Tissue Valve

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Bigchzz

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Dec 2, 2021
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I had avr with bovine in 2013 for regurgitation, my latest echo showed I now have severe stenosis. I chose to go tissue because I did not want to be on coumadin for the rest of my life. I really thought I would get more years out of the tissue valve. Does anybody know if you can get Tavr if you already have a tissue valve?
 

Hokiesid

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Oct 4, 2021
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Depends on your age. The major risk is how many times we need re-operation to replace that valve. My surgeon made it sound like at 51, just use the mechanical valve & be done.I am not excited to have my blood tested weekly, but apparently through the use of Eliquis, this monitoring should it be not as necessary.
 

Lynn

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Welcome to the forum Bigchzz. I really think you need to take up the issue with your doctors and surgeon to determine if you are a candidate. My surgeon cautioned me that if I went tissue I needed to be aware that I may not be a candidate for TAVR In the future. It depends on several factors including degree of calcification, size, positioning ect. Factors like age, and other heart issues also need to be considered.

My surgeon and cardiologist also pointed out, that based on my age of 58 and being in good health, the risk of open heart surgery was comparable to that of TAVR and both strongly advocated for a mechanical valve. Everyone’s situation is different though, so you need individualized advice. What I can say is that my concerns about warfarin were largely unfounded and I am very thankful for the advice I received on this board in making my decision to go with a mechanical Valve. Good luck.
 

Bigchzz

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I am 52 and they recommended that I go with mechanical valve the first time but seeing the risks of coumadin I wanted tissue. I am sure when I see doctor next week they will once again want me to get mechanical valve. I was just curious on if they can even do tavr if you already had one replacement. TIA
 

dick0236

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Hi Bigchzz and welcome to this forum. My suggestion is for you to read thru the stories on this forum that have been posted by the members who have been on warfarin for many years because they had "one and done" mechanical valves implanted many years ago. Most mechanical valve folks have little trouble with using warfarin and find little interference with their lives and lifestyles. Personally, I have been on warfarin since I was 31 and am now almost 86....on my "one and only" mechanical valve......and I would go mechanical valve if I had to do it all over again.

The majority of valve replacements are done on "seniors" above middle age and the use of tissue and/or TAVR products can be expected to last their normal life expectancies........that is not true for younger patients who can be expected to live many more years after surgery. I've waited a lifetime for a sure-fire cure which hasn't happed yet....but until that happens a mechanical valve is your best chance for valve longevity.
 

Superman

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Eliquis, to my knowledge, is not approved for use with mechanical valves.

To the OP, welcome to the forum!

Curious what risks of Warfarin you want to avoid that make it less appealing vs further major surgeries?

I’ve been on Warfarin 31 years. Aside from a finger poke every couple weeks and a couple pills with my OJ in the morning, I don’t think about it at all.

As far as if they can do a TAVR inside a bovine or porcine valve, I know it’s being worked on. I don’t know what patient population they are allowing for. But at 52, even if that can - will they be able to do it again? And again? And again? How many do you suppose they can stack? Say you get 10 years from a TAVR. If they can’t stack a third valve, you’re still looking at open heart again at 62. With scar tissue to cut through, it doesn’t get easier.
 

Chuck C

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Hi Bigcchzz and welcome to the forum.

I really thought I would get more years out of the tissue valve.
I wish I had a dollar for every time I hear that. Before making my valve choice I read thousands of posts on this forum, and even went back 10-15 years reading old threads. So many times members have said: "my surgeon told me that I could expect 15+ years out of the new tissue valves, but it olnly lasted___."

Well, the evidence was not there for their physicians to tell young patients to expect 15+ years tissue valve life expectancy in 2005-2015 and it still is not there for them to make this claim today. Tissue valve manufacturers are very good at influencing many clinicians to go outside the guidelins with the "hope" that their new valves will last much longer than the data predicts. But, I do see that your cardiologist and surgeon both recommended mechanical given your age and you went your own way. Ultimately, it is truly the patient's choice, as it should be. You got 8 years out of your tissue valve- seems 8-12 years is very common for folks under 60.

You chose tissue for the reason that I almost did and that most do- fear of Coumadin. I put great value in the experiences shared by members like @dick0236 who have used Coumadin for decades and shared that it is no big deal. My 8 months on Coumadin have been easy- weekly self testing of INR is a breeze.

