Decisions! New to the site

[sood]

Hi All,

What a great site this is, it has helped me a lot over the past few days after I discovered it. I'm a 35 year old male, diagnosed with Aortic stenosis with mild regurgitation when I was 23. Have usually had echo's every 2 years until last year when I saw my primary doc and said I felt a little discomfort while running. He referred me to a cardiologist. Had my first CT scan and did a stress echo, also found out around this time I had a ascending aortic aneurysm of 4.8 cm. He determined my pain which only happened that one time during running must have been musculo/skeletal. This year I had him give me an MRI because I am afraid of the radiation on ct scans. That showed 4.9 cm dialation of the aneurysm. Basically getting scarier but still could be no change from last years CT scan do to margin of error. He referred me to talk with a cardiac surgeon just to see what he would say. Before he sent me he said "I don't think you need surgery just yet". We met yesterday with the cardiac surgeon and got a lot of wonderful information.

First surprise I learned yesterday was all this time I was under the impression I had a bicuspid aortic valve, but my normal cardiologist who happened to review my last echo (I do the echo's where he works and he was assigned the echo to interpret) concluded that he is not positive I have a bicuspid valve based on the latest echo done a few months ago. The cardiologist never told me this, only the surgeon did today while reading his notes. The cardiologist thinks I might have a tricuspid valve but that the shape or pattern of it is abnormal. They basically can't tell without cutting me open. Why is this important? Because with a tricuspid valve the cut-off for surgery is a 5.5 cm aneurysm where a bicuspid the cut-off is 5.0 cm. My aortic stenosis has remarkably experienced no change in 12 years, with the peak gradient at 29. Cardiac surgeon said they look for a gradient of 50 for operative candidates. I've done a lot of research on the cardiac surgeon and he has done very well on the CABG reports here in california which report mortality for bypass type surgeries and he suggested to me that I wait to have the surgery and they continue to monitor the situation with annual CT or mri. The surgeon is also the head Cardiac person for their transplants with only a 2.0% mortality rate on that. He recommended the CT scan in the future because he said it was more accurate but I said maybe I can do a CT every other year and MRI the alternate year, still citing radiation fears. He also told me that if he were to do the surgery today and he cut me open and saw I had a tricuspid valve he would be inclined not to repair it at this time. He told me the risk factors of having the aneurysm and waiting vs the risk factors of having the surgery are about the same and that with the surgery I would have added risk of taking coumadin afterwards and what that does to the body long term as well. He also said he uses on-x valves and that if I had the surgery now I would never need another valve and that it would last forever, he said there are trials going on with the on-x valve that patients are only using aspirin for the blood thinner. And he said if I waited a few years who knows what more medicial advancements would occur in the field.

Anyway at this point I'm just going to digest all of this and not make any rushed decisions. I was very comfortable with the surgeon, he spoke with us for almost an hour and answered all my approximately 25 questions. I'm going to do more research on coumadin as well and evaluate getting the surgery now vs later.

What would you do if you were in my shoes? I know a lot of you would do the operation.

I am able to exercise without issue, although I can't lift weights anymore. I do sometimes(rarely) have chest discomfort primarily when I am stressed out. If the aneurysm didn't crop up I would be fine waiting out surgery. I still have to have them look through my past echo's and find out what the older readings might have been for the aortic root measurement. If prior to my 2011 echo's the aneurysm didn't show up, I have a very bad feeling that it might have started late in 2010 when I took sudafed for a cold and ended up in the ER with bad chest pain. The ER doctor said the stimulant in some meds bothers people and the surgeon confirmed it today saying it probably made my heart muscle work harder and as a result I was having the chest pain. I didn't tell him about my theory of this possibly leading to the aneurysm, I thought of that later. I have no idea about that it is a wild guess but I'll have to get my past echo results to see if that is when they started, because no one said the aneurysm word to me prior to 2011. The surgeon also said sometimes the aneurysms plateau for several years and don't change. And if I just decided to repair the aneurysm only he will use a graft and it would be a piece of cake and take only an hour.

Thanks for listening and look forward to your thoughts.

 

[epstns]

I did not have an aneurysm, so I can't really speak about its treatment. I did have a "probable" bicuspid valve that was never clearly visualized on echo's. At surgery the surgeon's notes called my valve a very, very badly stenosed bicuspid valve. I bring this up just to alert you to the fact that echo's are not always that precise or clear. They are used because they are usually directionally correct and can show trends over time. Once the situation gets close to the need for surgery, they will do other more precise tests to see just what to expect when they have you in the OR.

