Mechanical Valve

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Redone

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Joined
Sep 1, 2021
Messages
53
Location
Boston, Massachusetts
Hello Everyone! Initially I had planned on going with a tissue valve to replace my Bicuspid Aortic Valve, but now I'm seriously leaning toward the Mechanic Valve at the advice of my surgeon. He said, as an athlete and someone hoping to NEVER repeat this surgery it would be the best option. I'm leaning toward the On-X. What is the incidence of failure on a Mechanic Valve? Would you mind sharing your experience? Would you recommend a Mechanic Valve for athletes over a tissue valve?
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
1,175
Hi Redone.

It is important to know your age because age is of vital importance in determining which valve is right for you. In that you are an athlete, and your surgeon has recommended a mechanical valve and that part of his reasoning was that you are: "someone hoping to NEVER repeat this surgery", I am going to assume that you are relatively young- younger than 50, which is young in the world of valve replacement. If you don't mind sharing your age that would be helpful.

Like you, I am BAV. I was 53 years old when it was time for my valve to be replaced. I am very athletic, including combat sports which involved striking, and was initially very much set on getting a tissue valve so that I could continue in my active lifestyle. I changed my mind and went with a mechanical valve- in my case I chose a St. Jude mechanical valve.

Here are my reasons that I changed my mind and chose a mechanical valve:

- I came to terms with the reality that if I went with a tissue valve it would mean a certainty of reoperation. Although there is hope that one of the new tissue valves will last longer, at age 53, a tissue valve would be expected to only last me 8 to 12 years before I needed another operation, based on the available evidence, as the younger you are the faster your tissue valve generally will calcify and deteriorate. There is the possibility of getting TAVR valve on operation #2, but when you speak to the interventional cardiologists who do these procedures, they will tell you that not all are actually eligible for this procedure. So, that means a real possibility of another OHS for # 2. And, even if I am one of the lucky ones who is eligible for TAVR, how many more years will that take me before I need operation #3. No matter how I played with the numbers, taking my life out another 30 years, it did not look good once I get into my 70s and my family has a history of longevity, so I felt it was prudent to think that far ahead.

- From this forum, I was able to learn from others that there is no reason why a person cannot have a very active and athletic life with a mechanical valve. Having had a mechanical valve, I can say that I have been very athletically active since recovering from surgery. I run, lift weights, hit the punching back, bike, ride waves in the ocean on my Boogie Board and on and on. So, I would add my voice to the chorus who say that you can still be very active with a mechanical valve. I will say that I gave up hard sparring in boxing, as hard blows to the head are now no longer ok. At 53 it was probably time to give this up anyway, so I am fine with that.

- Having a mechanical valve means that a person will be on warfarin, an anti-coagulant, for the rest of their life. This was initially a concern to me. However, after reading from dozens of members here who have been on warfarin, some for 30, 40 and even 50+ years, I learned that this is not a big deal for most.

So, I chose a mechanical valve, which the scientific literature suggests should outlive me and I will not likely need another operation due to valve deterioration. Tissue valves deteriorate. Mechanical valves are designed not to deteriorate.

A very important point. If you do decide to go mechanical, you will need to take warfarin every day for the rest of your life. It is of critical importance that you take this seriously. You need to be honest with yourself about whether you will seriously commit to this. There are some people who do not take this seriously, forget to take their warfarin for days or weeks or just stop thinking that it is important. If you are an individual who is not likely to take warfarin compliance seriously, you will put yourself at risk for a blood clot and I would instead recommend tissue valve. So, just be honest with yourself as to whether you are the type who will commit to taking it consistently every day.

If you go mechanical, I would also strongly recommend that you get a home meter and self-test your INR weekly. That is an entire topic of its own and rather than go on about it here, there are many other threads on this topic. Here is one: my self management results for 2020

Please keep us posted on how things come along and feel free to ask any questions.
 

Beach77

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Feb 28, 2021
Messages
39
Location
San Diego CA
Hi redone,
It’s a hard decision! I had planned on a TAVR for my bicuspid surgery. (no question about that!) My heart team said either the TAVR or the mechanical would be a good fit, it was up to me. (I was 64-turned 65 a week after my surgery) my cardiologist, my cardiothoracic surgeon both suggested I talk with a heart surgeon to ask about an On-X valve. They wanted me to understand all the options to make the best choice. I started researching the On-X prior to the appointment. After meeting with the surgeon, I could see some benefit of a mechanical valve. The decision was mine to make and it was difficult for me.

