MVR and AVR soon

[IgorClearwater]

Hello everybody.
I am 59 and very active, facing a double valve replacement, and would like to proceed with the surgery within a couple of weeks.
I had AVR with St Jude's valve done in 2002. Now after the TEE test, it looks like my MV is in a bad shape and so is AV.
I have very light symptoms which I thought was normal and still is very active exercising practically daily
My AV after the surgery was showing gradient 60 and currently, ist's around 80. The high gradient is probably what damaged my MV.
I would like to go for surgery at Cleveland Clinic in Cleveland, OH.
I will appreciate it if you can share your experience having the surgery, the quality of the surgery, and the best way to contact Cleveland Clinic to schedule a second opinion and perhaps a surgery.
Thank you in advance!
Igor

 

[MdaPA]

I will appreciate it if you can share your experience having the surgery, the quality of the surgery, and the best way to contact Cleveland Clinic to schedule a second opinion and perhaps a surgery.

My wife had her 2nd and 3rd OHS' at Cleveland Clinic. She would go back there in "a heart beat" if she needs another procedure (hopefully not). Their heart institute and doctors are among the best.

Check out the below URL. Contact info on top right.

For the 26th consecutive year, Cleveland Clinic’s heart program has ranked as the best in the nation, earning the No. 1 ranking in U.S. News & World Report’s “2020-21 Best Hospitals.” Since 1995, no hospital in the country has ranked higher than Cleveland Clinic in cardiac care.

Miller Family Heart, Vascular & Thoracic Institute | Cleveland Clinic

 

[IgorClearwater]

My wife had her 2nd and 3rd OHS' at Cleveland Clinic. She would go back there in "a heart beat" if she needs another procedure (hopefully not). Their heart institute and doctors are among the best.

Check out the below URL. Contact info on top right.


Miller Family Heart, Vascular & Thoracic Institute | Cleveland Clinic

Thank you for your reply

 

[Eva]

Best of luck, Igor. Keep us posted.
In my situation, I Am glad I had both replaced at the same time in 2008. Did you have any issues with the Mitral in 2002?

 

[IgorClearwater]

Thank you, Eva!
No, in 2002 my mitral was Ok, but not perfect.
My current echo and TEE showed moderate regurgitation and stenosis of mitral valve, despite that a year and a half ago it was just mild. The docs think that my mechanical AV was installed smaller size than needed and caused MV to get worth.
did you install mechanical valves?

 

[Eva]

YW, Igor.
Yes, I still have both of St. Jude’s MV and AV. My surgeon was hoping to repair MV, but it was beyond repair when my chest was opened up! I had severe regurgitation and calcification in both of them. The Aortic valve was worn out and surgery was at the right time. I could/should have had it two years earlier!

 

[IgorClearwater]

I am practically symptoms free, just came back from a 25 mile bike ride A couple of months ago before a new diagnosis I used to do easily over 250 miles biking a week. What level of INR do you maintain now with two mechanical valves? Haw do you feel now and how is the test showing valves after 12 years?

 

[Eva]

I was symptom free until I was almost 54...my fatigue started worsening and I complained, but my cardio didn’t listen well to me!
My INR range is 2.5-3.5. I try to stay at 3.0.
I was 57 when I had my surgery. Right after surgery, I felt a difference and soon after I regained great energy that I was missing. I still feel much better than the last two years before surgery.

 

[IgorClearwater]

that's great. I need to make a decision about whether I go with mechanical valves again or tissue valves. My primary doc suggests to go with mechanical, the surgeon I saw locally was telling me to consider tissue valves. Have you ever gone off the coumadin for any procedure during these 12 years? Do you know of anybody who used the On-X mechanical valve?

 

[Eva]

Hi Igor, I’ll answer your questions in reverse order:

Do you know of anybody who used the On-X mechanical valve?

yes! Many fellow members here.

Have you ever gone off the coumadin for any procedure during these 12 years?

