aortic valve replacement

[wigwam]

Hi I'm looking for information, I'm due a valve replacement later this year I'm 47 years old but not sure whether to go for mechanical or tissue.
obviously mechanical will have to take warfarin and lifestyle change potentially last for ever.
the tissue valve not so much of a lifestyle change and no warfarin but question over how long the valve will last at my age, my doctor seems to think 5 to 10 years then will need another op. has anyone else been in similar scenario?

 

[Superman]

Welcome to the forum!

Other than taking medication and testing, what do you think will have to change in your current lifestyle? Unless you’re a cage fighter or something.

I’m 49 and have been on Warfarin for nearly 32 years. I can’t think of anything aside from a pill and testing that would have been different in my lifestyle. That said, going mechanical did not prevent a second operation for me as I had to have an aortic aneurysm repair just over 12 years ago. But everyone is different. We have a member that has nearly 55 years on his original valve.

As far as how long tissue valves last, it’s anyones guess. 5-10 isn’t unheard of. 15 plus years isn’t unheard of. But predicting where one data point in a statistical collection of data will end up is impossible. I think the safe bet is that with tissue, something will have to be done in the future. What that looks like is hard to guess. Another open heart. Inserting a trans-catheter valve. It’ll depend on your health at the time, new developments, etc.

Looking at what I wrote, it probably doesn’t help much and just muddies the water. Sorry about that. Just some things to consider.

Edited to add: Not forever. Just the rest of your life.

 

[wigwam]

Hi thank you for your reply. only cage fighting I do is trying get back out the doghouse

I think when I say lifestyle I'm thinking more of the constant back and forth to doctors / hospital for checks which is time out of work.
Don't get me wrong I'm swaying to the mechanical valve, I think a stumbling block is the social side maybe with drinking and some foods, I know I shouldn't worry about that as health comes first.

Just looking at both options.

I have read that either way being at my age a second op is probably going to happen

 

[Superman]

only cage fighting I do is trying get back out the doghouse :LOL

I don’t mind the couch. It’s like camping!

With mechanical, the valve itself will outlast you. It just doesn’t guarantee against the possibility of other unrelated heart issues and surgeries.

In terms of constant back and forth, I go in for a check up every year or two. I test my INR at home and email the results. Takes less than five minutes every week or two when I get ready in the morning. My prescription refills are automatic. If I run out, my doctor and pharmacy sort out the renewal. Being followed by a cardiologist is a good idea regardless of valve choice, so I wouldn’t expect tissue or mechanical to change that for anyone. With tissue, they are watching for signs of valve wear and other issues. With mechanical it’s mostly just other issues because the valves themselves don’t wear out.

Warfarin is something to be managed around with future surgeries. I’ve had to self administer shots of Lovenox in my abdomen for a couple procedures since they wanted my INR well below 2.00 before slicing and dicing. It also is a good idea to avoid or be very consistent with anti-inflammatories. I only take Tylenol for random headaches or whatever. No Advil or Motrin.

Diet wise, I’m on a see-food diet. I see food, I eat it. Consistency is key here. Dose the diet, don’t diet the dose. If you like spinach salad, enjoy. Just don’t eat a bag of spinach once a week and no veggies the rest of the time. Some people take a vitamin k supplement so their dose already accounts for a good level in their system.

Drinking, I never really gave much thought to. Nor have I ever seen any real impact on INR from alcohol. I was 17 when I got my valve so the only drinking I’ve done has been on Warfarin. I’d joke with my buddies about being a light weight. But that’s about it.

 

[ValveAdmin]

Welcome to the forum.

 

[carolinemc]

Hi I'm looking for information, I'm due a valve replacement later this year I'm 47 years old but not sure whether to go for mechanical or tissue.
obviously mechanical will have to take warfarin and lifestyle change potentially last for ever.
the tissue valve not so much of a lifestyle change and no warfarin but question over how long the valve will last at my age, my doctor seems to think 5 to 10 years then will need another op. has anyone else been in similar scenario?

If you go mechanical, should be no more surgery, if you go tissue, you will face more surgery. I was 36 when I got my St. Judes' aortic valve. No problems at all.

 

[KLS39]

Welcome to the forum. I had my first surgery at 14 to repair my BAV. I just had my second OHS last year at 57 to replace the valve with a mechanical one and repair an aortic aneurysm. I am hoping that by choosing a mechanical valve I am done with OHS. I second what Superman said in regards to taking warfarin, it's not a big deal.
Best wishes!

