Mechanical vs Tissue - need help deciding

[pellicle]

Novel Technology Could Prevent Repeat Operations to Replace a Faulty Bioprosthetic Heart Valve

Novel Technology Could Prevent Repeat Operations to Replace a Faulty Bioprosthetic Heart Valve

March 2, 2022 – An international study led by a researcher from Tel Aviv University offers a novel technology that can assist many patients implanted with bioprosthetic heart valve by avoiding additional complicated replacement surgery. Many heart patients implanted with such valves are forced...

www.dicardiology.com

I went to the actual paper the above interpreted:

The role of antibody responses against glycans in bioprosthetic heart valve calcification and deterioration - Nature Medicine

In a large cohort of patients who underwent aortic valve replacement, antibody responses to glycans present in bioprosthetic heart valves, notably galactose-α1,3-galactose and N-glycolylneuraminic acid, were implicated in valve calcification and deterioration.

www.nature.com

Moreover, in mice, anti-Neu5Gc antibodies were unable to promote calcium deposition on subcutaneously implanted BHV tissue engineered to lack αGal and Neu5Gc antigens. These results indicate that BHVs manufactured using donor tissues deficient in αGal and Neu5Gc could be less prone to immune-mediated deterioration and have improved durability.

Somehow more realistic claims...

 

[carolinemc]

She never fully recovered from the stroke but she was ~80 and the effects were not too dramatic. The irony per this board's discussions was she went off warfarin to have a tissue valve installed. About 25% of older patients with a tissue valve wind up on anticoagulants for reasons other than their valve.

They go on warfarin for heart issues, many of them after it happens, like strokes or heart attacks, or other situations. And I am not an elder, and had Open Heart Surgery and Aortic Valve replaced with a St. Judes' aortic valve.

 

[David W]

It sounds like you made your choice but want affirmation it is correct. Both paths, mechanical and tissue are paths to life. There is not a wrong choice.

My surgeon and cardio told me to choose valve type based upon current technology. Do not make your choice based upon hope for the future to bring different technology. Even now, TAVR is not for all patients who need a replacement for their worn out tissue valve. TAVR is by the very nature of the technique a smaller valve.

At age 55 with a tissue valve, you will have valve deterioration that will result in a reoperation. When this happens depends upon things out of your control and beyond the ken of modern medicine. Modern medicine will tell you when it's needed through routine surveillance, but modern medicine can only about 1-2 years into the future.

You're worried about your sternum. It will be as strong or stronger than before. It takes about 6 months to fully heal if you are into heavy weight lifting or hard manual labor. Some doctors limit driving, others don't see the risk of an airbag deployment as very high and it happens even if you are a passenger. I could drive as soon as I was off narcotic painkillers, about 2 weeks after discharge.

When choices are hard, that usually means both paths have merit and there is no inherently wrong path.

If this forum is about choice and an understanding of a persons own life, then allow that person to make a choice and offer the reasons for that choice without dampening their own perceptions of their own problems.

 

[chilly56]

I had my AVR replaced in 2016 with the St Jude bi-leafed valve. I only hear the clicking when all is Very quite. At night I use a pillow and tuck it around my neck and it seems to help quite down any sounds from it. I also at times, feel a pulsing in my neck due to the valve not being a tissue valve which would soften the pulsing. I monitor my own INR because "to me" its a pain in the butt to go somewhere to have it checked periodically. My INR fluctuates from 1.5 to 3.9 and is not very easy to keep between 2.5 & 3.5 like is needed. It all depends on your diet and fluid intake.
The ONLY great thing about the mechanical valves is; your pretty much done with having anymore issues with the valve once installed. The negatives are Warfarin pills, INR monitoring, pulsing in the neck (for me) and occasional clicking sound when it's very quite.
I have a friend who is a bit younger than me who got the latest tissue valve (two years ago) and he does not take Warfarin, has no pulsing in his neck and and zero noise issues. The tissue valves are getting much better and are lasting 10 to 18 years. You can also get a TVR replacement valve installed up to 3 times (through the groin area) "IF" the tissue valve goes south but it depends on the person and the situation. The TVR's last 5 to 7 years as I have read somewhere.
If I could snap back to 2016, I would have chosen the tissue valve for the three reasons I mentioned above. Good luck on your decision and God Bless!!