One question I would ask about aneurysm repair is what type of procedure they will use for access. Will they need to do a partial or full sternotomy or will they use a minimally invasive procedure. If they say they must to a full sternotomy, I would opt to do the aneurysm repair and replace the valve in one visit. If they will use a minimally invasive procedure (not cutting the sternum) I might choose to repair the aneurysm and wait to see when the valve is ready.

 

[ElectLive]

Sood - Sorry for the circumstances, obviously, but welcome aboard. You seem to have a very good handle on the situation overall which should only be helpful moving forward. Steve makes a great point about BAV not being definitively diagnosed at times. That's obviously a very important (but frustrating!) "IF" to consider. The balance of surgical risk versus the risk of waiting is the usual method and dilemma. Unfortunately, there are no guarantees on either side, but at least there are excellent odds. An alternative perspective that was one of the things (of many) I considered is that the surgical risk will always be there at some point in the future, so the longer the wait, with its own inherent risk, the overall risk (combined) over time actually goes up.

But I also had a much easier decision since I had definitive BAV and a valve that was at least at the threshold of severe. There are a few here who have done valve sparing procedures, so it is certainly one thing to consider and discuss further. Now, one thing I should point out is that the On-X trial does not have an Aspirin only arm, it is Aspirin in combination with Plavix. Also, whenever the time comes, you of course don't have to go with a mechanical valve, either, but it is the more traditional decision at your age. While aneurysms don't get smaller, they can plateau for quite some time, although I'd personally feel a lot more confident about a low (4.0 cm) stable than a higher diameter stable.

An aneurysm isn't an anuerysm until dilation is 50% above normal which on average at the ascending aorta might be at around the low to mid 4's (cm) range. You may have had dilation, though, so good to look at past reports, particularly since rapid growth is another surgical trigger. Another thing to consider is there may be a familial link, even perhaps a case of BAV and/or an aneurysm in grandparents that was never diagnosed. Aorta issues do present even without BAV when there is a family history, and when they do, they are usually managed identical to BAV patients. How is your blood pressure or have you been put on a beta blocker? Any discussion of more frequent monitoring (six months)? Those are both things to help minimize the risks of the waiting period.

In conclusion, putting myself in your shoes, I just have to say that your situation stinks! :thumbd: :biggrin2: Sorry, it just happens. You are aware of it, though, and that's the important thing. As things develop, these problems of yours are fixed with astounding levels of success. This place is a testament to that for both valve and aorta patients, and you should count on the same. Best wishes to you.

 

[sood]

Thanks for your replies, the surgeon said due to the location of the aneurysm in the ascending aorta it could not be done using a minimally invasive technique. He had a good explanation and trying to digest everything of course I missed some technical details of the explanation. I think he said it might be the nature of where it needs to be attached. But he said the aorta repair was very simple for him and could be done in an hour.

I'm not currently taking any blood pressure medication, I was on caduet for a few months last year and stopped it because it was making me dizzy and replaced it with garlic pills. I've been monitoring it since and my BP is consistently around or below 120/80 when I am not stressed. I'll probably schedule another appointment with my cardiologist to get some further info and also go back on a blood pressure medicine. The surgeon did not mention plavix with aspirin and an on-x valve being in trials, he said they are trying it only with aspirin. But it is in the very early stages.

 

[sood]

Maybe the surgeon forget to mention plavix or mentioned it and I didn't hear it, I do see the news release regarding aspirin and plavix with an on-x valve.

 

[Lynlw]

HI I dont have much to add, EL pretty much wrote most things i was thinking, especially that there are NO Aspirin only trials going for for the ON-X valve.
My other question was where is your anneurysm? You said ascending, but then you mentioned looking at the root measurements on your earlier echos. I probably would wait for for your next years testing to see if there are any changes or if things look stable. One reason waiting (if it is safe of course) might be good, is since you are 35 now, depending when you would need surgery even 5-10 MIGHT make a difference in which type of valve they would reccomend.
IF you have doubts about what would be best for you, I probably would get a 2nd opinion to see what another surgeon would reccomend

Ps I see we were writing at the same time. the ONLY Aspirin only trials I ever heard abbout for the ON-X or ANY mech valve, was the one in Germany several years ago, before the current low INR/Aspirin & plavix trials were started in the US. They stopped the aspirin only arm of the trail because increased clots/death, and when they started the US trials shortly after they did not have an Aspirin only arm, So i think it would be a very long time if ever before they would do trials for that. Altho from what I remember some people from On-X claim that had nothing to do with why it was stopped.

