Tissue vs. Mechanical - terrified and confused

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Cherie' said:
I guess there is no right or wrong answer. My question is what is the longest anyone knows of a tissue valve lasting? Was it pig or cow? Is there anyone that has tissue or mechanical that wishes they would have made a different decision, and why? WHat things can you absolutely not do on coumadin? Can you have any alcohol, coffee, iced tea, etc.?
Cherie'
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Cherie, I have a neighbor who had a tissue valve (I think pig) implanted in 1976 that lasted till 1992(16 years). It was replaced in 1992 with a mechanical valve(18 years and counting). He is now in his late 70s and doing pretty well. He was a building contractor prior to his normal retirement, so I assume he was pretty active with both valves:smile2:.

I honestly can't remember being told NOT to do anything because I have a prosthetic valve, but I was advised to use "common sense"....something I have not always done. One piece of advice is NOT to run with scissors:tongue2:. The worst I ever did was stick my head into an operating ceiling fan:redface2:. I got a haircut and a couple of stitches, but I did not bleed to death:wink2:. Seriously, I have been involved in a couple serious auto crashes in addition to many of the things that happen to people with no lasting problems from the valve or warfarin.

Alcohol, coffee, tea, etc. will pose no problem if done in moderation, and FWIW, I have never restricted ANY foods or drink from my diet.
 
The only bad choice you could make when selecting which valve is to not choose one at all.
Whichever you decide upon will be the right one for you and DON'T look back. Make your decision and no 'second guessing'.

I chose bovine and know that for me, it was the right choice. I had a feelilng of certainty and peace once I made my choice and have not once had second thoughts about it.

It's a hard choice but you are doing the research, reading and learning and will certainly make your choice and it will be the right one for you.
 
Cherie' said:
WHat things can you absolutely not do on coumadin?
Cherie'
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You don't want to sword fight, stay far away from surgeons with scalpels, try not to chop off any members of your body willingly. Don't ski into trees or other stationary objects. Stay away from terrorists that are dead set on blowing themselves and everyone around them, up. Did I leave anything out?

Dick, was that a 4 or 5 blade fan that got you? I had a 4 blade try to eat me.
 
Cherie, you asked about anticoagulation therapy (ACT) so you might benefit from going to the Anticoagulation Forum here and taking the time to read through some of the threads and discussions.

Remember that a person who takes ACT and/or aspirin therapy after valve replacement surgery does so to hopefully avoid potential clots from the valves, and then subsequent strokes. Too much anticoagulation can also contribute to serious internal bleeding, and even another type of stroke, a bleeding stroke.
 
Get it over with

Get it over with

Cherie, this is not going to be resolved by itself, denial of the situation doesn’t make it go away.
At 45 what is to be gained by trying to postpone surgery?
The surgery may appear overwhelming from where you are now, but I didn't find it that bad.
I would swap class IV heart failure for surgery any day. :smile2:
If you do not have surgery the end point is heart failure followed by death. :eek2:
Valve choice is always a personal issue after evaluating all the implications of the two options available.
Dick and Ross, I usually like to work around fans after turning them off. :biggrin2:
 
Cherie' said:
<snipped> The only symptoms I have now are some shortness of breath and some chest pains. Maybe I should try to push off surgery a year or two to buy me time - I AM TERRIFIED and CONFUSED!!!

PS - I originally posted this late last night under Penny's thread, but then realized I probably should have started a new one - didn't know how to move the couple of posts after mine over. Maybe someone can help me? Also don't know how to get my info to show up at bottom so I retyped it.
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Well, I thought I wrote a response to you last night and then couldn't find it, but it was in the other thread, so I'm glad you mentioned that.

Waiting a year or two would not be good at all. You might not make it a year or two. If anything, taking another week or so now to make your valve decision is fine, but putting it off much longer is a crap shoot you don't want to take.

As I said in my other post, the deal breaker for me was additional surgeries. So give yourself a wee bit of time to gather your thoughts on this, but, please, don't put your surgery off more that 30 - 60 days.

If you want info to show permanently in your signature, click on "Settings" at the very top of the page, and then on the left side, click on "Edit Signature," include what you want and click on "Save Signature," and what you put in there will be part of your signature, and then when you post, be sure the "Show your Signature" is checked under "Additional Options."
 
