Tissue Valvers second OHS

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Lorimacm

Well-known member
Joined
Jun 21, 2009
Messages
146
Location
California
I am in the decision stage now of which valve to choose, my surgeon is leaning toward mechanical and cardio likes tissue for me. I am 44 and I really don't know what would be best. I am currently not that active, but have an active 5 year old who is a very busy fellow. I am not too active because of shortness of breath but who knows after successful surgery I think I will want to have some fun! I bruise pretty easy and am a bit concerned with future surgeries. The biggest concern on future surgeries is that my mother and father have (and had, father is passed - aortic anerysm) severe arthritis. Dad had bone spurs removed from spine and mom has had two hip replacements. I also have diverticulosis (with no real problems at the moment).

I've been leaning toward mechanical but am worried about future surgeries (for non-heart related problems) and another OHS.

I was wondering if any tissue valvers having had their 2nd OHS wish they had a mechanical to begin with.

Thanks so much for sharing.

Lori
 
Hi Lori, i think a mechanical valve would be fine...becaue of your age...im facing the same thing, im only 35. I think its ultimately your choice, but im sure youll make the right one. Good luck , and keep us posted...Danny
 
Lori, I had a tissue valve put in last year at the age of 45. It was my second heart surgery (my first valve surgery). Depending on how this valve does in my body, I could need between 1 - 3 more surgeries in my lifetime. Did I enjoy the experience of having a second heart surgery? No. Am I looking forward to another? No. Is it as bad as your mind thinks it is going to be? For me, no. Is it terribly painful? For me, no.

If you have read thru the threads, you know that valve selection is and should be a very personal decision. What is the right choice for one person is the wrong for another.

With your history, I would make sure that everyone involved with your care is on the same page if you do decide on a mechanical. That includes involving your GI Dr. who takes care of your diverticulosis. I believe that there is another member on here (Roundsgirl), who went with a tissue valve partly due to GI issues.

Kim
 
At age 44, I'm guessing that even the best of the Tissue Valves will not make it to 20 years of service as they do in older patients.

One of the reasons I like the On-X Valves (introduced in 1996) is that they have a lower risk of Clot Formation which is especially important when going OFF Coumadin for other invasive procedures.

On-X is currently in trials for NO and Low Dose AntiCoagulation but the results of those tests wont be known for several more years. The Lower Clot Risk is there from Day 1, regardless of the result of those trials.

see www.heartvalvechoice.com and www.onxvalves.com
 
Hi Lori,

I had my first AVR in March of 2002 at age 45 and choose a tissue valve. At the time the surgeon suggested that valve would last 12 years. Of course I was hoping for more. :)

The last couple of months I've found out that my tissue valve is now leaking enough to require replacement. Had I known the answer would have been 7 years to the question "how long will it last", I've would have chosen a mechanical.

I now plan to get a mechanical (On-X) for a surgery that will probably be in the next few months. I'm getting short of breath more often that I would like and I'm not one to wait for much, including surgery.

Best of luck with your decision.

Chris
 
At age 44, I'm guessing that even the best of the Tissue Valves will not make it to 20 years of service as they do in older patients.

One of the reasons I like the On-X Valves (introduced in 1996) is that they have a lower risk of Clot Formation which is especially important when going OFF Coumadin for other invasive procedures.

On-X is currently in trials for NO and Low Dose AntiCoagulation but the results of those tests wont be known for several more years. The Lower Clot Risk is there from Day 1, regardless of the result of those trials.

see www.heartvalvechoice.com and www.onxvalves.com

To clarify, the Randomized On-X Anticoagulation Trial is found at: http://www.clinicaltrials.gov/ct2/show/NCT00291525

There are three test arms of the study: low risk aortic valve replacement, high risk aortic valve replacement and mitral valve replacement. Each arm has an equivalent control. Test therapies are: low risk aortic valve replacement - aspirin/Plavix, high risk aortic valve replacement - Coumadin at INR of 1.5 to 2.0 plus aspirin, and mitral valve replacement - Coumadin at an INR of 2.0 to 2.5 plus aspirin.

The purpose of the study is: "Various patient groups with the On-X Valve can be maintained safely on lower doses of blood thinner(Coumadin®) or on antiplatelet drugs (aspirin/Plavix®) only rather than the standard dose of Coumadin and aspirin presently recommended by ACC/AHA or ACCP professional societies."
 
I had second OHS about 18 months ago and chose bovine tissue valve in mitral position. I am so happy that is what I chose and no second thoughts whatsoever. Each of us must decide for ourselves (in consultation with our doctors) which is best. There is no wrong choice other than to not choose.

It's very hard making this important decision and I wish you the best.
 
Thanks for the info. I actually didn't think to talk to my GI doc, good idea. My daughter has Crohn's disease and no one else in the family has it and I heard it could be hereditary. I have never been tested, the doc just said I have the diverticulosis after my colonoscopy. Her Crohn's has caused quite a bit of bleeding before she was diagnosed and maybe I should get checked just in case.

