Tissue vs Mechanical

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hevishot

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Before making a selection consider this. Take a look at the Anti-Coagulation forum. Nearly 4000 posts. Most of which deal with problems and concerns. Do you really want to be reminded every day of your life that you have a mechanical valve and all the problems that go with it? Now with the new Valve in Valve Tavr procedure I see very little reason why anyone would select a mechanical valve. I got my tissue valve 15 years ago and the only time I am reminded of it is when I have my yearly echo. And the valve is working as good now as it ever did. So please read thoes posts in the Anti-Coagulation forum before you make a decision.
 

tom in MO

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Before making a selection consider this. Take a look at the Anti-Coagulation forum. Nearly 4000 posts. Most of which deal with problems and concerns. Do you really want to be reminded every day of your life that you have a mechanical valve and all the problems that go with it? Now with the new Valve in Valve Tavr procedure I see very little reason why anyone would select a mechanical valve. I got my tissue valve 15 years ago and the only time I am reminded of it is when I have my yearly echo. And the valve is working as good now as it ever did. So please read thoes posts in the Anti-Coagulation forum before you make a decision.
You are blessed.

But you shouldn't criticize other's choices so vehemently. This is a world class forum, and mechanical is still the only option in many parts of the world.

There are risks that you have ignored when it comes to a tissue valve:

  • Do you really want to be reminded every day of your life that you have a mechanical valve and all the problems that go with it? People who choose mechanical are not reminded of any problem every day of their lives. They take a pill every day and test every 2-4 weeks. Testing takes 5 min. People who are younger than 60 and choose tissue will be reminded of their choice when they need a new valve and that takes weeks out of their life...if they have insurance.
  • Now with the new Valve in Valve Tavr procedure I see very little reason why anyone would select a mechanical valve. That procedure has no long term data for viability. It is also not an option for all patients. Many people have multiple tissue valves installed, but there are some that see that time, money and life disruption as something to be avoided by choosing a mechanical valve.
  • I got my tissue valve 15 years ago and the only time I am reminded of it is when I have my yearly echo. And the valve is working as good now as it ever did. You are blessed. There are some whose tissue valves have lasted only 5 years. One I know of only lasted 2 years. They choose mechanical for the second valve. I assume you are old, since your profile says you are retired. Most people <60 yo who choose tissue have a slow decline in function as time goes on and all the problems that go with it, including risk of death due to inevitable valve failure. Those who choose tissue get an echo every 5 years because the mechanical valve system is stable.

I chose tissue because of "one and done." So far it's worked. I feel blessed since if I get Covid, my warfarin could help me survive :)
 

Superman

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Grand Rapids, MI, USA
Had my initial AVR when I was 17. How many valves can fit inside another valve?

Point being, there is no one size fits all solution. I always recommend whatever helps a person sleep at night. Regardless of choice, it’ll be better than the one you have.

Stands to reason that an actively managed lifelong medication will be one of the more active discussions here. And with new patients, makes sense that there will be problems and concerns as they get used to testing and dosing.

Forum activity shouldn’t dissuade a person from a decision. The post surgery forum has twice and many threads and posts. Perhaps we shouldn’t have surgery?
 
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pellicle

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Forum activity suggests it's a topic people can be engaged with and have a hand in making a difference in the outcomes. I'm willing to wager there is nothing you can do about your yearly echoes when they go towards "replacement time".

You just have to be patient.

Meanwhile on the anticoagulant forums we all help each other to manage this aspect of our lives and cope better in a real way.

I suspect you have a subconscious unhappiness with the whole process surrounding your heart operation. Something which is understandable. However one can not pretend that it didn't happen, one has to accept that it is part of your life, part of who you are.

Heart surgery can't make it like it was when you were actually ill but ignorant of this. Cancer treatments often leave people injured and diminished physically too. However if they leave you alive then you have the capacity to continue on. If those things which challenge us (heart issues) can be treated and we live on surely the option some choose of the pain of a weekly finger stick and some tiny pills isn't such a heavy cost to bear?

My last echo showed that everything is fine and they are now suggesting my next in two years. Something one rarely gets with a tissue prosthetic at the ten year mark in a younger patient.

I hope you come to terms with what seems to be driving you angry.

Best Wishes
 
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Protimenow

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I test weekly, as do many of us here. It's really no big deal. It isn't a reminder every day that I have a mechanical valve. I take Warfarin along with other 'nighttime' medications. I know that I'm taking it, but so what? For me, when I got my choice of valves at 41 years old, the decision was easy -- mechanical. I knew about anticoagulation. I dismissed the scare stories about anticoagulation. This valve has served me well, so far.