IMO based on the results so far, IF I needed/ had a replaced valve, I probably would NOT feel as safe with even lower INRs or taking part in the trials but that is just me and i always feared strokes more than death, especially since there would be no real beefit, still need Coumadin and the risks and still need testing etc so now real difference as far as day to day living for me at least

 

[Mike C]

Your aneurysm developed most likely due to a genetic defect and will need to be repaired. Most will tell you the cutoff of is 5.0cm as its when the benefits outweigh the risks. You are very close to that number and If I was in your shoes, I would begin preparing for surgery. Dacron is much better than your aorta at the moment. If it ruptures, you will die (sorry). It is possible when they repair it, that they confirm a bav. Also, the rate of growth is important in determining surgery, if not sure or growing fast, important to start preparing for surgery. The hour surgery seems unrealistic and I would ask questions on that. Also, you should be on blood pressure medciaiton or beta blocker for aneurysm

 

[sood]

Thanks for your reply guys. Just to give you guys an update on where I'm at. I feel like I'm slowly returning to my old self mentally now. I have scheduled a follow-up with my cardiologist next week to get on a blood pressure medication and to get down to the bottom of my echo results from the past (i've had echo's done 12 years back) so that I can see what the measurements for the aorta were compared to the recent echo's. Those results will help me determine if this thing has progressed rapidly recently (which I think is the case).

My only CT was in 2011 and an MRI this year. By the way I also asked for and did a brain mri to check for a brain aneurysm, even though I had a brain ct when I was 23 (was getting headaches at the time). Thats another thing to look for with the stenotic bicuspid valve, some people develop brain aneurysms although the rate is very low. Luckily my brain was good.

I am a man of faith, I trust in God. I'm still in the research phase of what my next steps will be and what the master plan will be for when I will pull the trigger on surgery. But I believe in pre-destiny and when my time here on earth is supposed to expire it will expire whether I have surgery or don't have surgery. Now that doesn't mean I am going to ignore what is going on, I will make the best decision possible, but that is where I am coming from. I feel fine physically, thank God. My biggest issue right now is my wife and sister and parents not letting me lift heavy things and that putting a dent into me as far as a man.

I'll post an update later next week after I meet with my cardiologist.

 

[sood]

So I met with my Cardio last Thursday, had a few questions we went over. We're going to push my monitoring to 6 months for the near future. I'm going to get a CT scan in October, it will be 6 months after my most recent MRI and 18 months since my CT scan last year. Surgeon recommended the CT since his opinion was that it was more accurate. But after this CT I'll probably stick strictly to MRI's since I am worried about the radiation exposure. So I think I'm in a much better place mentally. The big issue seems to be the whole question mark on whether I have a bicuspid or tricuspid valve. My cardio isn't sure it's bicuspid, although past cardio's who analyzed my echo's concluded it was. So besides the 6 month monitoring, if I cross the 5.0 cm threshold we're going to do a TransEsophageal Echo (TEE), have any of you done that before? Apparently you swallow a tube and it will give them the most accurate picture of your heart without cutting you open. With this the cardio is hopeful to conclude whether my valve is bicuspid or tricuspid. If it is tricuspid I can hold off the surgery until my ascending aortic aneurysm reaches 5.5 cm. The main issue also seems to be my valve is nowhere close to needing repair with a peak gradient of 29. And the fact that we don't have historic data on my aneurysm doesn't help at all to see if this thing will stay constant. My old echo's showed slightly smaller proximal aorta size, although my cardio said that is no indication of how big the aneurysm in the ascending aorta might have been in the past.

No one can predict what will happen in the future but I feel ok right now. I also was put on a beta blocker 25 mg metroprolol. I stopped my garlic tablets when starting this medicine, and I'm on vacation and today my BP was 153/98 and was feeling dizzy prior to taking my dosage. I'll have to keep a close eye on the BP and either have the cardio increase my dosage or supplement with garlic tablets. The garlic tablets were keeping my bp consistently in the 120/80 range give or take +/- 5. I'm hopefully that my BP can settle into the 110/70 range with the beta blocker.