 

[Brinntache]

I had that decision last year at age 50. I came to the conclusion that mechanical was best because I did not want another operation at 65 and 80, which is a best case scenario. Warfarin has not affected my life beyond my balance being a little worse then what it was before. Like Superman, I self test and email the results to the clinic. Other than that, I workout, go for bike rides, and have fun. I got used to the clicking fairly quickly. My standard joke is that my wife knows exactly how excited I am.

Like Superman said, I dose my diet, not the other way around. And I have a built-in excuse they say no to kale anything. And my drinking is the same as it was before.

I took a long hard look at going bio and relying on TAVR T to insert a new valve inside the bio valve as I got older. I decided I did not want to rely on improvements in surgical techniques and generally I would rather avoid all surgeries. Part of that is I watched my father have surgery at age 72 for the same issue and he never really recovered in terms of mental functioning. Everybody is different, but I figured I had the same genetic issues as my father and made my decision knowing that. Best of luck.

 

[RAS]

, my doctor seems to think 5 to 10 years then will need another op. has anyone else been in similar scenario?

Sounds familiar...
I was 46 in 2006 when I suddenly experienced symptoms. Went to the Dr, and was told I had a significant murmur, and needed an echo. As a result of the echo, I was diagnosed with a defective aortic valve with severe regurgitation. Two cardiologists told me I needed to get this replaced soon. I was told a mechanical valve would last a lifetime, but I would need warfarin. I was told a tissue valve would last 10-15 years, so I would need one or more future OHS. I was hoping to avoid warfarin, but after doing some research, I ended up going the mechanical route. The warfarin management has not been a major issue or disruption to my lifestyle. It does requires discipline to manage, but I've adjusted to that.

You have more and better valve choices now than were available 16 years ago, so you may choose to a different option. Do your research on this forum and elsewhere, discuss with your doctors, get second and third opinions until you get to a decision you're comfortable with.

 

[Dano64]

I cannot disagree with anything already said in response, but I have not gone with mechanical. I am 58 and just had my second OHS 2/7/22 due to an aortic aneurysm. I was 37 when I first replaced my aortic valve and I went with a homograft rather than a mechanical valve. It lasted 21 years and probably had some more life left in it if not for me being opened up to fix the aneurysm. If you have a BAV, you may develop an aneurysm at some point in the future. I enjoyed my version of normal with the homograft, and that state of mind probably led me to go with the Inspiris Resilia tissue valve this time, right or wrong. I wish you all the best in whatever you decide.

 

[reedonator]

Hi I'm looking for information, I'm due a valve replacement later this year I'm 47 years old but not sure whether to go for mechanical or tissue.
obviously mechanical will have to take warfarin and lifestyle change potentially last for ever.
the tissue valve not so much of a lifestyle change and no warfarin but question over how long the valve will last at my age, my doctor seems to think 5 to 10 years then will need another op. has anyone else been in similar scenario?

Welcome to the forum. I had my aortic valve replaced in March of 2010. I went with the mechanical valve and have no regrets. The idea of having to get the valve replaced again in 5 to 10 years steered me away from the tissue valve. I was working as a firefighter at the time of my replacement and was able to continue with that profession until I retired 3 years ago. I have had to make some lifestyle changes due to Warfarin but that was mainly just diet. As Superman stated in his reply, consistency is key. You don't have to completely eliminate everything, you just don't want to binge on certain foods. The same goes with drinking. I have a couple of beers every night with no issues. I have not found bleeding to be a big issue either. When I cut myself shaving or doing work with my hands I have found that the blood coagulates pretty similarly to the way it did before I was on Warfarin.

 

[tom in MO]

Hi I'm looking for information, I'm due a valve replacement later this year I'm 47 years old but not sure whether to go for mechanical or tissue.
obviously mechanical will have to take warfarin and lifestyle change potentially last for ever.
the tissue valve not so much of a lifestyle change and no warfarin but question over how long the valve will last at my age, my doctor seems to think 5 to 10 years then will need another op. has anyone else been in similar scenario?

We've all been in the same boat unless one is old enough to receive a tissue and not run a risk of replacement.

The lifestyle change with warfarin for me was a daily dose and testing every 2-3 weeks. I didn't change my diet however I believe in a varied diet with a little bit of everything. With warfarin I cannot take NSAIDs for arthritis and have to stop taking it for some procedures. There is a very very small risk of stroke going off warfarin. It takes ~2x longer for your blood to clot, so scrapes, scratches, etc. take longer to stop bleeding. This elevates your risk if you suffer major trauma. With tissue, you will need to continue echocardiogram monitoring and will have a degradation of your valve and overall physical function as you do now leading up to your valve replacement. Just like with your native valve you run the risk of valve failure as the tissue valve gets older and needing emergency surgery if not caught in time.