What I AM reminded of, sometimes many times a day, is my PVC arrhythmia. I know it's there because I can hear it when I concentrate on my valve's sounds. I know it's there when I get short of breath after doing practically nothing.

In my case, the prosthetic valve will make it more difficult to get an ablation below the valve - I'll have to trust the doctors not to kill me when/if they ablate the area of my heart that causes this damned arrhythmia.

On the whole, though, I'm glad that I have a mechanical valve - heading towards 29 years in my chest. The wekly testing and simple INR management are no big deal. And it NEVER bothers me to realize that I have a mechanical instead of a tissue valve.
 

caro

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Jan 7, 2020
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“Point being, there is no one size fits all solution. I always recommend whatever helps a person sleep at night. “

This is great advice. “Both are better than what I have now” was my mantra before surgery. I made a long list of pros and cons but “whatever helps a person sleep at night” brought me to my decision.
 

Protimenow

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'Whatever helps a person sleep at night' is a nice cliche but, for me, I'msure that, if I ever think about the valve that I have, I'm sure that I sleep better with a mechanical valve in my chest than I would with a tissue time bomb working away in my chest. I wouldn't want another surgery - or even a TAVI - if I can avoid it.

And, to answer Pellicle's question, I haven't heard of any manufacturing errors/issues related to mechanical valves. (It's possible that there may have been some during development and testing of prototypes, but these never made it into actual public use. The ones that got FDA approval are still ticking away - and those that fail are failing for reasons other than manufacturer error (as far as I know).
 

Warrick

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No bias here for the tissue valvers but don’t forget the toll that having your chest cut and cranked open has, my chest I wouldn’t say is 100% so I wouldn’t willingly set myself up for multiple 2, 3... 4 surgeries..
Yep the ticking is an ass, as for warfarin I would quite happily take warfarin forever if it was in conjuction with a tissue valve that lasted as long as a mechanical.
I agree read those post in the anti-coag forum and read how great we are all doing on the stuff
 

nobog

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Jun 14, 2019
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have you ever heard of such a manufacturing error / issue with a mech valve?
Not in the "modern era". If something is going to go wrong with a mech valve, it usually shows up in the first few minutes after the operation, and that is usually something to do with the implant technique or an anatomy related issue.
 

Warrick

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And while I think about it why does it have to be tissue VERSUS mechanical, its not a competion, just options for treatment of which path to go down
Seems people have to create a good guy and bad guy, like cowboys and indians.
A sh*t sandwhich still tastes like sh*t if you use white bread or brown bread
 

Suckyvalvegurl

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Tx
It is a very personal decision and a tough one. It depends on your own tolerance for different issues. At age 56 I chose a Bovine valve and I also chose minimally invasive surgery (not TAVR, minimally invasive). I went into it fully knowing the risks and benefits for each choice. For me personally, I just didn't want more problems sleeping and I hate all things medical (even though I am a nurse lol) so it was worth it for me to not have to do the blood thinners. I have been happy with my decision for the 1.5 years now that I have lived with it. There are many benefits though to going with a mechanical valve also. Will I ever regret my decision? Maybe, maybe not.
 

Thomas

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Aurora, Ontario, Canada
From a choice perspective, I believe in age being the major factor. No one wants to go through the experience again and I feel for those who do.

I for one am grateful to hear my internal clock ticking. It gives me comfort. Sometimes I remember how difficult day to day life was and that I'm far better off now than I was before surgery.

Also, and I believe this is of paramount importance (to me); it reminds me to stay diligent in making good fitness/dietary and lifestyle choices.

Mechanical has been nothing but a positive for me.
 
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Sheenas7

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Apr 22, 2014
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I test weekly, as do many of us here. It's really no big deal. It isn't a reminder every day that I have a mechanical valve. I take Warfarin along with other 'nighttime' medications. I know that I'm taking it, but so what? For me, when I got my choice of valves at 41 years old, the decision was easy -- mechanical. I knew about anticoagulation. I dismissed the scare stories about anticoagulation. This valve has served me well, so far.

What I AM reminded of, sometimes many times a day, is my PVC arrhythmia. I know it's there because I can hear it when I concentrate on my valve's sounds. I know it's there when I get short of breath after doing practically nothing.

In my case, the prosthetic valve will make it more difficult to get an ablation below the valve - I'll have to trust the doctors not to kill me when/if they ablate the area of my heart that causes this damned arrhythmia.

