Please help me out! :(

Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
Thanks for you replied dick0236.
I will say there are risk for re-op if i go with tissue valve. However with the new method (TAVI), the risk only 5% around each time i go for my tissue valve replacement.
I have been reading alot of old threads regards on TAVI, Tissue, Mech with the data but still cant decide which to go for.
Why? Because there are people saying with the latest 3rd gen tissue valve which able to last longer. (but how true the data on a age of 27 like me). If only i can ensure that the tissue valve able to last me at least 10-15yrs. I will definitely go with tissue valve. However i just worry it may not make it more than 5-7years.

IF today im going for mech valve. I guess there is no other reason than due to the cost price. (which i believe i will regret years down the road)

The problem is no one will guarantee a tissue valve will last a certain time no matter what your age, altho the have a better chance of lasting 15 or more years in a 50 year old than 27, OR noone can guarantee that if you get a mech valve you wont have a major clot or stroke. The real risk IMO to me is not What are the chances of having a REDO w/ a tissue valve, or a stroke or bled w/ a mech but what are the risks of having a BAD outcome w/ a REDO vs a BAD out come since you need Coumadin because a mech valve increases the risk of clots. There ARE risk of Bleeding or Clotting, even with the NEWEST Valves, Home testing, INRs and the best Doctors, there STILL is risk of a stroke for a clot or a stroke from a bleed. Just look at the results so far for he ON_X Proact trials.

Yes they are discovering more functions of the body that rely on Vit K.
and just like vit K plays an important role in Clotting with the vit k dependant proteins that Coumadin affects in the liver, they also are learning the role vit k plays in bone health or Arteries not calcifying, that Coumadin does affect the other roles Vit K plays a part in in other parts of the body So it is PROBABLY that, more than the fact people used to be told not to eat Vit K foods, that makes a difference in bone density and clalcified arteries. For the past decade or so they now know it is better to eat /take Vit K to help the INR be stable. But knowing how important the differen Vit Ks are is all pretty new. Also as everyone says, what you eat or dont eat, really doesnt affect the INR that much, just eat how you normally eat and adjust the amount of Coumadin needed to your normal diet. So beside the Ticking, blood work or increased risks of stroke or major bleeds, some people rather cut down on the years they will need to be on anticoagulants by getting a tissue valve now then seeing what is available when it needs replaced. There ARE risks every year you take anticoagulants for a mech valve, .but the math is a little different than you are talking about.

this is a good article. http://circ.ahajournals.org/content/117/2/253.full#ref-15 Choice of Prosthetic Heart Valve in Today’s Practice One of the interesting things in it is they take a 50 year old man and figure out the LIFE TIME Morbidity and mortality long term for each Choice, "Projected Future Risks After Aortic Valve Replacement in a 50-Year-Old Man, Assuming 30-Year Survival" taking into account the risk even if he had 2 REDO at various ages with a tissue valve and the risk of clots and bleeding in each decade of his life with a mechanical valve. Now of course it will be different for someone not quite 30, but I thought it was pretty good at explaining the different risks for each choice over the years.

TAVI, I'm not sure where the 5% mortality is from, unless that is from the earliest trials on just the sickest patients. I believe even now the risk is lower than that, about the same as a 1st time REDO, even with the highest risk patients, since they already have improved the valves and deployment systems and there is a learning curve, so even the later patients in the trials did better than the first couple the doctors did. BUt since they are so new and just starting to be done on healthier people who should have longer life spans, no one knows how long they last. FWIW the stats for people who had their TAVI valves 5 years the valves are still doing well, but older people tend to have tissue valves the longest.

IF you choose a tissue valve now, I would ask about what valves currently in use make it easiest to implant valves inside and which seem to be harder, to give myself the best chance of being able to get a valve in valve in 5-15 years or however long this tissue valve lasts. It IS better to have a larger valve, BUt I believe that you could only get 2 TAVI valves before they would have to replace your valve surgically, so even tho, they are doing TAVI and valve in valve now, I would plan on needing at least 1 more open heart surgery considering your age. Altho each valve you got would probably last a little longer than the previous as you get older still you would need a few valves if you live a long healthy life, IF you chose a tissue valve now, it is hard to tell what your options might be when it needs replaced, Maybe by that time there would be clearer picture of long term with either choice. Right now, beside all the time and money going into percutaneous valves, they also are working on better or in some people thoughts safer anticoagulants,and even tissue valves grown from the persons own cells (tissue engineered)

I do NOT know at all how different cost will be, yes the price of the valves themselves will probably go down, but beside the cost of the valve, considering you will probably have a shorter time in the hospital recovering from a cath than open heart surgery and the fact you will be able to go back to work much quicker from a TAVI valve probably balances out even with the higher cost of the valve. I'm sure the cost of another valve replacement, would be more than that many years of meds and blood work if you have a mechanical valve now But since there IS a risk of a bleed or clot that could be expensive too.

