Second Surgery 20 Years Later

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I was just making an easy to grasp mental analogy.

understood. Myself I thin its more like driving on a 4 lane motorway (4 lanes each way) in the quiet time on the road and sitting in lane 3 (not the fast lane); then changing lane without looking or signaling. Most of the time nothing will happen. Maybe someone will blast you with a horn. Rarely you'll be on the news for it.

some people are even luckier
Some folks don’t mentalize charts and graphs well.
that's about the kindest words I could choose too.

My day has started well, I hope your Thursday works out well too

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Hello all,
I will be 63 yo this year and I had a valve sparing ascending aortic aneurysm repair almost 20 years ago (2 months shy). I am scheduled for open heart surgery on May 26 for aortic valve replacement due to severe aortic stenosis, and yes, I do have a bicuspid aortic valve. I am returning to the same institution that did my initial procedure. In fact, the surgeon I am using sat in on my initial aortic repair so he has already seen under the hood, so to speak.

Just checking in to see how you're doing after your surgery last week. I hope things are going well. Please give us an update when you get home!

Just checking in to see how you're doing after your surgery last week. I hope things are going well. Please give us an update when you get home!

Doing OK Jennie, thank you. Hitting all the major milestones to recovery. I will update more later once I’m discharged but the main issue right now is getting back to normal sinus rhythm.
The 2-3 INR range is a general recommendation and not valve specific. It's a good metric since it's conservative and a one-size-fits-all approach that requires no thought by doctors and a consensus range protects against lawsuits.

However, the On-X has a range of 1.5-2 and my St. Jude is 2-2.5. Those ranges are valve specific and were approved by scientific specialists, i.e. expert scientists, statisticians and regulators. The scientific design is vetted before a study begins by multiple tiers of specialists at the manufacturer, often third-party consultants and the regulatory agency. At study completion the numbers are crunched, checked, crunched and checked again by professional statisticians at the manufacturer and at the regulatory authority that approves the INR range (e.g. FDA.) No firm wants to recommend an a INR range that would be dangerous to their patients. That's a good way to quickly ruin a company.
I'm glad to hear that you're home and everything went well.

Interesting analogy, but to be fair. the right shoulder is much larger than the left. Moving below 2.0 is much more dangerous than INR of 3, 4, or maybe even 5,

I had a TIA about a decade ago because I trusted a now discontinued meter -- it said 2.6. The hospital said 1.6.

Since then, I've chosen to trust my life to the Coaguchek XS. The CoagSense will also work but I usually stay away from it.
If you get a Coaguchek, be sure it's an XS, Vantus, or InRange -- any others are discontinued and won't work with the XS strips.

As far as self testing is concerned, you can buy a meter and strips without a prescription on eBay. I've even seen meters for as low as $29.95.

There's a trick to making them work, although a phone call to Roche may also work for you.

If you need help running tests or managing your INR, Pellicle can be very helpful.
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Hello everyone! I wanted to provide a short update on my procedure, recovery and next steps.
On May 26 I had my bicuspid aortic valve replaced with a 25mm bovine Inspira Risalia bio-valve. I'm pretty happy with the size of the bio valve they were able to install in case I need valve-in-valve someday.

First two days in ICU were mostly used to focus on my non-sinus rhythm and Afib that had developed pretty soon after anesthesia wore off. To be honest, I didn't really feel or notice the Afib. Whereas prior to surgery I had atrial flutter that I could feel exactly when it would occur. On day 3 they finally decided to try cardioversion to see if they could shock me back into normal sinus. Two zaps, no luck. Then they proceeded to place me on Amiodarone IV which did the trick. The doctors basically described it like this: "right now your heart is angry and inflamed" "Lets get you a steady rhythm with the help of Amio and then wean you off" So I have been in normal sinus as far as I can tell and I am using a zio patch for a couple more days and it is collecting all beat data. I am also at a lower dose of Amio for 3 days now. So far so good and fingers are crossed.

Rehab at home has been as good as it possibly could be. My wife has been my steady care taker and coach and sometimes psychologists :) I am gaining strength each day, sleep is getting better finally, and pain mostly under control. I walked for 1.0 mile non stop on day 15. I also add an additional walk later in the day ranging 0.4-0.6 miles. I am gradually upping my walks and hope to be at the 2 mile range in a few days. We will see if my care taker allows me to.

I mentioned the Amio earlier. I am also on Eliquis (apixaban) and half my pre-surgical dose of losartan. The rest of the pain meds, diuretics, potassium supplements, etc. have completed their regimen. Still taking acetaminophen for pain. That's it for now. Thank you all for your support.

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