Has tissue valve replacement become the new "preferred" for 40-50-60year olds?

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Malibu82 -

We've had a couple of young women who chose the Bovine Pericardial Tissue Valve while in their 20's in order to carry children. They both got 10 good years (and a few children) from their valves before they needed replacement.
 
Cop Out Excuses?

Cop Out Excuses?

Yes, one would think that taking a pill that keeps you alive would be pretty easy. The problem that I've encountered is simply that I feel so good and life is so normal I often don't even think about my valve. I suspect others encounter the same challenge I do.

Fortunately, I have a spouse who's much more anal about such things than I am. I've never missed taking my meds, but I'm not totally responsible for that good track record. It's nice to have backup.

-Philip
 
Philip B said:
Yes, one would think that taking a pill that keeps you alive would be pretty easy. The problem that I've encountered is simply that I feel so good and life is so normal I often don't even think about my valve. I suspect others encounter the same challenge I do.

Fortunately, I have a spouse who's much more anal about such things than I am. I've never missed taking my meds, but I'm not totally responsible for that good track record. It's nice to have backup.

-Philip
Click to expand...

Philip - Do you use a 7 day Pill Box to set out your weekly doses of Coumadin / Warfarin ?

If not, I highly recommend doing so.

I keep my Pill Boxes (one for morning, one for evening) on the kitchen counter.
I also have a chart (created on Microsoft Word) numbered 1 through 31 (for each day of the month)
with column headings bearing the names of my various medications. I record the dose (or time) for each pill as taken.
 
Well I have a pill box and with my feeble, senile, old mans mind, I still forget on occasion. Coumadin is very forgiving. If you forget, either take it within 12 hours or take the missed dose over the next two days with the regular dose.
 
I have an alarm set for 8pm every day to remind me to take the Warfarin but occasionally forget the Metropolol in the morning.
I notice at 8 pm when I take my evening pills as I have a 7 day AM/PM pill case.
 
drivetopless said:
Why do you have to take the warfarin at night? I'm an excellent pill taker so far but I always take my meds first thing in the morning when I get up.
Click to expand...

You don't. Doctors like it that way because they have all day to play golf before calling in a dose change. I take mine first thing in the morning.
 
a4wanman said:
Drivetopless,

Who was the surgeon at Emory? I had AVR on almost 3 months ago by Dr. Edward Chen at Emory. Before surgery, I was told "a guideline recommendation" was: mech for under 40; tissue for over 60; 40-60 was a "gray" area. He did sway me in either direction, but based on my age (39) and the fact I prefer not to have the surgery again, I chose mechanical. I asked about the On-X valve. His preference was the St. Jude Regent indicating hemodynamic performance. We also talked about a repair, but determined during surgery a repair would maybe last 1 or 2 years.


Scott
Click to expand...

Hi, Scott-
It was Dr. Chen. I didn't want to use his name initially as I knew this would be an inflammatory post for the group. I was paraphasing and don't want my post to be construed as his words verbatim in case I misunderstood what he meant/said. (you know how it is when you are the only one at the appointment). I liked him very much and have heard he is excellent. You had a great surgeon, and I'm sure you'll have a great outcome long term.

I appreciate that Dr. Chen took the time to give me a tissue valve option to consider. Emory installs more tissue valves than mechanical, in general (could be because they do a lot of high risk patients). Chen knew that I was leaning toward mechanical when we first met, and he said he wanted me to have all of the info to consider. He was not pushing me toward either one. He said the same thing to me about the St. Jude vs the On-X, but I got the feeling the On-X is bulker and harder to fit in his opinion. He ended the appointment by saying he would go with whatever valve type I decided on. If I go with On-X at Emory, I can participate in the low-ACT study they are doing.

I'm back to leaning toward mechanical, but having the surgeon pick the type of valve that fits me the best when they get in there.

I still have to get a CT scan to see if the aorta will be replaced at the time of valve surgery since I have the "true" BAV (i.e. potential connective tissue disorder). Chen said if the aorta was normal per CT scan he would recommend leaving it alone. I trust his judgement on this one, too. He's the aortic aneurysm expert in Georgia.
 
drivetopless said:
Excellent! Dr. Chen mentioned taking warfarin at night, too. That's good to know I can still do what the h*&@l I want.
Click to expand...