 

[Timmay]

If I could snap back to 2016, I would have chosen the tissue valve for the three reasons I mentioned above. Good luck on your decision and God Bless!!

How old were you in 2016?

I am still somewhat confused by the choice to have more Open Heart Surgeries ... the choice of using a tissue valve. If you're 65 and fairly inactive (don't jog, weight lift, etc) then sure. Tissue valves make sense. But I just don't understand this path of doing a tissue valve at younger ages. Sure, the Edwards Inspiris Resilia valve appears to be awesome. But we only have 5 years of data. And what we do know suggests that it will give someone, hopefully, an extra 2-4 years. Remember, the younger you are when you get a tissue valve installed, the shorter it will last. Younger people's body chemistry will start calcifying that tissue valve pretty quick.

So let's say you're 55 years old. And you choose the Resilia Tissue valve.

It lasts to 65-70. You expect to get a TAVR. There is no guarantee on this. Look at Arnold Schwarzenegger's recent OHS. Went in for TAVR. Ended up with OHS. But, let's say you do get a TAVR. And let's say you get 15 years out of that TAVR.

You're now 80-85 years old. What do you do?! OHS? No freaking way, IMHO.

So, even at 55 ... You're gonna need another OHS and a TAVR (if ... IF you can have one).

Tim

 

[Om Gnome]

How old were you in 2016?

I am still somewhat confused by the choice to have more Open Heart Surgeries ... the choice of using a tissue valve. If you're 65 and fairly inactive (don't jog, weight lift, etc) then sure. Tissue valves make sense. But I just don't understand this path of doing a tissue valve at younger ages. Sure, the Edwards Inspiris Resilia valve appears to be awesome. But we only have 5 years of data. And what we do know suggests that it will give someone, hopefully, an extra 2-4 years. Remember, the younger you are when you get a tissue valve installed, the shorter it will last. Younger people's body chemistry will start calcifying that tissue valve pretty quick.

So let's say you're 55 years old. And you choose the Resilia Tissue valve.

It lasts to 65-70. You expect to get a TAVR. There is no guarantee on this. Look at Arnold Schwarzenegger's recent OHS. Went in for TAVR. Ended up with OHS. But, let's say you do get a TAVR. And let's say you get 15 years out of that TAVR.

You're now 80-85 years old. What do you do?! OHS? No freaking way, IMHO.

So, even at 55 ... You're gonna need another OHS and a TAVR (if ... IF you can have one).

Tim

Your mean spirited response is discouraging. I wanted to get a mechanical valve (age 57) but my heart function was compromised to the point that they were not sure it would restart after surgery. If ones heart does not restart they have to insert a pump to get it going, which they cannot do with a mechanical valve. So, because of that risk I had to get a tissue valve. Its good that you are happy with your choice but posting toxic and disheartening negative crap is a real bummer.

 

[Timmay]

Your mean spirited response is discouraging. I wanted to get a mechanical valve (age 57) but my heart function was compromised to the point that they were not sure it would restart after surgery. If ones heart does not restart they have to insert a pump to get it going, which they cannot do with a mechanical valve. So, because of that risk I had to get a tissue valve. Its good that you are happy with your choice but posting toxic and disheartening negative crap is a real bummer.

Wow. Ok. If that is considered mean-spirited then I don't know what to say. There was nothing mean in my explanation of how things will most likely turn out when choosing a tissue valve at a younger age and expecting NOT to have another OHS. It is extremely important that individuals are presented with BOTH sides of what can happen. You cannot present cakes, pies, roses, and unicorns with every choice. You need to be presented with both sides in order to make a good choice. And that is what this thread is all about - choosing between tissue and mechanical. It's a personal choice and the more data you have, the better you can make your choice. I can tell you right now that I wish I would have had even more data going into my surgery. Probably would have chosen the St. Jude's valve instead of the On-X and probably would have pushed even harder for a Bentall procedure.

