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Peachy

Hi everyone

I've been told that I now require to have an AVR. The Cardiologist has recommend a mechanical valve however I do not want to have to take anticoagulants for the rest of my life, I'm only 40. I would prefer to have a pig valve even although this means that it will probably wear out in about 10 years time. I am a very active person and enjoy ski-ing etc and want to be able to continue as normal after the surgery. I am trying to get as much info as possible for when I go to see the Surgeon but I feel it is a big decision to make.
 
Hi,
I am 58 and just had AVR last Nov. They choice as to the type of valve was tough. In my case it came down to either a human valve(homograph) or a mechanical. I choose the homograph knowing that another surgery will be required some day. I am still not sure it was the right choice. At my age it was pretty close to the border line weather I should get a homograph or mechanical. All my docs recommended mechanical. My surgeon would not even discuss a pigs valve. You might want to also consider a homograph valve. If you absolutely do not want a mechanical then a homograph might be a better choice. Good luck :)
 
Peachy - Similar to Fred, I chose a homograft. I am presently taking no medications, so am happy about that part. They are unsure how long these valves will last, however, I decided to take the chance of a second surgery (I am age 48 and had surgery in Jan 2001). The blood thinners don't seem too bad, especially since I had to take them for three months while my heart was afib, so it is a difficult decision.
 
Hi, my name is martha. I had aortic valve replacment, on 12-15-2000 I was 49. I choose a homograph, not wanting to face coumadin or the ticking. Now 50, I'm glad I choose the way I did. Yes, I know that down the road there will need to be a replacement. However, at that time there will have been so many improvements.

My cardio at the time thought I should choose the machanical. He did not know enough about the homograph. He recommended I see a group of cardio's in the same clinic who specialize in valves. They where very into tissue valves. Thought I had made a good decision. They recommended a surgeon on that decision. The surgeon was wonderful. He understood that my choice was homograph, cow or pig, machanical. The day of my cath, he said, I know the machanical is out. I didn't know going in though if he would be putting in a homograph or animal valve. He said it would be decided once he opened me up, and had a look. When I woke up in ICU that's the first thing I wanted to know.
 
I had AVR surgery almost 11 months ago now. The surgeon right away recommended a mechanical valve as they will last the "rest of my life" he said. Little did I know that 11 days later I required another AVR surgery due to a blood clot that had formed underneath the new valve. No one told me about a "Homograft", pig valve or any other valve. I did not realize I had a choice until I came to the heart support forums.
I don't regret getting a mechanical valve though, as I don't ever want to go through this surgery again if I can help it.
Taking Coumadin is no problem, but to get the INR stable is. It takes a while for some people and for me it took quite a while.
INR stands for: IT'S NEVER RIGHT. It interferes with anything and everything, and I have no idea how Coumadin metabolizes in my body and how vitamine K metabolizes in my body. No one really knows. I think it is a guess every time. I get yelled at quite a bit by my doctor because he thinks I am taking some really off the wall homeopathic or herbal stuff which I am not, but he doesn't believe me.
It's so important that you find a supportive doctor who knows and understands about Coumadin, and knows how to talk and work with you, the Coumadin patient, and doesn't treat you like you are some idiot that doesn't know anything.

I wish you luck with your valve choice!

Christina
 
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Peachy

Peachy

Oeachy ..i've left a private message for you ..please check it out ..thanks
Scottie
 
heart valves

heart valves

www.stevegoldberger.com

Hi I know what you are going thru. I had my aortic valve replaced in Nov.98 and chose to go with a natural valve. They put in a pig vavle and all is well so far.

For an interesting read, please check out my BUM TICKER journal at my web-site above. In it I tell my whole story and it'll give you a better idea of what you're in for.

Good :Luck.

Steve
 
Hi

Congratulations for having hit the bullseye with the 64 million dollar question - mechanical or tissue valve.

Recommend you read my response to Ward under the thread "Upcoming surgery" in the Pre-Surgery section of topics.

If you have any further queries, just ask.

Regards
 
Peachy - decisions

Peachy - decisions

Peachy,

I go with everyone on this site who will tell you it is a very personal decision that only you can make after much research into the different valves.

