Surgery this Wednesday

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Jeff Lebowski

Member
Joined
Mar 23, 2024
Messages
15
Location
İzmir/TURKEY
Greetings, I live in Istanbul, Turkey.
On Wednesday 28 March my aortic valve will be replaced with a biological valve. Tomorrow I will have cardiac catheterizatio and other tomography.

I just noticed this forum. The positive feedback I read here has improved my morale before the surgery.
I hope my surgery will be positive.
I plan to present this picture I drew to the professor who will perform my surgery :)

IMG_3780.jpeg


IMG_3782.jpeg
 
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Welcome to the forum, Jeff.
Fantastic drawing of the heart! Your professor will be super happy with such a magnificent gift, I'm sure.
Sending you good thoughts for your Wednesday surgery and all the best for a smooth recovery.
Looking forward to your updates.
 
Welcome to the forum Jeff!

Glad that you found us and what an amazing drawing! You've got some serious talent.

Best of luck with your procedure and we'll see you on the other side! :)
 
Welcome to the forum Jeff!

Glad that you found us and what an amazing drawing! You've got some serious talent.

Best of luck with your procedure and we'll see you on the other side! :)
Thank you Chuck.
I unfortunately discovered this forum very late. I live in Turkey, but unfortunately there is no website where people who have had heart valve surgery share their experiences. There is no forum site like yours. I don't want to be too assertive about this, but I honestly don't think there is a website like this one in the world.
I learnt that my aortic valve needed to be replaced two months ago and I have been worried about my surgery for two months, I wish I had been aware of your forum site before and I wish I had read the articles containing your experiences.

I have been participating in marathon, ultra marathon and long distance road cycling races for about 14 years. During this period, I have run 9 marathons, more half marathons that ı cant remember, 3 ultra trail races over 100 miles, and more than 26 miles of trail races that I cant remember.
I have participated in many Granfondo races with road cycling. I am writing this for this reason, I have never had any problems with my heart while doing these activities. I am 51 years old and I learnt that I have bicuspid aorta only 2 years ago.
In my last doctor's check-up two months ago, the cardiovascular surgery specialist professor said that I should have surgery and that the valve should be changed.
 
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Thank you Chuck.
I unfortunately discovered this forum very late. I live in Turkey, but unfortunately there is no website where people who have had heart valve surgery share their experiences. There is no forum site like yours. I don't want to be too assertive about this, but I honestly don't think there is a website like this one in the world.
I learnt that my aortic valve needed to be replaced two months ago and I have been worried about my surgery for two months, I wish I had been aware of your forum site before and I wish I had read the articles containing your experiences.

I have been participating in marathon, ultra marathon and long distance road cycling races for about 14 years. During this period, I have run 9 marathons, more half marathons that ı cant remember, 3 ultra trail races over 100 miles, and more than 26 miles of trail races that I cant remember.
I have participated in many Granfondo races with road cycling. I am writing this for this reason, I have never had any problems with my heart while doing these activities. I am 51 years old and I learnt that I have bicuspid aorta only 2 years ago.
In my last doctor's check-up two months ago, the cardiovascular surgery specialist professor said that I should have surgery and that the valve should be changed.
Hi Jeff.

Wow, you're really into the cardio training. I also was an endurance athlete, doing a few marathons and two ultra marathons, but nothing like your level. The longest race I ever did was the Lake Isabella Damn Tough Run, which was about 39 miles.

I'm assuming that you've already done your due diligence in terms of valve choice and are aware that keeping up that level of activity, especially at the young age of 51, could cause you to go through a tissue valve relatively quickly. Not trying to change your mind, but just hope that you are aware of this. At age 52 I was told that I should expect to go through a tissue valve in about 10 years by two different surgeons and they were not taking into account my high activity level nor my high Lp(a) level. In a medical publication a couple of months ago it was found that elevated levels of Lp(a) correlated with much fast rates of SVD development. Hopefully your cardiologist has had your Lp(a) tested and has taken this into account in his discussions with you.

Regardless of valve choice, being so physically fit is excellent in terms of recovery from valve surgery.

Wishing you all the best in your procedure!
 
Hi Jeff.

Wow, you're really into the cardio training. I also was an endurance athlete, doing a few marathons and two ultra marathons, but nothing like your level. The longest race I ever did was the Lake Isabella Damn Tough Run, which was about 39 miles.

