Valve choice, lifestyle choice?

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Jeff C

I am scheduled to have a mitral valve repair on 1/15/2003, and am faced with the decision of a mechanical or bioprosthetic valve if repair is not possible. Wow, what a difficult choice. I must admit the real factor to me is Coumadin. I dislike drugs of any kind, and I find the thought of a LIFETIME of any drug distasteful-- even scary. I also have a history of diverticulitus, which I hear may be contraindicating for Coumadin. But, to my questions:
(1) Is anyone on Coumadin using the new home testing machines? Is insurance paying for it? Experiences?
(2) I am amazed at all of the drugs with interactions with Coumadin-- seems like EVERY drug interacts-- many severly--even topical creams. Is this a problem for long-time Coumadin users?
(3) It also sounds like choosing a bioprosthetic valve doesn't neccesarily mean Coumadin therapy couldn't happen anyway from post-op complications. Any thoughts from your collective experience? Does valve surgery realistically mean Coumadin therapy-- regardless of valve choice?
(4) I am intriqued by the Carpentier-Edwards pericardial mitral valve. It seems to be going strong in many patients after 15-17 years. What am I missing that this is not the obvious choice?
I have really enjoyed reading through the forums. It helps to put my anxieties into words-- and see that many others have struggled with many of the same issues. It is also heartening (bad pun) to see the spiritual side of this whole issue is so much in the minds and hearts of all in the forums. Thanks for the ear!
 
Hi Jeff,

Unfortunately I can't answer any of your questions. I would just like to welcome you to the site. There will be plenty of people that will come along and aswer your questions. You found the right place to be in the days coming up to your surgery. I hope you take advantage of what the site has to offer. There is a lot of knowledge here from people who have been down the same road, if not a few twists and turns. Hope all goes well.
 
Hi, Jeff - welcome to the forum - like Dave, I can't answer - didn't have valve replacement (had bypass and don't even belong on the site, but they put up with me). Before this day is out, you are going to get some truly good answers to all of your questions. I have seen the information that comes out when we get questions like yours and there is such a combined experience you won't believe. Stay with us, hear - right on up to surgery time and after as new questions will come up and this is the place to discuss them. God bless
 
Welcome Jeff.

Question 1.
There are quite a few members here using the home testing units though I'm not one of them. Everyone that has them are very pleased. Insurance may or may not cover the device and/or the testing supplies. You'll have to check your policy and may even have to have some assistance in getting it approved. I'll let those that have the units tell you more.

Question 2.
Being on Coumadin is a balancing act. What affects one side affects the other also. As long as your physician(s) are aware of your taking the medication, they should keep you in a satisfactory range. You may test more frequently during these times and have dosage adjustments, but it's not a big deal.

Question 3.
Most all Doctors use Coumadin/Warfarin therapy right after valve replacement surgery. This is to prevent the blood from clotting on the new valve and to reduce risks of a stroke or other embolism. With tissue valves, your on therapy for usually 6 months. With mechanical, lifetime.

Question 4.
I don't know the answer to this one, so I'll let the others jump in here.
 
Hi Jeff,

Just a couple of quick comments:

- Although my insurance company would pay for a home test unit, I like the peace of mind I get from going into the lab at my cardiologist's office every six weeks and having a professional do the testing and give me the once-over (check my blood pressure, etc.). I can also get immediate feedback if I'm out of range and need to make any adjustments.

-That being said, except for one incident, my INR has been rock-steady for the past 1-1/2 years. As many others here have discussed, consistency in your lifestyle (diet, activity, etc.) is the key. I am very active physically and the Coumadin has not been a problem at all.

Good luck,

Mark
 
Welcome Jeff,

This is a great site and you will receive a lot useful info from the members. I just had my surgery last week and it was the aortic not the mitral. I can offer you the following advice:
1. Do some research and weigh the odds on each option that you have : tissue , repair and mech. No matter which one you chose you will be happy with it. Now be prepared for the ole switcheroo during the operation. Sometimes they can't do what the originally intended and you will get your second choice. . Sorry but I don't have enough experience w/ coumdin to give u a informed opinion. I chose a tissue valve due to my age (32). Being on coumdin for 60 + years was too long for me. If medical tech. does not advance by my next surgery ( 50-55 age) then I will go with a mech. next time.