I have a homograft Jan.2000 at the Cleveland Clinic. The homograft was my choice. Reasons: I find I have a psychotic aversion to Coumadin...basically it is Wayfarin(the old rat poison I used to put out in the barn every fall and winter.). That blew my mind but good. Also a good friend's mom got a mechanical valve about a year before I needed surgery. She was very healthy prior to surgery other than the heart. She had a major stroke about 3 months after surgery and has continued to have five lesser strokes since. Her INR is all over the place, and I think her doctor treats her like crap. Even with all she has happening, he refuses to do her test more than once a month. We have all tried to get her to switch, but "he is who has always taken care of us."

I feel absolutely great. My homograft is doing beautifully. I have my 18 month echo this afternoon. Other than a baby aspirin a day, I am being weaned off the drugs I was put on after surgery. I hope we make the final cut in pills next month when I see my cardio. I took Avapro and Lopressor for strength of heart squeeze and blood pressure, but started being weaned at a year. My blood pressure is even better now, so hope it all goes away this time.

I know I may very well need a replacement surgery in the future, but I'm pulling for 20-25 years and then some little bot will go in and do it without any surgery! Yeah for technology! Honestly the surgery wasn't that bad. The fear beforehand was the awful part and I don't think that will be much of a factor the second time.

Check the past posts for comments from others who have made the decision. And do read Steve's Bum Ticker site!

Good luck and God bless. Keep in touch. There are great people here who can answer about any question and we do care for our own!
 
The most tried and true solution at your age is the mechanical valve, recommended by most surgeons. However, there are a variety of new developments in both mechanical and tissue valves to try to overcome having to make the choice between either another surgery down the road or Coumadin the rest of your life. Unfortunately, none of these valves in development have enough of a track record to gaurantee avoidance of these or other consequences.

I had aortic valve, root, and ascending aorta replacement two months ago (at age 50) and had the opportunity to get implanted with a cutting edge (pardon the pun or whatever it is) type of homograft valve that is treated in such a way that it promises to last the rest of my life, thus avoiding both Coumadin and another surgery. It is called the CryoValve-SG (SG refers to the SynerGraft biotechnology by which the human valve is flushed of its donor's genetic cells with DNA leaving a collagen matrix which is conducive to repopulation with the genetic cells of the recipient) provided by CryoLife, Inc. There are other valves representing different approaches to solving the another surgery vs. Coumadin for life problem, such as that of the Medtronic Mosaic valve. Also, I believe someone on this site reported that the Cleveland Clinic now offers a mechanical mitral valve replacement that promises not to require a lifetime of taking blood thinners like Coumadin.

In any case, you should consider these alternatives only if you truly prefer their risks over the risks and inconveniences of the mechanical, and you go with a surgeon who is both experienced with and confident in these alternatives. In my case, my surgeon and a retired surgeon friend of mine both assured me that the new valve would at least function like a regular homograft, if not lasting the rest of my life then lasting around 15-20 years before requiring another surgery. I preferred this risk and that's what I will have to live with. So far, it has gone extremely well for me, and my surgeon attributes my remarkably good recovery in part to my body's easier than usual acceptance of the new tissue. Of course, the true test of it will be over the long haul.

Good luck and Godspeed as you approach surgery and make this decision about your valve choice.
 
Peachy,

I feel just peachy keen (sorry) about my decision to go with a homograft rather than a mechanical valve. I'm only 3.5 months out from surgery, but already my life has returned to near normalcy. I am currently only taking one baby aspirin per day. I have been weaned from the other medications. I'm 37 and I know I will be having at least one more surgery in my lifetime. If it's even close to my first surgery, I know I will have made the right choice. The entire process was not nearly as bad as I expected. Yet, it's no picnic either. There is no perfect choice right now. It's a personal decision for you to make, assuming no other risk factors dictate one valve over another. Good luck with your decision. You've come to the right place for help and information.
 
I am Bionic woman, I am strong!

I am Bionic woman, I am strong!

I also seem to be in the minority in this thread--me and Christina anyway!

When I found out I required aortic valve replacement due to a congenital bicuspid valve, I spent months researching the options. My surgery was 2-1/2 years ago. Because I was 50, I ended up going with the St. Judes mechanical as it should last the rest of my life. I had a great surgeon who was happy with that choice. The coumadin is not (so far) a problem. It fluctuates some, but usually somewhere within acceptable parameters, and I like it on the higher end of the scale. Just have to be careful with the Vit K and cold medications, etc. I take no other heart or blood pressure medication, etc. and haven't since a few weeks after the surgery. I don't tick enough to notice--only when seriously quiet is it even faint. The surgery is really not that big a deal. Not a lot of pain involved--unless you sneeze. But you do need to get your strength back as soon as possible by walking walking walking and breathing breathing breathing!

