It Just Got Real

Seaton

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May 13, 2015
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220
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London, UK
Well, it seems Thunderbirds are go.

Saw my surgeon today (4th April) at a pre-admission clinic and it’s been decided to go ahead with surgery. In approximately two months’ time - June most probably. I signed the consent form. Eek.

My Waiting Room days are nearly over - some four years or so since first diagnosis of bicuspid valve stenosis.

Although I’m not significantly symptomatic (fatigue mainly, stenosis edged into severe, pressure gradients up), he feels my readings are all going in one direction and that it is probably better to get the valve replaced sooner rather than later so I can get on with the recovery period and the “rest of my life”.

We discussed valve types (mechanical or tissue) but he said there was no rush to decide on preference. He said I can leave the decision up until the day of the operation if I prefer! They will just pull whatever valve type I choose off the shelf on the day.

He mentioned they now implant the Edwards Inspiris Resilia Valve which I would get if going tissue. Although it appears the Inspiris is still in the guinea pig era relatively (still no long term human use data it seems), I suddenly found myself seriously considering tissue as an option for the first time. This despite having thought I’d made up my mind to go mechanical. That sudden change of heart took me by surprise.

I don’t fear the idea of anti coagulants (thanks primarily to this forum), but now that I’ve reached the sublime age of 60, I found myself today thinking maybe tissue wouldn’t be such a critical choice for my age and circumstances (famous last words).

Whichever valve type is chosen, he intends to do a mini sternotomy procedure, unless other issues or complications suggest a full sternotomy.

So there we have it. There was me thinking I was popping in to have a chat with a surgeon about continuing to watch and wait, when a suggestion was proffered to operate.

Today I had eight vials of blood taken, MSRA swabs, EKG, X-Ray and a lengthy consultation with the lead nurse who will be my point of contact for the duration of the coming period and after. I am being booked for a coronary angiogram to check if any coronary arteries are blocked or narrowed. The surgeon checked a previous CT scan I had in 2015 and seemed to think from looking at that that my arteries looked pretty clear. We shall see.
 

pellicle

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Queensland, Australia
Seaton;n886972 said:
Well, it seems Thunderbirds are go.
congratulations ... I predict it will be in the rear view mirror in a far shorter time than the anxious times have already been ...


My Waiting Room days are nearly over - some four years or so since first diagnosis of bicuspid valve stenosis.


We discussed valve types (mechanical or tissue) but he said there was no rush to decide on preference. He said I can leave the decision up until the day of the operation if I prefer! They will just pull whatever valve type I choose off the shelf on the day.
you have plenty of data here, so just do what feels right for you mate.

He mentioned they now implant the Edwards Inspiris Resilia Valve which I would get if going tissue. Although it appears the Inspiris is still in the guinea pig era relatively (still no long term human use data it seems)
Myself I don't think its quite like that, as it is just an iterative change to existing techonlogy. I'd expect a modest increase on previous generations.


I don’t fear the idea of anti coagulants (thanks primarily to this forum), but now that I’ve reached the sublime age of 60, I found myself today thinking maybe tissue wouldn’t be such a critical choice for my age and circumstances (famous last words).
that is not an unreasonable conclusion to reach ...


Best wishes
 

Paleowoman

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Surrey, UK
Hi Seaton,

Nearly the end of being in the "comfy chair in the Waiting Room" for you. But you have a couple of months to prepare for when you're up and out ! And it will be a nice time of year too - I always thought spring or early summer would be a good time to be recuperating from surgery, and pleasant to be out walking.

I was 60 when I had my surgery. You're lucky you have the chance to have the Edwards Inspiris Resilia valve if you choose to have a tissue vave. I was a few years too early to have that one - it was first used in the UK in June 2017 - but I personally would have gone with it, especially knowing they are using it in much younger patients.

It's natural that there's no long term track record for the Inspiris Resilia valve because how would they do that ? There's no long term track record for the previous Edawrds valve, the Magna Ease, which I have. I believe the name of the one prior to that one was the Edwards Magna valve - that one has a longer track record but no one is given it now because surgeons aways use the latest one developed.

You know we're all here cheering you on !
 

LondonAndy

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Messages
272
Location
London, UK
It is interesting that you are considering both types of valve, Seaton, and I guess it depends on our own sensibilities and lifestyles. For me, the priority at age 48 was to reduce as much as possible the risk of having to have open heart surgery a second or third time. Even with the improvements to tissue valves that I have read on this forum it seems likely that a re-do would be required at 10 to 15 years, so in your case at age 70 to 75, though of course further improvements may be in place by then either for the valves or the method, or both.

And make sure you have a comfy chair for after surgery too! I am not sure how different a mini sternotomy is in terms of the precautions needed compared to a full one, but I found an electric recliner invaluable for getting into just the right position for sleeping when first out of hospital.
 

tom in MO

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910
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MO USA
One thing to consider if you are 60 in the tissue vs. mechanical debate is your possible need to take NSAIDs for arthritis. You can't routinely take some of the common NSAIDs such as ipubrofen, meloxicam, etc. if you are on warfarin. However, my GP thinks that I can't take NSAIDs is kind of a good thing, because he doesn't like NSAIDs for a variety of reasons. I can take a 2-month course of an NSAID, which so far is good enough when an arthritic bone spur cuts off a nerve in the spine.
 

Seaton

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Messages
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Location
London, UK
Thanks everyone! Sound advice and kind words, as ever.

