Mechanical vs Tissue - need help deciding

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Mister_James said:
Don't ask us in here. Talk to your doctor...
Anything else is trolling people.
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Thank you ... and if I may further that "don't come here complaining about your doctor because "he or she knows best and none of us are doctors anyway"

I get very tired of the views (often from the same person) to trust the medical professionals and then complain about their advice in a different post.

Doctors are not magicians or gods they offer only medical opinions. Which is why, as Mister James has pointed out, you can go and get any number of them and look for the common threads (if any) in their answers.
 
pellicle said:
As identified by Neil (a card carrying tissue prosthetic valve supporter) some time back "why are you even here"

You bring nothing supportive and just do drive by criticism.

If I were a moderator here you'd have had the tap on the shoulder by now.
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I didn' hear you denying any of it so I will take that as a "No apology necessary"
 
hevishot said:
I didn' hear you denying any of it so I will take that as a "No apology necessary"
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you can (and will) believe what you like. I would take any apology from you with the same seriousness as any comedy, because you're so thick you can't even see when people are joking.
 
le19555 said:
The big thing to me with a mechanical valve was the noise. I was all set on a mechanical valve until I read many comments on YouTube about people having mechanical valves and the clicking noise was driving them insane especially. I couldn’t even imagine dealing with that for 30+ years. Some were considering having it removed in favor of a tissue valve. Add to that the bleeding risk and the need to take rat poison the rest of my life. No thanks.
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On 1/11/2022 I will have my 10 year anniversary of a St Judes Mechanical Valve and Aortic Arch replacement. I just turned 62 yesterday. My valve has worked flawlessly, including a trip to the ER after getting infection after Prostate Cancer surgery. When I arrived at the ER my Resting Heart Rate was 204 BPM. Within short order medication got me back down to normal rythmn. The x-rays showed my aortic valve was unscathed. Prior to surgery, I was back and forth regarding valve choice. In the end, I opted for mechanical due to the slim chance of reoperation. My reasoning was:

1. what will my overall health be like when I need OHS again,
2. what will be the recovery time on OHS #2,
3. what insurance coverage will I have when reoperation occurs.

I spent endless hours scouring these and other message boards, talking to people from both sides of the fence, and asking Drs. for their opinions. When I came home from surgery the valve was loud and annoying. Before long both my wife and I barely notice it. I have rested several young babies on my chest and rocked them to sleep when nobody else could (might it be the sound of a heart beating that they were so accustomed to in the womb?). I have my INR checked 1x/month and there ahs been minimal changes to my dosage of "rat poison". My only bleeding issue came after my prostate surgery and a catheter had been improperly positioned. It caused irritation and the formation of clots in my bladder. After reducing my "rat poison" dosage for a week the clots went away and I was able to return to normal. I have had 2 coloscopies and my prostate surgery. In those cases I needed to "bridge" off the blood thinners. This was not an issue, I needed to inject myself with a short life blood thinner before and after those procedures. I had no ill events with bleeding during any of those procedures. And the last comment is about what you can and cannot eat. I lover greens and salads. I can eat as much as I want, as long as I am consistent. The key is to establish a consistent diet of those Vitamin K vegetables, adn the experts will dose to meet your specific body. I do not count the meals or amount of K that I eat, I just know to be fairly consistent. I understand everyone can be different, some more sensitive than others. I am merely sharing my experience, and will end with this "If I had to do over would I change my choice of valves? The answer is NO". Whatever choice you make, is the right one for you. Live with it, own it, and be at peace with it.
God Bless and Take Care!!
 
thos_huxley said:
Anyone here familiar with "valve cracking"? Should I go ahead with the TAVR and assume that ten years of R&D will make any future procedure more predictable?
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if you mean the cowboy practice of over inflating a balloon via catheter to widen the gap to have a broken shell of the frame of the previous valve to allow valve in valve, then yes.

Do you really want a squeezbag (the heart) to have a broken sharp edged hunk of plastic in there?

Well assuming you're ok with that then the next thing is that not all valves are amenable, some are designed to not break (who'd have thought that was a good idea).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872348/
see table for those which wouldn't crack ... don't get that one (or get that one if you are safety oriented)

1639091585727.png


1639091635853.png


and some people are worried about a sound which despite best efforts to get anxious about are mostly not noticed in daily life or after 10 years ... but then who expects another ten years anyway?

Surgeons spend a lot of time coming up the path of surgery, proving their competence. I'm told this is an actual picture of an Interventional Cardiologist at a conference of Thoracic Surgeons in the US.

interventional cardiologist.jpg
 
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Warrick said:
turns out you cant say **** in a post
Hes a **** head
**** **** **** **** head
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What are you talking about? You can totally say "lunk" here.