Taking the blood thinners hasn’t been as difficult as I expected but it is more monitoring than I expected. My thyroid is only tested yearly, unless I feel that is off. INR monitoring needs to be tested more frequently, especially at first. But it's not to be too difficult now. I have my own monitor (ebay) to test weekly, I go to the lab every 4 to 6 weeks. My GP could set me up for only in-home testing but I like my Coumadin clinic. I will say, it took me a couple of months to feel completely comfortable with taking the blood thinners and how it works within me. Now it's no worries!

Since my surgery, I’m back to my ability from a few years ago! Hiking, gym, weights, walking, swimming and yoga, whatever I want! I’m hoping we get a skiing trip or two in this winter! (Mammoth is calling me!) I’ve done a bunch of high-altitude hiking during our camping trips this past year! To me, the surgery was worth it just for that! Hiking up in the mountains-is my happy place!

The main reasons I picked the On-X was I wanted to feel good and not go through the symptoms again-once the TAVR valve started to deteriorate. I was told the data is good for 5 years, looks good for 10 years and maybe longer but there was no way of telling. Doing a 2nd TAVR would be decided at the time. They couldn’t give me a definite answer. Also, I’m hoping for only one surgery. The On-X was the best choice for me. Good luck with your decision!

Next month, Dec. 3rd, will be my first-year anniversary! My surgery was at the peak of COVID in San Diego. Knowing what I feel now, I’d pick the On-X valve again!
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
9,101
Location
Queensland, OzTrayLeeYa
Hi

Hello Everyone! Initially I had planned on going with a tissue valve to replace my Bicuspid Aortic Valve, but now I'm seriously leaning toward the Mechanic Valve at the advice of my surgeon.
Your bio says:
Bicuspid Aortic Valve, Aortic Aneurysm and Anomalous Coronary Artery Reroute​

but it doesn't say your age. None the less those points are key to the issue. Mechanical valvers do occasionally find themselves in need of a redo, but typically this is due to either aneurysm (which you are getting fixed) or panus growth. The replacement of (part of) the aortic artery in repairing your aneurysm will mean that problem is no more and as I understand it panus comes down into the valve from the aorta above, so if I'm correct {please ask your surgeon} that will mean the other statistically significant driver of reoperation is gone too.

I would underscore everything that Chuck wrote and would further say that if you can push for it self management of INR is easy and I have helped a number of people over the years onto good self management paths. Self testing is of course the big improvement in this with devices (think what diabetics do) that you can test your blood and make your decisions and remain in the best possible place for the best outcomes.

This blog post may be way to much for you now, but I encourage you to keep the URL (web address) and refer to it (or just ask again here) when the time comes.




I'm leaning toward the On-X. What is the incidence of failure on a Mechanic Valve? Would you mind sharing your experience? Would you recommend a Mechanic Valve for athletes over a tissue valve?
I initially felt that way too, but wound up with an ATS valve (which is performing admirably). Without getting too technical (we can do that if you like) I would say that 90% of the claims that On-X make (in particular its lower INR protocol) are a combination of wishful thinking, advertising spin and are (if you adhere to their low INR protocol) potentially harmful.

My advice would be to consider the St Jude, as these guys are literally the longest player in the game, have nothing to prove and are ultra reliable. (I said I wouldn't get technical, but the evidence is they are the only ones who actually make a valve that measures up to the claims made).

I'm not as active as you or Chuck, but have been a keen XC Skiing person (but now that I'm back in Australia, I'm not able to do that as easily as in Finland).

Lastly I'll say I've had 3 OHS (starting my career early at 10) and now is the first time in my life I feel like "I probably won't need another heart surgery again" ... its a good feeling.

If you go tissue prosthesis remember this: tissue prosthetic valves begin degrading from the time they go in. So the clock has started. The only unknown is "when" you'll need it.

The simple matter is (was and remains) that there is no definitive cure for valvular heart disease, instead we exchange valvular heart disease for "prosthetic valve disease" of which there are two major types:
  1. bioprosthesis
  2. mechanical prosthesis
(lets leave homograft and Ross out of this)
#1 is managed by redo surgery - there is no user intervention that is known to change outcomes. Redo surgery is required because the tissue (bio) prosthesis begins to degrade over time. Key indicators on the duation of the valve are: age (younger gets less time), body chemistry and (I would argue) intensity of exercise.