 

[Unicusp]

Wow. Ok. If that is considered mean-spirited then I don't know what to say. There was nothing mean in my explanation of how things will most likely turn out when choosing a tissue valve at a younger age and expecting NOT to have another OHS. It is extremely important that individuals are presented with BOTH sides of what can happen. You cannot present cakes, pies, roses, and unicorns with every choice. You need to be presented with both sides in order to make a good choice. And that is what this thread is all about - choosing between tissue and mechanical. It's a personal choice and the more data you have, the better you can make your choice. I can tell you right now that I wish I would have had even more data going into my surgery. Probably would have chosen the St. Jude's valve instead of the On-X and probably would have pushed even harder for a Bentall procedure.

From my perspective, I did not find your response mean spirited. I found it to be objective, honest, and straight-forward. A response that I would also provide and expect to receive if I were looking for guidance and suggestions. Pretty ironic on your last sentence. My surgeon suggested the St. Jude (after the Resilia discussion) and I ended up choosing the St. Jude over the On-X. After surgery, he then informs me that he chose the On-X in surgery, as he felt it was a better fit to my specific anatomy. So far so good.

 

[Timmay]

From my perspective, I did not find your response mean spirited
...
I ended up choosing the St. Jude over the On-X. After surgery, he then informs me that he chose the On-X in surgery, as he felt it was a better fit to my specific anatomy. So far so good.

Thanks for the support. And Wow! - totally interesting on your surgeon's "in the moment" call. It was my understanding that the On-X is generally a more bulky valve and it's easier to achieve a good Patient Prosthesis Match with the St. Jude. To fit the 23mm in me (and I am 5' 10") they had to do an aortic root expansion. There are other reasons why the On-X kind of leaves me a little "Hmmmmm". The fact that the company has changed hands (or simply renamed) a few times is quite odd. Additionally, their INR study that recommends 1.5-2 is misleading in my opinion. I plan to stay 2.5+ while on the On-X given that there appears to be more clotting issues being reported than with the St. Jude's. But maybe that's just an opinion based on circumstantial evidence

Hopefully this is all just banter and doesn't pan out to be anything negative with our valves . I'm super happy to be given this second chance at life ... at only 50. I know that there have to be 10's of thousands of these valves in use (if not more) so fingers crossed that we have decades of trouble-free ticking

 

[pellicle]

Your mean spirited response is discouraging.

pardon me, but "like WTF"?

firstly I think its way too early to make a comment like that when someone is actually being helpful. Men should be able to talk to each other like men (not purposely taking offense like a bunch of fragile snowflakes).

An adult should be able to accept that "there is ambiguity in text messages" and that it takes a few examples of what someone says to remove that and judge. Right now I think such a call is premature.

You don't know @Timmay yet, but I do and I can say that from what I know of him he's the least mean spirited person I know.

I suggest you watch this segment, maybe go on to watch the whole movie to see an example of a man who actually cares but is perhaps not so "woke" in his speech ...


... and consider asking yourself if your comment and accusation may have been based on a context of some post surgical depression (very real) and not a true reflection of who you would otherwise be.

lastly people have said to me (here) that honey attracts more flies than vinegar. To which I reply "and bullshlt attracts even more, but why do I want to attract flies?

I come here for genuinely helping others, not blowing smoke up their arse. So if you construed Timmays words as hurtful somehow, the why not actually point out the specifics and ask "what did you mean by this" before pronouncing "mean spirited" sentence. Because if he just spoke in a way that rankled you but intended the best then it was not mean spirited.

Best Wishes

 

[Unicusp]

Agreed. I declined to participate in that study and target INR of 2.5. I also got a 23mm and those were the exact descriptive words my surgeon used "it's bulky". I had my ascending aorta replaced with Dupont Dacron 7 years earlier at 52.
And back then my surgeon said if you need a valve in the future we can do TAVR. Fast forward 7 years to hear that I'm not a TAVR candidate due to resurgery. Full sternotomy resulted in less issues than the less invasive mini.

 

[Unicusp]

pardon me, but "like WTF"?

firstly I think its way too early to make a comment like that when someone is actually being helpful. Men should be able to talk to each other like men (not purposely taking offense like a bunch of fragile snowflakes).

An adult should be able to accept that "there is ambiguity in text messages" and that it takes a few examples of what someone says to remove that and judge its premature.

You don't know @Timmay yet, but I do and I can say that from what I know of him hes the least mean spirited person I know.

