Tissue vs. Mechanical - terrified and confused

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I guess I am the rare person who rarely hears her valve. Outside of hearing it when I sleep on my side, I'm not aware of it. No one I've been next to or close to say they can hear it.
 
That's what I read.

I'm not sure what that was about because The CE Aortic Perimount , which is still being used, were implanted in 81 in CCF (I don't know other Countries or even US hospitals) because here is a "long term study" from 98 on the valves that were used from 81-83 http://www.ncbi.nlm.nih.gov/pubmed/9502139 (so if any of those patients are still alive they would be close to 30 years)
Canada started using them around the same time http://www.ncbi.nlm.nih.gov/pubmed/9930418 Ann Thorac Surg. 1998 Dec;66(6 Suppl):S57-61.
15-year experience with the Carpentier-Edwards pericardial bioprosthesis.
Poirer NC, Pelletier LC, Pellerin M, Carrier M.

PS I am NOT saying any valve would be guaranteed to last 30 years, or to count on 30, or even 20, just that the bovine valves have been being used in the uS much earlier than 2000
 
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Hi Cherie, I had my AVR 8 weeks ago now. As soon as I found out about my severe stenosis, which was only about 9 months prior (quite a shock!), I started reading up on valves etc. and was pretty sure I wanted to get a tissue valve, even though they don't last as long as the mechanical. I just turned 60 and thought that at my age they would probably tell me to get mechanical. But to my surprise when my surgeon asked me what I wanted to have, and I told him tissue, he said he agreed with me totally and said if it was him, that is what he would get. So that encouraged me that I was doing the right thing for me. He is an excellent surgeon and he put in the Edwards Perimount Bovine valve. After the surgery when I looked it up to read more about it, I was pleasantly surprised to read this article that said "Edwards Announces 20-Year Durability Data for PERIMOUNT Aortic Valve". So I'm hoping it does indeed last 20 years or longer. I'll be 80 then, and maybe by that time the non-invasive procedure will be going strong. So I'm happy with my choice. The main reason I chose a tissue valve was that I didn't want to have to take any medication after the surgery. Of course I am taking an aspirin right now, and I'm not sure how long that will last, but hoping it's just for now. I wish you luck and wisdom in your choice, that you will know in our heart with a certainty what is the right thing for you, and do that. You're gonna be fine, so don't worry, k? God is in control of us all, and loves us all, and will take care of us, one and all. --Valerie
 
While only a small percentage of folks don't survive the surgery, its a tough surgery nonetheless. Some folks may practically breeze through but I think most folks have some kind of hiccup. I know I did as I had "heart block" five days after the surgery and got moved back to ICU and then got a pacemaker installed (sort of a bonus prize). What I don't think is addressed much here is the total recovery time. Being a fitness buff, I was able to pretty well gauge recovery based on pre-op workouts compared to post-op workouts. I was about 70% recovered within about four months. However, getting that last ~30% to achieve at or near 100% recovery took a full year after surgery. From posts from other folks that exercise I think that is fairly typical, although folks that are younger probably show a quicker recovery.

For a sedentary person I believe the time for recovery is perceived to be much quicker, since recovery to a sedentary lifestyle only requires a return to a nominal state. But an athletic person knows the score. When you get in the gym pumping weights, or get out there running or biking, you know what's going on because you have been tracking your fitness levels for years. All I can say is that most folks should be able to fully recover from the surgery, but I believe that it really takes about a year. If you're going for reops that's a steep price to pay for avoiding taking Coumadin. Not to mention the risk.
 
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.
note: the bovine valve hasn't been out for 30 years yet, so unless he knows of people in the original trials from before it was released, he is mistaken. Edwards isn't even claiming 30 years in anyone yet, and they certainly would. (It's a great valve, though.) Also, while general cardiac health and a longer life can usually be obtained by fitness, there is no evidence that it will affect the life expectancy of the biological valve itself.

Best wishes,
 
I do think this type of open, honest discussion would be EXTREMELY helpful and supportive of people that may otherwise choose this type of valve if it were not for the noise factor.

This post got my attention and I am curious if others who have mechanical valves experience valve noise long after surgery. When I had the surgery, and for many years after, I was a small man, 5-9, 145 lbs(now about 165 lbs:frown2:). My valve is basically a "hard plastic ping-pong ball that bounces up and down within a titanium cage". I doubt that there was much consideration given to sound deadening back then. Immediately after surgery, my wife and I were very concerned about the "clicking":eek2: (that was one of the many things they never told me about prior to the surgery). In the beginning, the clicking was comforting, 'cause if I could hear it, it must still be working. The sound became more and more muffled as my body healed and my heart reconfigured and pretty much was gone in 3 to 6 months:smile2:. It has been decades since I heard it click, even in a very quiet room at nite and no one has asked me in years where I am hiding the clock:biggrin2:. I would think that the newer valves have had sound deadening engineered into them and should become quiet after a few months. Do the newer valves stay noisy?