No! I never needed major surgery. I had a tooth pulled out and replaced with a crown. My oral surgeon, luckily, agreed to proceed with each procedure if dropped my INR to 2.5 which I did.
My cardio recommended bridging! Yet, there were many times I wished I were not on Warfarin. Could be I was going through some difficult times!

... the surgeon I saw locally was telling me to consider tissue valves.

My surgeon in 2008 recommended tissue valves. I wish I asked him if he knew of any cons of having two mechanical valves in the long run! I chose mechanical only to avoid another surgery. Another surgeon I interviewed also preferred tissue valves “because I was too young to be on Warfarin”! With no experience, I didn’t know what more questions to ask about what may happen “in the long run” if I had two mechanical valves!
My very honest advice is to push your surgeon to honestly tell cons of having two mechanical valves after 12 years, since you’re still young.
Again and honestly, a few times during these past years wished I had tissue valves.

Please note this is only my own experience! So, just make sure your surgeon answers you if this is why he prefers tissue valves for you!

 

[FishnFool]

I am 55 and went with inspiris resilia aortic valve. Its too early to tell if made the right choice. I feel better already (1 month post operation). Everyone here has been amazing.

 

[stephenismycopilot]

I am 55 and went with inspiris resilia aortic valve. Its too early to tell if made the right choice. I feel better already (1 month post operation). Everyone here has been amazing.

I'm 38 and went with the Inspiris Resilia at my surgeon's recommendation. Everything working as it should so far, and I feel physically better and more capable than I have in many years.

 

[vitdoc]

Having been on warfarin for 37 years I would be remiss to deny that there have been times I wished I was not on it. I had a tissue aortic valve placed in 1977 which lasted 5 1/2 years. In 1983 a St. Jude was placed and I started on warfarin. Never changed a thing with my life style. Skied, biked , did just about whatever I wanted to do. Never had a life threatening bleed. Did have a hard bike fall and had a nice bloody contusion into my thigh. Took 2 months to clear. Had surgeries for other issues (back disk repair) no problems. Used bridging with low molecular weight heparin injections. But it would be nice not to need to think about it at all.
However on the other hand every time something is done say a TAVR in a failing tissue valve there are risks. Or the chest might have to be reopened if a TAVR like procedure fails or can't be done. In the case of the mitral the TAVR like procedures have much less of a track record and may not be very successful placed within a failing mitral valve. In my case I did fine with the St. Jude for 23 years until I developed an aortic aneurysm 6.5 cm requiring a third open heart in 2006.
New aorta and new St. Jude and continued on warfarin. I was 58 then. The surgeon said you really don't want a fourth open heart. Also at that time TAVR was not developed. So I hope my chest need not be opened again and that I am done with major procedures. Warfarin is a relatively minor issue which I surely would like to not deal with but I would rather not deal with another procedure even more.

Surgeons are surgeons (I am a surgeon) and they have their biases. Maybe they think what they would do if it was their own body. So in a younger individual you can make a case for both a tissue and a mechanical. Tissue: at least one maybe more procedures vs maybe a single procedure with warfarin.

Say one is 36 gets a tissue lasts 15 years. Then a TAVR another 10-? longer . So now at say 62 an open heart with a tissue and start all over possibly with another TAVR ? Or maybe some new unimagined breakthrough.

So these are not obvious choices at this time.

 

[user 15848]

I also think at times was better to choose a tissue at 62, but my surgeon was of the idea that for that age either one would be ok, but i choose to avoid as much as possible a second ohs, and yes, he did mention tavr, but also mentioned not always is possible, regardless of technology because the individual human factor also is different for every one and simply the valve can be no possible to replace via tavr for several reasons and then, voila, 77 another ohs, not for me, so i am happy with the tick tick and well W is a pill, like many other pills for seniors, you take them or else..... so no big deal, "for me", as always, this is my personal perception , no rights or wrongs here on anything, happy holidays and STAY safe from this virus that came to us