AVR questions

[Charlie]

Ok, so I am in the waiting room now and will have AVR in the next two weeks per my surgeon.

I am a 61 year old male. I'm not in bad shape for the shape I'm in, I have had extensive damage and surgery to my back and neck but I remain a VERY active person given my limitations. Perhaps I should say I was very active until shortness of breath took over my life.

My normal routines include walking, hiking and ride dual sport motorcycles into very remote areas while moto-camping along the way.

My question, I've read a ton of information on valve choice. I've be able to determined from that research that people under 50 tend to more often choose mechanical valves and persons above tend to opt for a Biological valve.

Given what I've told you about myself what considerations should I be making when making my choice. I am aware of the anti coagulant meds and given my activity level that is weighing into my considerations but it isn't a deal breaker either.

Bottom line is that I need to make a decision and it's been difficult nailing it down.

 

[ElectLive]

There are arguments for either choice, and discussions all over this site about pros and cons of each. You've probably already found the sticky post on valve selection here, if not, I'd start there. In theory, risks equal out at a certain age, maybe it is 50, maybe it's not. I don't think it's a stretch, though, to say that more at your age do choose tissue (biological) than mechanical. I'm not a medical expert by any means, but it is my understanding that two commonly argued reasons for a tissue valve at your age are to help avoid as much as possible the body's natural increased risk for both stroke and hemorrage, because of deterioration of vessels to the brain and older tissue that leads to GI issues.

Some your age do chose mechanical, though, and supposedly the newer mechanical valves combined with good ACT makes the risks I mentioned less of an issue than what studies indicated in the past. There are a ton of folks on here who can speak to the ins and outs of ACT, the most common viewpoint seems to be that it's much more manageable than you might assume. Lifestyle for many is unaffected, although motorcycles in remote areas would seem to me to be a possible exception.

I hope this helps a little. I encourage you to research as much as possible, as hard as that will be in the next two weeks. I had four weeks and the valve selection process for me was exhausting and went down to the very end. There are a good number of folks here who have had surgery around your age, hopefully a few will weigh in. Best wishes and remember that whatever you choose, it will be an upgrade.

 

[Julian]

Someone your age SHOULD get good mileage out of a tissue valve. With the new tissue valves MAYBE 30 years, it may outlast you!

It is possible that you may only get 10 years out of the valve even at the age of 62 but not likely. There is a GREAT chance that you wont have to take anti coags for life if you get a tissue valve but not guaranteed. When it comes to valve replacement I like to think of it like this:

-Tissue for MOST will require re operations and LOW chance of having to take anti coags for life.

-Mechanical for MOST wont require a re operation but WILL require life long anti coags.

In the end there is no guarantee that someone wont have to take anti coags or need multiple operations either way, just better odds depending on what you choose :tongue2:

62 is a funny age, your right in the middle. The good news is any choice you make will be the right choice because it will save your life either way! Its almost a coin toss. Ask yourself what bugs you more taking anti coags or re operations?

 

[ken taylor]

I will be 62 next week very active walking 360 miles a month in the past. I chose mechinical ONX. A tissue valve most last about 8 + years depending on how active you are. The first thing I did after surgery was sell my motor bike. P>S> the warfarin is no prob.

 

[neil]

doesnt make a difference how active you are, its your body chemistry that counts and nobody knows that,also at your age you should be looking at 10 to 15 yrs +, but you cant say for sure what it will be, as julian rightly said what bugs you more anti coags or re op?

 

[Cooker]

Talk to you cardiologist, your surgeon, do your research and then go with your gut feeling (it's usually right).

The question for me was life long anticoagulation or re-op. I chose anticoagulation but that's me. Good luck and I'm sure you will be satisfied with your choice.

 

[epstns]

Yes - Definitely speak with your surgeon. If they specialize in valve replacement, they should have the current best information on each of the available valves.

The tipping point for recommendation of tissue valves over mechanicals used to be 65 years of age -- I have been told (by two highly regarded surgeons) that this has been lowered to 60 or even younger due to the longer expected lifespans of the third generation tissue valves.

Neil is right. Our activity level has no impact on valve life. What happens to tissue valves is that they become stenotic - they calcify. The calcification is the result of our bodies' immune systems attacking the valve. In younger patients, the immune systems are much more active, thus they calcify the valves faster. Once we get past a "certain age" our immune systems become less aggressive and it takes longer for them to calcify the tissue valves.

If you look at the statistics from the Cleveland Clinic, Mayo, Northwestern and many other leading valve surgery hospitals, you will likely find that their current mix is about 85% tissue valves, 15% mechanicals. It is the extended life span of the third generation tissue valves that has caused this shift.

I rolled the dice and chose a tissue valve at age 63. This was the right choice for me -- it might not be the right one for you.

 

[ALCapshaw2]

Re: Talking with (a) Surgeon, remember that MANY (if not Most) Surgeons do NOT offer ALL Valve options, i.e. Surgeon Choice often amounts to Valve Choice. It would be wise to ASK what Valves each surgeon uses.

 

[nngbwh]

There are disadvantages and advantages of tissue and mechanical valves. It's something you should decide on your own, either valves you will still live a long time.

Good luck and keep us posted.

 

[Lynlw]

As others said it is a personal choice, FWIW the most used Tissue valves TODAY that have proven track records ( Edwards Perimount bovine, St.Jude biocore and medtronic's porcine hancock II..altho to be honest most surgeons I know of in the US tend to use Medtronics, freestyle or Mosaic if they use a pig valve, depending on if they want stented or nonstented)and have been around over 20-25 years, in patients OVER 60 for the most part about over 85% of the patients still had their valves doing well at 18-20 years. Also MOST surgeons and cardiologist believe IF you get a tissue valve NOW by the time it needs replaced they will be doing them by cath-(percutaneous valve replacement) like they already are doing for the most high risk patients today in trials and are expected to be FDA Approved at the end of this year or 2012. So its getting very close to the point that choosing a tissue valve will NOT mean if you live long enough it will require re operations.
Right now and for the forseable future percutaneous valve replacement will only be available for people with their native valves OR tissue valves, not mechanical.

As Steve said one of the reasons MORE surgeons, in most of the leading centers are using tissue valves in younger patients is the longer lifespan of the newer tissue valves, the other BIG reason is how much better the morbidity and mortalty of REDO surgeries are than they were even 10 years ago. TODAY the risk of death from a 2nd surgery is the same as the first surgery about 1% with experienced surgeons and centers. I'm sure the high likelihood of percutaneous valve replacements will also play a role.

I rarely give my opinion about what (either tissue or Mech or even brand) anyone should get, but I have back problems- not nearly as bad yours, I'm over 50 and don't need valve surgery, but since my My Mom had Aortic annuerysm surgery and my son many heart surgeries, I've thought for ME IF I did need surgery, one of my concerns (which I don't know if this applies to you) would be I get spinal blocks about 3 times a year. One of the times Coumadin is the most risky is when you have to stop and start it for other surgeries or procedures, even IF you "bridge" with other ACT meds. Spinals are one of the times you have to stop Coumadin for a couple days, since it can be VERY dangerous if even 1 drop of blood gets in your spinal colum (paralysis etc) I wouldn't want to have the increased risk from having to keep stopping and starting Coumadin every couple months for spinals, on top of the other risks that everyone who has a mechanical valve so needs to take coumadin has.