Confused about valve choice

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Mark - your thread may have been hijacked somewhat - although all still relevant information to making an informed valve choice that works for you. I am anxiously awaiting your post on how your consultation went today! Have yuou decided on a valve choice as yet - or do you have more pondering to do?

Rhena
 
"but feel free to have the last word."
What I really don't understand is why you feel the to be so rude and condescending in many of your posts.
I do find it odd that a person would write
"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_...bio_v_mech.pdf


THEN on the same thread writes THIS.

"My basic position is that most of us here are not in a position to evaluate the medical literature and draw our own conclusions. Even with my years of training and experience doing so, I am reluctant to suggest others do this. Those who suggest you can gather a bit of "information" here and direct your own care need to reconsider this"

And as Mary pointed out neither Bob or the paper " argues that therefore people should choose tissue valves" Like you twisted their words to say. I doubt you have a comprehension problem, but maybe you do. He did say this is the type of results that are the reason CCF and other major conters are giving tissue valves to younger people over the past few years, which is true.
Noone here suggests you "direct your own care". Over and over we say talk to your doctors, what do they recomend, they know you best. However there is a big difference between making sure you know about the different choices, Tissue or mechanical and how they will affect your life, so that when your surgeon talks to you about it, you can understand what they are talking about and ask important questions to make informed choices and trying to direct your entire hospital stay, telling the fellows and nurses how to do their jobs to the point you affect you own recovery, and need to be told to chill. There are no cut and dry answers on valve choice, what is important to one person, avoiding REDOS, isn't as important to another person who rather avoid coumadin and since it is something you will deal with the rest of your life and WHY most surgeons give you a choice, people want to be informed.. Most new members find VR by googling valve choices because they are the small percentage of people undergoing Valve surgery that want to learn as much as they can, so ask other people who have gone thru it why they chose what they did and it is WHY many people who had surgery stick around, on their own time to help.
I have read people suggest IF you want a specific valve to go to a surgeon that does them, but for the most part the vast majority say pick a surgeon/hospital you trust and discuss your options with them and are willing to share what they learned either by talking to surgeons and cardiologists or reading pubmed and their own personal experiences.
 
Lyn:

I'm sorry if I came off rude and condescending. Honestly. I meant no disrespect to Bob or anyone. I just wanted to point out that it is risky to look at medical literature and think there are clear answers there based on the author's claims. This was a particularly bad "study" and I felt it was misleading. Again, I apologize if my rather caustic words about this particular medical publication offended you or Bob or anyone. I would rather say they were directed at the author. I spent decades participating in and reviewing clinical trials of all kinds, so I felt entitled if not obligated to drag this rather sorry paper through the ringer. Even thoiugh Bob defended it well, I still think all my points are valid.

Also, I know my comments about some few wrong bits of information on this board were going to hurt, but it's important that everyone remember that the vast majority of people posting here are not trained in any of the technical aspects of valve replacement or drug therapy. I do have extensive education, training and experience in drug therapy, so I felt it necessary to make a few observations. And if that came off condescending because I claimed some specific knowledge in this case, so be it.

This is primarily a site for encouragement, moral support, and fellowship among valve replacement candidates and their families. I have found it contains a wealth of good information about the subject. But I see people trying to deal with some complex subjects here that should be best directed to a properly trained health professional. I have no problem with people who are confused trying to gather some information here, as long as they do not take that as direction. If you witnessed my struggle with making the valve choice, you saw that I learned a powerful lesson that I should have trusted the advice of my surgeon. Some surgeons may not be so helpful and may throw the decision on the patient, as actually seems to be the case in the article I so strongly criticized. I now believe that is a disservice and abdication of professional responsibility.

Again, I apologize. I will try to restrain myself. I do get carried away and a bit too intense for many people's taste when something like this hits a nerve. Thanks for bringing this to my attention. You have been one of my favorite posters here, so I take your comments seriously and am disappointed in myself that I came off this way to you.

Bill
 
I requested and received a mechanical valve (St. Jude) but was in an emergency situation and had no time to research. The surgeon gave me the pluses and minuses at the time. Tissue valves wear out in ten years or so, she said. I was 57. (I was in a a pre-opt room with a guy who was getting his second tissue valve. First place 9 years earlier. He looked pretty sick. That may have helped. One of the hospital volunteers in the cardiac ward had her valve replace 17 years prior and it was a mechanical.)

After almost four years of warfarin (anticoagulant), testing, Lovenox injections, diet/Vitamin K and such, trying to maintain my INR (2.8-3.5), I often wonder if I made the right decision. I am not sure if the tissue valves are getting longer lives these days...Still for me, the mechanical was the best choice then. When I try to put things in perspective, I am fortunate to live in a country where we have choice and the medical advances to keep me going--even with the hassles of warfarin.
 
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The bottom line is, no one has a crystal ball and can tell you what sort of surgical outcome you will have. You have to make the most informed choice you possibly can given the thoughts presented, then from there, don't look back or second guess yourself. ;)
 
Ross: Good to have your sound perspective back on the bosrd again! I trust things are settling down for you.
 
Hi it is mspinder ((mark), remember me? I am having OHS for aortic valve on 11-6-09, that's tomorrow, Friday.

