Confused about valve choice

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M

mspinder

Member
Joined
Oct 29, 2009
Messages
16
Location
Rochester, NY USA
Hi, my name is Mark and I am new to this board. There sure is much information to digest here and I think I read every post.

My story.
I was born with a heart murmur. It has never restricted me in any way. I see a cardiologist every year for all the tests. I developed a-fib in Dec. of 05. Meds have controlled the problem so far. When I started having symptoms of aortic stenosis my cardiologist suggest replacement soon. I am ok with this and pretty positive about the surgury as I am 59 and relatively healthy and very active. After reading all the info here (and I know it is my choice) I am not sure which way to go with the type of valve. My cardiologist made a moderate recommendation for a mechanical valve. My surgon, Dr Peter Knight, Strong Memoril Hospital, University of Rochester, said if it were him he would go tissue. He said he does not like blood thinners. I am stuck in the middle as far as age. A little older or younger and I have no decission to make. I have read all the pros and cons of each and still undecided. I saw Robin Williams had a tissue valve at 57. My surgury is set for Nov. 6 Any insight would be healpful. Thanks

No spell check oops!
 
I had a choice also. To avoid another surgery in as little as 5 years to as much as 15 years,my choice was mechanical. Do your reasearch on coumadin. It may help you make your decision.
Best wishes
 
Hey there mspinder welcome to the forum.
Personally I think the reason your doc doesn't like 'blood thinners' better known here on the forum as anticoagulants is because he may not truly understand the drug - maybe doc's don't. But we're here to help with any misconceptions you may have. Lords knows everyone here has helped me a great deal when it came to warfarin. One really shouldn't have any worries about taking warfarin.
Then on the other hand (I may be wrong here) but you may have to take an anticoagulant with a tissue valve also - someone will correct me if I'm wrong.

I really didn't have a valve choice, either it was repair or a replacement with a mechanical once the surgeon got 'in there'.
 
hi there mspender,i choose tissue as didnt want to be on warfarin,but as a lot will tell you on here there take it and have no problems,never the less if you could have a valve that didnt need it everbody would come off it,usually with tissue you dont require to be on it,but yes there are sum cases that people with tissue req warfarin as sum people with mech require a re op.it all comes down to a personnel choice,mech properly no re op but warfarin,tissue re op but properly no warfarin,but remember,what ever you choose its better than what you got ok,hopefully one day there will have a valve that doesnt need warferin and lasts forever,till then we gotta choose which is best for us,
 
lb151 said:
I had a choice also. To avoid another surgery in as little as 5 years to as much as 15 years,my choice was mechanical. Do your reasearch on coumadin. It may help you make your decision.
Best wishes
Click to expand...

Welcome aboard!

Choice of valve was the most torture I had to go through before surgery...I kept switching from one to the other until 3 days before surgery I finally decided to go mechanical as I did not want to face another surgery again whether in 5 or 20 years!!! when I would be in my 70s and not sure in what health condition I would be then.

This is a very personal choice and as others said in previous threads: any choice you go with is better than what you have now.



Good luck and keep us posted.
 
As you are aware, you are in the Gray Zone and a good argument can be made for either the Bovine Pericardial Tissue Valve (longest proven durability of the tissue valves) or a mechanical valve (and you probably know which one I would recommend if you have read my posts). OR, one of the "New and Improved" Porcine Valves.

I have three Questions for you to Ask Yourself.

Are your parents still living?

If not, how old were they when they died?

What did they die from?

If you do not expect to live for more than another 20 years, then the Bovine Pericardial Tissue Valve would be a very good choice.

If you come from a family of Long Livers, then your decision gets a little more 'dicey'.

Hopefully you will settle on a valve choice that 'feels right' for you. That's the one to go with (BUT, be sure to have a Plan B, 'just in case' there is a problem implementing your first choice. That does happen sometimes.)

Keep mulling it over. After a while, something will most likely settle out as being most compatible with you and your lifestyle.

'AL Capshaw'
 
Hi, Mark. I'm also 59 and 5 weeks post op. Valve choice is a problem, especially, when your Primary, Cardiologist and Surgeon disagree as was true in my case. Since I had spent some time learning about my surgeon, I knew going into our first meeting that he is one of the best. I ended up going with his recommendation as it was based on more than just the issue of anticoagulants and I am comfortable now with my choice. It does need to be your choice so I would encourage you to learn as much about your options as you can and if you have questions call up your surgeon and ask them. I hope it is obvious that we here in VR will also help if you with answers as much as we can. Welcome aboard.
 
