got this news.... i have read through this post and there are so many arguments for and against i am just not sure anymore........

I was quite certain that my 2nd AVR would be TAVR and i was NOT going to go through the sternum being broken and mended a 2nd time. I am pretty bummed at this point. Curious what all of you think about this?

You got 10 good years out of that valve, hardly wasted in my book. It is a very hard choice, just be glad what we have is fixable!!!! I am hoping for a TAVR bailout when my tissue valve goes, here's hoping!!!
 
I am 43 years old and went through this gut wrenching decision just the past few weeks. To say the least it was probably the hardest decision of my life. As many have said on this forum there is no right or wrong decision nor is there a perfect solution for the valve replacement. After constant back and forth, I decided to go with a mechanical valve and for me it came down to the possibility of not going through another re-op. At my age, I am looking at least two re-ops if not three and I frankly don't want to go through that. I was not a fan of taking Coumadin for rest of my life, but having talked to several patients and doing research, I believe it will be manageable especially with home monitoring. My surgery is scheduled for Sept. 23rd and it involves CVG (composite valve graft) as the surgeon wants to fix the dilated root and part of the ascending aorta. My surgeon recommended St.Jude CVG as it has a long proven track record. All the best with your decision and I know its not easy.
 
Congrats on arriving at a decision GoBlue. Im 44 and made the same decision to go mechanical and my surgeon highly recommended the On-X aortic valve replacement. I even got a replacement aortic root, dont know what they used for that. But the lower dose of coumadin exclusive to this new On-X valve means few complication and less risk of bleeding. Its only been 4 weeks since my surgery but so far taking Coumadin has been really no big deal at all. Having to go through another surgery like that would not be the end of the world, but that doesnt mean Id EVER choose to do it all over again willingly. Let alone possibly a third time. Every persons decision is theirs alone to make, but I fail to see going the other route...
 
Finally I have a date (This Wednesday) and have gone for the Edwards carpenter tissue valve. I will be in touch post op for a check in. Thank you so much to all the
responses and advice thus far. David
 
David W;n858498 said:
Finally I have a date (This Wednesday) and have gone for the Edwards carpenter tissue valve. I will be in touch post op for a check in. Thank you so much to all the
responses and advice thus far. David
That is great news! Before you know it, you will be on the recovery side. Wishing you all the very best with your upcoming surgery. Glad that you have made a decision on the valve . Now, no looking in the rear view mirror. :) Look forward to an update when all is said and done.
 
Just got back from France, not been on forum for two weeks and just seen this (sent you a private message - forum still very slow). All the very best David ! Be thinking of you on Wednesday and wishing you well for your recovery !
 

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