#2 is managed by your maintaining your INR in the right "numbers" ... as long as you do that you will have very low cases of harm (which can be either a bleed related injury or a clot) and the valve itself will outlast you.

So as long as you properly commit to your Anti Coagulation Therapy (warfarin) you will stand the best possible chance of a "one and done" and a normal outcome for the remainder of your life.

Best Wishes
 

drleng

Active member
Joined
Oct 22, 2021
Messages
26
Really great solid opinions expressed here - based on personal experience...and these are the best, I reckon.
I like to keep it simple because I can think myself into a corner when I overthink things :)

1) You are young -> go mechanical. Can you imagine redoing OHS every 10-15 years for tissue valves? It takes a good 6 months for the sternum to heal. Forget about doing pushups till 6 months post OHS! Warfarin has not stopped me from keeping fit. Your surgeon will advise you to avoid contact sports - you can do just about anything that doesn't involve you getting bashed up.

2) Which mechanical valve? I think you have a few votes for St Jude - add mine to the list. My surgeon advised me to get this one due to the robustness and solid predictable performance. It's been a good 5 years for me so far.
 

Superman

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Joined
Oct 3, 2009
Messages
1,374
Location
Grand Rapids, MI, USA
Mechanical valves themselves almost never fail. There are issues that can drive the need for another operation.

- Aortic Aneurysm, which is probably the most common driver for another operation. Far more common among BAV patients than among the general population. No certain way to guess if or when you’re going to face this. I did 19 years after having my mechanical valve put in.

- Panus growth, which is scar tissue that can develop around the valve and possibly obstruct driving the need to get in a clean it up. Rare but not unheard of.

- Then just other stuff. Some people get a size of valve that doesn’t work for them. Some have other heart issues (need a pacemaker or whatever) that drives further intervention.

But the valve itself? Practically bullet proof.

As far as athletes and warfarin, it depends. Are you insistent on playing high contact sports like American Football, Rugby, combat sports? Probably requires a bit more thought on how you’re going to protect against injury.

If you’re a runner, cyclist, hiking, other non-contact - you’re probably fine. Just a good idea to carry something letting EMS know you’re on warfarin so they take appropriate action in event of emergency.

I’ve been taking warfarin for over 30 years without any issues related to athletics. I’ve done mountain biking, road biking, downhill skiing, ice skating, basketball, school yard football, rec league softball, coached my kids in baseball (taking a couple line drives in coaches pitch) and lived to tell about it.
 

Michael O

Well-known member
Joined
Jun 22, 2021
Messages
101
Alternate opinion here. 56, very active, etc.

I went tissue because I'm due for a full shoulder replacement next year, and a very likely hip replacement in the next few. While not impossible, these trickier surgeries and recoveries on warfarin than without.

All of the reasons that the other members cited as reasons to go mechanical are very good ones, but everyone is different, and there are compelling reasons to go tissue.
 

Michael O

Well-known member
Joined
Jun 22, 2021
Messages
101
Can you imagine redoing OHS every 10-15 years for tissue valves? It takes a good 6 months for the sternum to heal. Forget about doing pushups till 6 months post OHS! Warfarin has not stopped me from keeping fit.
A couple of minor notes:
- re-do's on tissue valves are often TAVR, and based on all other factors with my heart health, my surgeon indicated it was "very likely" that my replacement would be TAVR
- I'm at 90 days out and am doing pushups quite comfortably.
- YMMV re: 6 months for a sternum to heal. Mine gives the very occassional twinge when I sneeze, but I'm generally back on track with my workouts, albeit at lower levels (most of which I attribute to taking a year off during Covid).
 

Redone

Well-known member
Joined
Sep 1, 2021
Messages
53
Location
Boston, Massachusetts
Hi Redone.

It is important to know your age because age is of vital importance in determining which valve is right for you. In that you are an athlete, and your surgeon has recommended a mechanical valve and that part of his reasoning was that you are: "someone hoping to NEVER repeat this surgery", I am going to assume that you are relatively young- younger than 50, which is young in the world of valve replacement. If you don't mind sharing your age that would be helpful.

Like you, I am BAV. I was 53 years old when it was time for my valve to be replaced. I am very athletic, including combat sports which involved striking, and was initially very much set on getting a tissue valve so that I could continue in my active lifestyle. I changed my mind and went with a mechanical valve- in my case I chose a St. Jude mechanical valve.