Lunkhead

" A lunk head is (usually male) someone who lacks creativity, is very slow on the uptake on understanding situations, is not well read or well informed politically or intellectually, is most likely barely literate, has not desire to educate themselves, no intellectual activity, has no ability to plan for the future, and has very little perception skills, if they do read anything, it is usually a low level tabloid newspaper, has no hobbies outside of watching televison "

https://www.urbandictionary.com/define.php?term=lunk head
 
eftdan said:
I had my AVR at 45, tissue valve. Both my cardiologist and surgeon, while they were keep saying, "it's your decision, we're not trying to influence you", were obviously pushing for tissue valve.. The whole industry is pushing for tissue valve, "this is where the future is", they'll tell you... While the future might be there, we live in the present, I'm 53 now and I can feel that soon, few more years maybe, I would have to go again through the same ordeal... and I kind of regret the decision I made back then. Eating well, going to gym, keeping yourself in shape, sure, it's important, but this won't save you from future surgeries, especially if you are 'relatively' young. It all depends from individual to individual, of course, but as a basic rule of thumb, one younger that 55 should go with mechanical, 55 to 65, SAVR tissue and over 65, SAVR or TAVR tissue.
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Agree with everything except last sentence. Valve choice (in my opinion) should consider expected/projected lifespan. Sure, if you plan to die by 75 then yeah go with tissue in your example. But, if you plan to live until 90 or 95, you certainly do not want to look forward to re-surgery again, in your late 80's or 90's. Not likely to be successful at that point.
To each his own!
 
pellicle said:
if you mean the cowboy practice of over inflating a balloon via catheter to widen the gap to have a broken shell of the frame of the previous valve to allow valve in valve, then yes.

Do you really want a squeezbag (the heart) to have a broken sharp edged hunk of plastic in there?

Well assuming you're ok with that then the next thing is that not all valves are amenable, some are designed to not break (who'd have thought that was a good idea).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872348/
see table for those which wouldn't crack ... don't get that one (or get that one if you are safety oriented)

View attachment 888269

View attachment 888270

and some people are worried about a sound which despite best efforts to get anxious about are mostly not noticed in daily life or after 10 years ... but then who expects another ten years anyway?

Surgeons spend a lot of time coming up the path of surgery, proving their competence. I'm told this is an actual picture of an Interventional Cardiologist at a conference of Thoracic Surgeons in the US.

View attachment 888271
Click to expand...

Hey, I remember that photo well!!! That's you in your cowboy outfit shaking hands with your buddy Buckaroo Banzai. Fess up man.

(That's me in the background in the suit with the redshirt)
 
eftdan said:
I had my AVR at 45, tissue valve. Both my cardiologist and surgeon, while they were keep saying, "it's your decision, we're not trying to influence you", were obviously pushing for tissue valve.. The whole industry is pushing for tissue valve, "this is where the future is", they'll tell you... While the future might be there, we live in the present, I'm 53 now and I can feel that soon, few more years maybe, I would have to go again through the same ordeal... and I kind of regret the decision I made back then. Eating well, going to gym, keeping yourself in shape, sure, it's important, but this won't save you from future surgeries, especially if you are 'relatively' young. It all depends from individual to individual, of course, but as a basic rule of thumb, one younger that 55 should go with mechanical, 55 to 65, SAVR tissue and over 65, SAVR or TAVR tissue.
Click to expand...

Your rule of thumb can poke you in the eye :) There is no real rule, that's why people get choices. The only rule is you will die if your valve is not replaced.
 
just read through this thread and checked my genotypes on 23andme

rs2108622 : CC
rs12777823: AG

certainly explains the low warfarin dose I require to keep me in range (1.5mg/day)

" The rs2108622 (V433M) variant in this gene, a C>T missense SNP with global MAF 0.24, designated as the *3 allele (CYP allele nomenclature website at http:// www.cypalleles.ki.se/) has been associated with warfarin dose. Several studies have reported an association between the T allele and increased warfarin dose requirements [29–32]. A recent meta-analysis estimated that subjects with the rs2108622 T allele required an 8.3% higher warfarin dose than those with the CC genotype
We found an association between rs2108622 (V433M) in CYP4F2 and INRVAR in European-Americans; subjects bearing one or more copies of the T allele had significantly lower INR variability compared with those with the C allele"

" A study of Italian patients concluded that rs2108622(T;T) patients require 5.49 mg/day of warfarin versus 2.93 mg/day for (C;C) patients. Analysis of variance indicates that about 7% of mean weekly warfarin dose variance is explained by CYP4F2 genotype. "
 
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