Welcome, I know you have tough choices, as for what valve ect, I tend to listen more to the surgons than cards about the different valve choices. Usually they are more involved in the actual valve choice and know more of the details ect about the different valves. As you know it is not a cut and dry thing which is what makes it tough. There are positives and negatives about each option, it is basically a matter of what you prefer. At your age the data seems to be about equal in the long term, wether it is the risk of a probably 1 more surgery or life on coumadin, especially as you get older and what goes along with that. I know this probably isn't what you want to hear but chances are you will go back and forth a few times in the next week. The good news is both choices are good. Hopefully you will know when you decide what is the right choice for YOU and you'll find a sense of peace.
Did you read the stickies at the top of this thread? http://www.valvereplacement.com/forums/showthread.php?t=14330
 
All I can add is this. I was 58 back then and my surgeon said I was too young for a tissue valve. So I have a St. Jude mechanical. Coumadin can be a pain but not nearly as bad as some make it out to be. I am now a little over thirteen years post-op and very happy with my valve.
One point I try to stress is how do you know what physical condition you might be in if and when a tissue valve had to be replaced. I was told my mechanical valve most likely will outlive me and hopefully no more heart surgery for me. No guarantees but the odds are in my favor.
Rich
 
Welcome to this wonderful place!! You will find lots of caring and supportive people and we are all here to help you weather this journey. :)

Valve choice is a very personal choice, as has been mentioned. Sometimes these threads get a little crazy (controversy and then defensiveness) so I hope we can all keep it together for this newbie and just help him find his own way.

I'm kind of a go with the gut person and for some reason, when I first started reading up on valves I just said it's tissue for me. I was 49 and then had to wait 3 years for the actual surgery (for the stenosis to get bad enough) at age 52. I guess where I was coming from was, who am I? How do I live my life? Do I want it to change much? No. Do I want to hear my valve ticking? (I am very noise sensitive). No. Do I want to have to think about something called an INR level. No. I just didn't want to be bothered with some of those things. I'm kinda lazy and sensitive. So I figured since I am really healthy otherwise, I'd go with tissue because FOR ME, it would mean less of a change in my then currently wonderful life.

That said, I knew that it was possible that even with the tissue, I would be put on warfarin for one reason or another. No one really knows the cards they will be dealt on all this. Some tissue valvers are on coumadin.

My surgeon was exactly my age. When asked he said he would use the valve I chose for his wife, his brother and/or himself. He really trusted it.
I didn't even ask my cardio, I don't think. She made me wait so darn long :mad: that I didn't really want her opinion. (I do love my cardio, though :eek:)

So think about who you are. Does a future surgery just scare the dickens out of you? Are you great at remembering your pills and somewhat meticulous about having things checked that need to be checked? Would a noisy valve bother you? Are you generally very healthy already and not have some other genetic thing lurking in your future? Read, read and read and then weigh out how you understand the choices to affect the person you are now.

Good luck and ask anything here that comes to you. We have a lot of ideas. The answers you make, though, should come from you and your doctors.

:D Marguerite
 
Read this paper and see what you think then. It persuaded me, and I tried like the dickens to convince myself tissue was the way to go.
http://www.norcal928.org/files/risk_corrected_analysis_of_bio_v_mech.pdf

Still, this can be an agonizing personal choice. The fact that your surgeon favors tissue is interesting. He dislikes blood thinners. It is true they have risks, expecially in the very elderly, but I have become convinced that most of the problems relate to over all health. If you have a condition that would make blood thinners dangerous, that is another ballgame.
 
Thanks to all the great advise. I do not have lots of time right now but I will respond later today or tomorrow. I do have a more intense consultation with my surgeon on Monday. I have many more questions to ask him about his choice of a tissue valve. I was not as informed at the last meeting as I am now. I am tending to see a tissue valve as a more agressive decission and mechanical as a more conservative.
Thanks and I will be respomding again as I do have more questions and am not a great one to type.
 
Hello everyone. My consultation with my surgeon is on We. morning. I have a long list of questions. In response tosome of those who replied:

Eva: How old were you? Blood thinners are ok with you so far?

Al: Dad died of colon cancer at 51, 1979, Mom just last March at 82 of heart failure. Her arteries were probably a cause. She smoked and was overweight. I have none of those conditions to consider. I only worry about the thinners for later on in life not the near future.

Rich : Did you labor over the decission or was it a no brainer for you?

