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AndrewToronto

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Jul 21, 2024
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54M, reasonably active. Mechanical bentall procedure (49% EF, 5cm aortic root, etc).

Talked to numerous cardiologists and cardiac surgeons. Some had opinions - go with a mechanical valve given my age and activity level. Others just listed the pros and cons of tissue vs mechanical valves and said it was up to me. They effectively said if I was responsible and could handle managing a daily drug regimen, then mechanical would work. If not, tissue was best.

When I met with the surgeon who will be doing the surgery, he said that if I chose tissue, he would attempt a repair if he thought it was possible. He also said that the best repair duration for a BAV he was involved with was 10 years. If I were to go tissue, he said the tissue valve would last 10 to 20 years. To determine, the number of future surgeries, he used 10 years, saying that assume I would get 10 years from the tissue valve and assume I was eligible for a TAVR giving me an additional 5 years. That would give me a total of 15 years. So, an operation now at 54 and then again at 69 and then potentially again at 84 assuming I lived that long.

My preference was for one and done. There are no easy choices. Trading off multiple surgeries (tissue) for lifetime ACT and noise (mechanical). I heard a lot of interesting stories. Some who had tissue valves went over 20 years, but some were far less. Large range of outcomes. An acquaintance's relative had OHS at 82 with a tissue valve. She is now 90 and her valve is failing and they are looking at whether she is eligible for TAVR. On the other hand, I spoke with a doctor who was initially upset when his father was given a mechanical valve at 73. However, the father lived until 94 and passed away from other causes.

I thought about doing a tissue valve first and then doing mechanical after the tissue valve failed assuming that technology would come to the rescue in time. However, I wasn't keen on multiple OHS's as I read more and more, especially if the valve failed in the early years.

Weighing the pros and cons, it seemed that mechanical would work best for someone in my situation.

Surgery coming on July 23.

This site is fantastic. Thanks to all the members for their contributions. It has been really helpful in my research and decision making process.
 
Welcome to the Forum. I received my mechanical valve about three years before you were born. It is the only valve I've had and on August 16, 2024 it will be 57 years old......and still going strong.

ACT(anti-coagulation therapy) is a pill and routine blood testing that is as simple as "tying your shoes each morning". The ticking, for most people, becomes less and less over time. I haven't heard mine in years and years....and years. Like the father of the Doctor you spoke with, my doctors tell me it will be something other than my valve that ends my life......I am going on 89. I got this valve when I was 31.

BTW, I lived a very normal life and played golf into my mid-80s.
 
Hi and welcome

54M, reasonably active.
that's great!

Mechanical bentall procedure (49% EF, 5cm aortic root, etc).
now or upcoming? This sounds like "a state of play report" but the rest sounds like "a choice"

Talked to numerous cardiologists and cardiac surgeons. Some had opinions - go with a mechanical valve given my age and activity level. Others just listed the pros and cons of tissue vs mechanical valves and said it was up to me. They effectively said if I was responsible and could handle managing a daily drug regimen, then mechanical would work. If not, tissue was best.
I would concur.

When I met with the surgeon who will be doing the surgery, he said that if I chose tissue, he would attempt a repair if he thought it was possible.
a repair of the aneurysm or the valve? Sorry I'm not clear on the current status

He also said that the best repair duration for a BAV he was involved with was 10 years.
seems reasonable

If I were to go tissue, he said the tissue valve would last 10 to 20 years.
also seems to fit the known data...

To determine, the number of future surgeries, he used 10 years, saying that assume I would get 10 years from the tissue valve and assume I was eligible for a TAVR giving me an additional 5 years. That would give me a total of 15 years. So, an operation now at 54 and then again at 69 and then potentially again at 84 assuming I lived that long.
pretty reaosnable, although you may actually get more but its also like this
1721629615336.png

without as many smiles ...