Here are my reasons that I changed my mind and chose a mechanical valve:

- I came to terms with the reality that if I went with a tissue valve it would mean a certainty of reoperation. Although there is hope that one of the new tissue valves will last longer, at age 53, a tissue valve would be expected to only last me 8 to 12 years before I needed another operation, based on the available evidence, as the younger you are the faster your tissue valve generally will calcify and deteriorate. There is the possibility of getting TAVR valve on operation #2, but when you speak to the interventional cardiologists who do these procedures, they will tell you that not all are actually eligible for this procedure. So, that means a real possibility of another OHS for # 2. And, even if I am one of the lucky ones who is eligible for TAVR, how many more years will that take me before I need operation #3. No matter how I played with the numbers, taking my life out another 30 years, it did not look good once I get into my 70s and my family has a history of longevity, so I felt it was prudent to think that far ahead.

- From this forum, I was able to learn from others that there is no reason why a person cannot have a very active and athletic life with a mechanical valve. Having had a mechanical valve, I can say that I have been very athletically active since recovering from surgery. I run, lift weights, hit the punching back, bike, ride waves in the ocean on my Boogie Board and on and on. So, I would add my voice to the chorus who say that you can still be very active with a mechanical valve. I will say that I gave up hard sparring in boxing, as hard blows to the head are now no longer ok. At 53 it was probably time to give this up anyway, so I am fine with that.

- Having a mechanical valve means that a person will be on warfarin, an anti-coagulant, for the rest of their life. This was initially a concern to me. However, after reading from dozens of members here who have been on warfarin, some for 30, 40 and even 50+ years, I learned that this is not a big deal for most.

So, I chose a mechanical valve, which the scientific literature suggests should outlive me and I will not likely need another operation due to valve deterioration. Tissue valves deteriorate. Mechanical valves are designed not to deteriorate.

A very important point. If you do decide to go mechanical, you will need to take warfarin every day for the rest of your life. It is of critical importance that you take this seriously. You need to be honest with yourself about whether you will seriously commit to this. There are some people who do not take this seriously, forget to take their warfarin for days or weeks or just stop thinking that it is important. If you are an individual who is not likely to take warfarin compliance seriously, you will put yourself at risk for a blood clot and I would instead recommend tissue valve. So, just be honest with yourself as to whether you are the type who will commit to taking it consistently every day.

If you go mechanical, I would also strongly recommend that you get a home meter and self-test your INR weekly. That is an entire topic of its own and rather than go on about it here, there are many other threads on this topic. Here is one: my self management results for 2020

Please keep us posted on how things come along and feel free to ask any questions.
Hi Chuck,

Thank you so much for sharing your experience. I am 54 years younger and have recently finished all 48 4000 footers in the White Mountains, did a Pemi Loop of 33 miles over the summer, was a former figure competitor and am a personal trainer. I do understand all the intricacies involved with mechanical and tissue and mechanical is the way I'm going to go. I must admit I am not looking forward to this journey, but I want to live and get back to the life I've been enjoying. This is such a tough thing for those of us that are asymptomatic. Thanks again for your great advice!
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
1,175
Hi Redone.

I am 54 years younger and have recently finished all 48 4000 footers in the White Mountains,
I too like climbing mountains, both running and hiking. There was a run called the Mt Baldy Run to the Top, that was an 8 mile run starting at 6,000 ft elevation and ending at 10,000. So, dealing with a steep climb the entire time and also altitude and less oxygen accordingly. I ran it 3 times- it was brutal. More recently I have been climbing a local mountain, Mt. Monserate, 15 minutes from my house, which is a 1,154 ft elevation gain in just 1.6 miles= a 14% average grade. I did it several times per week in the lead up to my surgery and have done it post surgery without any issues. Not that I really had any doubt, but it was a wonderful feeling the first time that I climbed the mountain again after surgery. You will be climbing mountains again after you recover from your surgery, and if you want to do all the 48 4,000 footers again, you will be able to do so.

I must admit I am not looking forward to this journey, but I want to live and get back to the life I've been enjoying.
Life is a journey and sometimes we get set on paths not of our own choosing. But, we can always make the most of our own journey. There are many silver linings if you look for them. No one looks forward to OHS, but it is really just a bump in the road of your journey. You will be in recovery before you know it and getting energized with each little victory, whether it be climbing mountains again or whatever else you decide to take on.
 
