Coumadin and biologic valve choice???

[Lasker]

I have a new problem and urgently need your help.

To recap, at 67 I decided that a biologic valve was best for me and my lifestyle. I was comfortable with this decision, after waffling for several months. Now I have been seen by a new cardiologist who pointed out that because I have an enlarged left atrium (4.9 cm) that I had a high probability of needing to be on Coumadin permanently because of a-fib. I phoned my old cardiologist who confirmed this possibility, but with a lower degree of risk--about 30% probability, which is still significant, but not as bad as the first one indicated. It would be awful to choose a biologic valve to avoid Coumadin and then have to be on it anyway.

I appreciate most of you on this website have mechanical valves and do well with Coumadin, but I am hoping that you may have experience with the problem I am encountering or a suggestion on how I can learn more and assess my risk.

I go into the hospital one week from today so a feeling of panic has set in. I plan to discuss the matter with my surgeon of course, but hoped to get some more information before I speak with him.

Thanks so much.
Lorraine Lasker

 

[Ross]

Lorraine there is no easy answer. It's just like Afib in itself. Some people get it and others do not. Same with the Coumadin therapy, some people have too, some don't. It's an associated risk that must be assumed.

I'd be more inclined to think they'll have you on an aspirin regimen and perhaps Plavix, but Coumadin cannot be ruled out.

 

[bvdr]

I understand your concern. There is the risk that atrial fib will develop following surgery even without an enlarged atrium. There just aren't any guarantees.

You may want to ask your doctor why he thinks your left atrium is enlarged and if he thinks it will reduce in size following correction of your valve problems. It may make a difference on the likelihood of develping and staying in atrial fib. Keep in mind too that eventually there will probably be a replacement drug that is more user-friendly than coumadin. If you do end up on coumadin, it is really not so bad...........you would adjust.

 

[MarciaB]

Lorraine,

I appreciate your position. I was sure that I would not want to be on coumadin until I read so many posts from folks that are on it and don't mind it (too much). There is a possibility that you may outlive that tissue valve and need a replacement in your 70's or 80's. I'm 45 and it seems overwhelming, I can't image it at 80. Also, my surgeon confirmed that a second surgery is not the same as the first, the heart doesn't take kindly to the abuse. The decision is a hard one, and in the end, I think your gut will tell you what is right for you.

Marcia

 

[Kenny F]

I appreciate greatly what you are facing. I went with a homograft, then 2 weeks after surgery I had A-Fib and A-Tach. Cardio put me on Coumadin. I was floored. He also put me on Cardizem. Apparently, the Cardizem did its job and 3 days later he took me off Coumadin (we had planned a min of 3 months).

There are no gaurantees, either with tissue or mechanical. I still belive after the healing process I will be on NO heart meds - that is the goal!

 

[sylviayasgur]

hi lorraine!
i'm so sorry to see that just when you thought you had these huge decisions behind you, they are arin=sing once again.
i think sometimes choices can be so difficult. still, it's nice to have them.
joey was put on coumadin after his surgery just as a precaution for a few weekds.
he was very upset about it, considering he had gone with the ross specifically to avoid the coumadin.

i also think that you need to talk to coumadin users on this site. you might get different feelings on the subject.
most coumadin users, however, don't seem to mind it all that much. i guess "you have to do what you have to do" is how they must think of it. my father was in chronic afib before his surgery which helped him decide to go with a mechanical valve. he is still on it and is really fine with it, considering he hates blood and bloodtests. he'll tell you it's no big deal.
i would just ask around here and get a consensus from those on it.
wishing you all the best in your decision.
be well, sylvia

 

[Lasker]

As usual, it is good to hear from those who can understand just what the concern is as a new situation emerges.

I have had the opportunity to speak with yet another cardiologist who has advised me that the good news is that I have not had a-fib to date and that the surgery may stop the atrium from enlarging further, so that permanent a-fib is not a certainty. He also reviewed the several therapies that would be available should a-fib set in, some of these drugs that you have mentioned.

This cardiologist did my cath in July, and will be doing the second cath next Wednesday, to see if there is any advance in coronary artery obstruction, at the request of the surgeon. He has agreed to follow me in the hospital, and I intend that he will be my permanent cardiologist, as he is both competent and calming.

The bottom line is that he has advised me that he did not believe I should change my choice of valve (biologic) based solely on this concern.

I am sleeping better, and the equanimity so desirable in the final days before surgery has returned.

Lorraine

 

[Marcia]

afib

afib

I saw the Cardiologist Friday and asked if I could be taken off the Cardizem and lanoxin. He said no since the atrium is still stretched from the bad valve and will stay that way. I am also having high blood pressure which was controlled prior to the surgery. I am glad in a way that I have the mechanical because I do not want to have another surgery. I guess after the first one they are a lot more difficult and harder on the patient. I was having a lot of afib prior to the surgery which I did a good job of ignoring. Coumadin is just another pill to take. I haven't had any really bad bleeds or too many problems. Good luck on the choice that you make or is made for you.