Mechanical vs Tissue - need help deciding

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Chuck C

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you have to make decisions about not just yourself, but about yourself in 10 years, yourself in 20 years .
This was a key reason why I changed my mind about valve type. As you know, I was originally planning to go tissue, but then switched to mechanical. I kept thinking how difficult it is to get those echos every 6 months and to always get bad news- things have become a little (or a lot) worse. If I went tissue, at some point, probably after 7-9 years, I would be told that SVD has started and we better start upping the frequency of the echos and watch it closely. Whereas with mechanical valves, apparently, what is more common is to be told that things have looked the same for so long that you need less frequent echos. I'd much rather be getting that news.
 
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pellicle

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Whereas with mechanical valves, apparently, what is more common is to be told that things have looked the same for so long that you need less frequent echos. I'd much rather be getting that news.
my last consultation with my cardio was very encouraging, in summary "doing very well with INR management, tolerates exercise well, we'll book in for a 10 year CT scan and discuss after that"
 

krosson62

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You are missing out on life. I stop kids putting things in their mouths with a story about how I swallowed my daddy's favorite watch and they can hear it for themselves.
And the know it all adults who say is that your pacemaker ticking? NO! I have a mechanical heart. They do make them. I charge it up once a month.
Love that story hope u dont mind if I borrow it now and then?
 

krosson62

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This was a key reason why I changed my mind about valve type. As you know, I was originally planning to go tissue, but then switched to mechanical. I kept thinking how difficult it is to get those echos every 6 months and to always get bad news- things have become a little (or a lot) worse. If I went tissue, at some point, probably after 7-9 years, I would be told that SVD has started and we better start upping the frequency of the echos and watch it closely. Whereas with mechanical valves, apparently, what is more common is to be told that things have looked the same for so long that you need less frequent echos. I'd much rather be getting that news.
I just had my 1yrs follow up and had echo 2wks before that at the follow up was taken of all meds cept warfarin and told didnt have to return for a year. But had to keep up with INR TESTING which is real pain. Make sure you get all details for that!!
 

Chuck C

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But had to keep up with INR TESTING which is real pain. Make sure you get all details for that!!
Hi.
I'm curious why you find INR testing a real pain? I self monitor once per week and it is super easy. Bought a used Coaguchek xs for about $230 and test strips can be bought on Ebay that average to about $6 per strip. I find it relatively easy to stay in range and testing takes about 2 minutes per week.
 

almost_hectic

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My On-X is something I can hear every day. Not at all times, but if Im in a quiet room and theres no other noise, for sure I can hear it. Id rather I didn't hear it, but it doesn't bother me much. Sometimes at night if I can't sleep, then I can also hear it. I usually manage to ignore it, or put on some background noise, sometimes music, usually a rain storm track. That aside, I still think even with the noise Id rather not hear—Id sure as hell rather not go through that surgery again. And thats my goal, one and done. Pray I never have any other complications that require another heart surgery. I already have an aortic graft, so an aneurysm isn't likely going to happen again. I have an atrial appendage clip and thats likely never coming out.

From time to time, Ive wondered if I could go to someone who could maybe hypnotize me and convince me that I can no longer hear my valve clicking.
 

Chuck C

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are you self testing or being forced into a lab to get a vein draw?

Mine literally involves this
(I say literally because that's me)
Excellent demo video!

That was a big drop- I'll have to try the tourniquet method. I'd had to toss a few strips because my drop was too small.
 

pellicle

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That was a big drop- I'll have to try the tourniquet method
I had a discussion about this with the mate who's a pathologist. He said something like: "there will be some people who'll tell you that somehow the blood chemistry can be altered by a torniquet being applied BUT ", he continued " if you ask them what that might be and what evidence they have for that the conversation turns less definite"

My view is that if you keep the time between "wrap and puncture" very short (seconds) then there is no likelihood anything will be changed. If there was a difference then I'd see that appear in the with and without tests I have done in the past. That I'm usually withing 0.2 INR units away from a vein draw I'm calling it "none or insignificant"
 