Last edited:

Brinntache

Active member
Joined
Mar 25, 2021
Messages
31
Location
Hamilton, Ontario, Canada
Hey Redone,
Like Chuck and others I chose mechanical avr at age 50. I was very unsure of which route to take, and actually enrolled in a study looking at weather the Ross procedure or mechanical was the best option for people my age. Ended up in the mechanical side but was given the option of Going for a Ross procedure. It was really difficult to find clear information on the outcomes for someone my age without co morbidities.

My wife tracked down and old friend who is now the director of the of one top clinics in the world for doing the Ross procedure. He said simply for me the best choice was mechanical. Not Ross, not bio. One and done. With a tissue valve you are having another operation every 10 to 15 years, plus the downturn for two to three years before each re operation.

Life with warfarin isn't so bad. I took a tumble off my bicycle and did not go to the hospital. I did not bump my head so I saw no reason. And honestly, six months after my operation, I feel better and stronger that I have in the past three years.

I chose On-X because it was the valve my surgeon had the most experience with. I believe the quality of the operation is far more important then which valve you choose. I did a lot of deep dives into studies on potential outcomes and the number one factor seemed to be how many of these operations the institution and the particular surgeon did. In my case my surgeon was so used to mechanical valve surgery that he already knew exactly how long each part of the surgery would be and exactly when I would be out of surgery. Best of luck.
 

Redone

Well-known member
Joined
Sep 1, 2021
Messages
53
Location
Boston, Massachusetts
Hi Redone.



I too like climbing mountains, both running and hiking. There was a run called the Mt Baldy Run to the Top, that was an 8 mile run starting at 6,000 ft elevation and ending at 10,000. So, dealing with a steep climb the entire time and also altitude and less oxygen accordingly. I ran it 3 times- it was brutal. More recently I have been climbing a local mountain, Mt. Monserate, 15 minutes from my house, which is a 1,154 ft elevation gain in just 1.6 miles= a 14% average grade. I did it several times per week in the lead up to my surgery and have done it post surgery without any issues. Not that I really had any doubt, but it was a wonderful feeling the first time that I climbed the mountain again after surgery. You will be climbing mountains again after you recover from your surgery, and if you want to do all the 48 4,000 footers again, you will be able to do so.



Life is a journey and sometimes we get set on paths not of our own choosing. But, we can always make the most of our own journey. There are many silver linings if you look for them. No one looks forward to OHS, but it is really just a bump in the road of your journey. You will be in recovery before you know it and getting energized with each little victory, whether it be climbing mountains again or whatever else you decide to take on.
Hi Chuck,

Thank you once again for your message and words of encouragement! It is amazing you've run Baldy (I am familiar from being involved in the hiking community mainly on Instagram and Facebook). It's wonderful to hear you're back to your pre-surgery routine! I can't wait to be on the other side in all honesty. Two weeks from today. I am convinced the Mechanical Valve is the best choice and have read articles about the difference in regard to cardiac output. There are references to athletic individuals faring far better with Mechanical Valves and performance over tissue. I don't mind tracking my INR data at all. Even though it's an extra step it seems well worth it to me! My surgeon said, by the time a tissue valve begins to deteriorate it places additional stress on the heart while in this phase and by the time surgery is done (if even TAVR is an option, which for many it is not) it's like loading the heart with a lot of weight without a spotter. That's how he described it to me! So one and done it hopefully is! As to St. Jude or On-X I was leaning toward On-X in the hope Eliquis would be a possibility alleviating the need for regular INR testing. I know this is a long shot and is still being researched.

Again, thank you for your positivity! Due to my job, lifestyle and activity level it's been a huge blow for me, but I also have a tremendous amount of faith and am glad this was caught before something worse happened.
 

Redone

Well-known member
Joined
Sep 1, 2021
Messages
53
Location
Boston, Massachusetts
Hey Redone,
Like Chuck and others I chose mechanical avr at age 50. I was very unsure of which route to take, and actually enrolled in a study looking at weather the Ross procedure or mechanical was the best option for people my age. Ended up in the mechanical side but was given the option of Going for a Ross procedure. It was really difficult to find clear information on the outcomes for someone my age without co morbidities.