At this point I'm feeling comfortable with a wait and see approach with semi annual tests and watching my BP like a hawk. I might also seek another opinion soon just to get more feedback. I feel good and comfortable with the advice I am getting though. I know more than likely I will end up needing surgery sooner or later. In my opinion the longer I can delay, the more advancements are made in medicine and AVR and the less I'll have to deal with the warfarin side effects.

 

[Kilkenny Rose]

I had a TEE last year to determine more accurately the stenosis in my aortic valve in order to get clearance to have vital surgery on my neck as quickly as possible. Even then my cardio wanted to operate on my heart first. That was a shock. We were able to convince him the neck surgery was more urgent due to the risk of quadriplegia without it. The TEE was not difficult or unpleasant, but I did bruise my throat. I swallowed as he was pulling it out. Bad idea. But then, I have a very small trachea, so that might be why. The TEE showed that I had moderate stenosis. Unfortunately, my valve calcified rapidly after that as 6 months later the stenosis was very severe, heading into critical and by the time I had surgery a few weeks later it was very critical. My AVR was 3/5/2012 and went well.

 

[Gin Saw]

Hi Sood,
I understand your worries. I have been helping my younger brother cope with a similar situation. His congenital bicuspid aortic valve regurgitation situation was first discovered this past January. My brother wants repair, but the surgeons are telling him that it is not an option. But it sounds like one for you. Research and think as calmly as you can about this. Good luck. Ginger

 

[sood]

I'm back. I had a CT Scan in October, still at 4.9 CM with the ascending aortic aneurysm. I've been having blood pressure issues, started another BP med in addition to the metoprolol. Had unexplained pains in my chest (area of beginning of aorta) last week. Had an appointment with my cardiologist by coincidence because he wanted to discuss my BP issues, since I had started an anxiety med recently I noticed my BP higher. When I went in he gave me an EKG, it was abnormal. My BP was 140/90 when I went in. He said the EKG shows my heart skipping a beat. He said he wants me to get another scan to see what is going on. Have an MRI saturday. Bicuspid valve is still the same. The cardiologists still have not made a determination if it is bicuspid or not, they are of differing opinions with some thinking it is a malformed tricuspid valve.

Anyway I'm about at the end of my rope, my body is telling me to get the operation done. And that is the direction I'm starting to lean. It's all still pretty terrifying. Even though I've known this day would someday come since I was 23. I'm 35 now.
I have to put somethings in place for my business, I'm a one man company and have to hire someone. I'm thinking I wanna get the operation done in early spring. The surgeon I met with whom I am confident with wasn't sure if we should repair the aortic valve at this time, since it hasn't really changed since they have been monitoring it. It would be a much easier decision if that was degrading also. With the prospects that I will have to face another OHS in the future to repair the aortic valve I will probably just tell them to fix it all. I don't know though, I might leave it up to the surgeon's best judgement when he opens me up.

Am I doing the right thing possibly opting for the surgery? Would you guys have the aortic valve replaced as well and call it a day? The peak gradient on my aortic valve is still a 29.

Thanks guys.

 

[Lily]

I appreciate your frustration.

To answer your question: Have you asked your surgeon how common it is to have an aneurysm repaired without the valve being replaced, and what his/her success rate is with that procedure, and how long would he/she guess your valve could continue without needing another OHS, and similar questions? I don't know what the most common current theory is among medical people about bicuspid valves and aneurysms and possible connective tissue issues; there were conflicting opinions when I had my surgery over nine years ago at age 42. My root was slightly enlarged pre-valve replacement but it was apparently related to the misdirected blood flow from my malfunctioning bicuspid valve; that's what my surgeon told me. I consulted with three highly recommended surgeons and they weren't in agreement with their recommendations for me; it's not uncommon to consult with more than one surgeon.

You have my best wishes

 

[ElectLive]

Am I doing the right thing possibly opting for the surgery? Would you guys have the aortic valve replaced as well and call it a day?