Another thing to consider is the heart-lung machine. One of the reasons I was interested in the mechanical valve as, under normal circumstances, it is the fastest operation. Thus you are on the bypass machine the shortest length of time. That was an important factor for me based on the research I had been doing. You can go to some of the medical sites like Cleveland Clinic, Texas Heart Center, and St. Judes and view the different valves. And a replacement for coumadin that doesn't require diet regimen
is about to be released in the next year or so.

All in all, it is a personal choice, but I have not been stopped from doing anything I ever did before. I work hard and play hard. Contact sports should be avoided, but I don't play football--just tennis!

Good luck! Susan:cool:
 
In the mechanical club

In the mechanical club

Hi Susan, I'm with you. I've got a St.Jude bileaflet mitral mechanical valve and proud of it. My surgeon wrote a book on valves( He didn't tell me but I saw it in the library) He and his associates do about 2000 open hearts a year and about 10 -20% are valves, I was 72 when I had the MVR and he said they had a conference about what type of valve to use. I think even at age 72 they didn't want me back on the table at say 80 or 82. My surgeon is conservative and I was happy to learn he did not allow any Silzone valves into the hospital. New is not always better. My sport is golf and as long as I don't get hit with a Tiger Woods shot or struck by lightning I should be OK with the rat poison. I'm waiting for Exanta!
 
Taking coumadin and having blood tests monthly really is no big deal. If you get a mechanical valve you probably will not hear the ticking, at least I never hear it. When the room is very quiet, people standing very close say it sounds lime a watch ticking.

Also, coumadin will not really constrain any of your activities unless you get involved with hand to hand combat. In any case a new type of blood thinner is under development and has been tested. It will not require monthly blood tests or diet restrictions.

In my opinion, the risk of a second surgery/replacement is much greater than any risk from coumadin, especially since the second surgery will usually take place when a person is in advanced years or not in good shape because of a failing valve.

I am not a medical expert.
 
Heart Valves

Heart Valves

Hello Peachy,

My cardio was all for a mechanical valve too. He kept telling me they last a life time... but when I tried to get him to put ?a life time? into a number of years he always got a little vague. After LOTS of research I decided on the mechanical valve. I decided I could deal with coumadin a lot easier than having another heart surgery hanging over my head.

I also LOVE to water ski! That was one of my arguments to him. I told him it?s unrealistic to think I?m not going to water ski. I?m more careful, for sure... but I still do all the things I did before the surgery. I water skied for the first time since my surgery on the fourth of July. I?ll never slalom ski fast and crazy like I have in the past. But I will take a nice slow ski around the lake occasionally. (The cardio doesn?t like it)

It?s a tough decision.... I really feel for you. I remember very well how scared I was when I was trying to decide what valve was best for me. Just being here and knowing you are with people who care about you and have been or are going through the same thing you are will make the world of difference. Welcome to our family.

Best wishes,
Rain
 
Stentless Option

Stentless Option

I think it's important to clarify that there are more than one kind of pig valve. As I understand it, they typically like to put the old style pig valves into older people. They do not tend to wear them out as fast as younger people.

The stentless pig valve is similar to a homograft, but porcine parts are used.

I was 23 when I had my homograft put in. It deteriorated faster than anticipated and here I sit 11 years later having just gone through my second surgery at 35 years of age.

In my opinion, biological is still a good way to go for those of use who do not feel blood thinners are a good option.

If this is your first surgery, there is less risk, no scarring to deal with and you would still be quite young by the time you need your second surgery (if that is required).

I can tell you from my experience that although the homograft didn't meet the doctor's expectations, I have no regrets since it allowed me to live a 100% normal life for a good decade.

Like you, I deliberated on this for a long time. I went as far as researching and finding all kinds of medical journals on the subject of stentless/mech/homograft. (Not that I understood all that I was reading, mind you!)
Feel free to private message or email me if you wish to discuss further.
Kev
 
Hi Peachy,

I know how you must be feeling right now as I went through exactly the same process last year. Like you, I'm now forty and considered myself active, if somewhat unfit, so I wanted to be as sure as I could that my decision didn't curtail my lifestyle any more than was strictly necessary.