As to your question. Yes, TAVR is possible for someone who has a tissue prosthetic. It depends on at least two factors

1) If you have the right type of tissue valve. Some are capable of accepting a TAVR, but there are a few that will not work with TAVR. Last year I met with the interventional cardiologist at Scripps who does most of their TAVRS, for TAVR evaluation and to discuss also the possibility of going tissue and then TAVR. He cautioned me if I do decide to go tissue and then plan to do TAVR for the next round, then I should avoid two certain tissue valves, which are not compatible with TAVR. I have them in my notes somewhere. Ended up being a moot point, as I went mechanical. BTW, after reviewing my echo, he concluded that I was not a TAVR candidate for surgery #1 due to uneven aortic calcification in my native valve- see #2 below.

2) Even if you have the right tissue prosthesis, there are other factos, such as distribution of calcification, which will determine if you are a TAVR candidate.

If you are considering TAVR, you will evaluated whether it is even an option, depending on the type of tissue valve you have. They will then probably need to do a CT scan to determine if you are a good candidate for TAVR based on what is going on with your current prosthetic valve.

Best of luck with whaterver you decide and please keep us posted.
 
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pellicle

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me but seeing the risks of coumadin I wanted tissue
I'm also curious as to what risks you see ... the primary risks are all on you really:
  • you fail your compliance and didn't take it
  • you don't bother testing and therefore don't know your INR and if its out of range there are real risks
the risks of having a tissue are that it will fail (note, not might) and require reoperation unless you die earlier. There is the possibility that you can (at your age) get 15 years before the onset of Structural Valve Degradation (SVD) and then have a TAVR which may last as long as 10 (not so much data around) 15 + 10 + 52 = 77 : which is a real bad time to be needing an OHS. However you may be dead by then anyway. Not that TAVR is without risks ...

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52 is an age were I think that if you aren't active and sporting then a tissue isn't a bad choice.

If you are not the type that wants to take the helm and look after your own health then tissue is the best choice IMO

The real kicker would be that you pick tissue for the sole reason of avoiding warfarin and then become one of the lucky 10% or so who are stuck on warfarin with a tissue valve anyway (of course your surgeon will tell you "that won't happen to you".

I would make efforts to educate yourself on facts. Because after surgery is too late to go "oh, nobody told me that"
 

pellicle

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I really thought I would get more years out of the tissue valve.
sadly I too have the same view of "I wish I had a buck for every time I read this".

Did you want a few links from here where people have said this?

I would advise licking your wounds, revaluating your decision matrix with some stout reading and then consider carefully if you want a third.

Sorry to be blunt, but this subject is really a vexing one for me. I hate seeing people make misinformed decisions and then spiralling down the rabbit hole of denial of this (because admitting it would kill them).

I recommend you watch this as a starter to your next wave of research


get a coffee, and take notes, then follow up with research, you may like to start with some of mine from 2014

Best Wishes
 

Bigchzz

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Dec 2, 2021
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Wow this Forum is amazing, first thank you for the "welcomes". Some of my concerns are of course the testing every week or so, bruising, stomach ulcers...etc. I am somewhat active but of course slowing dow as I get older, I am also an emergency room nurse. I initially got the tissue valve thinking it would really last 12-15 years like they told me it would, So I am actually in shock the it didnt even last 9 years. Reading some of the responses here I think maybe I will have to consider the mechanical valve. I truly dont want to have open heart again but it certainly beats the alternative.
 

Patrick2018

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Mar 17, 2021
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I am 68 and I was diagnosed with severe mitral stenosis just over a month ago following an echocardiogram. My cardiaologistat at that time, said I would need a procedure, but would need to be evaluated before knowing what procedure to perform. I was put on warfarin at that time, but I did not like the communication issues and the apparent uncertainty with my cardiologist. I changed to a more experienced cardiaologist, which I had originally had when I had my OHS for replacement of my mitral valve with a bovine tissue valve in 2018. He had moved to a different group, so I switched and am seeing him now. So, after being on blood thinners for several weeks, my symtoms disappeared and after a repeat echocardiogram, all criteria is normal. We are still not sure what caused symtoms that coincide with congestive heart failure. Note: my current cardiologist put me on Eliquis because he told me Eliquis is at the point of being approved for patients with tissue valves.
My new old cardiologist said if a procedure is necessary in the future for complications that might arrive, he can performed the procedure that is needed on my tissue valve. Although this Doctor is relatively young (in his 30's) I have confidence in him, knowing his background, education and confidence.
Thank God everything seems fine and if I have to stay on blood thinners, so be it.
 