Chuck C

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Hello All! I'm new here a personal trainer. After being offered the Ross Procedure I have decided against it and am going with a tissue valve. I am very active, a former figure competitor, hike 4k's in New Hampshire and do a lot of resistance training. Valve choice is a confusing process in my opinion. I haven't had the surgery yet, but am completely dreading it! I don't like taking time away from my clients, working out (also not a huge fan of cardio other than hiking). I probably should have put this comment under another thread, but I hope someday advancements in this procedure will go far beyond the TAVR! It seems like we should be way ahead now. My biggest fear is the healing of the Sternotomy and possibly having future limitations to getting back in shape i.e. pull ups, bench press, tricep extensions, etc.
Welcome to the forum Redone!

We have a lot in common. Both born in 1967 and both physically active. I had my aortic valve replacement 6 months ago, so I can relate to what you are facing with concerns about the surgery and the issues around valve choice.

I think the best strategy is to just accept that the surgery must happen, the odds are overwhelmingly favorable for you, and to look forward to waking up in recovery and to beginning the healing process and beginning your return to top physical condition. You will wake up in recovery and you will return to top form little by little, which can actually be a very rewarding experience.

I detail my experience in this thread, including my thought process before surgery and my recovery.

I've crossed the line into severe and need to make a decision

I can tell you that once you are a few months out from surgery, your cardiologist will likely clear you to resume all your physical activities and you will almost certainly eventually get back to100%. Look forward to each victory as you return to your former conditioning. For the past two months I have been hiking up mountains, doing hard cardio at the gym, including HIIT (High Intensity Interval Training). I have been lifting weights hard and flipping the 220 pound tire up and down the cross fit area without any pain or difficulty. You mention concern about resuming pull ups, bench press and tricep extensions. Well I do all of those hard, in addition to bar dips, which put a lot of stress on the sternum as well. No issues whatsoever for me.

You may have already made up your mind on valve selection but I would encourage you to not rush your decision. Take your time to do your due diligence. Make a long list of pros and cons of each valve and try to be as realistic and honest with yourself as you can.

I came to the forum certain that I was going with a tissue valve because I wanted to continue with my physically active lifestyle, but ended up changing my mind and choosing mechanical. Hearing others talk about the active lives that they live on warfarin and the ease of self-monitoring INR was crucial in changing my mind. I really do not want to have another surgery and so it became a matter of being willing to take a daily pill and stop hard contact sports, like boxing, in exchange for the probability of avoiding future valve surgeries. When I was leaning heavy tissue, I was hoping I would get 15-20 years out of the new Edward’s Resilia valve and then just pop the next replacement through my leg with a TAVR. Ultimately, I determined that it would be prudent to make my decision based on the current evidence and not based on hope. The reality, after consulting with the top valve surgeon at Cedars Sinai and the top valve surgeon at UCLA, is that at my age I could only expect 10 years out of a tissue valve, based on the current evidence. I might get lucky and get more because of the “hope” that Resilia will last longer, but there is no data to support that it will actually last longer, as they only have 5 years of human data published for this new valve. Also, getting a TAVR in the next surgery is not a certainty. They need to evaluate you for TAVR and not all qualify, for reasons such as uneven calcium build up on the tissue valve. I was evaluated for TAVR for my first surgery, just so that I was aware of all my options. Echo confirmed that I was not a candidate due to uneven calcium deposits on my native valve.

Anyway, the choice is yours and only yours. There are pros and cons for each valve. I don’t share the above info to try to sway you, but just to share the evolution of my thought process. The important thing is to make the decision based on which is the best choice for you. Whatever you decide, we will all be here to support you and cheer you through your recovery.
 