So all of that pretty much says both choices have their advantages and both choices have their risks, maybe it would help to decide which set of risks you rather live with and once you make up your mind, try not to second guess your self or ask what ifs.
 
Last edited:
Yes they are discovering more functions of the body that rely on Vit K.
For the past decade or so they now now it is better to eat /take Vit K to help the INR be stable. But it is all pretty new. Also as everyone says, what you eat or dont eat, really doesnt affect the INR that much, just eat how you normally eat and adjust the amount of Coumadin needed to your normal diet.

So since Vit-K is good for our body and we are able to control our INR. Does this mean we still able to consume vit-K which is good for our body? Just that we have to adjust the coumadin dosage to prevent us from getting bleed or blood cot?

TAVI, I'm not sure where the 5% mortality is from, unless that is from the earliest trials on just the sickest patients. I believe even now the risk is lower than that, even with the highest risk patients since they already have improved the valves and deployments and there is a learning curve, so even the later patients in the trials did better than the first couple the doctors did. BUt since they are so new and just starting to be done on healthier people who should have longer life spans, noone knows how long they last. FWIW the stats for people who had their TAVI valves 5 years the valves are still doing well, but older people tend to have tissue valves the longest.

I got the 5% data from my surgeon. Seriously since no one know how long it last. that's why i cant place my chip on the bet. But he seem so sure with the technology advance. perhaps 10years down the road. The next TAVI tissue valve replacement will last even longer.

IF you choose a tissue valve now, I would ask about what valves currently in use make it easiest to implant valves inside and which seem to be harder, to give myself the best chance of being able to get a valve in valve in 5-15 years or however long this tissue valve lasts. It IS better to have a larger valve, BUt I believe that you could only get 2 TAVI valves before they would have to replace your valve surgically, so even tho, they are doing TAVI and valve in valve now, I would plan on needing at least 1 more open heart surgery considering your age.

Why can't i keep using TAVI method? ( may i know does TAVI mean the same as Minimally Invasive Cardiac Surgery? By opening a small hole from the groin area?)
Why only able to get 2 TAVI valves? I asked my surgeon and he said i can keep doing it without going through the normal OHS surgery again.


thanks Lyn for your information.
 
Why can't i keep using TAVI method? ( may i know does TAVI mean the same as Minimally Invasive Cardiac Surgery? By opening a small hole from the groin area?)
Why only able to get 2 TAVI valves? I asked my surgeon and he said i can keep doing it without going through the normal OHS surgery again.
Look at it this way: Each time you use a TAVI to replace another valve, you are placing it inside the old one and just kind of smashing it aside. Every time you do this, you must be installing a valve that is just a little bit smaller. There has to be some kind of diminishing returns, whereby after so many times the valve is just too small to do the job. There is at least one company working on a TAVI with replaceable leaflets, but that is even farther into the uncertain future.

TAVI is also known as percutaneous, the one where they go through a small hole in the groin and thread it in via catheter through the artery. Minimally invasive usually refers to actual surgery that is done through a smaller incision than the usual OHS.
 
Look at it this way: Each time you use a TAVI to replace another valve, you are placing it inside the old one and just kind of smashing it aside. Every time you do this, you must be installing a valve that is just a little bit smaller. There has to be some kind of diminishing returns, whereby after so many times the valve is just too small to do the job. There is at least one company working on a TAVI with replaceable leaflets, but that is even farther into the uncertain future.

TAVI is also known as percutaneous, the one where they go through a small hole in the groin and thread it in via catheter through the artery. Minimally invasive usually refers to actual surgery that is done through a smaller incision than the usual OHS.

Thank You clay for your quick replied.

May i ask things about warfarin. With a Mechanical valve, we may have a chance to face bleed or stroke problems in the future. These Bleed and stroke is due to the warfarin and due to the INR ratio right? If I'm a good patient who stick closely to my INR, will i face these 2 issues in my life? Or i will still face the 2-4%(max 4) to get either one of the problem?

