Pretty well decided....I Think.

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priley

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Well my RAVR is scheduled for the 3rd of November. In the beginning I was sure I was going to go with a tissue valve. Later even with the Warfrin I was thinking the mechanical valve may be the better option. Now I'm leaning towards tissue again with the option of doing a TAVR when necessary. I'm a 60 year old male so it wasn't clear either way. I'm thinking the best 10-15 years will be the best in the rest of my life and if the 1st valve lasts that long hopefully technology will be even better in 10-15 years so who knows. I'm still not having symptoms except out of breath when I climb or have to run. Thought that was because I am overweight 5-11" 235# and 60 years old. Did anyone feel much better after the surgery? Maybe I'll run marathons after this :)
 

Chuck C

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Good luck with your procedure. At age 60, you are at the point at which either valve choice is generally considered reasonable. Given the pros and cons of each choice, it is not surprising to go back and forth like you have. I think that hoping for 10-15 years from a tissue valve at your age is a very realistic expectation. With some luck, if you go with the new Resilia valve, it may even last longer than that.

Wishing you the very best of luck with your operation.
 

70sdiver

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. Did anyone feel much better after the surgery? Maybe I'll run marathons after this :)
Yes way better I'm in cardiac rehab right now at 9 weeks from surgery. I do interval training on the treadmill and walk 3 minutes and I run for one minute! I know it doesn't sound like much but I haven't run in like 8 years. You might want to look at this valve but in the end who know if it can get 20 years.

Edwards Inspiris Resilia I gave it a shot we will see how it holds up.​

 

priley

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. Did anyone feel much better after the surgery? Maybe I'll run marathons after this :)
Yes way better I'm in cardiac rehab right now at 9 weeks from surgery. I do interval training on the treadmill and walk 3 minutes and I run for one minute! I know it doesn't sound like much but I haven't run in like 8 years. You might want to look at this valve but in the end who know if it can get 20 years.

Edwards Inspiris Resilia I gave it a shot we will see how it holds up.​

When I talked to the nurse I thought the Dr picked the valve. Am I wrong? I know they asked me about tissue or mechanical but I thought the Dr picked what style he thought best? I've heard of the Resilla valve but I don't know what else there is or really anything about them. I would hope he would know better than me on what valve would be the best for me? Right?
 

pellicle

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Did anyone feel much better after the surgery? ... :)
Yes way better I'm in cardiac rehab right now at 9 weeks from surgery. I do interval training on the treadmill and walk 3 minutes and I run for one minute! I know it doesn't sound like much but I haven't run in like 8 years
sounds excellent, and yes I felt significantly better after surgery #2 (where I was significantly run down due to personal life choices about project completions like my degree), even after a week of being home.
I can only say good things about how it feels after surgery and in the months after surgery (not the days).

If anything that I felt nearly nothing in my 3rd OHS in recovery (except for the discomfort of the recovery) speaks to the idea of "get it done before you severe" ... I got it done at early valve failure stages because the aneurysm on the rising aortic artery was the driving factor (5.6cm dilation)

Best Wishes
 

pellicle

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but I thought the Dr picked what style he thought best?
perhaps due to sales opportunities it has become increasingly popular in the USA to have "patient informed decision" as being inserted as the first listed key point in the US surgical guidelines.

No doubt all patients are properly informed and become highly expert in grasping all of the points with respect to valve choice and all of its effects on post surgical life.

Some countries (outside the USA) still seem to prefer letting the actual experts (or even indeed national standards) make the call in the majority of valve cases.

I've written a lot on this, so I won't bore you here with my views
 

priley

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Bore me, I am unsure of what you are saying. Like I said the nurse said th Dr would pick the "Best" valve for me. Evidently after he sees' what the conditions are? Maybe I should ask again to be sure that's what was said? I don't know one valve from another, How would I pick? From a manufacturer's advertisement? I would hope after the thousands of valve jobs that the surgeon has done, he would be much better at picking the right valve than me. I'm all about doing research but can I expect to better pick a valve than he? I'm rooting for Dr Badhwar on this I think.
 
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pellicle

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I'm all about doing research but can I expect to better pick a valve than he?
well I guess it depends on views, however there is a strong bias in the US for surgeons to promote choose a tissue valve for a patient, and there are some decent basic reasons to do that depending on factors.

I think I covered some of that to start you down that path here:

however aside from issues of "drug compliance" (IE taking the dam pill) the more under 60 you are the less logical a tissue valve is. The closer you are to 70 the more there is a sound argument for a tissue valve.

Given what I see of testing and INR management and outright failures of drug compliance the more I tend towards seeing the surgeons point of view.

Click this image
1666488051853.png
if you'd like to know more.

My main issue is with the whole 10 or 15 years thing.
 

dornole

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Priley - you’re asking about valve brand right, separate from the whole tissue / mechanical issue? Yeah, the consensus on this board definitely seems to be let the surgeon choose the specific brand of tissue / mechanical, based on what they find, just like the nurse told you. They can make a judgment call or simply use the one they’re most used to implanting.
 

dornole

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I do think most patients choose tissue or mechanical for themselves but not the specific brand. I certainly would want to make my preferences known on that point
 

AZATADINE

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I was given the choice of tissue or mechanical but the choices given to me were:

Mechanical: On-X
Tissue: Edwards Magna-Ease

Although other options such as Inspiris Resilia were discussed, my surgeon wanted to err on the cautious side due to my age (52) and the fact that the Magna Ease has decades of supporting data. I get the impression that he has high hopes for the Inspiris Resilia but wanted to go with the well proven valve at this stage.