Duffey

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This was a key reason why I changed my mind about valve type. As you know, I was originally planning to go tissue, but then switched to mechanical. I kept thinking how difficult it is to get those echos every 6 months and to always get bad news- things have become a little (or a lot) worse. If I went tissue, at some point, probably after 7-9 years, I would be told that SVD has started and we better start upping the frequency of the echos and watch it closely. Whereas with mechanical valves, apparently, what is more common is to be told that things have looked the same for so long that you need less frequent echos. I'd much rather be getting that news.
I had an Edwards bovine aortic valve implanted in 2005. My cardiogist schedules an echocardiogram only once every two years. My last appointment was in October of 2020, and to come back in October, 2022. If I had any problems or concerns, to call. My point is . . . you can’t project or speculate too much into what may or may not happen in the future. I never expected my tissue valve to last this long, but it has. I was 52 when it was implanted. Each person has their own reasons for their choice, and I personally think the continual rehashing of opinions and possibilities is counterproductive. Life is a gamble. Make your choice and get on with your life, because that’s the guarantee a mechanical or a tissue valve implantation gives you.
 

Chuck C

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My point is . . . you can’t project or speculate too much into what may or may not happen in the future. I never expected my tissue valve to last this long, but it has
It is definitely an individual choice. Some may feel that life is just a gamble and that they should go with whatever valve feels right and then hope that they are a statistical outlier, one of the lucky gamblers who get 15+ years from a tissue valve even if they are young. Others prefer to look at the data and the opinions of experts to determine the most probable life expectancy of their valve choice and base it on that.

No wrong choices, just individual differences. Personally, I prefer not to gamble when I can avoid it and prefer to look at the data and experts to try to determine how long my valve should last should I make one choice or the other. The statistics and the experts said that I should expect to have at least 3 or 4 surgeries if I chose tissue, given my age and life expectancy. Perhaps I would be lucky like you and would defy the statistics and get 16+ years. I chose not to gamble and not to base my decision on hope.
 

Chuck C

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Each person has their own reasons for their choice, and I personally think the continual rehashing of opinions and possibilities is counterproductive. Life is a gamble.
I guess I'm going to have to disagree here. The title of this thread is "Mechanical vs tissue- need help deciding". So, clearly the original poster was seeking to have a discussion on the topic and others come to this thread seeking to participate in the ongoing discussion. It seems that the sharing of personal experience and opinions is very much one of the main purposes of this forum.
 

pellicle

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and I personally think the continual rehashing of opinions and possibilities is counterproductive
If it were only among us I would agree with you, but we get new members who ask questions and it really is a dynamic community here not just a library.

Besides you may notice there is no black and white answers, you may notice that I at least always want to know age and situation, that I ask about other underlying conditions (like BAV) and direct my advice and thoughts based on that.

Imagine a scenario, that somone about 38 joins (you know, the age Dick was when he had his valve done) and everyone just says "go with tissue because that won't require ACTherapy" ... Dick would have by now been facing his third surgery. How would that be for him, how would that be for the family.

So re-hashing is essentially re-discussing for people who are new and who genuinely "didn't know that"
 
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elMIguel

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I guess I'm going to have to disagree here.
I second this. I’m 6 1/2 months post AVR and was oblivious to my condition until I was diagnosed 9 months ago. I’m appreciative to this community for being so open and patient with newbies. I realize that much of this information can be found in searching through old forum threads and that a lot of it may seem redundant,, but it’s nice to have veteran members here willing to share and debate their views on a variety of relevant topics to those of us early in this journey.
 

Hyp2r

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I had an Edwards bovine aortic valve implanted in 2005. My cardiogist schedules an echocardiogram only once every two years. My last appointment was in October of 2020, and to come back in October, 2022. If I had any problems or concerns, to call. My point is . . . you can’t project or speculate too much into what may or may not happen in the future. I never expected my tissue valve to last this long, but it has. I was 52 when it was implanted. Each person has their own reasons for their choice, and I personally think the continual rehashing of opinions and possibilities is counterproductive. Life is a gamble. Make your choice and get on with your life, because that’s the guarantee a mechanical or a tissue valve implantation gives you.
That’s a great story Duffey, so pleased to hear.
I tend to take things as they come - I certainly don’t sit back worrying if my tissue valves will last and that I should have gone mechanical. Whatever will be will be.
Just get on and enjoy life that we have been given.
If something does happen, I’ll deal with it then.
 
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