I posted this a day or so ago and have seen no responses that a new, or old, mechanical valve stays noisey. There seemingly have been a number of decisions to NOT get a mechanical valve due to the "clicking" noise, yet few mechanical valve owners seem to find it a problem. I am sure that some may have a problem due to body acoustics, but I wonder if the "noise" problem is a very valid reason to shy away from a good long term valve choice....so I'll ask again. As a mechanical valve owner, have you experienced a loud, and prolonged clicking for long after your implant?
 
As a mechanical valve owner, have you experienced a loud, and prolonged clicking for long after your implant?

I noticed a slight click soon after AVR but mainly was concerned because no one had told me it would click. After I found out it was normal it was no big deal. I seldom ever hear it now.
I can't imagine anyone making a decision not to use a valve that may last a lifetime because it might have a slight click. They must like heart surgery better than me.
 
When I first woke up from surgery, still under the effects of anesthesia, I could hear mine loudly in my head. I remember thinking, no way can I live with this. The next time I awoke, 40 some days later, it was no longer an issue. I don't hear mine at all unless I'm in a totally quiet room. Even then, I have to struggle to hear it.
 
I can't imagine anyone making a decision not to use a valve that may last a lifetime because it might have a slight click. They must like heart surgery better than me.

No kidding. I agree beyond 100%. Of course, I hate to see people dissing the idea because of anticoagulation too. I'm speaking of when the situation is right. It's not, in this case.
 
Grrrrr, just lost my post.. lets make this short and sweet.
Yes I was angry with the surgeon for not advising me how coumadin and celiac could create havoc. I have found many doctors have no or little knowledge on the disease. I have 3 specialist diagnose me with fibromyalgia and here all along it was just celiac disease. POOF! No more fibro.
I will have to take aspirin, I have already purchased my gluten free brand and it is packed and ready to go with me to the hospital. I will be meeting my nurses on monday and they will be informed. Nothing left to chance. As for other meds the surgeon said until she does the surgery she can't advise me of what I will be needing. She said she is probabley replacing my ascending aorta with the dacron graft cylinder but won't know for sure till she opens me up.. that won't require me to be on coumadin but if I need a pacer then I will.. At this point I am still sticking with my tissue decision. NO looking back now! Just going to focus on bright futures and new beginnings! :)
 
I posted this a day or so ago and have seen no responses that a new, or old, mechanical valve stays noisey. There seemingly have been a number of decisions to NOT get a mechanical valve due to the "clicking" noise, yet few mechanical valve owners seem to find it a problem. I am sure that some may have a problem due to body acoustics, but I wonder if the "noise" problem is a very valid reason to shy away from a good long term valve choice....so I'll ask again. As a mechanical valve owner, have you experienced a loud, and prolonged clicking for long after your implant?

Haha, sorry Dick, I was pre-occupied and missed this the first time ;) I think I must be one of the few that can hear my mechanical valve pretty much all the time. Before surgery, my surgeon told me this particular valve (St. Judes Regent) tends to be a little louder than his second choice (ATS) but the benefits outweigh the noise so we went with it. That may be part of why I hear mine all the time. BUT - I'd stress, even though I CAN hear it all the time, most of the time it's like white noise in an office - I don't pay attention to it. And it has never kept me from falling asleep (and I'm a fairly light sleeper).

Now, keep in mind I'm only 9 wks post-op, so maybe the ticking will get quieter as I heal more. But for now I can hear it pretty much all the time if I stop and think about it. And it's probably even louder than I expected it to be. The only time I couldn't hear it when I was trying to was when I was mowing the other day. I think the reason I can hear it, even when it's loud outside, is because the noise I hear comes from the inside, not the outside. Seems like it comes from inside my throat and up to my ears, on the inside (if that makes any sense). I'd compare the noise to a ticking watch that you put up close to your ear. There are a few people, with very, very good hearing (like my daughter) who can even hear it outside my body. But most can't unless they put their ear to my chest.

As others have said, the position I'm in makes a difference. For me, it gets quietest if I lay on my stomach for some reason (maybe my lungs are muffling it or something). And unlike others, the noise gets a little more noticeable for me when I lay on my right side than on my back. On my left side it becomes quieter than on my back (again maybe because 'stuff' is resting on my heart muffling it).