Hello again, sood. You know, I remember how frustrating your situation was 6 months ago, and obviously that has not improved. These are not easy questions for any of us, even for a surgeon for that matter. But I guess my thoughts would be this, trying to put myself in your shoes:

I would time the surgery based upon the lead of the surgeon, back to my earlier discussion of your particular surgical risk in the context of the risk of waiting. The aneurysm would seem to be the most pressing risk you face, so it should lead the surgery timing, not the condition of the valve, as I assume your surgeon has already indicated. I would then inquire as much as possible into the pre-surgery forecast for the valve...surgeon, cardiologist, and other opinions as you see fit. You may not get definitive answers, and even if you did, they could easily be wrong, but hopefully there will be some degree of conclusion to base your decision on. Next, I would try and decide what type of valve to go with, in the case of replacement, no matter when it is actually done. The repair option also enters in here. Then, in that context, and with further surgical consultation, I would try and decide how important avoiding additional surgery really is, both in terms of risk and obviously personal preference.

For what it's worth, I replaced my valve early, but only probably by a few years at most. If I had thought I might have made it 10 more years with my own valve, I probably would have left it alone, particularly since I was leaning initially more toward tissue than mechanical valve. Even with a mechanical in mind, it still would have been a dilemma though. There are very valid reasons for postponing replacement, especially if closer to a decade than only a year or two. And if repair is an option (much less common but certainly a possibility) well that's even another consideration, that could sway things either way.

One thing I would suggest is to discuss every possible "discovery" scenario fully with your surgeon before placing it in his judgment during the surgery. He may not know exactly what he'd do until he opens you up, but have him walk you through the various possibilities and what he would recommend in each case, so that you can be fully aware of and advise accordingly.

Also, I'm pretty sure at least one of our members (camgough) went through a somewhat similar circumstance, and did a valve sparing approach. You might try and check out some of his posts and/or send him a message if looking for info on that approach. Hope this helps a little and continued best wishes to you.

 

[pellicle]

Hi

I'm back. I had a CT Scan in October, still at 4.9 CM with the ascending aortic aneurysm.

well no change is a good thing in that area ... but it seems to not be your only complication

I've been having blood pressure issues, started another BP med in addition to the metoprolol. Had unexplained pains in my chest (area of beginning of aorta) last week.

ok

When I went in he gave me an EKG, it was abnormal.
..
My BP was 140/90 when I went in. He said the EKG shows my heart skipping a beat. He said he wants me to get another scan to see what is going on.

the high BP isn't going to help things as I understand it, but *I* am not a specialist

Have an MRI saturday. Bicuspid valve is still the same.

which isn't really the main issue as I understand it ... mild regurgitation right?

Anyway I'm about at the end of my rope, my body is telling me to get the operation done.

and the surgeons?

It's all still pretty terrifying. Even though I've known this day would someday come since I was 23. I'm 35 now.

yes, I now it is. I went through this twice in my life before.
Firstly I was operated on when I was about 11, I can't tell you that was terrifying or not.

Secondly I was operated on when I was 28 (about 1992) and the 'valvotomy' done to my bicuspid aorta became incompetent. I was otherwise healthy, but in the year leading up to that my health went downhill quite rapidly. I was uncertain about many things and was aware that I could die in the surgery (which actually isn't the worst outcome btw). I decided that I had to calm my mind and accept that what happens is what happens. I became at peace with the world as much as I could and submitted my self to that. I guess that was time number 1 for feeling a bit of terror.

I had a homograph tissue valve and none would give me details on its expected life span. All was going well and I was doing heaps with my life and had unconsciously expected that I may get away with being asymptomatic for the rest of my life.

Then I was diagnosed with an aneurysm on my aorta in 2011 which took me by surprise. My valve still felt functional and indeed the reports on that were such that it was not the pressing need for operation.

I had that operation (http://cjeastwd.blogspot.com/2011/11/heart-of-matter.html) and they replace my valve with a ATS pyrolytic carbon (quite similar to the on-x valve).

I too had dreaded being on warfarin ALMOST ALL my life. I too knew that it was only a matter of time.

But heart surgeries are not like car repairs, and so when you are in doing one thing it is prudent (and perhaps impossible or dangerous not to) to do the other.

People seldom discuss here the increasing dangers that come with reoperation. It is actually undesirable to have more than 3 and as I understand it 4 is the cutoff. Risks of failure to heal of the sternum, scar tissue adhesions making operation more difficult ... the list goes on.

So if you have the opportunity do it once and do it right.

I have to put somethings in place for my business, I'm a one man company and have to hire someone. I'm thinking I wanna get the operation done in early spring.

I understand your position here. My friend and I have been talking a lot about this as he and his wife are a 2 man band business and if ONE of them went down it would also bring the entire business down.

