It's not really life vs. death when it comes to tissue vs. warfarin eater. There are complications with both paths. Warfarin eaters cannot take most arthritis medication and warfarin complicates a variety of procedures that a lot of people need as they get older. Tissue valvers will suffer the same slow degradation of valve performance that they originally had with their God-given valve. They will play the same old game of "replace it now or wait for it to get worse." However both paths have merit that's why the choice is difficult.
How to Choose
- Thread starter Richie Rich
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Hi Richie, We're in a same/similar boat except I'm 5 years older (54). I need a new aortic valve myself (and posted mechanical vs tissue questions recently on the chat). This forum is super (both the members and the information presented), isn't it?
I've thought of mechanical for a long time, and certainly leaning in that direction because of the reasons stated on this thread. I had the initial surgeon appointment yesterday and my surgey is on July 22nd.
As far aorta, your in ONLY 4cm. That's just about normal (especially if you've bicuspid valve anatomy). It MAY take another lifetime to reach 5.5cm. It's a not a guarantee that you would need aorta replacement although you would need to monitor is closely. Consider taking ARBs (like Losartan) if you take blood-pressure med. I switched to ARB?Losartan 10 years ago and my aorta didn't even move a millimeter. My aortic root was 4.8/4.9 cm and ascending aorta was 4.5/4.6 cm in 2014, and still the same. Prior to that it did grow 0.5cm in 10+ years (I didn't take blood pressure meds and lifted weights etc). Lifestyle also matters to keep it stable, to an extent.
I would need aorta replacement of course since it's much closer to 5.0/5.5 and while there are in there doing my AVR, they would also replace it. I will get valve and aorta up to the arch (Bentall procedure). So my surgery is 2x longer and complex than yours. Yours will be a breeze
I've thought of mechanical for a long time, and certainly leaning in that direction because of the reasons stated on this thread. I had the initial surgeon appointment yesterday and my surgey is on July 22nd.
As far aorta, your in ONLY 4cm. That's just about normal (especially if you've bicuspid valve anatomy). It MAY take another lifetime to reach 5.5cm. It's a not a guarantee that you would need aorta replacement although you would need to monitor is closely. Consider taking ARBs (like Losartan) if you take blood-pressure med. I switched to ARB?Losartan 10 years ago and my aorta didn't even move a millimeter. My aortic root was 4.8/4.9 cm and ascending aorta was 4.5/4.6 cm in 2014, and still the same. Prior to that it did grow 0.5cm in 10+ years (I didn't take blood pressure meds and lifted weights etc). Lifestyle also matters to keep it stable, to an extent.
I would need aorta replacement of course since it's much closer to 5.0/5.5 and while there are in there doing my AVR, they would also replace it. I will get valve and aorta up to the arch (Bentall procedure). So my surgery is 2x longer and complex than yours. Yours will be a breeze
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Richie Rich
Well-known member
Love the videos, especially the scooter it looks great fun. OK so I can see that riding a motorcycle won’t necessarily put me at significantly more risk than any other motorcyclist. Just need to convince myself that my aorta has a good chance of lasting as long as a mechanical valve.
Thanks.
Richie Rich
Well-known member
Good poem, ThanksJust for fun I asked AI to create a poem about a guy riding his motorcycle who runs into a kangaroo. The characters in this poem are fictional. Any resemblance to real persons, living or dead, is purely coincidental.
In the land where eucalyptus sigh,
And kangaroos beneath the sky,
A lone rider on his steel steed,
Roared through the bush with speed.
His heart beat with the engine's roar,
As he chased the horizon's lore,
But fate, like shadows in the night,
Cast its cruel hand, unforeseen, in flight.
Beneath the moon's soft silver gleam,
A kangaroo, in shadows unseen,
Leapt in front, a sudden foe,
In the path where wild winds blow.
With a thunderous clash, a shattering sound,
Man and beast met on sacred ground.
Metal met muscle in a clash of fate,
And the rider met his final state.
The earth stood witness, silent and still,
To the tragedy on its rolling hill,
As life ebbed from the fallen one,
Underneath the setting sun.
Gone the dreams that once did soar,
Now scattered on the bushland floor.
Gone the laughter, gone the cries,
Underneath the starlit skies.
Yet in the quiet of the night,
His spirit lingers, taking flight,
A rider still, in memory's keep,
Where the bushland whispers secrets deep.
So let us mourn, but let us see,
In the heart of this tragedy,
A reminder of life's fragile thread,
In every moment, every tread.
For in the land where kangaroos roam free,
There lies a lesson for you and me,
To cherish each moment, hold it tight,
And ride through life with open sight.
Richie Rich
Well-known member
This is my other concern. If I go mechanical and need my aorta doing in several years time I’ll be regretting not having a tissue valve and avoiding warfarin. If I have a tissue valve and it fails before my aorta needs replacing I’ll regret that decision. Feels like quite a gamble and it could easily end up regretting whatever I choose. What’s the odds of my aorta getting bigger and me needing another op?