In terms of how I feel almost one year post surgery, I'd say I'm back to where I was pre-surgery bearing in mind that I was asymptomatic before. Maybe less tired but everythingelse is more or less the same performance wise. I opted to have the op proactively rather than waiting for symptoms.
 

nobog

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Jun 14, 2019
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Wisconsin, USA
Bore me, I am unsure of what you are saying. Like I said the nurse said th Dr would pick the "Best" valve for me. Evidently after he sees' what the conditions are? Maybe I should ask again to be sure that's what was said? I don't know one valve from another, How would I pick? From a manufacturer's advertisement? I would hope after the thousands of valve jobs that the surgeon has done, he would be much better at picking the right valve than me. I'm all about doing research but can I expect to better pick a valve than he? I'm rooting for Dr Badhwar on this I think.
What makes a "good" heart valve?

20 years

Go with one with a proven track record.
 

Chuck C

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Bore me, I am unsure of what you are saying. Like I said the nurse said th Dr would pick the "Best" valve for me. Evidently after he sees' what the conditions are? Maybe I should ask again to be sure that's what was said? I don't know one valve from another, How would I pick? From a manufacturer's advertisement? I would hope after the thousands of valve jobs that the surgeon has done, he would be much better at picking the right valve than me. I'm all about doing research but can I expect to better pick a valve than he? I'm rooting for Dr Badhwar on this I think.
It is the patient's choice of valve type, tissue or mechanical. Sometimes other options are available to choose from, such as TAVR, a Ross Procedure or a Homograft.
In my situation, I also had the choice of which mechanical valve, St. Jude or On-x. In fact, I scheduled my second consultation with my surgeon specifically to discuss the St. Jude vs the On-x and that consultation lasted almost an hour, for which I was very grateful for his time. He clearly preferred the St Jude, based on their long proven success record. He also made it clear to me that if I preferred to go with the On-x, then that is what he would go with.

Having the 2nd consult was my idea, as I had already met with him before. I'm sure that most people just leave it to the surgeon, even for the decision on tissue vs mechanical, and you will get what he prefers both in valve type and manufacturer. There is an argument to not be involved at all and let the surgeon decide based on his expertise. But, as the patient is the one who will have to live with the trade offs, I believe that the patient should be very involved in this discussion.

Once the valve type has been decided on, probably the vast majority don't get involved in the discussion beyond there. But, I think that there is a good reason to be involved at that point as well. For example, if one chooses tissue, does the patient want to go with the more proven track record of the Magna Ease, or do they want to go with the relatively new Resilia valve, with 5 years of data, but the hope that it might last longer due to its treatment meant to delay calcification? Similarly, if one chooses mechanical, do they go with the long track record of the St. Jude or the newer On-x valve?

Personally, I like to know the trade offs and be very involved in the decision process. I understand that some don't feel the same way. I'm glad that I have medical professionals that welcome this involvement and are willing to get into deep discussions with me about trade offs, as well as discuss the medical literature. I had input from my cardiologist and surgeon on valve type, but ultimately going mechanical or tissue was very much a personal choice. I'm the one that has to live with reoperation or a life on warfarin. As to valve manufacturer, it was also my decision. Ultimately, I went with the St. Jude, as recommended by my surgeon. At that point, it probably would have taken a lot for me to choose a valve manufacturer different than that preferred by my surgeon. But, I was glad to have had the discussion with him as to why he preferred the St. Jude over the On-x.
 

erricojj

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These are some resources I found while looking into the Edward Inpiris Resilia...

Long-term durability of a new surgical aortic valve: A 1 billion cycle in vitro study - ScienceDirect
Journal of Thoracic and Cardiovascular Surgery (JTCVS)
https://www.sciencedirect.com/science/article/pii/S2666273621004162

Inspiris Resilia vs other aortic valves - British Heart Fou...
Inspiris Resilia vs other aortic valves - British Heart Fou...

INSPIRIS RESILIA Aortic Valve, Valve-in-Valve Surveillance Study - Full Text View - ClinicalTrials.gov
INSPIRIS RESILIA Aortic Valve, Valve-in-Valve Surveillance Study - Full Text View - ClinicalTrials.gov

Note that sizes up to 25 mm come with an expandable ring to enable future valve-in-valve procedures. The 27 mm and 29 mm (the size I have) have a fixed ring and are out of scope for the study above. I do not know if that precludes valve-in-valve for me (I hope not), but that was a decision my surgeon made. I was asleep at the time.

Hope this helps your process.

Good luck !
 

Timmay

Grandfather Clock
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Frederick, MD
You definitely have a choice. Your thoughts and desires truly matter.

You can choose tissue or mechanical. Because YOU have to be the one to live with it.

As far as “brands”, that is often up to the surgeon’s preference during the operation. Notice my choice of the word “often”. You can still register your preference and a good surgeon will be willing to go over the pluses and minuses with you of the different brands and describe why they’ll make certain brand choices over others.

I have an On-X mechanical valve and am super happy that I talked to my surgeon about tissue vs mechanical … and we made that decision together. I didn’t think too much about discussing the different brands with my doctor AND doing the research into the brands. I wish I would have. In retrospect I would have chose to the St. Jude’s. But the On-X is fine enough.

I think that if you’re set on the tissue valve then definitely look into and research the Inspiris Resilia. It’s still an Edwards valve and that says a lot.
 

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