Well, I spoke with my surgeon on Wed. and he never really recommended one over the other but he did say that due to an enlargment of my aortic root that a pig valve would be a good choice because he could use part of the pig aorta with the valve as one piece. He said that in his experiences, 22 years, this valve shoud last 12-15 years. He said he would do a Maze? procedure to fix the a-fib. He said that it could return in 15% of the patiants. But shouldn't be any worse than what I have now. I take propafonone now and have no problems 2 years running. He said that someone in fairly good health should have the same risks as the 1st op. I sould be 72 or so by then.

So it appears that, at this point, I am leaning toward, (75%) a tissue valve and take my chances down the road. For me it came down to worrying about a blood thinner for the next 12-15 years everyday or worrying about a reop for the 1st year and then probably forgetting about it until the time comes to have it done again.

That's it for now.

God willing at this time tomorrow I will be in ICU recovering.

Wish me well.

Mark
 
Hi it is mspinder ((mark), remember me? I am having OHS for aortic valve on 11-6-09, that's tomorrow, Friday.

Well, I spoke with my surgeon on Wed. and he never really recommended one over the other but he did say that due to an enlargment of my aortic root that a pig valve would be a good choice because he could use part of the pig aorta with the valve as one piece. He said that in his experiences, 22 years, this valve shoud last 12-15 years. He said he would do a Maze? procedure to fix the a-fib. He said that it could return in 15% of the patiants. But shouldn't be any worse than what I have now. I take propafonone now and have no problems 2 years running. He said that someone in fairly good health should have the same risks as the 1st op. I sould be 72 or so by then.

So it appears that, at this point, I am leaning toward, (75%) a tissue valve and take my chances down the road. For me it came down to worrying about a blood thinner for the next 12-15 years everyday or worrying about a reop for the 1st year and then probably forgetting about it until the time comes to have it done again.

That's it for now.

God willing at this time tomorrow I will be in ICU recovering.

Wish me well.

Mark

Thanks for the update. I'll keep you in my prayers, do you have anyone that will be able to update us?
 
Best of luck Mark. I'm hoping that you feel a sense of peace as you walk into the hospital tomorrow. We will be here waiting to hear from you .

Kim
 
Mark,

For what it is worth, here are my 2 cents. I am 42 years old and had my AVR in July and opted for a Carp-Edwards bovine valve. Like Marguerite said in one of the earlier posts, I too am a "gut feeling" kind of person. From the very beginnning, I felt like this was my preference and as I kept researching and reading, I kept coming back to tissue. Not to say I never waivered slightly, but there was never any serious doubt. When pressed, my surgeon said he too would choose a tissue valve. One of his reasons was the rapidly advancing technologies for future surgeries, as well as his own dislike for taking medicines.

I know a lot of people on this site talk about how coumadin is not nearly as bad as it is made out to be, but given my age and lifestyle, I just did not want the risk. I kept thinking of one time last year when I was doing some catching on the baseball field. Another of the coaches was pitching and throwing quite hard. The batter tipped the pitch, which then hit me square in the inner thigh. Serious pain and within 2 days, the entire inside of my leg from my knee to my groin was purple, black and yellow. Ugliest and biggest bruise I have ever seen. Can't imagine how it would have been if I was on Coumadin. And I am on the field year round, so this is not uncommon. It just comes down to lifestyle and what you are comfortable with.

I will also say that because of a bout with a-flutter, I have been on Coumadin for about 2 1/2 months, so there is always that possibility. But my cardio said she will be stopping that within the next month, as well as my Amiodorone (sp?). I will be glad to see both of them go.

Finally, I will say this. The other big consideration is the fact that being younger, a second surgery is definitely down the road. This made the decision a bit harder, cause I had no idea what to expect from the first surgery, so what was I setting myself up for ? But I had a very good surgery, and outside the a-flutter, a textbook recovery. In all honesty, there is not one thing about the surgery or recover process that I can truly say I would dread or not want to go through again. I fully realize that this could be completely different when I have my next surgery in 10,15,or 20 years, but I have not fears about it and am completely satisfied with my decision.

Hope you can reach a decision that you are at peace with. Once you do, don't look back........
 
Coach: Thanks for writing what you did. It could have been my post exactly( except for the age thing) I am about 15 years older. The best line was not knowing what to expect from the surgury. That is what made my decission so hard up to yesterday. Having had injuries from sports before and having to recover, not that this is the same thing, but I do have a high tolerance for pain and believe I can come through this better than I am today. I just worry about comming through the surgury. Having said that, how will I take it 12-15 years from now? If I new that I would have bet 10 million on the Yankees to win the series!

Mark
 
Mark,

I forgot to wish you well and will be thinking about you tomorrow. It will be over before you know it and remember we have the easy job - we get to sleep through it. It is our family and friends who have the agonizing waiting part. Please let us know as soon as you can and remember, it is never as bad you what runs through your head going in.

Greg
 
WOW Mark - that was fast! I guess if things stayed as scheduled you are in surgery or recovery by now. I am thinking of you now and sending very good thoughts your way for a successful surgery and a speedy and problem free recovery.

Godspeed!

Rhena
 
WOW Mark - that was fast! I guess if things stayed as scheduled you are in surgery or recovery by now. I am thinking of you now and sending very good thoughts your way for a successful surgery and a speedy and problem free recovery.

Godspeed!

Rhena
 
Hi Mark, hope to see you in the post-surgery area very soon! I hope everything went exactly as expected today. Feel better soon!

Also, Greg (Coach), thank you for your post. Being the same age as you, it resonates with me. Still not sure I'll have the courage for tissue though. :)
 
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