Born-Again Valver

[paulk]

I was on this site 15 years ago during my last Valve Surgery, when I was a young 45, and thought it'd be fun to have another one. Yay! It's been so long I had to get my account re-instated. Yeah, I'm one of those.

Anyhow, I've been reading posts on here in the meantime, just to catch up a bit, and to listen in on conversations regarding valve choice - last time was a repair (Mitral) this time is a replacement (Aortic). Doc says it's gotta be the hard way, split the ribs and open 'er up (sorry, I don't know all the acronyms). I'm on the fence, but still have 3 days to decide, no sense rushing into these things. He recommends Inspiris at my ripe old age of 60, but I'm still considering mechanical. It's been helpful to read through folks thought processes regarding valve choice. I really don't have any questions, just wanted to say hi.

-Paul
WI

 

[MdaPA]

last time was a repair (Mitral) this time is a replacement (Aortic).

Is there a chance that once the surgeon gets in there that he would consider replacing your repaired MV also? If so, then that might be more of a push for mechanical, for both AV and MV's, to lessen the chances of a redo later on.

 

[pellicle]

Hey welcome back

I was on this site 15 years ago during my last Valve Surgery, when I was a young 45, and thought it'd be fun to have another one. Yay! It's been so long I had to get my account re-instated. Yeah, I'm one of those.

Anyhow, I've been reading posts on here in the meantime, just to catch up a bit, and to listen in on conversations regarding valve choice - last time was a repair (Mitral) this time is a replacement (Aortic). Doc says it's gotta be the hard way, split the ribs and open 'er up (sorry, I don't know all the acronyms). I'm on the fence, but still have 3 days to decide, no sense rushing into these things.

dunno, see what you think of this presentation from the Mayo



its lengthy but to the point (still imo)

I hope that your upcoming surgery is "unremarkable" and your recovery "uneventful"

Best Wishes

 

[gpr100rs]

I am 63 and had AVR in April '21 at Cleveland Clinic. Went through the same thought process you are going through. Went with the Inspiris with the hope that the Edwards' treatment to the leaflets will indeed slow the deterioration (hope to get 15-20 yrs) and the ring allows for expansion which will accommodate transcatheter valve replacement in the future. No "right" or "wrong" choice given your age, but be forewarned, if you pose the "which valve is better," you'll have the Hatfields (tissue) squaring off against the McCoys (mechanical). Never pretty.

 

[Brinntache]

I had a hard time getting real data on how long I should expect a bio valve to last (given age and health condition) and even a harder time getting info on what the decline would be like. As in, what will the last 2-3 years be like before re-op? My last 2-3 years before op sucked (maybe my doc should have sent me sooner). There is the time before re-op, and there is the time living my best life. I'm not going through this just to sit in a rocking chair, keeping my heart rate below 120 again. Now I had surgery at 50, so different. But for me, choosing to have an avoidable surgery at 65 and another at 80 wasn't worth the benefit of not taking warfarin daily and an INR test every three weeks.

 

[Chuck C]

Hi Paul.

Welcome back!

I wish that you were dropping in just to say hello because you missed everyone. Sorry to hear that you need to get #2.

Best of luck in the challenging decision before you and in your upcomming procedure.

Please keep us posted.

 

[pellicle]

you'll have the Hatfields (tissue) squaring off against the McCoys (mechanical). Never pretty.

Pretty rarely in consideration of the over 60 age group. Mostly when discussion turns to the sub 50yo...
I do notice that Hatfields seem inclined to say "there is no wrong choice" or "none of us here are doctors" while the McCoys usually are evidence based and discursive about parameters.
Funny thing is some here are doctors.

 

[pellicle]

Morning

I had a hard time getting real data on how long I should expect a bio valve to last (given age and health condition)

Did you mean from your team or from here?

and even a harder time getting info on what the decline would be like

I would suggest from what I've read about the same non-linear rate of progression that occurred in your native valve.

Just for conversation...

 

[tom in MO]

Hey welcome back



dunno, see what you think of this presentation from the Mayo



its lengthy but to the point (still imo)

I hope that your upcoming surgery is "unremarkable" and your recovery "uneventful"

Best Wishes

That video dates from 2009 or so. Not really up-to-date.

 

[vitdoc]

The problem with valve choices is that there is still a lot of uncertainty.
There are plenty of statistics to look at but they are not available for the most current valves looking out 20 years. There are statistics on complications with TAVR but not much yet on TAVR in a previous valve. Also new things may come along. So it is tough to be dogmatic about which is the way to go.
I had an early bio prosthetic valve last 5 1/2 years in the aortic position placed in 1977. Now maybe now I would have 10-15 years. Then TAVR. TAVR x 2 ?
So right now probably age 70 bio prosthetic or TAVR. Age 60 tougher call.
I tend to be very suspicious of people that are very dogmatic. They usually are not very nuanced.

 

[pellicle]

I tend to be very suspicious of people that are very dogmatic. They usually are not very nuanced.

Agreed. However some points:

• its not so nuanced as to be a labyrinth for the majority of people and the surgical guidelines are still pretty clear for helping make a decision
• while its true that at some ages the decision is clearer even then there are issues (the nuances) which are best grasped for the waiting room patient by open and honest discussion
• informed consent is an interesting topic with assumptions about how possible it is to actually inform some people out of their preconceptions

As a generalisation I observe that people likely to always suggest a tissue prosthesis there is a dogma of "its out of your hands really" which is the most polite explanation for "none of us are doctors" discussion shutdowns I see.