I suggest you watch this segment, maybe go on to watch the whole movie to see an example of a man who actually cares but is perhaps not so "woke" in his speech ...


... and consider asking yourself if your comment and accusation may have been based on a context of some post surgical depression (very real) and not a true reflection of who you would otherwise be.

lastly people have said to me (here) that honey attracts more flies than vinegar. To which I reply "and bullshlt attracts even more, but why do I want to attract flies?

I come here for genuinely helping others, not blowing smoke up their arse. So if you construed Timmays words as hurtful somehow, the why not actually point out the specifics and ask "what did you mean by this" before pronouncing "mean spirited" sentence. Because if he just spoke in a way that rankled you but intended the best then it was not mean spirited.

Best Wishes

Loved that movie. And Clint was nasty at times, but he meant well and tried to do the right thing. Some of his nick names. Oh man. But he pulled it off.

 

[pellicle]

Hey Chilly

I monitor my own INR because "to me" its a pain in the butt to go somewhere to have it checked periodically. My INR fluctuates from 1.5 to 3.9 and is not very easy to keep between 2.5 & 3.5 like is needed. It all depends on your diet and fluid intake.

if you want to reach out I can perhaps give you some help on managing your INR better. The 1.5 is a mild concern (and if its often, then a more significant concern) but 3.9 is pretty well fine. If it puts your mind at ease a very extensive study (over 2000 patients and over a number of years) puts the risk ratios like this:

Also INR can usually be managed around various issues that come up in post surgical life, and sadly the INR management by Clinics in the USA is not really up to snuff or of particularly high standards.

I hope the following blog posts provide you some more confidence

Grapefruit and Warfarin

Basically people either like Grapefruit or don't. I'm firmly in the bank of "why would I drink something that I have to ply with so much sug...

cjeastwd.blogspot.com

Perioperative Management of INR

Eventually one finds that some sort of small surgery is needed, for those of us on warfarin (perhaps after a large surgery such as a heart v...

cjeastwd.blogspot.com

another example of perioperative management of INR around a small procedure

I needed to have a little surgery to remove arthritis from my toe, so this being a peripheral surgery where bleeds were less likely (because...

cjeastwd.blogspot.com

rapid dust off perioperative INR management

A post on the management of Anti Coagulation Therapy (ACT) by Vitamin K Antagonist (VKA) - Warfarin I've decided to call this the rapid Du...

cjeastwd.blogspot.com

Superglue as a wound dressing

For those of us on warfarin (and maybe some others) abrasions and mild cuts bleed like stuck pigs (as the saying goes). As I age my skin see...

cjeastwd.blogspot.com

and lastly:

Managing my INR (some practical tips observations and theories)

A patients perspective I've decided to put this page together because on looking around the internet I see heaps of rubbish, mis-informatio...

cjeastwd.blogspot.com

I hope that helps you in your journey.

Best Wishes

 

[pellicle]

And Clint was nasty at times, but he meant well and tried to do the right thing.

exactly my point ... he seemed mean, but his heart (or spirit) was always in the right place.

 

[AZATADINE]

the choice of using a tissue valve. If you're 65 and fairly inactive (don't jog, weight lift, etc) then sure. Tissue valves make sense. But I just don't understand this path of doing a tissue valve at younger ages.

In fairness, that's fine from your point of view. You chose mechanical and I"m sure you made the choice knowing all of the pros and cons based on your lifestyle etc.

I chose tissue at 52 and I'd make the same choice again, knowing as I did, that I'd require further intervention down the line. Even still, 8 months after surgery, I'd make the same decision because it was right for me and it was an informed decision. No medication, no clicking, ride horses, drink alcohol without any concerns on INR etc. Horse riding is pretty much a no no if using warfarin (or at least a significantly elevated risk) and that was part of my decision making.

I guess my point is that my choice to go with tissue was my choice and while you may not understand it, I do, and I'd do the same again .

 

[Timmay]

In fairness, that's fine from your point of view. You chose mechanical and I"m sure you made the choice knowing all of the pros and cons based on your lifestyle etc.