So much to think about!
 
OOPS! I forgot about the connection between Crohn's Disease, Bleeding Issues, and Diverticulitis.

YES, member "Roundsgirl" went with a Tissue Valve as the 'Best of Bad Choices'. She had serious bleeding issues but was only 39 (that's not totally clear from her profile) at the time of her surgery.

==================
Here is her signature line:

Roundsgirl
Lisa

Age 39 years old, was told surgery would be 10 to 15 years down the road, but no such luck.
Aortic Valve replacement Jan.3 2008
Bovine Pericardial heart valve used, had to go with tissue valve, due to bleeding issues with diverticulititis.

Not looking forward to another surgery, but would love to be around to have some grandbabies to chase around.
===================================

I believe she also had some serious post-op issues
(and several co-morbidities, before and after surgery).

To find her (21) Threads, click on "community" on the Blue Line, then "Members List", then first letter "R", then scroll down to her screen name "Roundsgirl", then find the box with the Search Options for "Treads started by Roundsgirl".

It would be wise for you to check ALL of your issues with experienced Doctors in each area of expertise before deciding on a plan of action.

Selecting a Surgeon who has experience with patients having your issues is a Big Benefit. I'm a believer in using a Major Heart Center if possible for patients with complex issues because of their more extensive experience / expertise.
 
Hi, good question to ask. I had a tissue valve (homograft) when I was 48. I am now having a second surgery at 57. At this point I do wish that I had a mechanical valve the first time. It is not only the risk and discomfort of the surgery, but also the strain on my wife, kids and other family, as well as disruption at work. I trust everything will go. I am planning on the On-X but have several tests to go.
 
Interesting thread and thanks for putting this one out Lorimacm. I am in a similiar boat to you with a possibility of re-op anyway for a pulmonary valve issue so surgeon is leaning toward tissue for me. Cardio. really sat on the fence.
So, for those who wish they went with the tissue a few years back and now are due for the 2nd OHS, if you could look back, are you glad that you had those years coumadin and ticking free?

I guess this is a difficult spot to be in. That is the beauty of hindsight, which we never get until 'after the fact'.
 
Lori, this was probably one of my hardest decisions, which way to go mechanical
or tissue. I chose mechanical and Dr. Shemin at UCLA put an On-X valve in for
me on June 17, 2009. I have not been sorry I went that way. Weigh all the
info. and then whatever way you decide to go just stick with that plan. It does
not sound like you will have a lot of time to decide but just do as much research as
possible. Talk to those who have been there and go for it!
 
Thanks All!!!
My husband talked to doc and he is still leaning toward mechanical since I have not had any bleeding issues and not uncommon for many people to have diverticolosis with no problems. He did say that if I had infection or "diverticulitis" (when the small pouches are inflamed) then it would be a different story. I will still ask opinion of GI doc just for peace of mind and the crohn's disease question since my daughter has crohn's.

So I guess the jury is still out on this one!!

Lori
 
I don't regret choosing tissue the second time around either. I take warfarin for other reasons so I wound up being anticoagulated in spite of my aversion to the drugs. The valve implant I received in 2000 was overgrown by pannus in 6 years. I have no reason to believe that my valve material influenced this problem since pannus is dependent on other issues.

We do what we need to in order to live the life we desire. Make your decision based on those factors that give you the best odds in attaining that goal. Don't forget to ask your surgeon the magic question... "If this was your loved one, what would you choose for them?" The doctor's answer shouldn't be your sole criterion but if 'twere me, I'd use that choice in my calculating process.

I wish you strength, hope and wisdom as you make your way through the muddle that is life as you wait for the day when all of this is past. You will feel better no matter which way they repair your heart.

Take Heart, we all make this intensely public, personal decision,
Pamela.
 
I am about 2 and a half weeks post op for 2nd AVR. My first was a homograft that I got a really good 19 years out of. I'm 36, and there was never really any question in my mind that I would go with mechanical this time around. I would not choose to have another OHS if I can avoid it. 2 is more than enough. I know being on warfarin is not ideal, and complicates any future proceedure. And the ticking does annoy me from time to time, but who would voluntaire to be hit by a truck a third time?
 
I don't regret choosing tissue the second time around either. I take warfarin for other reasons so I wound up being anticoagulated in spite of my aversion to the drugs. The valve implant I received in 2000 was overgrown by pannus in 6 years. I have no reason to believe that my valve material influenced this problem since pannus is dependent on other issues.

We do what we need to in order to live the life we desire. Make your decision based on those factors that give you the best odds in attaining that goal. Don't forget to ask your surgeon the magic question... "If this was your loved one, what would you choose for them?" The doctor's answer shouldn't be your sole criterion but if 'twere me, I'd use that choice in my calculating process.

I wish you strength, hope and wisdom as you make your way through the muddle that is life as you wait for the day when all of this is past. You will feel better no matter which way they repair your heart.

Take Heart, we all make this intensely public, personal decision,
Pamela.

Pannus Tissue Growth can happen with Either Mechanical or Tissue Valves.