Marguerite: I too do not want to change my life style but I fear a re op not knowing how I will react to the first. Also how much more of a risk is the 2nd than the 1st?

Bill and Lynlw: I tried reading the artcles you suggested but really had a hard time sifting throufg the numbers. I will print them off and try again.

Gris: I cosultation is Wed AM. I will keep you posted.


Thanks again for all the replies. I'm really starting to get nervous. Trying to picture myself a few days from now!

Mark
 
mspinder said:
Hello everyone. My consultation with my surgeon is on We. morning. I have a long list of questions. In response tosome of those who replied:

Eva: How old were you? Blood thinners are ok with you so far?

Al: Dad died of colon cancer at 51, 1979, Mom just last March at 82 of heart failure. Her arteries were probably a cause. She smoked and was overweight. I have none of those conditions to consider. I only worry about the thinners for later on in life not the near future.

Rich : Did you labor over the decission or was it a no brainer for you?

Marguerite: I too do not want to change my life style but I fear a re op not knowing how I will react to the first. Also how much more of a risk is the 2nd than the 1st?

Bill and Lynlw: I tried reading the artcles you suggested but really had a hard time sifting throufg the numbers. I will print them off and try again.

Gris: I cosultation is Wed AM. I will keep you posted.


Thanks again for all the replies. I'm really starting to get nervous. Trying to picture myself a few days from now!

Mark
Click to expand...


The risk for 2nd surgeries is pretty close to the same as for first (with experienced surgeons), which is why many of the centers, like Cleveland are using tissue valves for younger people.
 
I was somewhat around your age when I had my mitral valve replaced and after doing 'my reading', speaking with my cardio and surgeon, it was clear to me that for ME, tissue was the way to go and I am so grateful now I made that choice. (This was my second OHS in four years. :eek: )

It is common after having a tissue valve placed to have a short course of coumadin while the heart is healing. It was to be three months for me and I knew that in advance. As it turned out, my surgeon let me stop at 2 1/2 months. I was on a very large dose by the time I stopped and still never actually reached my therapeutic range. It probably would have settled into something like 105 mg per week and that is a lot of coumadin no matter what anyone says. Yes, the correct dose for each of us is the dose that keeps you in the proper range for you but I would have been very, very, very uncomfortable taking that much coumadin for the rest of my life. No one has successfully talked me out of unease over such a high dose. I hated being on it. If I was to be on it long term, I would have gotten a home tester and that would have made it better for me, I expect.

Noise of a ticking valve was among other reasons I chose tissue. There were other reasons I won't go into.

Sure, if I should be so unlucky to develop a-fib in the future, I might be faced with coumadin but I will have known I did what I could to avoid it. It was not 'no big deal' for me. Certainly, I can only speak for myself.

Everyone who says you cannot make a bad choice as long as you choose one valve or another is absolutely correct. You need to make your own choice for all your reasons.

Best Wishes.
 
Mark, you have a tough call. Each option has its pros and cons. I was in just about the same situation as you as I had my AVR at 58. I guess the deciding factor for me was to try to avoid the operating room. I saw that as the lesser of two evils. But its still a roll of the dice as you don't know how long you're going to live. I have to admit I don't like taking anticoagulation medication. I guess the payoff with a mechanical comes 15 - 20 or so years down the road. I want to wish you all the best whatever your choice is.
 
JKM7: Thanks for the reply. How old were you for each of your 2 OHS? Was the first one for arortic valve or something else? Do you believe the 2nd surgery had more risks than the 1st?

Sorry for all the questions but I am looking for that one thing that will make me make the right choice for me.

Mark
 
I was about your age for my second OHS. My replacement valve is Mitral.
My first surgery was almost exactly four years earlier. I was much sicker having my first surgery and though I had a smooth, uneventful recovery for both, I found my second surgery much easier on me. I knew the moment I first woke from the surgery that the 'train that hits us all when we have this surgery' did not hit me quite so hard.

Statistically, the risk factor does increase for subsequent OHS but I got back to my life and regular routine very quickly after the second. My surgeon said there was scar tissue but he said it was easily handled. I had the same wonderful surgeon, Mass General Hospital both surgeries with some of the same nurses and support staff.
I was driving in just barely three weeks (short hops to do light errands) and was walking good distances daily very soon. I became independly able to care for myself almost from day one home. The biggest restriction is, of course, varying length of time for no driving and no heavy lifting until sternum is healed. (About 6-8 weeks).

Hope this helps you.
 
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