My preference was for one and done. There are no easy choices. Trading off multiple surgeries (tissue) for lifetime ACT and noise (mechanical).
indeed there are no "easy choices" ... however managing ACT is not as hard as it is made out to be (by those with a vested interest in moving you into a more permanent client relationship).

... An acquaintance's relative had OHS at 82 with a tissue valve. She is now 90 and her valve is failing and they are looking at whether she is eligible for TAVR.
uhgg .,. tha'ts a difficult position

On the other hand, I spoke with a doctor who was initially upset when his father was given a mechanical valve at 73. However, the father lived until 94 and passed away from other causes.
I hope that doctor took the lesson properly

I thought about doing a tissue valve first and then doing mechanical after the tissue valve failed assuming that technology would come to the rescue in time. However, I wasn't keen on multiple OHS's as I read more and more, especially if the valve failed in the early years.
this makes me feel like you haven't had surgery yet and your above was just "wording"

Weighing the pros and cons, it seemed that mechanical would work best for someone in my situation.
There is less likelihood of a redo operation but can I suggest that you pay really good attention to oral hygiene from now on and
Surgery coming on July 23.
Fingers crossed for a straght forward surgery and an uneventful recovery.

This site is fantastic. Thanks to all the members for their contributions. It has been really helpful in my research and decision making process.
As you're in Canada (which seems more amenable to self management of INR) please feel free to reach out by PM if you want a (personal opinion follows) good start in a reasonably straight forward and structured approach to INR testing and using that information in a way that informs your INR management.

Best Wishes
 
Greetings, Andrew. Welcome to the forum.

I had my BAV replaced in 2019 with a bovine Edwards Inspiris Resilia. I'd originally intended to go mechanical, but in the end opted for tissue.

Nearly five years later, the valve’s becoming increasingly stenosed and my gradients are trending upward.

The end of last year saw me experience a mini stroke (cerebellar infarction), probably valve related. As a result, I’m now on warfarin permanently (currently learning the self-testing ropes).

I don’t regret having chosen a tissue. It’s what it is. It felt like the right choice, all things considered. But alas…

I’m currently under 6 monthly cardiology review. Next appointment 8 August. Will be interesting to see if there’s been any further deterioration to my valve since February. Let’s see.

Should another surgery be required soon, I intend to go mechanical – assuming that’s an option!

Sending good thoughts your way. Wishing you the very best for Tuesday's surgery. And a smooth and healthy recovery going forward. ☀️
 
Thanks for your thoughts and support.

@dick0236 - I appreciate hearing your experiences with ACT and the noise. I think both of these issues will take some getting used to on my part

@pellicle - Answering some of your questions: mechanical bentall procedure is upcoming. That's what I will be going to surgery for.
Repair of the valve is what the surgeon said was an option. My preference is for the mechanical valve.
I will be vigilant on oral health - great advice
Thanks for the kind offer on INR assistance. I will be reaching out

@Seaton - thanks for sharing your experience. I hope all goes well on your end too.
 
Hi
I will be vigilant on oral health - great advice
welcome ... just to add some substance to this claim

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8748486/

The oral microbiome consists of over 700 different species of bacteria (11), including numerous commensal and also opportunistic pathogens, some of which are organized in complex biofilms entering the bloodstream in the event of mucosal or gingival disruption. Traumatic injury to the mucosa or gingiva as part of physiological processes such as chewing food or oral hygiene (12), but also particularly in diseases such as dental caries or periodontitis and their secondary symptoms, as well as in various therapeutic measures for their prevention and treatment, can thus inevitably lead to the transfer of bacterial pathogens from the oral cavity into the bloodstream, resulting in bacteremia (1).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770162/

The authors found that oral hygiene and gingival disease indexes were associated significantly with IE-related bacteremia after toothbrushing. Participants with mean plaque and calculus scores of 2 or greater were at a 3.78- and 4.43-fold increased risk of developing bacteremia, respectively. The presence of generalized bleeding after toothbrushing was associated with an almost eightfold increase in risk of developing bacteremia.
 

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