Cherie' said:
Dear all-
Thank you all for all of your encouraging words. It really makes me feel like I am not alone. Like many of you I have been going around and around in my mind. Have even wondered if I should postpone the surgery. Cardiologist & two surgeons say I need to do in next 30-60 days as I am symptomatic. Another surgeon says I could postpone and get another chest CT in 3 months and see how things are going. I have been lucky enough to talk to multiple surgeons. I have two daughters - one is college - who will be available to help care for me in the summer - so thinking sooner is better than later as it will take some stress off of my husband.

Spoke with nurse at On-x ans she had some very interesting information. Says they are awaiting FDA approval for the assembled On-x value with the conduit already attached - Dont know if I have correct terminology - This sounds very exciting to me. Kind of leaning toward On-x if I go mechanical.

I guess there is no right or wrong answer. My question is what is the longest anyone knows of a tissue valve lasting? Was it pig or cow? Is there anyone that has tissue or mechanical that wishes they would have made a different decision, and why? WHat things can you absolutely not do on coumadin? Can you have any alcohol, coffee, iced tea, etc.?

Thanks for all of your words of wisdom and insight,

Cherie'
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The Bovine Pericardial Tissue Valves have been around the longest, with early recipients (over age 60) approaching 20 years of service. Young women who have chosen Bovine Valves to bear children have gotten 10 years of service from these valves. There have been some early failures, but fortunately, this seems to be a fairly rare occurance.

Standard (unmodified) Porcine Valves typically do NOT last more than 8 to 12 years, and often less, especially in younger recipients.

There are several types of "New and Improved" modified Porcine Valves that are hoped to last longer but they have not been in service long enough to know how long they will last. We have had several members whose Porcine Valves failed early (1 to 7 years).
 
What Bill said is worth repeating "Anyway, most of us have BTDT and sincerely sympathize with your situation. Just remember, ultimately you will do well and your life will be saved by this operation."

In most cases, the surgeon may have to make a judgment call on what valve is best upon seeing what is actually the condition of the heart. The pre-surgery diagnostics give some idea, but there still may be surprises. In my case, I agreed with the surgeon recommending mechanical, and I was thrilled that he told me it is likely to outlast me! I am 58, and my 6 month anniversary of surgery is next week.

I too was a bit concerned over the Coumadin (or generic warfarin), but I agree with Andy that it is pretty much a non issue. You will have frequent monitoring and adjustments of dosage early on, especially since some other medications you probably will have, can affect INR values. One of the good points of the latest state of the art mechanical valves, such as the ATS AP 360 Open Pivot I have, and the On-X, is that they both are low turbulence valves, which in turn means a lower INR range is generally used, after the initial post-op risk of Atrial Fibrillation has passed or been dealt with.
 
Ross said:
You don't want to sword fight, stay far away from surgeons with scalpels, try not to chop off any members of your body willingly. Don't ski into trees or other stationary objects. Stay away from terrorists that are dead set on blowing themselves and everyone around them, up. Did I leave anything out?
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I tried, not always successfully, to avoid these things before I was on Coumadin.
 
Terrified?

Terrified?

We're often faced with a lot of situations in life that suck... facing your mortality because you have to have valve replacement surgery really sucks... like you, facing valve replacement surgery terrified me. Even though I went through it and had a pretty easy recovery, facing the prospect of doing it again would undoubtedly terrify me again.

Others have noted that there are no guarantees regardless of whether you choose tissue or mechanical. I decided to play the odds and go with a mechanical... hopefully, this will play out in my favor and I'll avoid another round of surgery.

Doing the meds associated with having an artificial valve hasn't been bad. For me, it was simply a matter of establishing routine and following it. Doing dosage adjustments with the help of a home monitor has been easy.

Yeah, all the stuff that goes with having a bad heart valve is overwhelming and dealing with it sucks, but people tend to be pretty tough. Just deal with things one step at a time. You can handle it... dig deep.

-Philip
 
Cherie,

Have you asked the Surgeon you are planning to use about his experience doing Surgery of the Aorta?
You may also want to ask him if he knows how to recognize signs of Connective Tissue Disorder(s) and how to sew a valve into 'defective tissue'. This kind of experience is typically not commonly found in surgeons whose practice deals mainly with Coronary Artery Disease and relatively simple first time Valve Replacements.