I was one of the ones that was worried about the noise before surgery, even mentioned in my original post that was one of the main reasons I was leaning towards tissue. But now that I have experienced it first-hand, even though the noise is even more noticeable than I thought it'd be, I'd say it's a relatively minor issue for me. Maybe similar in severity to the scar and the Coumadin, it's just something I've resigned myself to living with. And I would honestly say, for me (at least so far), none of those three things (scar, Coumadin or the ticking) have had much of an impact on me living my life.
 
seems like you mech valve guys and girls are well pleased with your valve, and people with tissue are well pleased...so thats sorted then....as i keep saying there both better than the one you got, luckily for us we gotta choice of 2.....sorted
 
Grrrrr, just lost my post.. lets make this short and sweet.
Yes I was angry with the surgeon for not advising me how coumadin and celiac could create havoc. I have found many doctors have no or little knowledge on the disease. I have 3 specialist diagnose me with fibromyalgia and here all along it was just celiac disease. POOF! No more fibro.
I will have to take aspirin, I have already purchased my gluten free brand and it is packed and ready to go with me to the hospital. I will be meeting my nurses on monday and they will be informed. Nothing left to chance. As for other meds the surgeon said until she does the surgery she can't advise me of what I will be needing. She said she is probabley replacing my ascending aorta with the dacron graft cylinder but won't know for sure till she opens me up.. that won't require me to be on coumadin but if I need a pacer then I will.. At this point I am still sticking with my tissue decision. NO looking back now! Just going to focus on bright futures and new beginnings! :)

I'm not sure WHY they would say IF you needed a pacer you would need coumadin. Justin had his for 7 years and was on NO meds at all (he MIGHT have needed something right when it was implanted, but if so it was 12 years ago, and hes had a couple surgeries since, so i'm a little foggy and he had it during a surgery to replace/rebuild part of his conduit, so was on the normal post of meds for that, but no coumadin or any meds added because of the pacemaker) He still isn't on any meds, even after he's had so many surgeries and complications and even had 2 stents for a while. Right after surgeries he is on the usual pain meds and depending if he has any complications, meds for that short term, like antibiotics for infections or motrin /steroids for effusions and when he had the 2 stents placed his was on baby aspirin for a couple weeks. He is still young and most likely will end up on meds for his heart in the future since he has alot of things wrong with his heart, but so far the only heart meds he was on was from a 1 day old baby until he was 2 and had his BIG repair and recoverred from that 6 months later.
 
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I am sure that some may have a problem due to body acoustics, but I wonder if the "noise" problem is a very valid reason to shy away from a good long term valve choice....so I'll ask again. As a mechanical valve owner, have you experienced a loud, and prolonged clicking for long after your implant?

In the first few months after my surgery I would notice it at night in bed, I think mostly because it was something "new" or different. My wife could also hear it at night at first.
In the 9-1/2 years I've had mine, I've had only ONE person other than my wife who noticed the ticking. The really odd thing was that it was at a Habitat for Humanity worksite with a lot of hammering, power saws, and other noisy stuff going one. Another volunteer who had been working about ten feet away came over and asked me if I had a mechanical heart valve. It really surprised me, especially since I couldn't even hear it. It turned out that the guy who asked about it had a brother who had a mechanical valve and knew what they sounded like, plus he must have had Superman-like hearing.
My surgeon did tell me that body type has an effect. In my case I've got a muscular upper body which helps to muffle things. Older patients with less muscle mass and women tend to hear theirs more.
These days I really have to focus to hear it. Like Coumadin, its never been a big issue for me.
YMMV.
Mark
 
On the subject of ticking!

On the subject of ticking!

I have an On-X and very occasionally hear/feel it when lying on my left side. However, I sleep on a fairly firm pillow. I am on vacation and at my Sister-in-law's house I am sleeping with a softer, puffier pillow and CANNOT hear/feel my valve at all, even in the "problem" position. I suggest a serious pillow test for those who find the ticking at night disturbing;).
Cameron
 
Kathy: As AL said, my St Jude's mechanical makes "soft thump". I can hear it if I concentrate on it or I'm in a real quiet environment. It's not a click and it's not at all annoying. No trouble sleeping, etc. I'm a small guy too, so I thought I might have a problem with noise but I was wrong.
 
My aortic valve before AVR was a whole lot nosier than the St. Jude valve I have now. I was starting to think that maybe breasts make good mufflers, but then I wouldn't have heard my old valve, so guess that's not the case.
 

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