Coumadin is so slow acting, that you can take it virtually anytime within the same 24 hour period. It takes 3 days for a dose to show in a test. Cracks me up these guys testing people everyday. You aren't going to know squat until day 3.
 
malibu82 said:
I am 28 and have 2 babies. When I found out about my heart condition my cardiologist asked if I was done having children. I said well I always wanted more children, but yes I guess 2 is enough! He said okay you are going to get a mechanical valve. I knew nothing at this point about any heart things or problems or valves. I asked him if that meant I would never need another surgery and he said yes. I went home 100% for the mechanical valve. I was only scared about hearing the "ticking" noise. For 2 months I stuck with my decision for the mechanical valve. I went to see the surgeon downtown and received a booklet on the whole heart valve replacement procedure. I read through it and it had a section about tissue valves and mechanical valves. The tissue valve section was 1 large paragraph. The mechanical valve was a page and a half of information. After reading it, then doing research online, I suddenly changed my mind and decided to go tissue valve. After having my surgery, I am 100% happy with my decision and am very confident about living my life with a tissue valve now. It is a very personal decision and go with your gut or you won't be happy!
Click to expand...

Malibu, If I were 28 I KNOW I would go tissue, too. Good choice!
 
Topless -

Perhaps the reason that the On-X Valve is "bulkier" than other mechanical valves is that is is the ONLY valve that has a built in Barrier to prevent / retard Pannus Tissue Growth from interfering with the movement of the Valve Leaflets. FYI, Pannus Tissue Growth is the leading reason that mechanical valves are replaced. (I'm thinking it is a low percentage problem, definitely below 10% and probably only a few percent). Do you want to take that risk?

BTW, Pannus Tissue Growth can also impact Tissue Valves.

----------------

Re: Taking Coumadin at night allows patients who use a Doctor or Clinic to monitor and dose their anticoagulation to make a dose change that evening, after their appoitment, assuming a dose change is recommended. That said, when patients take their medication is a matter of Personal Choice.

'AL C'
 
You know it's true white chocolate over pretzels is AWESOME!!!!!!!!! Goes great with beer too.
 
Drivetopless,

I agree 100%. My response was to let be known my experience with Emory, not to rile peoples emotions. I've been visiting Elgeston Children's and the Emory Clinic for 34 years and really trust the people in my care. That's why I drive 2 hours for the surgery. My recovery has been extremely on the upbeat side. Though it took a short while to stabilize my warfarin dosage, I'm now in the sweet spot. I've been in range that last month and a half. If time was rewound to January, I wouldn't change a thing.

I was hospitalized at Emory to clear up a bacterial infection. I knew the day was coming to have my BAV replaced, but it came sooner than I was expecting. My surgeon's compassion and demeanor eased my tension after talking with him for just a few minutes. He gave me all the options for me to decide what I felt was in my best interest. I chose mechanical but also relied on medical experience.

There have been numerous posts: tissue vs. mechanical; ATS vs. St. Jude vs Carbomedics vs On-X, etc. MY decision came down to what I felt was best for me while. Everyone is passionate about their own situation and experiences. If 1 thing worked for everybody, there would be no need for different valves, manufacturers, etc.
 
Here is another opinion on Mechanical Valves from the Chief of CardioThoracic Surgery at Emory University
in answer to a Question from our member Marty (who is an M.D. / Radiologist) posted to VR in 2009.

Question to Dr. Pruskas re: PROACT trial & On-X

QUOTE:

I e-mailed Dr.Puskas , chief of heart surgery at Emory, asking him how the trial was going (trying to find out if On-x valvers need to take warfarin) and also what he thought of the On-x compared to St. Jude and Medtronics.

Here is the answer:

Dear Dr Thomas:
I do feel that the On-X valve is superior in design and materials to any of the
previous valves. It was just being introduced to the market 10 years ago when
you had your MVR. (I should mention that I have NO financial relationship to the
valve manufacturer.)

The results of the PROACT trial will not be available for at least 6 years. We
have enrolled over 400 patients, surpassing 1/3 of the planned 1200 patient
enrollment. All will be followed for 5 years.

Results to date are too limited in follow-up to make any recommendation other
than the standard coumadin and baby aspirin that is recommended in the present
ACC/AHA guidelines for anticoagulation of mechanical prostheses.

I can state that the independent Data Safety and Monitoring Board of the PROACT
trial has met regularly to review adverse events in the control and "test"
groups of the Trial. The DSMB is empowered to halt the trial at any time if it
feels that continuing the trial would jeopardize patient safety. It has not
found any reason to contemplate such an action.

Warm regards,

John Puskas (Chief of CardioThoracic Surgery at Emory University)

--------------
Marty (M.D.)
Mitral valve replacement
September 17, 1998
Mechanical St. Jude
Inova Fairfax, Falls Church VA
Dr. Ed Lefrak
 
a little pill each day in addition to the others I take, like lipitor and vitamins. no biggie, trust me. you don't want to go through two surgeries.
 
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