My wife tracked down and old friend who is now the director of the of one top clinics in the world for doing the Ross procedure. He said simply for me the best choice was mechanical. Not Ross, not bio. One and done. With a tissue valve you are having another operation every 10 to 15 years, plus the downturn for two to three years before each re operation.

Life with warfarin isn't so bad. I took a tumble off my bicycle and did not go to the hospital. I did not bump my head so I saw no reason. And honestly, six months after my operation, I feel better and stronger that I have in the past three years.

I chose On-X because it was the valve my surgeon had the most experience with. I believe the quality of the operation is far more important then which valve you choose. I did a lot of deep dives into studies on potential outcomes and the number one factor seemed to be how many of these operations the institution and the particular surgeon did. In my case my surgeon was so used to mechanical valve surgery that he already knew exactly how long each part of the surgery would be and exactly when I would be out of surgery. Best of luck.
Thank you for sharing your experience! I truly appreciate it! I agree and will likely go with the On-X Valve. I am hopeful eventually Eliquis will be an anticoagulant choice, but realize studies are still ongoing here. I have read the evidence that Mechanical Valves appear to be a better choice for highly active individuals regarding cardiac output and performance. My surgeon said, getting a tissue valve when the time comes around to replace it is like leaving the heart squatting too much weight without a spotter (this was his example). I hope to never go through this surgery again so it makes sense to me. I'm glad you've experienced a positive outcome and hope you get a lifetime of activity and joy out of doing what you love to do!
 

Redone

Well-known member
Joined
Sep 1, 2021
Messages
53
Location
Boston, Massachusetts
Hi



Your bio says:
Bicuspid Aortic Valve, Aortic Aneurysm and Anomalous Coronary Artery Reroute​

but it doesn't say your age. None the less those points are key to the issue. Mechanical valvers do occasionally find themselves in need of a redo, but typically this is due to either aneurysm (which you are getting fixed) or panus growth. The replacement of (part of) the aortic artery in repairing your aneurysm will mean that problem is no more and as I understand it panus comes down into the valve from the aorta above, so if I'm correct {please ask your surgeon} that will mean the other statistically significant driver of reoperation is gone too.

I would underscore everything that Chuck wrote and would further say that if you can push for it self management of INR is easy and I have helped a number of people over the years onto good self management paths. Self testing is of course the big improvement in this with devices (think what diabetics do) that you can test your blood and make your decisions and remain in the best possible place for the best outcomes.

This blog post may be way to much for you now, but I encourage you to keep the URL (web address) and refer to it (or just ask again here) when the time comes.






I initially felt that way too, but wound up with an ATS valve (which is performing admirably). Without getting too technical (we can do that if you like) I would say that 90% of the claims that On-X make (in particular its lower INR protocol) are a combination of wishful thinking, advertising spin and are (if you adhere to their low INR protocol) potentially harmful.

My advice would be to consider the St Jude, as these guys are literally the longest player in the game, have nothing to prove and are ultra reliable. (I said I wouldn't get technical, but the evidence is they are the only ones who actually make a valve that measures up to the claims made).

I'm not as active as you or Chuck, but have been a keen XC Skiing person (but now that I'm back in Australia, I'm not able to do that as easily as in Finland).

Lastly I'll say I've had 3 OHS (starting my career early at 10) and now is the first time in my life I feel like "I probably won't need another heart surgery again" ... its a good feeling.

If you go tissue prosthesis remember this: tissue prosthetic valves begin degrading from the time they go in. So the clock has started. The only unknown is "when" you'll need it.

The simple matter is (was and remains) that there is no definitive cure for valvular heart disease, instead we exchange valvular heart disease for "prosthetic valve disease" of which there are two major types:
  1. bioprosthesis
  2. mechanical prosthesis
(lets leave homograft and Ross out of this)
#1 is managed by redo surgery - there is no user intervention that is known to change outcomes. Redo surgery is required because the tissue (bio) prosthesis begins to degrade over time. Key indicators on the duation of the valve are: age (younger gets less time), body chemistry and (I would argue) intensity of exercise.

#2 is managed by your maintaining your INR in the right "numbers" ... as long as you do that you will have very low cases of harm (which can be either a bleed related injury or a clot) and the valve itself will outlast you.

So as long as you properly commit to your Anti Coagulation Therapy (warfarin) you will stand the best possible chance of a "one and done" and a normal outcome for the remainder of your life.