The On-X Valves are the ONLY valves I know of that have a built-in Barrier to prevent / retard Pannus Tissue Growth from impinging the leaflets.
 
Pannus Tissue Growth can happen with Either Mechanical or Tissue Valves.

The On-X Valves are the ONLY valves I know of that have a built-in Barrier to prevent / retard Pannus Tissue Growth from impinging the leaflets.
I thought the coating on the leaflets merely inhibited clot formation. The pannus that grew at the aorta side of my valve didn't grown on the valve, but instead stuck to the annulus and began an inexorable ingrowth through the cells sticking to themselves.

eta: I saw in the video at the On-X website that it's not the leaflets that are coated but instead, because of valve annulus depth and flare, there's a physical barrier on the heart side of the valve. Interesting Al, I'm glad I took a look, thank you for the accurate info.
 
I think that it's very important to consider your likelihood for later surgeries, particularly in conjunction with any health issues you already have or see a likelihood of having. If aneurysms are in your family, it's a consideration in my view.

- The activity level of you or your children (unless you are personally into contact sports, or activities that are prone to creating head trauma)) is pretty much immaterial. Coumadin wouldn't keep you from any of that. The most dangerous types of bleeds that are most associated with warfarin would be intestinal bleeds, delayed post-surgical bleeds, and ruptured blood vessels in the brain. Bumps, bruises, and superficial cuts may be more visible, but only for some users, and just don't represent a special danger for the vast bulk of mechanical users.

- The fact that you bruise easily might indicate a consideration. You could find out by having tests to determine if your blood has other clotting issues that might be worsened by warfarin. or if you have overly fragile blood vessels. Liikely not, as even taking The Pill can cause that, but it's worth consideration.

- It is extremely unlikely that you would get 20 years even from the newest tissue valves at your age. If you chose and stuck with tissue, the likelihood is that you would have a minimum of two, and more likely three further surgeries. The last one or two might be through transcatheter placement, but the first two would likely be standard surgery (my guess/estimation of the medical industry's readiness). I just had my second AVR five days ago. It isn't/wasn't fun, but it's doable. I did go with a tissue valve again.

- Coumadin complicates later surgeries. Bridging is one of the specific points at which stroke - or bleeding - danger is higher than usual. Surgeries can be done (such as hip surgeries, replacement of other valves, or repair of aneurysms), but doctors will put it off longer and it will carry a higher risk load, and some surgeons just won't touch you, maybe limiting your choices.

- The overall history seems to be that neither choice will affect your longevity after the surgery by any appreciable amount, so that's hard to weigh in. The risks largely counterbalance each other.

- There's certainly nothing wrong with a mechanical valve for most people. They are excellent valves and pretty much don't go bad - ever. I would opt for the On-X that Al Capshaw likes to point to, as there is a possibility still of aspirin-only ACT (AntiCoagulation Therapy). The trials have been going for some time, and haven't been stopped. (They would be stopped if there was reason to believe the death rate was unacceptable.) It's worth it, just on the chance that it's approved. Other than that, all of the leading mechanical valves are excellent. The On-X also has the protection against pannus (scar tissue that can grow quickly or very slowly at the operation site, or even creep up onto the valve itself), which is one of the more common reasons for removal of a mechanical valve when it does become required.

Best wishes,
 
Hi Lori.
Lotti here in the UK. I had a tissue valve put in in Feb 06 at age 37. If I had known how tough the whole ordeal was going to be I would have gone mechanical so that I would never have to do it again. I will definately be going mechanical next time. Having said that I had a good report this Feb, that despite my new tissue valve being faulty it had had no degredation in the previous 12 months, so hopefully it will last many many years.
Ask questions of your professionals and your friends/family and go with your gut. You will make the right decision for you at this time of your life.

Hope it goes really smoothly
Lotti
 
Tobagotwo writes: "I would opt for the On-X that Al Capshaw likes to point to, as there is a possibility still of aspirin-only ACT (AntiCoagulation Therapy)."

To clarify: the Randomized On-X Anticoagulation Trial is found at: http://www.clinicaltrials.gov/ct2/show/NCT00291525

There are three test arms of the study: low risk aortic valve replacement, high risk aortic valve replacement and mitral valve replacement. Each arm has an equivalent control. Test therapies are: low risk aortic valve replacement - aspirin/Plavix, high risk aortic valve replacement - Coumadin at INR of 1.5 to 2.0 plus aspirin, and mitral valve replacement - Coumadin at an INR of 2.0 to 2.5 plus aspirin.

The purpose of the study is: "Various patient groups with the On-X Valve can be maintained safely on lower doses of blood thinner(Coumadin®) or on antiplatelet drugs (aspirin/Plavix®) only rather than the standard dose of Coumadin and aspirin presently recommended by ACC/AHA or ACCP professional societies."

No where in the clinical trial is there an arm for aspirin only. There is an arm for aspirin and Plavix (considered an antiplatelet rather than an anticoagulant).
 
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