Aortic Valve Replacement - Choosing Between Mechanical and tissue valve

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Hi all! I am a 27 year old female born with a bicuspid aortic valve and progressively worsening aortic stenosis. When I went in for a routine check with my cardiologist in October, I was told that the time has come for valve replacement surgery. It's been a whirlwind and what I'm struggling with is choosing the valve - mechanical or tissue. What REALLY complicates my situation is that I haven't had kids, and with the mechanical valve that really wouldn't be an option because blood thinners can cause birth defects. The decision would be obvious (mechanical) if my husband and I already had kids or didn't want kids.

On one hand, I could get the mechanical valve and not have to have it be replaced, but also no kids and blood thinners for the rest of my life. On the other hand, with the tissue valve, I would be able to get pregnant and have kids, but the valve would have to be replaced at some point in the future. The thought of a second surgery terrifies me.

Any input would be greatly appreciated!!!

Jamie
 
Hi Jamie,

I know this is a big decision for you, and you are trying hard to make a good choice.

The one thing I want you to be aware of is that mechanical valves sometimes do need to be replaced, just like tissue valves do.
I once thought the same as you, but after having my mechanical aortic valve for 10 yrs, I had to have it replaced.
This does happen, and actually we need to have a poll or survey on here so that folks can chime in on this, and indicate
if they had to have their mechanical valve replaced. Many have not had to have theirs replaced, but it does happen, mostly for various other reasons,
not so much for mechanical failure. Mine was due to pannus development which was inhibiting the valve from functioning.

Good luck in your efforts to make the best choice, and please make sure that you have all the facts about your options.

Rob

Ascending Aortic Dissection-St Judes mechanical valve/graft.
3/23/00, Vanderbilt Med Hosp, Nashville, TN
9/16/10 ON-X Aortic Valve+Root replacement Cleveland, Clinic, OH, Dr. Pettersson
9/16/10 Aortic Stent and Frozen Elephant Trunk Procedure Cleveland Clinic, OH, Dr. Roselli.
12/07/15 - Aneurysm Repair (aorta) - stint - CCF
12/11/15 - Another aneurysm Repair - stint - CCF
12/11/15 - Dissection & Repair of SMA artery - CCF
 
 
Hi Jamie, I'm a 39 year old male so wrong gender but I have recently had my bicuspid aortic valve replaced with a mechanical and I have 3 children 11-18 years old so I can certainly understand your concern with having children.
Your cardiologist can advise you certainly better than I can but from what I've read there are anticoagulants that can be used in pregnancy that are safer than warfarin if you had a mechanical,

with a tissue valve there are some cases where anticoagulation is still necessary depending on other issues so you may go thru the process of a tissue valve but then lose then benefit of not needing warfarin and still have the reoperation risk in the future. There is no easy one way or the other as both options have their pros and cons. I think the more info you can get from your doctors the better informed your decision can be.
I don't want to sound rude and crass but I assume that you and your husband are both fertile so you can plan ahead for future pregnancy.

Bicuspid valve disease can be also inherited by your children and I am waiting for testing for mine at the moment, would I have had children if I knew what I know now 20 years ago.. yes . Life happens .
Kind regards
Warrick
 
In addition to searching the forums like pellicle suggests for background, you might consider a consult with a perinatologist to learn more about what your options could be for pregnancy with different valve choices. And doing some basic screening to check that you and your husband are likely to be fertile is not a bad idea, it'd suck to decide on the basis of children and then have something else go wrong.

I feel lucky I had my kids before I had any idea anything was wrong with my heart, though it certainly was not ideal to have the twins via emergency C-section at 27 weeks due to totally unexpected heart failure either! I think we probably would have gone the adoption route if we'd known and built our family that way. I hope you find a clear path to your decision and can keep building a great life from there.
 
Guest;n862432 said:
...........On one hand, I could get the mechanical valve and not have to have it be replaced, but also no kids and blood thinners for the rest of my life. On the other hand, with the tissue valve, I would be able to get pregnant and have kids, but the valve would have to be replaced at some point in the future. The thought of a second surgery terrifies me.
Jamie
Click to expand...


Hi Jamie. As was mentioned above by Pellicle, there have been several woman on this forum who have successfully borne children while on an anti-coagulant. Talk with a professional about the risks involved for the mother and the baby.

BTW, I've never heard that anti-coagulants "can cause birth defects".
 
Hello Jamie

I can not imagine how hard the decision must be for you. I am a male almost the same age as you and I had to take the decision this January, I am just out of the hospital. I have 2 kids and a third on the way. This decision seemed one of the hardest of my life but compare to your choice it does seem so easy. I wish you good luck for you decision and I am sure you will find great advice from people on this forum.

Julien
 
Agree with all above. Hard choice and only you can make that. Have another chat with the experts and IMO take note what there have to say as they are the experts. Good luck with whatever path you take
 
I had my surgery after having children (didn't know of any issues at the time). Talk with experts. I thought the need for pig valve was also due to need for stretching during pregnancy, not just anticoagulation, but I could certainly be mistaken. If indeed neither choice appeals to you, there are other options with today's technology (surrogate, etc). I chose mechanical because I am done having children and I do not plan on a second surgery - so really did not research pregnancy with pig valve - but i wouldn't let fear of a second surgery convince you to go mechanical and forego children. Yes, surgery is NOT fun and second surgery is higher risk, but the pain of surgery and recovery is short-lived compared to the benefit of having children. I suppose the other thing to consider is how many children do you want? For example, I would ask whether a pig valve would typically last through two pregnancies? Again, you really should speak to an expert with valve replacement in pregnant women before making a decision.
 
I'd recommend asking what the next expected procedure 7-15 years from now is after the first tissue valve replacement - it may not be open heart surgery in your particular case & even if it is the case that a 2nd surgery is required, 7+ years from now they may find a way to replace your tissue valve thru the cath lab. I had open heart for the pulmonary valve ~2 weeks ago, they affix the valve to a metal mesh ring. When this existing valve is in need of replacement they'll replace the valve thru the cath lab and affix the valve to the same metal ring - no more open heart surgery.

Also, you might ask around at some of the research hospitals in your area or another major hospital in the country with a research division. They can in some cases replace valves thru the cath lab without a prior open heart surgery (first time) but its based on the existing size of the valve & which valve is being replaced.

Best wishes on your decision - no matter which decision you make you'll be better off in the end.
 
Get your information from Cardiologists who work in a clinic that specializes in the care of pregnant patients with cardiac disease, not from a forum on the internet.

Pregnancy with a mechanical valve can be life threatening. It's a hyper-coagulable state (pregnancy makes blood clots more likely to happen). A few anecdotes about a few women who accomplished it safely is not what should sway your decision. The risk of valve thrombosis is significant and the mortality associated with it is significant.

Warfarin is well-recognized to be a teratogen, though the risk might be acceptable if one's dose is on the lower side (< 5 mg/d). I don't think that there is anyway to predict what your warfarin dose requirement will be.

This is a difficult and big decision. Make it with experts in this very field, and if you do get pregnant, no matter what type of valve you have, you should be followed by experts in fetomaternal medicine & cardiology. Good luck.

http://www.escardio.org/The-ESC/Pres...pregnancy-risk

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2612108/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642488/
 
well put silver bullit, experts in the field are the ones you should be talking to,although opinions on here are good to read through
 
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