Anyone familiar with my posts will know that I usually say "depending on your age, you will likely be well served by a tissue prosthetic. Particularly when I know they are over 60. Further I usually also say to the young "if you aren't going to strictly adhere to the INR management then don't get a mechanical valve or you will come to harm".

Its not so nuanced as to be impossible to comprehend.

 

[AZATADINE]

Just on TAVR, I sometimes see mention of cracking the ring on previously installed bio prosthetic valves to do it. Surely that can't be a particularly great thing? I speak from the point of view of a tissue valve recipient who will need re-intervention at some point myself. Not sure I like that option. As I sit here now, I'd be inclined to go with OHS again rather than that?

 

[Superman]

I was on this site 15 years ago during my last Valve Surgery, when I was a young 45, and thought it'd be fun to have another one. Yay! It's been so long I had to get my account re-instated. Yeah, I'm one of those.

Anyhow, I've been reading posts on here in the meantime, just to catch up a bit, and to listen in on conversations regarding valve choice - last time was a repair (Mitral) this time is a replacement (Aortic). Doc says it's gotta be the hard way, split the ribs and open 'er up (sorry, I don't know all the acronyms). I'm on the fence, but still have 3 days to decide, no sense rushing into these things. He recommends Inspiris at my ripe old age of 60, but I'm still considering mechanical. It's been helpful to read through folks thought processes regarding valve choice. I really don't have any questions, just wanted to say hi.

-Paul
WI

I believe the scientific way to express it is, “Joining the zipper club”, but since your mitral valve repair already put you there, “split the ribs and open ‘er up” is acceptable vernacular.

At 60? Flip a coin? I guess I’d want to know the status of the mitral repair. Am I at risk of a second operation there? If so, might as well go tissue. I’d also want to know the status of my aortic root / ascending aorta. If I’m at risk of a future aneurysm repair, might as well go tissue again.

If the above both look great, I’d lean mechanical to avoid future surgery, but that’s my sleep at night test. I’ve done open heart twice. Not a fan.

You have to know your own sleep at night test. I guess if I really believed I’d get 20 years out of a tissue valve and knew for a fact they’d do a TAVR if I needed another - I’d go that route.

Good luck with your decision. Never easy, but regardless of what you do, it’s better than what you have.

 

[pellicle]

I at risk of a second operation there?

err ... a third?

 

[MdaPA]

I guess I’d want to know the status of the mitral repair. Am I at risk of a second operation there? If so, might as well go tissue.

That's where it gets complicated. If MV needs to be replaced and can be done in same surgery as AV is replaced (the OP's 2nd surgery), then OP should really consider going mechanical for both rather than tissue. If both were replaced with tissue valves, then there's a good chance that one or both of the valves would need another OHS surgery, TAVR or TMVR procedure down the line, and not necessary at the same time.

 

[pellicle]

Not sure I like that option. As I sit here now, I'd be inclined to go with OHS again rather than that?

as has been discussed, its not always an option anyway ...

 

[paulk]

Thanks for the warm welcome! Knowing what I'm in for reduces worry in a way, but increases the dread of recovery period, at least the days immediately following surgery - Yuk! In any case, I'll get through it, and have my ducks in a row to keep from going crazy once out of the hospital, I think. And it beats the alternative.

My Cardiologist & Surgeon say my MV repair looks great, so no worries there. They didn't find anything else of concern after the Vascular Ultrasound, TEE, Cardiac Cath and CT (phew!). When I asked the surgeon when he needs my decision, he said day of surgery is fine. I'm thinking of smuggling in a coin to flip before I'm put under. (Joking helps keep the worrying at bay)

Getting this done in February will also hit my out-of-pocket max early (high-deductible insurance), so perhaps I should see what else I can get fixed this year.

 

[MdaPA]

My Cardiologist & Surgeon say my MV repair looks great, so no worries there.

That's good news!

 

[Brinntache]

Morning

Did you mean from your team or from here?

I would suggest from what I've read about the same non-linear rate of progression that occurred in your native valve.

Just for conversation...

I meant data from medical studies. As in, how long will a bio valve last in a 50 year old man who is getting valve replacement surgery without other underlying conditions (obese, diabetic, blood issues, etc.)

And if the last 5 years before re-op are like my last 5 before op #1 I'm glad I went mechanical. I want to lead my best life.

Now where do I sign up for the study looking to see if Testosterone and viagra prevent Alzheimer's?

 

[Dano64]

Paulk,
Welcome back! I too am born again here, after a hiatus of almost 20 years. I am scheduled for ascending aortic aneurysm surgery and likely aortic valve replacement 2-7-22 (wow, that's just 4 days away), although my homograft continues to do its job 21 years after insertion. From my own research, perhaps limited in comparison to others, and perhaps my hopefulness in the future unknown, along with family cancer risks that took my parents too young, I am going with the Inspiris Resilia valve, even though I am 3 weeks shy of 58. I do feel a bit defensive posting this here, given my own perception of a very strong lean towards mechanical on this site compared to what I recall from 20+ years ago. The other odd factor for me is that I have never really had any symptoms whatsoever from my condition and I feel pretty good now, so I have my own definition of what normalcy looks and feels like that may not fit others. And because of my own sense of normalcy, I left this site for a long time. My surgeon softly leaned towards the bioprosthetic valve, but entirely left the decision to me. In my opinion, there are convincing studies and videos that go both ways on this. All the best for you in whatever you decide.