 

[dick0236]

I never knew that my mechanical valve was an issue in my life or lifestyle until I read some of the warfarin BS on the Internet around 2000. I've had my first, and only, mechanical for almost 55 years........I was 31 when it was implanted in 1967. Since I was unaware of the BS that surrounds warfarin I just lived a normal life that included most of the vices during those years. I've never known warfarin to be anything but a nuisance from time to time........but certainly not bad enough for me to opt for guaranteed additional surgeries as I got older.

BTW, welcome to the forum. Any choice you make will be better than "stickin' your head in the sand"

 

[pellicle]

I had my aortic valve replaced in March of 2010

silly question, but I was about to reply to you saying we had ours done in the same year (as I was looking at your signature) and then noted "wait, didn't he say 2010" ... either way glad you're still tickin

I recall another fireman here some time back who was agonising over the choice. Can't recall what he picked in the end. Doesn't really matter to me however as long as he's happy.

 

[LondonAndy]

I was 48 when I had my valve replaced, in 2014. Went mechanical - no regrets, and hopefully no more surgery as I get older and weaker.

I test my INR weekly at home or wherever I am, using a CoaguChek XS (model now superseded but they're still the same basic machines and use the same test strips), and a finger-prick of blood, and go to my doctor's twice a year to check my machine is giving about the same results as theirs. I go once a year for an ultrasound review of the valve and chat with my cardiologist. My diet is not consistent at all - I eat what I want, except cranberries and grapefruit that can interfere with how Warfarin is processed.

My mother went with a tissue valve in 2009, at age 70. She is now 83 and does not want any more surgery, is in a care home and will die within months I think.

 

[pellicle]

She is now 83 and does not want any more surgery, is in a care home and will die within months I think

Really sorry to read that.

Take care mate

 

[dick0236]

[QUOTE="LondonAndy, post: 915097, member: 15775"
My mother went with a tissue valve in 2009, at age 70. She is now 83 and does not want any more surgery, is in a care home and will die within months I think.
[/QUOTE]

There comes a time................ At her age we are all forced to make decisions differently than when we were younger. A couple years ago, when I was 83, I was diagnosed with an aneurism and elected, due to my age, not to undergo surgical correction. Recently I have been diagnosed with a non-operable heart condition, pulmonary hypertension that is requiring infringing on my lifestyle. I agree with your mom.

When I was 30 the docs told me I would only live to 40 w/o corrective OHS then and that surgery would double my life expectancy to 80 and my new, shiny valve was designed to last that long.........so it was a "win-win"

 

[LondonAndy]

[QUOTE="LondonAndy, post: 915097, member: 15775]
My mother went with a tissue valve in 2009, at age 70. She is now 83 and does not want any more surgery, is in a care home and will die within months I think.

There comes a time................ At her age we are all forced to make decisions differently than when we were younger. A couple years ago, when I was 83, I was diagnosed with an aneurism and elected, due to my age, not to undergo surgical correction. Recently I have been diagnosed with a non-operable heart condition, pulmonary hypertension that is requiring infringing on my lifestyle. I agree with your mom.

When I was 30 the docs told me I would only live to 40 w/o corrective OHS then and that surgery would double my life expectancy to 80 and my new, shiny valve was designed to last that long.........so it was a "win-win"
[/QUOTE]
Thank you Dick, and I agree. And to be clear, it is not just her valve that means she is of this view: this is only one of several health issues mean that her quality of life is very poor now. Whatever valve any of us choose gives us more life than if we didn't have that done.

 

[pellicle]

Dick ... I wondered what was wrong with your post (in the computers view of it): and realised that the " was somehow missing from the end of this bit
QUOTE="dick0236, post: 915102, member: 3372"

and I have to strip the [ ... ] from that or one can't see what I mean

being an old coder I often find that I'm missing the closing brace ) and the parser goes nuts...

 

[Lynn]

Welcome, wigwam. It’s a tough decision and I admit I struggled with it. On the advice of my surgeon, I chose mechanical for my aortic valve replacement last year. I was 58, so in a bit of a gray area in terms of the best choice based on age. My surgeon pointed out that other than my valve, my health was excellent so he felt strongly that I would need another surgery if I went tissue. At 47, the same is likely true for you. I was concerned about warfarin but reading the experiences of others on this board helped a great deal. And they were right. Warfarin is no big deal. I would strongly recommend home testing, it’s very easy and weekly testing helps you to catch any issues before they get out of hand. Best of luck with your decision.