And make sure you have a comfy chair for after surgery too! I am not sure how different a mini sternotomy is in terms of the precautions needed compared to a full one, but I found an electric recliner invaluable for getting into just the right position for sleeping when first out of hospital.
And thank you @LondonAndy
Advice taken. 👌🏼 Just ordered a new electric recliner. My new, all purpose comfy chair. I’ll never need to walk again. 😁
 

Gordo60

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Apr 3, 2019
Messages
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Location
Australia (Sunshine Coast)
I’m 59 and in the watchful waiting mode for a 4.8 cm root TAA. Go for my annual echo etc next month. One never knows if it will be time or not each checkup.

I’ve done quite a lot of research on mechanical vs tissue value for a few years now. When the time comes I’ve decided on the Edward Inspiris Resillia tissue valve. Around age 60 falls into that difficult grey area but it appears that more and more surgeons are favouring tissue valves for this age group given the advances in technology and operating procedures.

Even if the Edward Resillia valve falls well short of its expected life and only lasts 10 - 15 years that puts one around 70 - 75. Then due to its design a non invasive procedure can likely be used to insert another new valve if the need arises. In that age group there’s plenty of other medical issues / operations that could result in death unrelated to the valve issue.

I intend to keep myself as fit as possible as I age. If I need another operation in my 70’s then I hope to be in as good as health as I can be. Even if someone at 60 gets a mechanical valve there’s the possibility of an aneurysm arising later on requiring another surgery anyhow.

In summary when getting toward 75 there’s so many unknowns I’d rather get the new generation tissue valve at 60 and be free of the issues relating to warfarin. I know many here say it’s no big deal but I also know a number of people personally on it who don’t like it at all. So not an easy decision.
 
Last edited:

DL1017

New member
Joined
Apr 20, 2019
Messages
1
Well, it seems Thunderbirds are go.

Saw my surgeon today (4th April) at a pre-admission clinic and it’s been decided to go ahead with surgery. In approximately two months’ time - June most probably. I signed the consent form. Eek.

My Waiting Room days are nearly over - some four years or so since first diagnosis of bicuspid valve stenosis.

Although I’m not significantly symptomatic (fatigue mainly, stenosis edged into severe, pressure gradients up), he feels my readings are all going in one direction and that it is probably better to get the valve replaced sooner rather than later so I can get on with the recovery period and the “rest of my life”.

We discussed valve types (mechanical or tissue) but he said there was no rush to decide on preference. He said I can leave the decision up until the day of the operation if I prefer! They will just pull whatever valve type I choose off the shelf on the day.

He mentioned they now implant the Edwards Inspiris Resilia Valve which I would get if going tissue. Although it appears the Inspiris is still in the guinea pig era relatively (still no long term human use data it seems), I suddenly found myself seriously considering tissue as an option for the first time. This despite having thought I’d made up my mind to go mechanical. That sudden change of heart took me by surprise.

I don’t fear the idea of anti coagulants (thanks primarily to this forum), but now that I’ve reached the sublime age of 60, I found myself today thinking maybe tissue wouldn’t be such a critical choice for my age and circumstances (famous last words).

Whichever valve type is chosen, he intends to do a mini sternotomy procedure, unless other issues or complications suggest a full sternotomy.

So there we have it. There was me thinking I was popping in to have a chat with a surgeon about continuing to watch and wait, when a suggestion was proffered to operate.

Today I had eight vials of blood taken, MSRA swabs, EKG, X-Ray and a lengthy consultation with the lead nurse who will be my point of contact for the duration of the coming period and after. I am being booked for a coronary angiogram to check if any coronary arteries are blocked or narrowed. The surgeon checked a previous CT scan I had in 2015 and seemed to think from looking at that that my arteries looked pretty clear. We shall see.
Hi, seems we both will be in surgery in June. I am new here, again. I was a member years ago when I had my BAV replaced in 2006, at 50 years old, with a porcine value and aortic wrap. Things went just swimmingly until a few months ago when I started having shortness of breath issues. It took me a little while to realize exactly what was going on. The symptoms have come on a lot stronger it seems...by the time I get to the top of a flight of stairs, I'm huffing and puffing! Now, I'm 62 and for some naive reason I thought I could get the TAVR approach. I could, if I wanted, but the surgeon doesn't recommend it. Apparently it doesn't last any longer and they can only do it once. Am I understanding this correctly? If I get the TAVR, it might last 12-15 years, I'll be in my mid 70's, and would have to have OHS because they couldn't do the TAVR again. It all seems to be a crap-shoot. Maybe I won't live to be 75, hopefully I will. So, my decision seems to be: another tissue value, or a mechanical value and coumadin (which the doc says has a good chance of lasting the rest of my life. But quickly reading some posts on here, it doesn't sound like that's a definite) Like a lot of people, I'm scared of coumadin. I've already had other medical issues: Breast cancer at age 35 with surgery & chemo; I was found be to type 2 diabetic at the same time I found out I needed my BAV replaced at age 50. I'm already sticking myself to test for my blood sugars, do I feel like doing that for blood thinning too?
I guess I'm not really asking a question, am I. Just wanted to say, I'm in the same boat as you, Seaton, or at least waiting like you. They scheduled me for 6/13 (with the same surgeon as first time around), but I have a 2nd opinion this Tuesday. If I didn't book it, I might have to wait till July because of his vacation.
I'll be curious to see what valve you choose. Right now, I'm leading towards a tissue one again.
Thanks for listening.
 

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