I'm assuming that you've already done your due diligence in terms of valve choice and are aware that keeping up that level of activity, especially at the young age of 51, could cause you to go through a tissue valve relatively quickly. Not trying to change your mind, but just hope that you are aware of this. At age 52 I was told that I should expect to go through a tissue valve in about 10 years by two different surgeons and they were not taking into account my high activity level nor my high Lp(a) level. In a medical publication a couple of months ago it was found that elevated levels of Lp(a) correlated with much fast rates of SVD development. Hopefully your cardiologist has had your Lp(a) tested and has taken this into account in his discussions with you.

Regardless of valve choice, being so physically fit is excellent in terms of recovery from valve surgery.

Wishing you all the best in your procedure!
Frankly speaking, many articles I read on this forum about the choice of tissue or mechanical valve choosing made me question my decision.
As far as my decision-making process is concerned, nothing is too late yet, I will discuss this issue again with my professor who will perform the surgery tomorrow.
My surgery will be performed next Wednesday, as far as I have learnt from what I have read, the most important problem of mechanical aortic valve is the obligation to use blood thinners for life and also make continuous ING follow-up.
not very often, but I sometimes drink alcohol, although I have also read that green vegetables and some painkillers have different effects on warfarin.
Finally, and perhaps most importantly, what happens if ı have a motorbike or bicycle accident at the on a lonely mountainside.
I also work as a captain on transoceanic sailing ships. I use a lot of mechanical equipment for my job and from time to time I fight with small or medium tissue cuts. As you can imagine, there is no 911 service that you can call immediately when you have an accident on the open sea.

I have also read a lot of information and experience in this forum regarding biological aortic valves. The most important advantages are that I will not use the blood thinner Warfarin and ı will be free from the side effects of this drug.The disadvantages are short life span of biological aortic valves, rapid deterioration due to infections caused by dental caries, The fact that I am 51 years old and at best I will have to be operated on again in 15 years.
And finally, I started to be sceptical about biological valves because of the fact that they may not withstand the blood pressure in high endurance sports, which you mentioned in your paragraph and which I had no idea about until today.

I can honestly say that I was afraid of surgery until today, but today ı learn that it turns out that the real problem is which aortic valve to choose.
Tomorrow I will ask my professor who will perform the operation, which one you would choose if you were in my place. :)
 
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Hi

Tomorrow I will ask my professor who will perform the operation, which one you would choose if you were in my place. :)

a vexing question because:
  1. he may actually decide differently when put in that actual place
  2. he may not actually be well informed about the actuality of AntiCoagulation Therapy (because that's really not his bag)
I'm glad your questioning these things, but ultimately offering you any more information than you can find here is vexed by the fact that we don't really know your lifestyle and we don't really know anything at all about your "personality type" ... all of which feeds into the question of : which valve type best suits me.

which is why I didn't address what Chuck did. However as always Lp(a) is on the tip of his tongue and its only a recent discovery for me (thanks to Chuck's very data driven information).

Best Wishes
 
That is an amazing picture!

I'll share some perspective from a lifetime distance runner who had 2 mitral valve surgeries at the age of 50. As I obviously cannot truly know your exact situation, I'll just share some thoughts on what I would be asking/thinking about today "knowing what I now know".

- I did not want another surgery. I got one anyway. I now want another surgery even less! Mechanical valve has a large advantage in this area. I never considered a biologic valve.
- Warfarin is a non-issue for me. (reminder that I am responding just for myself!). I am on trails regularly. I fall regularly. I get minor cuts regularly. I am more concerned with taking a header off a bike on a trail and breaking a bone. Warfarin does not change this risk for me. I just spent the afternoon in my woodshop where an accident could be quite bloody . . .. with or without warfarin. It's a risk I accept because there are many things I can do to minimize the risk and make it acceptable to me.
- Going from a native mitral valve to a repair then to a mechanical valve reduced the size of my valve area. This is clear to me when exercising. As an endurance athlete I spend some time on most days wanting my heart to pump 3-4x its resting volume. The hemodynamics of the valve matter. Biologic valves have advantages in this area. However, replacement valves of any type have a cuff to attach the valve to the heart and this reduces the opening. Knowing what I know now, I would have more questions about this because the surgeon is not installing the valve while it's beating at 150bpm.
-As I understand Aortic Valve surgery (reminder, I know more about the mitral position and am fairly limited about the aortic), there is a tendency/need for some incisions to get close to the AV node or related apparatus. An endurance athlete will have thick walls (generally). I'd have some questions about how this impacts the surgical approach.
- Overall, I would want the surgeon to know/understand my lifestyle and have a candid discussion with him/her about how he/she will handle surgical details (when possible) in a manner that is best suited for this lifestyle.
 
Going from a native mitral valve to a repair then to a mechanical valve reduced the size of my valve area.
interesting, is this an outcome of there not being proper mechanical valve choice (meaning is this common) or is this because of mismatch?