Let me get philosophical here for a moment. People often are under a delusion that they control things. The truth is we often only control what is available to us. Sometimes this control fall outside of our understood parameters and we discover that the castles we have built on foundations were in fact houses of cards with greater risks of failure than our risk analysis would have otherwise shown. Most of us don't ask "what if" questions like "what if I got a brain tumor" because we think of that as being impossible.

For sure its unlikely, but so are car accidents (about 12 per 100,000 each year in the USA where you come from). Brain cancer death rates in adult males is about 8 per 100,00 each year too.

So what I am saying is "we all sail along assuming we get dealt a good hand" and some of us simply don't. I know that sucks as my wife just died suddenly from a brain tumor which noone knew she had.

So now its down to management (which is what I do). What is important to you? How important to you is survival, and being there for your family? What are the options and what are the costs of said options.

Keep in mind that all of it that seems like planning is really planning outcomes based on gambles.

The surgeon I met with whom I am confident with wasn't sure if we should repair the aortic valve at this time, since it hasn't really changed since they have been monitoring it.

are you sure he wasn't also factoring in your apprehension to get it done in one go?

It would be a much easier decision if that was degrading also.

possibly ... but then that's exactly what I did. You will note if you examine my history here that I am now going through a post surgical infection treatment which is less than comfortable. I developed this from the 2011 surgery and it took a year to 'show itself' (well I had been complaining for longer but what would I know?)

surgery always has risks, and though there are many who have zero problems ... how lucky do you feel?

One hassle free operation with a good fast recovery is something to be thankful for, not evidence that you could do more of them.

With the prospects that I will have to face another OHS in the future to repair the aortic valve I will probably just tell them to fix it all. I don't know though, I might leave it up to the surgeon's best judgement when he opens me up.

indeed ... I would choose that, and if you discuss that with the surgeon then he may be more inclined to agree.

My surgeon chose the ATS valve as it is the only one that comes with a pre-stitched rising aorta replacement at the time he did the operation. That was a factor in his choosing.

Am I doing the right thing possibly opting for the surgery? Would you guys have the aortic valve replaced as well and call it a day?

I think I answered that in the above.

Feel free to PM me if you just wanna have a yabber. We can tee up a skype chat or I can do landline calls to the USA and just buy some other guy a beer to pay that forward.

 

[sood]

Thank you Lily, Elective and Pellicle for all your thoughts and advice.

Lily:
I think those are great questions and I haven't asked most of those things yet, even though I met with the surgeon a good 75 minutes or so last time we talked. I'll be sure to follow-up and ask him those questions to make the best decision possible and also perhaps seek the opinion of another surgeon.

Elective:
Definitely the aneurysm is leading the surgery time and has become the critical concern. I most definitely want to do a mechanical valve and like the ON-X valve which my surgeon recommends. But my valve choice may also may also be impacted by a connecting carbon graft that might be built into some valves as was mentioned here so that part can take care of the aneurysm as well. I haven't yet had this conversation with my surgeon but it will be discussed. I will also try to get a pre-surgery forecast regarding my valve because that is obviously important. I think there are a lot of question marks there and hopefully when I go down this road I can have a TEE done which will give them further information in that regard.

Pellicle:
Appreciate greatly all your feedback and extending an olive branch to talk to me, that is so nice of you. I am very sorry to hear about what happened to your wife, and pray that you can move forward and may your pain ease.
I do have mild regurgitation. When I met with the surgeon in June his recommendation was to wait and monitor the aneurysm to see if it stabilizes. But he said if you want me to operate on you I can.
I loved your philosophical thoughts, we do not control anything you are right. I'm not sure I expressed any apprehension when I met with the surgeon to get everything done in one shot, I think he was just being conservative in his recommendation.

In the past couple of days since I posted I'm starting to feel a sense of calm, I've 90% made up my mind that I want the operation done and soon. I will collect more feedback regarding the valve issue but my inclination is that I want to take care of everything in one operation. Even if that means I could have used this valve another 5-10 years. I'll have to ask about the repair option there as well. I don't want to put myself through this again, nor my family. Coming from a background where my uncle has had 4 open heart surgeries and my grandmother has had one, I know the toll this takes on everyone. It's tough and I don't want to have another operation if I can help it.

Thanks for your comments guys, it is much appreciated. God bless you all.