I did as much research as I could (and I found this site extremely helpful) and went into hospital last October to have a St Judes valve fitted. Like many of the replys to your post, I have no reason at all to regret my decision, and that's the most important thing whatever you decide.

The operation and recovery was not as bad as I expected, but I'm glad I don't face the prospect of a second operation inthe next couple of decades. I seem to have no problems with my INR, although I have moderated my drinking (never heavy, but I enjoyed the odd night out with the boys) so that I have a couple of glasses of red wine a day. I've not had to moderate my diet although I am concious of my green vegetable intake.

As for the ticking, well I can hear it when it's quiet and I find the sound rather reassuring! Better that than no tick!! I used the recovery period to get myself fitter than I've been for a long time, and I've already bragged on this site that I completed the London Marathon in April, six months after the operation.

Good luck.
 
I became so sick, so fast, that I never had a chance to discuss which type of valve I would receive. The doctor said that because of my age (41 in 1999) they always put a mechanical valve in. The doctor also told me that it had a "life-time warrantee? but never told me WHO?S "lifetime."

Good luck, Phil
 
Peachy,

I feel the need to add one more alternative to the list, namely the Carpentier-Edwards Bovine Pericardial Valve which is made from the pericardium of a cow's heart but shaped similar to a human valve if my understanding is correct. This valve is highly touted by the Cleveland Clinic. Durability is better than pig valves but probably not as good as human valves and definitely not as good as mechanical valves. Like all tissue valves, it does not require Coumadin therapy.

My surgeon, who trained at the Cleveland Clinic, offered me the choice of the pericardial valve and the basic St. Judes mechanical valve. He would not do a human valve which requires a longer root due to my bypass grafts being attached to the aorta. I'm currently on an ACE inhibitor to reduce mitral valve regurgitation as I wait for the day when surgery will become necessary.

'AL'
 
Hi Peachy:

Dr. Lawrence Cohn,(listed as one of the countries best heart doctors) http://homearts.com/gh/health/03cardbc.htm#MA a Harvard Medical School professor of cardiac surgery, has congenital heart problems that forced him to undergo surgery to replace his aortic valve four years ago. A surgeon who has implanted scores of heart valves, he wanted an Edwards cow-tissue valve for himself.

Here is a copy of the article that appeared in yesterday's LA Times:
http://www.latimes.com/business/la-000058181jul16.story?coll=la-headlines-business

IRVINE
Animal-Tissue Valves at Heart of Edwards' Success
Medical devices: The Irvine company is capitalizing on new technology to capture a burgeoning market.


MARC BALLON, TIMES STAFF WRITER


In a scene that mingles stark old-world slaughterhouses with high-tech surgeries, thousands of pig hearts and hundreds of cow tissue pieces are unloaded daily at Edwards Lifesciences Corp. and transformed into life-saving heart valves.

For the Irvine medical device maker, the unsightly animal parts constitute precious cargo. Animal-tissue heart valves, especially those made with more malleable and longer-lasting bovine flesh, are gaining favor here and abroad over mechanical ones as surgeries to repair coronary valves burgeon.

Edwards is the only company with federal approval to sell cow-based valves in the U.S. and is a major provider of such products overseas. Worldwide, sales of cow tissue valves are growing at a 15% clip, analysts say, and Edwards is parlaying its bovine monopoly to make itself the world's dominant maker of heart valves--an $825-million market last year. "With the population growing and heart valves increasing their penetration in developing nations, like India and China, I see this market growing solidly for at least the next five to 10 years," said Bud Leedom, an analyst with Wells Fargo Van Kasper.

And Edwards is in an excellent position to capitalize on its technology, said Tim Nelson, an analyst with US Bancorp Piper Jaffray.

The company also has caught the attention of Wall Street, where investors boosted Edwards stock to a 52-week high of $28 a share during trading Friday. The stock settled a bit to close at $27.78 a share, up 82 cents, on the New York Stock Exchange.

But competitors are gearing up.

In March, Medtronic Inc. in Minneapolis, the largest maker of heart pacemakers, bought the cow-based valve business of VenPro Corp. in Irvine. The VenPro product already is approved in Europe to correct congenital malformations of certain heart valves in children. Medtronic also introduced several new pig-tissue valves recently.