Best Wishes
Thank you for your response. I will update my profile, but I am 54 years young and am an athlete and personal trainer. I was offered the Ross Procedure, but decided against it as messing with my healthy Pulmonary Valve didn't seem like a good option to me. I'm so glad this will hopefully be your last surgery after 3 already! It's amazing you're X country skiing in Australia! Regarding which Mechanical Valve to choose I was considering the On-X mainly in hopes Eliquis might be a possibility in the future without the INR testing. I realize this is wishful thinking, but to have the option would be wonderful! Thank you for your feedback! I truly appreciate it!
 

Christyleedh

Member
Joined
Oct 22, 2021
Messages
21
I had an aortic tissue valve placed when I was 32, and a mechanical mitral valve at 37.
I’m now 40.

The first surgeon recommended the tissue valve even though I was young so I wouldn’t have to worry about warfarin. I did this with knowledge I would need another surgery in future.

Unfortunately, my mitral valve started to fail, and the second surgeon said I should do mechanical to avoid having to replace the mitral valve in the future- because apparently mitral valves tend to wear out sooner. So now I’m on warfarin, have had two open heart surgeries, and have an aortic tissue valve still needing replacement sometime in the future.

The problem is, I’ve had multiple silent and symptomatic strokes because of the mechanical valve (luckily with no lasting damage.) they are now recommending I replace the mechanical valve with a tissue valve to stop the strokes. (I have a higher INR range- and it still doesn’t stop the strokes).

(I have my own home monitor, check twice a week, take the same dose everyday, watch what I eat very carefully, and stay in close contact with Coumadin clinic- but my numbers still unexpectedly jump up and down with no apparent cause). From my understanding, this is not normal though and most people have a very low risk of stroke and have no problem managing warfarin.

Personally, I can’t wait to get rid of my mechanical valve because I’m tired of the strokes and managing diet, etc. but I also hate knowing I have multiple surgeries in the future-and Each one will be riskier than the last.

Despite all this, if I was young and otherwise healthy, (and didn’t know I couldn’t manage warfarin), and my sports activities were low impact, I would probably go for mechanical, because the thought of multiple future surgeries is pretty scary.

Just know that you can’t guarantee anything with either choice, but that whatever choice you made made sense at the time and you did your best trying to make the decision.

My best advice is to find the best surgeon possible. It made a difference between my two surgeries, and probably never would have needed the second, if I had a better surgeon.
 

Redone

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Mechanical valves themselves almost never fail. There are issues that can drive the need for another operation.

- Aortic Aneurysm, which is probably the most common driver for another operation. Far more common among BAV patients than among the general population. No certain way to guess if or when you’re going to face this. I did 19 years after having my mechanical valve put in.

- Panus growth, which is scar tissue that can develop around the valve and possibly obstruct driving the need to get in a clean it up. Rare but not unheard of.

- Then just other stuff. Some people get a size of valve that doesn’t work for them. Some have other heart issues (need a pacemaker or whatever) that drives further intervention.

But the valve itself? Practically bullet proof.

As far as athletes and warfarin, it depends. Are you insistent on playing high contact sports like American Football, Rugby, combat sports? Probably requires a bit more thought on how you’re going to protect against injury.

If you’re a runner, cyclist, hiking, other non-contact - you’re probably fine. Just a good idea to carry something letting EMS know you’re on warfarin so they take appropriate action in event of emergency.

I’ve been taking warfarin for over 30 years without any issues related to athletics. I’ve done mountain biking, road biking, downhill skiing, ice skating, basketball, school yard football, rec league softball, coached my kids in baseball (taking a couple line drives in coaches pitch) and lived to tell about it.
Thank you for your response and feedback! I will be replacing my Bicuspid Aortic Valve, Aortic Aneurysm of 4.5cm and reroute of Anomalous Coronary Artery for lack of a better word. Thankfully, my Aorta won't be an issue after surgery two weeks from today. I am definitely leaning toward the On-X in hoped there will be advancements to anticoagulant choice in the future and possibly the elimination of INR testing although if it remains the same I'll deal with it. The thought of having to repeat this again makes me lean toward mechanical as well as what I've read about athletic performance with mechanical valves over tissue. Thanks again for your response!
 

Redone

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I had an aortic tissue valve placed when I was 32, and a mechanical mitral valve at 37.
I’m now 40.

