Hi
well as you know if you've read any of my posts and clicked through to read about me I've had a career of 3 OHS, starting at 10 and my last one was at about 48. I had a repair, a homograft and finally a mechanical; each spaced about 15 to 20 years apart.
The reality of the world when I was 28 was there there was no Point of Care INR monitoring (as there is today) which would have meant that if I'd been advised towards a mechanical valve back then I'd have been facing: being chained to an INR clinic and weekly or so vein blood draws. I know that would have been bad.
Equally I knew when considering my 3rd OHS at 48 that I didn't want to have a 4th because while it would be better than death from avoiding a failing tissue prosthesis and death from SVD, no operation needed would be better. So picking a mechanical valve was pretty much a no brainer to my frame of reference.
I say, to younger people here time and time again that compared to the already old (meaning those over 60) the actuality of our choices is quite different. I'm actually nearing 60 but my valve has now done 12 years of operation and of course shows no sign of failing.
Reoperation in itself is not the problem; the problem is the cumulative interior damage created by the inevitable scar tissue and the stuff left lying around and the increased risks of infections (contributed to by the scar tissue).
If you met me you'd probably say "wow, you don't look like someone who's had 3 heart sugeries. In part that's because I had really good surgical care and really paid attention to maintaining my health.
This is a site founded upon the concept of patients who are sharing what they have experienced; so it should seem strange when someone who had their first operation at over 60 who has never been on warfarin and how doesn't manage it in any way (doesn't even self test) will tell you about how bad that option is; while never having had a reoperation and crowing about how my valve is still good at 9 years. As if 9 years is a long or good amount for measuring the rest of your life by.
The following is predicated on the fact that you are not "contra-indicated" for warfarin (which is rare, but exists).
My advice to you is this: you've already kicked the can down the road and found that SVD is actually real and the statistics do indeed apply to you. You need to look past the surgery into the next 20 years. Sure if you pick a mechanical valve you'll be managing your INR for the rest of your life. If you don't pick a mechanical valve you will most assuredly be going to testing again looking for SVD and so basically (if you recall the process that led to your current situation) you'll be setting yourself up for that again.
Is that the future you want?
I recommend you to read my blog post here about choices (make sure you don't miss Dr Schaffs old presentation here)
and here about the facts of INR management.
SVD is also increasingly linked to Lp(a) as I understand it, so if you have higher Lp(a) then choosing another bioprosthesis would be like expecting something different by doing the same thing as last time.
Lastly there is no definitive cure for valvular heart disease, we only exchange it for prosthetic valve disease; of which there are two main branches. One is managed by future surgeries the other is managed by you managing your INR.
Let me show you some glimpses of my life after mechanical on self management of INR
Going to the local micro brewery at Mt Alford
Explaining life in Finland to my Australian mates
(because I lived in Finland on and off both before and after surgery)
A common trip on my eScooter to hike Queen Mary falls
(this time followed by my mate on his bicycle to record it, I do this trip a couple of times a week in summer)
So in my view, learn about the actual outcomes and make you choices on the actual data (not just a perception of them)
Lastly I often hear "but I'm so active, I can't choose a mechanical", are you more active than Veronika?
My Turn: Climbing Everest with a 'Bionic' Heart
Summitting Everest was just one of my triumphs as a recipient of a mechanical heart valve.www.newsweek.com
because the above "...I'm so active..." is based on a presumption that's simply false.
Whatever you choose to do, I hope you have a typical event free surgery and a smooth recovery.
Best Wishes
Hey, I was thinking of you when I watched this video recently