I chose tissue at 52 and I'd make the same choice again, knowing as I did, that I'd require further intervention down the line. Even still, 8 months after surgery, I'd make the same decision because it was right for me and it was an informed decision. No medication, no clicking, ride horses, drink alcohol without any concerns on INR etc. Horse riding is pretty much a no no if using warfarin (or at least a significantly elevated risk) and that was part of my decision making.

I guess my point is that my choice to go with tissue was my choice and while you may not understand it, I do, and I'd do the same again .

Thank you so much for posting. Very much. It's important that individuals can come here and see both points of view. That's what this thread is all about. And you're right on! I don't need to understand it (although I like to made sense of things). That said, in your case case I do understand your decision. Thanks for sharing! The key point here for me is that you were aware of, understood, evaluated, and truly accepted that you'd "require further intervention down the line" ... and you've accepted all of what that further intervention means. That is awesome and exactly what I, personally, believe people need to do. Too many horror stories of people being led down the path of a tissue valve indicating that it will last 15-20 years and needing another OHS significantly earlier ... or accepting a tissue valve to find out later that they will need to be on Warfarin anyhow.

Thanks again for your post.

 

[AZATADINE]

You are welcome .

One other comment that I have is that the warfarin wasn't as big a deal as I'd feared it would be beforehand. I was on warfarin for 3 months post op and getting it dialled in was a PITA in the first couple of weeks after release but it was straightforward enough after that.

 

[PeterII]

Although I am a retired mathematical engineer i do not like using statistics to send a message across to illustrate my point of reference. So, in simple words, Tissue or Mech(Jude/OnX), If you are 70+ a tissue valve should, most likely, last you 15-17 years, at that point IF you still need a valve, then TAVI may or may not work, Besides, TAVI inserts a Valve INSIDE your old valve and the 2 people i know that went that way after their Pig Valve expired after 12 years, then TAVI worked for them, and lasted 3 Years, so, yes, you can get a TAVI maybe, but that TAVI will NOT last another 15 years, talk to a Surgeon, do not talk to Cardiologists, they are on a different business and Big Pharma pushes a lot. That said, i am not happy i was born with a Bicuspid Valve, but i dislike more to be inside a hospital exposed to Viruses of all kinds and placing my family "again" under that stress, so yes, not happy i had an OHS, but yes, happy i got it done and thats it, i got an Onx as that is the only valve my surgeon uses, Surgeon #2 in the Country, but i know complete Hospitals in other countries that only use St Jude because that is what they have always used, Come from a family of 12 Doctors so i do have lots of stories. INR ?, i target 2.0, and it goes from 2.5 to 2, and is now 6 years. This is "My" point of reference, does not need to be right, nor needs to be wrong, is just My Experience.

 

[kentuckyed]

Wow, 21 pages, 418 postings, May 2019 to June 2022. And we still don't have the definitive answer. Maybe there is no definitive answer. Is 15 years of no warfarin, no clicking, no diet watching worth 30+ years or warfarin, clicking, diet monitoring? Who knows. Nobody lives forever.
I really appreciate people expressing their opinion cogently, and I've learned quite a lot on this forum. But I just gloss over the conversation when it degrades into an argument. I don't think anybody learns anything during an argument.

 

[Mister_James]

Wow, 21 pages, 418 postings, May 2019 to June 2022. And we still don't have the definitive answer. Maybe there is no definitive answer. Is 15 years of no warfarin, no clicking, no diet watching worth 30+ years or warfarin, clicking, diet monitoring? Who knows. Nobody lives forever.
I really appreciate people expressing their opinion cogently, and I've learned quite a lot on this forum. But I just gloss over the conversation when it degrades into an argument. I don't think anybody learns anything during an argument.

False argument.
Almost all mechanical valvers will have zero valve replacements in 10 years. They may have a heart surgery because of other issues but not valve failure. Operating word ALMOST.
On the other hand, MOST under 50 with tissue valves will have surgery again and after second surgery end up with more complications and some end up on medications, pacemakers etc BECAUSE of the tissue valve.
A mechanical valver who needs a new valve is an exception, a tissue valver who does not need a new valve is an exception.
Yes I click, yes I monitor my INR.
Now if folks in this room say they are not on any meds, I think those are the exception...where are rate control, statins, BP meds, cialis/viagra folks?