FYI, Connective Tissue Disorders are often associated with BAV and Aortic Aneurisms (25% if I remember right).
In the hands of Surgeons with the appropriate experience, the risks are not much greater than more basic Valve Replacement.

The reason that I raise these issues is that a few of our members with BAV and CTD have had to have their valves replaced a second time by more experienced surgeons after the stitching holding their first replacement valves began to come 'undone'. It's Better to get it right the First Time!

Please understand that I'm not trying to scare you about your surgery.
I'm hopeing that you will Verify that your Surgeon has the Knowledge, Skill, and Experience
with these issues that he may find 'once he gets in there'.
As I said before, for surgeons with the appropriate experience, these issues are routine.
As Ronald Reagan said, paraphrasing a Russian Expression, "Trust but Verify".
 
whichever you choose will be right for you, i have a piggy one and am totally happy with it, great for truffling ha ha, cardio said i should get 12 to 20 yrs,but hey who knows, live for today not what might happen in 15 yrs, as long as your happy with your choice go for it,
 
Cherie':

Good luck with your surgery! You'll never be able to forget your heart's "birthday." July 28 is a great day -- it's my birthday and that of my younger sister, too!

I chose a mechanical at age 52 because my grandmothers lived to 94 and 99.5YO. My parents were 74 and 76 at the time; they just celebrated their 61st anniversary July 2 and are 81 and 83 today. My decision was good for me.
I haven't had problems with warfarin; I home-test and my family doctor gave me the green light years ago to let me adjust my own dosage. It's worked very well and I haven't had bleeding problems that others wouldn't have had. Had a colonoscopy while on warfarin.
But like others have said, it's YOUR decision, one that YOU have to be comfortable with and live with.

I'll have an extra piece of birthday cake on our mutual birthday and expect to see a great note that you sailed through your surgery!
 
Lily said:
Too much anticoagulation can also contribute to serious internal bleeding, and even another type of stroke, a bleeding stroke.
Click to expand...

Poor management, non compliance, no respect for the drug can lead to serious problems. If you eliminate these, you'll have no problem.
 
Cherie' said:
Dear all-


I guess there is no right or wrong answer. My question is what is the longest anyone knows of a tissue valve lasting? Was it pig or cow? Is there anyone that has tissue or mechanical that wishes they would have made a different decision, and why? WHat things can you absolutely not do on coumadin? Can you have any alcohol, coffee, iced tea, etc.?

Thanks for all of your words of wisdom and insight,

Cherie'
Click to expand...

I am taking the 17 year warrantee on my bovine valve as gospel. My surgeon says that he knows of cases where the bovine valve has lasted 30 years and is going strong. I have been a couch potato since I retired and now I have to get back into athletic fitness. This is a painful time but I'm going to do it because I want my valve to last 30+ years.
 
:) Hi Cherie',
So glad you shared, and with honesty! While I had known I had the same as you (BAV, etc) for about 15 years, it still didn't prepare me when told out of the blue that I needed surgery within 2 weeks! I had deteriorated quickly prior to this I guess. BAV progressively worsens over time. I'm sure if was a shock for you to learn you had this so suddenly! But at least now you know; that's the first step to recovery! And if the doctor's are suggesting surgery at this certain date, I would do it! There's a reason for it, like perhaps you're to point that it's a must. I was told I'd die very soon if I didn't have the surgery asap.

Anyway, I'd suggest the mechanical as others have, simply because it does last longer. Who wants another surgery?! You will find that out when you do have this surgery. Is no picnic! A mechanical can last you the rest of your life even. And Coumadin isn't so bad. In fact I've found I even feel better after having taken it. Plus I'm forgetful too, so I put it in my computer calendar and it pops up beeping when it's time to take it (around same time every day). It just takes some self-discipline which later becomes habit. I've found it's really not that big of a deal. Now you can put the Coumadin with your other med and not forget it, lol (suggestion). Best wishes to you (& prayers)!

In this together, ~Karen

P.S. My cardiologist told me they're working a new drug to replace Coumadin in the future (forgot name of it lol). Supposedly it won't need the constant attention Coumadin does. We'll see I guess.
 
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