On the whole, though, I'm glad that I have a mechanical valve - heading towards 29 years in my chest. The wekly testing and simple INR management are no big deal. And it NEVER bothers me to realize that I have a mechanical instead of a tissue valve.
Great on your 29 years on mechanical valve! I’m going on 19 years! Thankful and hoping it will last my lifetime.
 

dick0236

Eat the elephant one bite at a time
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A sh*t sandwhich still tastes like sh*t if you use white bread or brown bread
:LOL::p:poop:++++++! Funniest truism I've ever seen.

One option(mechanical) requires another pill.......one of several pills I take each day for reasons unrelated to my mechanical valve.(n)

One option(tissue) requires multiple surgeries and, probably, the eventual use of an anticoagulant anyway.(n)

One option(TAVR) is a great idea for the elderly who are unlikely to require multiple replacements via a catheter. Young, active patients will go thru valves "like sh*t thru a tin horn" (I couldn't resist;)).......until a surgery is required to go in and clean out the junk and start over.(n)
 

Protimenow

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The choice of which type of valve is a fairly personal decision - but one that may be strongly influenced by your surgeon, and is a decision that may actually be made by the surgeon during surgery.

There are a few factors at play - including the 'possibility' that something new will come along to either repair existing tissue valves in a non-invasive way, or through new mechanicals made of other materials (high strength, flexible plastics, for example), or other methods. There's the possibility that some new, obscenely expensive, anticoagulant may flood the market, with a strong marketing effort pushing the move from inexpensive warfarin to this new medication.

But we're not there yet. There's no guarantee if or when any of these new approaches will come to pass. Expecting that there will be a better alternative, or a non-invasive fix to aging tissue, or an alternative to the much maligned warfarin, is a gamble. There's no assurance that any of these will come to pass and, if so, how long they'll take for testing and approval by the FDA or other government health agencies.

I stated my personal opinion and experience - for myself. I'm not about to recommend one type or another to anyone here. I AM saying, though, that if you select a tissue valve, there's no real guarantee on how long it will last. In effect, you're sort of making a decision about how long you plan to live (in which case, you'll outlive the valve before it fails), hoping that the valve will stay operating for decades until you die of other causes or that the valve can somehow be repaired if it starts to fail (using a TAVI or other method), and, if so, that the TAVI repair will hold up long enough that you won't need another repair (each time they do a TAVI, the size of the orifice through which the blood flows gets smaller and smaller.

As others have noted here, and in other posts, repeating heart surgery is more difficult for the surgeons. There's scar tissue from earlier surgeries that they have to get through to reach the heart, and each re-operation becomes more risky than the ones before it. I expected to have my chest cracked open just once for the mechanical valve.

Warfarin really IS no big deal. Many on this forum self-test and self-manage. Others go to clinics. Some do both (unfortunately, I'm in that small minority - as of this week - my conservative doctor won't prescribe warfarin if I don't do this redundant, time consuming, expensive (in terms of time and distance) redundancy. I've been self-managing for 11 years, and others have been doing this for considerably longer. Whether it's one, two or three pills (I was taking 7.0 for a while - 1 1/2 of a 4 mg pill, plus a 1 mg pill), it isn't difficult to get a daily dosage that works for you. And, for the most part, it doesn't force many lifestyle changes on most of us.

I hope that this doesn't come off like a recommendation either way. These are just items to be considered when choosing the repair/replacement of a bad valve.
 

vitdoc

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Apr 16, 2017
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Southern Ca.
The human brain wants us to be part of a tribe. This is built in for survival purposes. Here we have the mechanical valve tribe and the biological tribe.
So we have to realize this and try to think in non tribal terms.
I had a pig aortic valve in 1977 at age 29. It lasted 5.5 years. By 1983 the St. Jude was just becoming popular and I probably was in the first 1000 or so patients to get it. In retrospect I was sort of lucky because the mechanical valves available in 1977 had more issues than the St.Jude. But two open hearts were not great fun. In 2006 when I had my aortic aneurysm repaired a new St.Jude was placed at age 58. Hopefully this is it for open hearts.
I could have had a tissue valve but in 2006 TAVR was not available. So for me it was a no brainer. TAVR does throw a monkey wrench into the decision making process. But it is not a guarantee. The valve will be smaller and the procedure is not 100%. There are peri valvular leaks and other issues.
Finally how long will the TAVR valve last? So let’s say on a good day the original tissue valve lasts 15 years and the TAVR 10 years. So one might get 25 years before something else need be done. So if you are 50 you might be looking at an open heart at 75. (Based on current technology). So mechanical done once or two or three procedures with non mechanical.
I would be a one procedure person but someone else fearful of warfarin might take the other route. Every procedure has risks so in general the fewer the better.
 
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