trying to decide

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robert s

I am 59 years old & in good health. My Aortic Stenosis first diagnosed in 1975 has progressed to the point that a replacement is now needed. I don't want to be on Coumadin forever. I also have a long history of minor nose bleeds. Two years ago, I had a persistent one & needed cauterization in emergency. Almost every morning, when I clear my nose there is some coagulated blood expelled. This, of course, gets worse in the winter when it is so dry in upstate NY. I am concerned that the Coumadin will greatly agravate this. Anyone had any experience with this that could help me understand what will likely happen? I am leaning toward the procine or bovine tissue valve.
Good Question

Good Question

I too have had coagulated blood first thing in the morn, but never serious nose bleeds.
So far, and it has only been a little over nine weeks I have had no serious bleeding events such as your are talking about.
Choice of valve is pretty much a personel thing and requires a lot of questions and research
I too would like to not be on coumadin for the rest of my life but even more pressing issue to me was the thought of another surgery. At fifty nine this will be an issue for you also. You might check with I believe Steve in Florida. He recieved a new type of tissue valve that is supposed to last longer than the ones currently in use.
:confused: I think it was Steve, will have to go back to old forum and check.
Good luck in your research and chooseing of valve.:)

:D AVR April 5, 2001. St Judes Mech.


Hi Robert s-

I see you're from upstate NY. My husband (who has 2 mechanical valve replacements, mitral and aortic) and I live in Glenville, NY.

Joe is on Coumadin and has been for 24 years. He has occasional nosebleeds, especially with hot air heat in the winter. But nothing that can't be managed with a little nose-pinching.

He would not have done things any differently. Facing another surgery later in life and possibly when you are weaker and sicker is a tough proposition. He had his aortic valve implanted 24 years ago, and the mitral valve implanted 2 years ago. He's just about to turn 70. The recovery from the mitral valve surgery was very long and difficult because he was older and had had a pretty rough time prior to the surgery.

Valve choice is quite personal, but Coumadin is not as scary as most people think. In fact it's not scary at all. His doctors are very good at monitoring his bloodwork and he's never had serious bleeding incidents.

There is a lot of info. available on the different type of valves and what the normal longevity is of them. Here's link for one of them.

Best wishes, Nancy :)


I am 66 and had my aortic valve replaced on 13 March 01 with a Toronto stentless porcine valve. I didn't want the clicking of the mechanical valve and I didn't want to take blood thinners - although there are many, many people here who don't have a problem with these two things. If I live that long maybe I will face another replacement at an advanced age. Maybe I will regret what I have had done. For myself, I would still choose the same.

All the very best in making your decision.
St.Jude Mechanical vs. bio valve

St.Jude Mechanical vs. bio valve

Robert, I understand your concern. I was 72( Sept. 17,1998) when I had a mitral valve replacement with a St. Jude mechanical. I have done well and find the coumadin therapy a minor inconvenience. I use a Coaguchek finger stick monitor to self test and self regulate. I asked my surgeon ( who wrote a book on valves in the 70's) why he didn't use a bio valve. He said this issue was discussed at a staff meeting prior to my surgery and the concensus was a mechanical valve would be best even at my advanced age. They did not want to see me back for reoperation at an even more advanced age. Having said this, I have found that the bovine pericardial Carpentier-Edwards valve is looking more durable than other older bio valves. The Cleveland Clinic has the greatest experience with this valve and I would advise you to contact them.By the way, I understand the patients that get this valve still need to take anticoagulants post op for at least three months. Email me if you would like to discuss this further. Marty [email protected]
Hi Robert,

I am 51 and have had an aortic valve replacement. I have a st. Judes Mechanical. I have never had any severe nose bleeds. However, in the winter months with the dry heat from the house, I do have an occation nose bleed. I have noticed that since my surgery, and being on Coumadin, they happen more often. With that said, I only notice this when I get up in the morning... or when I blow my nose. I have never had a profuse nose bleed. It is just that is seems to only happen to me in the dry winter months.

valve choice

valve choice

As others have said, this is a very personal choice and a lot depends on what surgeon you have, as the choice must be one that the surgeon is both experienced with and confident in.

The most durable valve is undoubtedly a mechanical one at this point, so generally someone of your age who has an additional life expectancy of more than 15-20 years is advised to go with the mechanical. However, there are many developments to produce a valve, either mechanical or tissue, that will both endure the rest of one's life and not require Coumadin. In other words, there are mechanical valves being developed that aim to no longer require lifelong Coumadin or other blood thinners, and there are tissue valves being developed that promise to endure longer than normal tissue valves, even the balance of one's lifetime and thus not requiring additional surgery.