Richie Rich
Well-known member
I realize that neither option is ideal, but I just want to give myself the best chance of a normal lifespan with as few operations and complications as possible.
Richie Rich
Well-known member
Hope your surgery goes well. It’s good to see that your aorta was fairly stable and slow to increase to a size needing surgery. The surgeon did say that the advantage of not replacing the aorta is that it’s a simpler and quicker operation, but it’d be kind of good to just get it done with the valve and out of the way. Thanks.Hi Richie, We're in a same/similar boat except I'm 5 years older (54). I need a new aortic valve myself (and posted mechanical vs tissue questions recently on the chat). This forum is super (both the members and the information presented), isn't it?
I've thought of mechanical for a long time, and certainly leaning in that direction because of the reasons stated on this thread. I had the initial surgeon appointment yesterday and my surgey is on July 22nd.
As far aorta, your in ONLY 4cm. That's just about normal (especially if you've bicuspid valve anatomy). It MAY take another lifetime to reach 5.5cm. It's a not a guarantee that you would need aorta replacement although you would need to monitor is closely. Consider taking ARBs (like Losartan) if you take blood-pressure med. I switched to ARB?Losartan 10 years ago and my aorta didn't even move a millimeter. My aortic root was 4.8/4.9 cm and ascending aorta was 4.5/4.6 cm in 2014, and still the same. Prior to that it did grow 0.5cm in 10+ years (I didn't take blood pressure meds and lifted weights etc). Lifestyle also matters to keep it stable, to an extent.
I would need aorta replacement of course since it's much closer to 5.0/5.5 and while there are in there doing my AVR, they would also replace it. I will get valve and aorta up to the arch (Bentall procedure). So my surgery is 2x longer and complex than yours. Yours will be a breeze
pellicle
Professional Dingbat, Guru and Merkintologist
having had an OHS driven by aneurysm (and I'm not the lone ranger there) I can understand how you feel there.
Best Wishes
pellicle
Professional Dingbat, Guru and Merkintologist
well, that's a matter for a surgeon, and I'd also seek a second opinion ... but my primary view is that if you ask a surgeon "do I need a surgery" they'll probably be inclined to say "yes" ... I mean its what they do.
Equally they must accept some responsibility for outcomes (even if its just their rating) and so they'll try to minimise the risks.
Sorry to level that as "no bias" ...
Best Wishes
pellicle
Professional Dingbat, Guru and Merkintologist
Just fished back
at 4cm it may never need it ... which is why they would be hesitant to change it. Further, there is some evidence that after a surgery it may be further stabilised by the additional scar tissue ... sorry, no crystal ball here, only some stats and fewer studies.
at 4cm it may never need it ... which is why they would be hesitant to change it. Further, there is some evidence that after a surgery it may be further stabilised by the additional scar tissue ... sorry, no crystal ball here, only some stats and fewer studies.
Hi Richie Rich,
Just my personal experience...
I'm a biovalver and I had an accident doing construction work a few years ago and the ER doctor who treated me said I was very lucky that I had a bio valve instead of a mechanical valve and on warfarin. What was a simple concussion with a bio valve could have killed me with a mechanical valve.
Riding a motorcycle is definitely a risk for you and it's not a joke or something to dismiss out of hand, regardless if another poster rides and hasn't had serious problems yet or not.
Another thing is that there is overwhelming confirmation bias/Dunning-Kruger issues on this site by posters saying warfarin/warfarin management is not an issue, ticking is not an issue, etc., etc., etc.
These posters are not doctors and googling studies does not make them qualified to advise you in any way. One poster, with admitted mental issues, even claims he was a medical researcher in college 30-40 years ago but yet does not understand basic probability calculations routinely used by medical researchers everyday. I'd be very wary risking my life/health decisions on what you read here.
As far as anticoagulation goes, if you simply scroll back through the posts on this forum and count how many posts there are on warfarin management/mismanagement you can judge for yourself if warfarin management is an issue or not.
A quick Google search will also show you the effects of anticoagulation gone wrong.
Lastly, is the fact that doctors and nurses, who see and treat the actual impacts of warfarin on people seem to think warfarin/warfarin management is an issue with serious weight in any decision on which valve to choose.
(There's a reason researchers/manufacturers are constantly working towards a valve that doesn't degrade like a tissue valve and that doesn't require anticoagulation like current mechanical valves.)
Do yourself a favor and take what you read here with a grain of salt and listen to your doctor's advice.
Your doctors and their teams have years of training, experience with thousands of patients and the true expertise to help steer you to the best option for you, mechanical or tissue, with an understanding of your actual specific situation and your unique health history that posters on this forum do not have.
Nobody on this site is qualified to tell you which valve is right for you, myself included.