Side Question. If today i am on warfarin and i get a big bruise from falling down. What should i do? Just as per normal intake my warfrain dosage and rub the bruise myself?

Sean
All your reply will be deeply appreciated
 
Well Seanskx, there is always a risk of bad stuff happening, but you greatly reduce the risk by keeping your INR in range. In fact, I think that most of the bad things happen when it goes significantly out of range (more than a point?). As to the specific numerical percentage risk, I don't have an answer for that and I don't think you can depend too heavily on those who can. There are too many other influencing factors, such as age, gender, other medical conditions, diet, physical condition, etc.

As to minor injuries such as cuts and bruises, you might want to check in with your doctor, but I wouldn't worry about it. I pinched my finger at the gym and got a pretty good sized blood "blood blister" and my finger swelled up. I emailed my doctor who told me to just keep an eye on it and the swelling should go down in a few days. It did. In the meantime, I continued all my medications as usual. I've also gotten minor cuts and scrapes and none was a problem.
 
Thank you clay.

IM going for my AVR next wed. As i know after surgery, i will perhaps been facing alot of things in my future life. May i know what are those common or anything to take notes? I just read a post at the post-surgery which someone mentioned about valve infection due to fever?

May i know what are there to watch out for?
and symptom consider unusual?

I know regards on the pain for the sternum to recover is really individual. but usually what is the common period to recover?

I really wish to know everything before it happen. Thou i believe there are people saying the lesser you know, the lesser you worry.
However i feel insecure if i don't know anything. I will prefer to know it before hand.
So do you mind share your experience of what you face after your surgery?
Beside cold, warm, itchy, additional emergency that have to re-surgery, etc etc..

Thank you v.much
Sean
 
Hi guys.

Update from me.

Will be warded in today to do CT scan to check my heart whether am i suitable for BAV repair.
Im not sure how long will the repair last. But i did check out somehow if it success and im lucky, Perhaps it will last a lifetime
However if cant be repair. I decided to go for Mech valve (longer life span)

Pray that i will never regret choosing this path and taking warfrain in my entire life!

God bless
sean
 
I understand how difficult this is for a young person. You've almost climbed the mountain and pretty soon you will be on the other side and ready to assume a normal, healthy life.

God bless
Dick
 
Glad you got a decision made Sean. None of this is what you planned but all WILL be well in its own way. You don't need to be ready for everything that "could" happen yet. With my own and my children's medical and developmental issues I have found that I "grow into" the capability to handle things as they develop. You don't need to be ready for everything at the start.

And forget about regrets - you took care of your responsibility to choose, you did an awesome job with that. And who knows, even if it gets rocky, the other choice might have been even worse for you! So now that you've decided, try to imagine how awesome everything might turn out, the best possible outcome. Somebody has to be that guy. Why not you? I vote you :D

God bless
 
Hi everyone.

It's been almost a week after my surgery. I'm back home since yesterday.
I will like to thanks Valvereplacement website to provide great forums for people like us to sharing among out experience to the rest.
Next, I will like to thanks everyone for sharing their care and concern plus encouraging me to face this battle.
I'm feeling much better just that the pain still hanging there. Still gotta depend on painkillers.

My surgery consider quite successful and im recovering fast during those ward days.
1day ICU,
1day HD,
and 5day normal wards and im discharged there after

Thank you once again. I guess next post from me will be much more related to warfrin in the future.

Regards,
Sean
 
So good to see you posting, Sean.

Happy you are safely through surgery and into your recovery.
Wishing you a smooth, easy, bump free recovery.
Please keep us posted.
 
Hi everyone.

It's been almost a week after my surgery. I'm back home since yesterday.
I will like to thanks Valvereplacement website to provide great forums for people like us to sharing among out experience to the rest.
Next, I will like to thanks everyone for sharing their care and concern plus encouraging me to face this battle.
I'm feeling much better just that the pain still hanging there. Still gotta depend on painkillers.

My surgery consider quite successful and im recovering fast during those ward days.
1day ICU,
1day HD,
and 5day normal wards and im discharged there after

Thank you once again. I guess next post from me will be much more related to warfrin in the future.

Regards,
Sean

Welcome home ! Remember to rest often, some days are good and some are slow. :)
 
thanks everyone.
dick i will stay around to help out people who have concern too
im part of this family
 
Back
Top