Lynn

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I understand where are coming from Big chzz, I initially thought a newer model tissue was the way to go. However the warfarin advice and the real world stories on this board coupled with advice from my cardiologist and surgeon changed my mind. My surgeon was very clear. He said if I chose tissue he WOULD be seeing me again at some point.

The other factor was how my family felt about things. My husband and children felt very strongly that I should go one and done. I have a daughter and daughter in law who are health care professionals and they thought I was over reacting to the idea of warfarin. And I have come to believe they were right. Good luck with your decision.
 

tom in MO

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...Tissue valve manufacturers are very good at influencing many clinicians to go outside the guidelins with the "hope" that their new valves will last much longer than the data predicts...
Chuck, that's a real strong statement of fraud. Can you show some objective evidence to support that statement? If you have some, notify the FDA because it is illegal for a medical device manufacturer to market outside their device's defined attributes or to market w/o full disclosure of risk.

Bigchzz: Managing warfarin is easy if you have the type of personality that can take daily meds and test every 2-3 weeks. However, being on warfarin means your blood will take 2-3 times longer to coagulate or clot. This can lead to complications in other areas of medicine, such as surgery, recovery from surgery, arthritis care, spinal stenosis treatment, ulcers due to stomach problems or diabetes, severe trauma (e.g. car accident), etc.
 

Chuck C

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Chuck, that's a real strong statement of fraud. Can you show some objective evidence to support that statement? If you have some, notify the FDA because it is illegal for a medical device manufacturer to market outside their device's defined attributes or to market w/o full disclosure of risk.
I never used the term fraud. It is actually brilliant marketing and educating; optimistic human nature does the rest. The hope is not made up. They have reason to hope they will last longer and, therefore, educating about why they believe this is not fraud. They educate physicians and the public and the optimistic nature of those who wish to believe hope, rather than data will lead many patients, and yes, many physicians, to speculate on expected valve life when the actual data is not yet there. Because with only 5 years of human data, you can't realistically predict that a new valve will last 15 to 25 years for a young patient, despite a new anti-calcification treatment that they hope will extend the life of the valve.

But, just in case I change my mind and do decide that it is fraud, perhaps you can help me out. Perhaps you can send me the form that you used to file the complaint with the FDA when you told us all about the fraud that the vaccine manufacturers were committing.

You did file a complaint with the FDA after you said the below, right?

"If you want proof of fraud in vaccine production, just look to the contractual scandals surrounding Emergent and the fact that vaccine developers don't need a few billion more in profits. They have already recouped costs with most of them were paid by your tax dollars and not Pfizer et.al. They have reaped insane profits from a pandemic."
 
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pellicle

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So, after being on blood thinners for several weeks, my symtoms disappeared and after a repeat echocardiogram, all criteria is normal.
It could be just that your valve is causing some thrombosis, I understand that happens (yes even with tissue valves). I'm glad to hear it's sorted and you've found a non-surgical treatment.

Reach out if you encounter management grief on INR management.

Best Wishes
 

bizinsider

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You got 8 years out of your tissue valve- seems 8-12 years is very common for folks under 60.
Hi Chuck,

When I got my valve 2 years ago, at 67, my surgeon for some reason chose an older-type tissue valve. It was surprising since he was a lead investigator on one of the newest, most popular that seem to be used today. He felt this valve was the best for my procedure/situation. But he sized it for a TAVR replacement, and said this one should last 8-12-15 years. As you and I both know, having read these forums, some people have them replaced much sooner; some others have had them last longer.

FWIW, after I made my choice my surgeon, who was also in his 60s, said he thought tissue was the right choice.... for me. (As you know, they let YOU choose mechanical vs tissue, then THEY choose the brand/model valve.)

When mine is replaced, assuming it's via TAVR, I'll likely also need a pacemaker. I have a right-bundle-branch block, so apparently the way TAVR is done will play games with my heart rhythm. (That said, thankfully I had no aFib after my current implant.)

I had been watching my valve for 40+ years. If I had been younger, I would have likely chosen mechanical. The one constant I've read here is that living with INR testing and Coumadin is more bark than bite.... sort of like heart surgery, itself.

Like everything in life, and given the way the brain works, you adjust.

Cheers,
Herb
 
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