The first surgeon recommended the tissue valve even though I was young so I wouldn’t have to worry about warfarin. I did this with knowledge I would need another surgery in future.

Unfortunately, my mitral valve started to fail, and the second surgeon said I should do mechanical to avoid having to replace the mitral valve in the future- because apparently mitral valves tend to wear out sooner. So now I’m on warfarin, have had two open heart surgeries, and have an aortic tissue valve still needing replacement sometime in the future.

The problem is, I’ve had multiple silent and symptomatic strokes because of the mechanical valve (luckily with no lasting damage.) they are now recommending I replace the mechanical valve with a tissue valve to stop the strokes. (I have a higher INR range- and it still doesn’t stop the strokes).

(I have my own home monitor, check twice a week, take the same dose everyday, watch what I eat very carefully, and stay in close contact with Coumadin clinic- but my numbers still unexpectedly jump up and down with no apparent cause). From my understanding, this is not normal though and most people have a very low risk of stroke and have no problem managing warfarin.

Personally, I can’t wait to get rid of my mechanical valve because I’m tired of the strokes and managing diet, etc. but I also hate knowing I have multiple surgeries in the future-and Each one will be riskier than the last.

Despite all this, if I was young and otherwise healthy, (and didn’t know I couldn’t manage warfarin), and my sports activities were low impact, I would probably go for mechanical, because the thought of multiple future surgeries is pretty scary.

Just know that you can’t guarantee anything with either choice, but that whatever choice you made made sense at the time and you did your best trying to make the decision.

My best advice is to find the best surgeon possible. It made a difference between my two surgeries, and probably never would have needed the second, if I had a better surgeon.
Hi Christyleedh,

I am so sorry you've had issues with your mechanical valve, which is something that concerns me. I believe my surgeon is one of the best in the Boston, MA area. I'll find out as I'm two weeks away from the surgery and require a Bicuspid Aortic Valve replacement, Aortic Aneurysm repair and reroute of Anomalous Coronary Artery. Part of me wanted to put the surgery off for another year as I was told 1 - 4 years, but once Drs learned what I did (activity wise) hiking, heavy lifting, etc they said sooner is better. I will be thinking of you and hope they solve the situation you're dealing with. This is definitely not an easy situation for anyone and I feel for you! Thank you so much for sharing your experiences with me! I truly appreciate it!
 

pellicle

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Hi
I know there is a lot to consider, but truly it .ca me simplified into just go with the most reliable valve and the commit to being a good patient, getting the surgery and then weaving ACT into your life as you get into recovery

It's amazing you're X country skiing in Australia!
Err... my posting was a bit ambiguous, I've never XC skied in Australia, I did that in the many years I lived in Finland.


Best Wishes
 
Last edited:

Redone

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Messages
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Hi
I know there is a lot to consider, but truly it .ca me simplified into just go with the most reliable valve and the commit to being a good patient, getting the surgery and then weaving ACT into your life as you get into recovery


Err... my posting was a bit ambiguous, I've never XC skied in Australia, I did that in the many years I lived in Finland.


Best Wishes
Yes, I agree! To be honest I spoke to another cardiologist tonight about valve choice and now I'm more confused than ever. It appears most cardiologists recommend the tissue valve. My surgeon said this is due to their lack of interest in wanting to carefully track your INR numbers as it's more work for them. To me this is not an honest practice and it doesn't make sense to recommend a valve because it's too much work to track numbers. This new cardiologist works with athletes and said, he could do a cardiopulmonary test to measure Vo2 Max and determine if surgery can wait or not. How did you make a decision on when if you're asymptomatic?
 

pellicle

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To be honest I spoke to another cardiologist tonight about valve choice and now I'm more confused than ever.
indeed ... its now the standard process in the USA to do this ... everyone profits ... sometimes its even good for the patients.

My surgeon said this is due to their lack of interest in wanting to carefully track your INR numbers as it's more work for them
well to be honest it shouldn't be their jobs, patient self management seems to be unheard of in the USA, but then everyting there seems to be profit oriented.

How did you make a decision on when if you're asymptomatic?
that's sort of out of my area of strengths, but I would rely on the surgeons views. I would suggest that its better to get it done earlier than later ... the old days of "wait till the risk of death is high enough" are pretty stale by now IMO.

Get it sooner, get it healthier and recover better and sooner IMO. @Astro has something on this ... I'll see if I can fish it out sooner than he replies.
 
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