Also was it a 1, 2, 3 staging down as ordered above or was it just the order?
 
Several things come in to play. Fundamentally, there is always the issue of the mitral valve not being round nor flat and that the two leaflets are not the same size. So a rigid ring (which is what my initial repair utilized) or a replacement valve with a rigid OD, both reduce flexibility. In my case, it turned out that after the rigid ring nicely tightened things up and fixed the leakage (regurgitation) problem, my leaflets were so stiff (likely calcification) that they were not moving out of the way like they should. My mitral valve area after my repair was 1.2 cm^2 which is meaningfully less than the normal 4-6 cm^2.

I've since learned that there are more flexible rings and semi-rigid rings (not a complete circle) that are now used to help with this 'loss of flexibility' issue in a mitral valve repair.

[ My previous bullets were just listed as I thought of them . . . no priority intended. But looking back at them, might have been subconscious, as I think that's how I'd order them. Definitely not having another surgery was/is #1 for me.]
 
[ My previous bullets were just listed as I thought of them . . . no priority intended. But looking back at them, might have been subconscious, as I think that's how I'd order them. Definitely not having another surgery was/is #1 for me.]
even though I'm not in the market, I'm always on the hunt for more data points (and user findings are always worth it to me.

Thanks
 
It is easy to accept a short-term solution (tissue valve) to a long-term problem......especially when the long-term solution (mechanical valve) involves some minor lifestyle changes. When I had the surgery, mechanical valves were the only choice available and I knew nothing about living with the valve after surgery. I have now lived 56+years with my "one-and-only" mechanical valve and for me the stories I've heard about the dangers, problems and lifestyle limiting of mechanical valves have proved to be mostly BS when the patent follows a few simple rules.

I was only 31 years old when I got my valve......and if I had to make that choice all over again, it would be "hands-down" a mechanical valve.

Your situation is a little different since you are 51 years old. Your decision is "how many re-ops" will I need before my life ends?

BTW, either way you go, the docs will encourage you to give up the pipe.......been there done that. The good news is you can still drink alcohol........and I still sneak in a cigar every now and then.
 
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Your decision is "how many re-ops" will I need before my life ends?
don't forget the hope of TAVI and valve in valve (in valve in valve...) which is routinely promised today.

But in all seriousness, at 51 a bio is unlikely to last 20 year, and would you want it to last 10, 15 or 20? (meaning 61 at reop, 66 or 71 at reop)

Reop is harder work on the patient (as well as the surgeon).

However its entirely correct that you must make some minor lifestyle changes:
  • taking ACT seriously
  • having a pill box
  • being a bit disciplined
Crazy stuff right
1711329878942.png
 
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some readings
https://www.sciencedirect.com/science/article/pii/S002252231200027X

The mean follow-up was 33 ± 24 months (range, 2–120), and the mean age at implantation was 50.6 ± 8.8 years (bioprosthesis, 55 ± 8.9 years; mechanical valve, 50 ± 8.6 years; P = .03)....​
prosthesis mismatch [PPM]), determined by echocardiography as the effective orifice area index (EOAI) [pellicle: meaning it wasn't mismatched, but became mismatched because of SVD]...​
1711330911455.png
Long-term survival data from younger patients after biologic versus mechanical AVR are rare and the relative risks and benefits of biologic AVR in this population have not been clearly determined.​



https://www.ahajournals.org/doi/10.1161/JAHA.120.018506
The onset of SVD generally occurs 7 to 8 years after BHV implantation, with freedom from SVD rates substantially decreasing 10 to 15 years after surgery.6, 13 The durability of xenograft BHVs implanted in the aortic position has been well investigated​
The durability of both xenografts and homografts also depends on host factors. For example, young age of graft recipient is one of the most significant risk factors determining early SVD onset, whereas patients >60 years of age often do not outlive the durability of BHVs because of relatively low life expectancy after valve surgery.​
To summarize, the proposed mechanisms responsible for dystrophic calcification of the BHV are presented in Figure 2.​
1711331162517.png
Heart valves operate in complex hydrodynamic conditions, experiencing significant shear stress, bending deformations, and leaflet tension. However, BHVs are more prone to mechanical degeneration than native valves because of the altered structure of the chemically treated ECM, which is unable to self‐repair.​
Fatigue failure of BHVs occurs independently of their calcification.44 Yet, these processes are interrelated because BHV calcification mainly develops in areas of high mechanical stress.​


the data from these shows that there may be some discomfort in future years for people taking bioprosthetic
 
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