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Tissue Valve Versus Mechanical Valve,

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Sep 3, 2011
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I am new to this web site and just learning how to navigate. I am scheduled for AVR surgery November 1st at Emory (Dr. Robert Guyton). I had a homograft valve replaced in 3/98, which is failing. I also have been told that the aortic root may be damaged and the mitral valve may need repaired or replaced. The mortality risk greatly increases as the complexity of the surgery unfolds, which won't be known until the surgeon has the chest opened. Very scary time.
My question is valve selection. I am 64 years old in reasonably good shape and regularly golf (125 times a year), occasionally downhill ski, and walk extensively. To avoid having the surgery a third time, I was going to go with a mechanical valve. The surgeon indicated that I might consider a tissue valve, because the replacement can be with a catheter versus open heart. I need to tell time on my pre op appointment on 10/26, which way I am going to go. Would appreciat feedback regarding anything that I have included in this tread.

Sincerely,
WVU Mountaineer
 

Jkm7

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There's not a lot I can help with except to note that though you are on pradaxa for a-fib, you probably would have to switch to coumadin if you get a mechanical valve. This should be discussed with your doctors but, to date, pradaxa is not being used for anti-coagulation with mechanical valves. If you are using that as a deciding factor, you probably want to verify what your doctors would order for you.

At 64, it's a particularly hard decision as many (perhaps most) surgeons suggest tissue valve for those 60 and over.
I personally opted for tissue mitral valve and for me it was definitely the right choice but we are all different and have to make the choice predicated on all those personal conditions and wishes.

My best wishes to you as you go through this difficult time.
 

Duffey

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You've got alot to consider. Are you expecting to have both the aortic and mitral valve replaced/repaired? Looking at possible future scenarios, what would happen if the mitral needed to be repaired before the aortic? Would you have to still undergo another open heart surgery?
I would want to have some firm answers from the surgeon before I commited to valve type.
Best wishes
 

dick0236

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At 64, it is almost a coin flip:confused2:. If you maintain a moderate activity level and continue in pretty good health, you may get 20+ out of a tissue valve. If you go mechanical, you almost certainly, will not require additional surgery, but you will have to deal with warfarin as a "senior".... So far, I have no problems with ACT. My mechanical valve has a "design life" of 50 years....and so far, so good, but I don't look forward to surgery in my 80s:tongue2:.
 

ElectLive

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If you haven't already, the A-Fib / Pradaxa issue seems pretty important to discuss further with Dr. Guyton and your cardiologist. Depending on the circumstances of your A-Fib, even with a tissue valve, you might end up on Warfarin eventually anyway. There seems to be a little controversy also regarding Pradaxa as the best choice for A-Fib in older patients because of bleeding concerns. The jury may still be out on this, but something worth asking about. There are also surgical interventions for A-Fib, depending again on your situation, that might possibly be considered at the same time. I second the thought posted above that the mitral valve situation is an important factor in the valve decision as well.

In many cases, the final decision isn't made until the actual surgery, but certainly you would want to fully discuss and be comfortable with a Plan A, Plan B, etc, depending on what he finds. At your age, a tissue valve followed by catheter procedure is becoming more and more likely everyday. It's not an absolute certainty, but not much is. Dr. Guyton does the cathether procedures on 80 year olds, though, so he is speaking from experience. If I remember correctly, as of a year ago, the number of cath procedures at Emory was over 100, exclusively in high risk 80 year olds, and no surgical deaths. I just wonder, though, if for you, maybe the A-Fib and/or mitral issues might be more important factors to consider in your decision.

Dr. Guyton was my surgeon, as well as another member here only a few weeks ago. I bombarded him with questions, and I encourage you to do the same. He was more than happy to take the extra time to address all my concerns, even over the phone.

Best wishes during this difficult process. In some ways, this is the hardest part I think. I found I was much more at ease after the decisions were made.
 
Joined
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I was told that the aortic valve would definitely need to be replaced. They just discovered the mitral valve situation on the latest doppler and will not know if it should be repaired or replaced until they get in there. I am leaning toward the tissue valve, but want to investigate all possibilities. Thanks for your help.
 

Cooker

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Very personal decision ... whichever way you go I'm sure it will be right for you ... Godspeed
 

pem

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As far as I know, percutaneous (catheterized) valve replacement ("valve-in-valve" insertion) is still only used in cases in which the surgical risk is too high. In 20 years, it maybe routine and perfected. But who knows. If you go the mechanical valve route, you may consider one of the pyrolitic carbon valves, such as On-X or Medtronic Open-Pivot, which seem to require lower anticoagulation, which would be better tolerated by an aging vascular system. At age 41, I chose mechanical (Medtronic). This decision was based in large part on the belief that a tissue valve would likely not last longer than about 12 years for me (I calcified young in the first place and tissue valves last longer on average when you are older). In your case I might be tempted to go with the Mosaic (which I think replaces the aortic root as well).

Frankly, I think either is a good choice. Do your due diligence (as you are), and then ultimately go with your gut.

Best of luck!
pem
 

Kiwimac

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Never had a choice - I went in for a repair to an aortic dissection, they found a bicuspid aortic valve so they decided to replace it while I was on the table!!

I got a St Jude mechanical. Apparently made from pyrolitic carbon - same as rocket nose cones or something!!
 

scott.eitman

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Best of luck to you. I had my 1998 model Homograft replaced last year. The thought of a third surgery was too scary for me and I chose Mechanical.

On coumadin, I run the risk of haiving a bicycle accident and then needing to go to a trauma unit to get check out. I will stop riding. I mention this as it is something you need to consider in terms of sking.
 

Lily

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I was told that the aortic valve would definitely need to be replaced. They just discovered the mitral valve situation on the latest doppler and will not know if it should be repaired or replaced until they get in there. I am leaning toward the tissue valve, but want to investigate all possibilities. Thanks for your help.
I don't know if my experience is common but perhaps the information will be helpful to you so I'll share it:

My mitral valve was struggling too. Once the surgeon replaced my failing native aortic bicuspid valve, however, he did a TEE while I was still under and by then my mitral valve was working fine and didn't need anything done to it afterall.

Best wishes :smile2:
 

OldManEmu

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Lily
My first AVR was much the same as yours.
The MV leak was only occurring because the AV was in such bad condition it was causing things to back up though the heart and the MV was unable to maintain normal pressure through the lungs and this caused right side heart failure.
My MV function has been normal since the AVR.
 

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