Is there even a choice?

[Tom Berning]

Ovie,

Just wanted to reinforce that there is no right or wrong choice when it comes to picking a valve, it'll be better than the one you have and all valve choices are a compromise. Two things come to mind though, do you plan on having children? if so you'll want a tissue valve. Even though I did pick a mechanical valve, one of the attractions for me towards tissue was the fact that it gives you more options later in life. Sure it means more surgery, but for a younger person who knows what might be available in their lifetime.

 

[ElectLive]

In the end I concluded that like most of the medical literature, the data comparing valves is so lacking and unclear, that it is rather useless to surgeons, let alone mere mortals undergoing surgery.

Ovie, find a surgeon you can trust and ask him to help you make this decision. You do have a choice. My surgeon had a very strong preference, but he opened up the can of worms by adding he would implant any valve I wanted. He thought I was smarter and had a lot more medical expertise than I have. I went on a several month search of the literature before I finally saw the light and went with his recommendation.

Bill - Great post and links. You bring a valuable perspective to the topic.

 

[chaconne]

But again, I've never even heard or seen anybody claim that On-X was the quietest until I read that claim right here. (And we've had some bloggers here who were very frustrated with how loud their On-X valves were, too, though that's just anecdotal.)

I'm fairly sure all valve companies claim theirs is the quietest, including On-X, see:

http://www.onxlti.com/heart-valves/designed-for-life/design-features/#soft-closure
http://www.onxlti.com/heart-valves/...s-of-each-option-for-heart-valve-replacement/

Where they don't seem to explicitly say they are the quietest, but it is implied. I know in my conversations with the president, Dr. Bokros, and marketing reps, that they have made this claim.

My On-X is fairly quiet, and only a few have heard it. Nurses and Techs at the hospital have told me that mine is quieter than ST Jude valves they've heard, but they may have only heard the loud ones. Also, very few On-X valves are installed at Kaiser, so I'm not inclined to take this as a valid study. I'm just glad that my valve is perceived as quiet!

I agree with Lynn, Norm and Bill, current evidence points to all the valves being the same with no great advantage to the On-X. However, I chose one because I don't think its worse, there is a "cool" factor, and some of the things may show themselves to be an advantage in the future.

 

[chaconne]

I've heard that one of the reasons ATS valves are quieter (If it's really true, on average), is because they are smaller for a given size. I have a chart comparing ST Jude, On-X, ATS and Carbomedics. For a given size (ie: 23mm), the ATS had a smaller opening area than the others, and therefore smaller leiflets. Apparently smaller means quieter? I don't know if this is true in practice, but it seems like that would be the case.

 

[Ovie]

Ovie,

Just wanted to reinforce that there is no right or wrong choice when it comes to picking a valve, it'll be better than the one you have and all valve choices are a compromise. Two things come to mind though, do you plan on having children? if so you'll want a tissue valve. Even though I did pick a mechanical valve, one of the attractions for me towards tissue was the fact that it gives you more options later in life. Sure it means more surgery, but for a younger person who knows what might be available in their lifetime.

Wait, so if I go Mechanical, I can't have children? I thought that was only for the woman's sake? I've thought about tissue, but who knows where I'll be financially next time round. I'd like to have kids though, so this has now become an issue.

 

[Madsometimes]

Ovie - A man with a MHV can safely father a child. For a woman it is different though. Warfarin is not safe to take in pregnancy, particularly during the first trimester, because it crosses the placenta and can cause miscarriage or birth defects.

So if you are male, you do not need to worry about this. It is not clear from your username if you are make or female!

 

[Tom Berning]

Ovie,

The issue with women, mechanical valves and childbearing is the coumadin usage that it requires, which makes childbirth riskier. I'm not sure about coumadin's side effects on a developing fetus either. Hopefully someone here with more knowledge will weigh in. I'm sure that it is something to discuss with your Dr's, so they know that you want to have children at some point in your life.

Tom

 

[chaconne]

Wait, so if I go Mechanical, I can't have children? I thought that was only for the woman's sake? I've thought about tissue, but who knows where I'll be financially next time round. I'd like to have kids though, so this has now become an issue.

This does only apply to women who could have a lot of bleeding issues during pregnancy, and may need to stay off Warfarin during the pregnancy. No issue for men. I think it's better to make choices on current technology and not bet on the future. Also, younger patients tend to do well on Warfarin. I, for one, am very active (run, hike, bike, swim), do some manual labor, get cuts, bump into things and haven't noticed any problematic bleeding or bruising yet.

 

[Bill B]

Ovie:

I bugged the daylights out of my surgeon's staff in the months before my surgery with these kinds of questions, if the surgeon was not available. You should go over your concern about childbearing with them. Since my surgeon made a strong recommendation about which valve he would prefer to use for me, as soon as I concluded that most of the literature on specific valves was rather lacking, more so on the newer ones, I just went with his recommendation (although that only occurred at 8PM of the night before surgery!). Your surgeon should provide a SPECIFIC recommendation if s/he did not give you one. It's fine that you are asking for our perspective, but your surgeon should be most clear and helpful. I would not want to personally make any comment on warfarin and childbearing as I do not know what the REAL risks are and whether this can be managed safely.

 

[Superman]

Wait, so if I go Mechanical, I can't have children? I thought that was only for the woman's sake? I've thought about tissue, but who knows where I'll be financially next time round. I'd like to have kids though, so this has now become an issue.

As a male, don't sweat it Ovie. I've been on warfarin for 21 years and married for over 12. Just had our fifth in December. Not only can you have children, you might end up with more than you bargained for because the urologist isn't comfortable performing your vasectomy when your INR didn't drop below a certain level prior to the procedure!

ETA: All of my children are healthy, intelligent kids. Three are school age and we just had conferences. All are performing in the top of their classes. Two of my boys have a very mild BAV presentation but neither present a murmur at this time nor do they face any limitations. Not sure about my youngest two, but none of my kids even have so much as a murmur. That being said, this (BAV) is a congenital (hereditary) condition - and that aspect needs to be considered when having kids whether choosing mechanical or tissue. It was something I didn't realize and put quite a strain on my marraige when we learned this after having three kids. It is something a future spouse of yours should be made aware of so she can make an informed decision about potential kids with you.

 

[Bill B]

Oh, I wasn't sure Ovie was male. I should read more carefully.

Ovie: Enjoy parenthood with whatever valve you want.

 

[Ovie]

Oh, I wasn't sure Ovie was male. I should read more carefully.

Ovie: Enjoy parenthood with whatever valve you want.

It's alright, I can understand the name could be deceiving. But it's Ovie, nickname of Alexander Ovechkin of the Washington Capitals Hockey team. My favorite player, kind of a comfort factor when making my name. Glad this has been cleared because I had a major problem on my hands if that were true. Glad to hear ill be alright, as well as the boys down under.

 

[Tom Berning]

Ovie,

An oops is appropriate from me to, I made the assumption that you were female also. Thanks for the explanation, I'll second the idea that you should enjoy parenthood with whatever valve you choose.

Tom

 

[Ovie]

No needs for an oops, Tom. It happens, but thank you anyways, good sir.