I am 50 and just had AVR with root and part of my ascending aorta replaced as well 4 weeks ago. I opted for a new kind of homograft (human tissue valve) called the CryoValve-SG (bioengineered with SynerGraft technology) that has had all the donor's genetic cells flushed out of it leaving a genetically neutral collagen matrix. The intent is that this valve will not calcify like other tissue valves and, indeed, will enable the recipient's body to grow, repair, and otherwise maintain it as its own. They have successfully demonstrated this with implants in animals. With implants in humans, they have shown that it does not calcify like other tissue valves in the short-term and, with several of these valves implanted in humans that have been observed because the patient was 'reopened' for other reasons (e.g., coronary problems), they have verified that the recipient's body has indeed populated the valve with its own genetic cells and thus 'adopted' it as its own. (See studies presented at recent May cardiothoracic surgeons conference in San Diego.)

So far, so good for me. My body accepted this valve very favorably and my surgeons are very pleased with it. In a few years, they will be able to tell if it is calcifying or not, and, if so, at what rate. If it does not calcify in several years or at least does so at a significantly slower rate than a normal homograft valve, then they will consider that it is working as intended and then will expect that it will last the rest of my life. In any case, they expect it to endure at least as long as a normal homograft, that is, about 15-20 years.

If you don't mind Coumadin, opt for the mechanical. If Coumadin concerns you, as it seems to from your message, then you might consider alternatives such as the CryoValve, the Medtronic Mosaic valve, the bovine pericardial, the mitral valve mechanical being offered by the Cleveland Clinic that promises to avoid blood thinners, or other valves that are recently developed but without a sufficient track record to be sure they will perform as expected.

In my case, I figure, if it doesn't work, in 15-20 years they will have developed something that will. It's a chance that I decided to take knowing what is at risk.

So, get informed as much as you can, work out a plan you and your surgeon are comfortable with, and then go with it. You will have our prayers and support all the way. God Bless.
coumadin-trying to decide

coumadin-trying to decide

Hello Robert S,
Where in upstate are you living? I had the St Judes av 4/97 and I too have an occasional nose bleed especially in winter months. I had a bad nose bleed only once about 2 yrs ago. It felt like Niagara Falls was running down the back of my throat and the front of my nose too. The dr said that as you age the lining of the nose thins a bit which can cause the blood vessels to bleed. I had my inr checked that very day and it was within the normal range so it wasn't because of the coumadin. The dr told me to use the saline nose sprays - didn't help me very much. I've been using some vit E on a q-tip and gently wiping the inside of my nose. When it's cold and dry out I do it am & pm. Otherwise, I use it every few days. It seems to help. I've also used the vit E before a plane trip too as the air is usually very dry. I was 53 when I had my surgery and was advised by several drs to get the mechanical because of its longevity and because I really didn't want a reoperation. The past couple of years have shown that there will be some new valves available that may prove to be better than the mechanical - if you think that they have proven their safety then by all means consider them - but be sure to investigate all claims. Good luck.
The furnace puts out dry heat, and that causes the membranes in the nostrils to become dry and prone to bleeding, especially when dry mucous is removed. Adding a humidifier to your furnace will alleviate the problem.
Have been on Coumadin since 1990. Problems with it are minor if one monitors it closely. Hve had a broken arm, CABG, three other surgeries, badly cut finger, etc in past 10 years and all without major problems from Coumadin. Have been well cared for by nurse wife and MD's who know what to do with Coumadin patients. I think good medical care from doctors who are knowledgeable and care is paramount. Takes some looking, but they are out there.

Choice of valve very personal and between you and doctors, but clicking is no problem unless one wants it to be. Have clicked for 12 years. Beats the alternative.
bigjim -

I've also had my valve 12 years. What a coinc-e-dink. That's not a real word but my daughter always uses it and it caught on with me.
MVR 04/06/89.
Do you have a Mitral or Aortic?
Welcome to the forum, I'm sure you have some valuable experiences to share from your 12 years.

Take Care.
:) Tammy
For everyone

For everyone

As a rookie of this site, I am totally intrigued and awestuck by the information I have been reading. This is truly great stuff! Website links are very nice to see included in some of your posts as well. Thank you all and I am looking forward to actually reading the"whole book."

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