St. Jude Medical Inc. in St. Paul, Minn., the world's biggest maker of mechanical valves, has a bovine valve in European clinical trials, said company spokesman Peter Gove. It also is improving its mechanical valves to compete better against the more popular tissue products, he said.

Mechanical valves, co-invented by Edwards founder Miles "Lowell" Edwards 41 years ago, typically are used now in younger patients because they last a lifetime.

Patients, though, must take blood thinners for life to stop clots from forming, and such medicine tends to make patients bruise more easily and bleed from cuts more profusely, drawbacks that make some people less active.

No such drugs are needed for valves made of animal tissue. But those valves don't last a lifetime; they eventually stiffen and calcify and must be surgically replaced. Pig tissue lasts about 10 years; cow tissue 15 years. Cow tissue also is more flexible, making it easier for surgeons to sew in.

Dr. Lawrence Cohn, a Harvard Medical School professor of cardiac surgery, has congenital heart problems that forced him to undergo surgery to replace his aortic valve four years ago. A surgeon who has implanted scores of heart valves, he wanted an Edwards cow-tissue valve for himself.

"I'm living a completely normal lifestyle. I'm playing golf, tennis and traveling around the world," said Cohn, 60.

That's what a growing older population wants, industry experts say. They are used to being active and don't want diseased or worn-out heart valves to limit their lifestyle. Their demand helped create a market that has grown 13% in three years.

Last year, new valves or valve parts were implanted in more than 300,000 patients worldwide--about 90,000 in the U.S.--and the number is expected to grow by at least 5% a year, analysts say. Edwards has about 32% of the worldwide market for all valves, followed by St. Jude with 31% and Medtronic with 18%, analyst Nelson estimates.

"It's a neck-and-neck race," but Edwards should pull ahead to control 35% by the end of the year, he said.

Porcine valves were introduced in 1975, and Edwards received U.S. approval in 1991 to use bovine products as aortic valve replacements, which account for about 60% of heart valve surgeries.

Last year, the company won U.S. approval to use cow-valve products to replace the mitral, or bicuspid, valve in the right atrium of the heart. Those valves represent 39% of the surgeries. Two other valves in the heart rarely need to be replaced.

To make the devices, Edwards employees, clad in sterile gowns and gloves, peer through magnifying glasses and microscopes to trim porcine organs or stitch flat strips of bovine flesh together.

Those products, Chief Executive Michael Mussallem says, are the future of Edwards. But getting the company this far took some doing after it was spun off 15 months ago from Baxter International Inc.

Edwards "inherited a whole pile of junk," analyst Nelson said, along with $520 million in debt from Baxter.

The company shed under-performing assets and is focusing on faster-growing, more profitable businesses, such as heart valves and heart catheters that monitor blood flow.

It sold a medical services business to Fresenius Medical Care in Germany for $45 million in cash earlier this month. Last year, it sold its unprofitable Bentley line to Germany's Jostra for about $30 million and peddled its struggling Novacor unit to World Heart Corp. in Ottawa in a stock deal worth $59 million.

The Bentley sale accounted for most of the $362-million charge the company took last year for an annual loss of $272 million on $804 million in revenue. The sales of the units cut 500 employees from Edwards' work force to leave it 5,000, including 1,500 in Orange County.

Mussallem said he now can focus on adding new products internally or through acquisitions. He said the company probably will target devices that treat coronary artery disease and congestive heart failure.

The young company has hit some bumps along the way.

Edwards' stock plummeted by 41% in one day last October after the company lowered its 2001 profit estimate from 30% to 20%, citing a weak European currency and sluggish sales of some products.

The company also had to pull the plug on domestic clinical trials and on European sales of one of its most promising products, fabric-covered wire grafts for protecting weakened aortas. A wire had fractured, and the setback cost the company millions of dollars and allowed competitors to jump ahead.

Mussallem said the company now is better prepared for currency fluctuations and has corrected the wire problem, which should allow trials to resume soon.

But it is the bovine valve that has made Edwards a world leader, he said, and that product "will keep us there."

You might want to even contact Dr. Cohn. After opening the following URL - http://research.bwh.harvard.edu/rdbook/s5.htm if you click on his name it will open Outlook Express with his email address.

Good luck

Ken
 
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