Richie Rich
Well-known member
It’s good to see a different point of view on this. I understand taking warfarin carries a certain risk, as does having multiple surgeries. Both my cardiologist and surgeon told me mechanical was definitely the best choice for me if I didn’t ride a motorcycle. I’m not taking it lightly, if I were I wouldn’t be on here looking for advice and opinions. I’m simply trying to weigh up what would be best considering my lifestyle and the fact my aorta is at 4cm.
Thanks.
Richie Rich
Well-known member
It’s good to see a different point of view on this. I understand taking warfarin carries a certain risk, as does having multiple surgeries. Both my cardiologist and surgeon told me mechanical was definitely the best choice for me if I didn’t ride a motorcycle. I’m not talking it lightly, if I were I wouldn’t be on here looking for advice and opinions. I’m simply trying to weigh up what would be be
pellicle
Professional Dingbat, Guru and Merkintologist
frankly this is a prefect approach.
Its widely understood that there is no perfect solution to this, and so everything is a tradeoff. What is important is to understand those tradeoffs and which you prefer (better yet, projecting 10 or 20 years past surgery).
I frequently say to people that if they are not going to properly engage with anticoagulation, properly manage their ACT then they should seriously consider the tissue valve choice. To put it another way: if you prefer not to be a DIY sorta guy then buy into the 10 year plan (and hope for 20). For the young (and young at heart) this is the FAFO outcome potential with ACT:
https://www.valvereplacement.org/th...-with-an-on-x-aortic-valve.888128/post-910489
jag004
Active member
Word to the wise. Please go by the proven studies that we have now. Do not go by possibilities or future studies. The same stats are the same as they were for my first surgery 11 years ago. Nothing has changed.
Don't say to yourself, I'm going to go this route because in 10 years modern medicine will have come a long way.
Base your decisions on proven info and the way the valve and surgical industry already works.
I based my first decision on a pipe dream, and it bit me in the butt.
Don't say to yourself, I'm going to go this route because in 10 years modern medicine will have come a long way.
Base your decisions on proven info and the way the valve and surgical industry already works.
I based my first decision on a pipe dream, and it bit me in the butt.
pellicle
Professional Dingbat, Guru and Merkintologist
something I found a good reflection
pellicle
Professional Dingbat, Guru and Merkintologist
brave and honest ... hats off to you.
christopherj
Member
I was you just last October where at 48 it was time to decide. (I'm 49 now as well) I'm just going to lay out my personal thought pattern on this topic.
The American College of Cardiology and the American Heart Association generally recommend mechanical valves for people under the age of 50 and biologic valves for those over 70. For those about in between, like us, neither has an absolutely clear advantage over the other.
So you get to choose what's more important to you. A durable mechanical valve that will typically last a life time but includes blood thinners. Or a biologic valve that may not require blood thinners but typically need to be replaced after 10-20 years.
Either approach means you still have heart disease, but now you get to choose your symptoms and treatments.
So for me this becomes about risk management and the AHA says for my age group the risk is about equal for the choices. There are plenty of other risks we can consider in life, such as car and motorcycle accidents. I mean technically there is a non-zero chance you're killed by a cow. But for me, I stick with the statistical outcomes based on the ACC and AHA which says I get to choose, or maybe leans slightly toward mechanical.
I plan to live until at least 80, and I don't want to be tied to an insurance company and faced with the risk of another $600,000 surgery after I retire.
Do I care about warfarin treatment? Warfarin is cheap, about 3 pennies a pill. Test strips are $6 a week.
Do I care about another surgery that is basically guaranteed in my future?
So I thought about the time cost it takes to manage INR over the span of 10-20 years and the amount of time and cost of another heart surgery. (hopefully maybe TAVR)
Good luck in your decision, there is no wrong answer.
The American College of Cardiology and the American Heart Association generally recommend mechanical valves for people under the age of 50 and biologic valves for those over 70. For those about in between, like us, neither has an absolutely clear advantage over the other.
So you get to choose what's more important to you. A durable mechanical valve that will typically last a life time but includes blood thinners. Or a biologic valve that may not require blood thinners but typically need to be replaced after 10-20 years.
Either approach means you still have heart disease, but now you get to choose your symptoms and treatments.
So for me this becomes about risk management and the AHA says for my age group the risk is about equal for the choices. There are plenty of other risks we can consider in life, such as car and motorcycle accidents. I mean technically there is a non-zero chance you're killed by a cow. But for me, I stick with the statistical outcomes based on the ACC and AHA which says I get to choose, or maybe leans slightly toward mechanical.
I plan to live until at least 80, and I don't want to be tied to an insurance company and faced with the risk of another $600,000 surgery after I retire.
Do I care about warfarin treatment? Warfarin is cheap, about 3 pennies a pill. Test strips are $6 a week.
Do I care about another surgery that is basically guaranteed in my future?
So I thought about the time cost it takes to manage INR over the span of 10-20 years and the amount of time and cost of another heart surgery. (hopefully maybe TAVR)
Good luck in your decision, there is no wrong answer.