Best of luck Jeff
 
Welcome Jeff,

Your questions all sound pretty familiar.

I have a home testing unit which use as a safety net, i.e., I still go to a Coumadin Clinic every 4 weeks now, but check at home if / when I start or stop any medication or suspect something else may affect my INR. My insurance didn't cover such units so I appealed and was instrumental in getting them to cover home testing for Mechanical Valvers (or anyone who has been on Coumadin for over 3 months) in my state. Bottom Line: Check with YOUR insurance company. I'm learning to live with Coumadin (which was NOT my choice) and finding that it is not as difficult as I feared it might be. It DOES complicate one's life / choices.

My FIRST choice for a valve was the Bovine Pericardial Valve for the same reasons you cited. Unfortunately, my surgeon was not comfortable with the potential risks in my case (after opening me up) and informed me he made the decision to install a St. Jude Mechanical valve instead to ensure no need for a future replacement. I'm not thrilled about having to go off Coumadin to have other invasive procedures or surgery and there are still times I wish he had installed the Bovine Valve we had originally agreed upon.

When discussing valve options with your surgeon it is probably a good idea to also agree upon a SECOND (and maybe even Third) Choice.

'AL'
 
Hi, Jeff C.

You mentioned you're intrigued by the C-E Perimount mitral valve and wondered why you're not hearing more about this. I'm the Carpentier-Edwards rep in Central FL and I'd be happy to share information with you about the performance characteristics of this valve.
No, I'm not soliciting business. My business develops through contact and relationships with cardiac surgeons who actually make their choices based upon a number of factors. Part of my job is to keep them informed about durability and hemodynamic of this product, as well as the rest of my product line. I'm really not trying to sway you one way or the other. I'm simply willing to share information with you if that's what you want.
Let me know if I can help you with anything and good luck with your surgery.

Valverep1
 
Welcome aboard Valverep1 !

Yes, by all means, please tell us where / how we can learn more about the durability, effective area, and hemodynamics of the Carpentier-Edwards Bovine Pericardial valve. I have seen some durability data but nothing on the other issues.

'AL'
 
Valve information

Valve information

ALCapshaw said:
Welcome aboard Valverep1 !

Yes, by all means, please tell us where / how we can learn more about the durability, effective area, and hemodynamics of the Carpentier-Edwards Bovine Pericardial valve. I have seen some durability data but nothing on the other issues.

'AL'
Click to expand...
 
Thank you all for your thoughtful replies. Mostly, thank you for helping me realize I am not the only one struggling to make sense of all this. In the end, I will have to let go and realize the team of professionals I have chosen will do the best they are able-- and that will by definition, will be good enough. Most of all, I need not be afraid-- I can and will handle whatever happens-- valve type, Coumadin, and all. Thanks! I will check in before I go to "the big house". Having the chance in this wonderful country to have a "second chance" sure beats the opportunity the 98% of humanity has-- zero second chance. I count my blessings!
 
Don't be a stranger Jeff. Your allowed and I insist that you ask any and all questions that are on your mind. Your right about letting go. It will happen in it's own time and space and you have no real control over what is done. You can give input, but what they find when they open you will be the determinator. :)
 
Hi Jeff,

Before my surgery, when I realized I could put my faith in God and the professionals, I became calm and felt a positive attitude overcome me. I think you'll find that and think it helps toward the positive outcome. All the best to you!

Zipper/Joan
 
Congratulations Jeff !

It sounds like you have reached the best possible position going into your surgery, namely a Positive Mental Attitude. Believing you will survive and be able to cope with whatever develops goes a long way towards making that a reality.

Peace be with you. Please let us know how you are doing and of course know that you are welcome to ask any questions that come to your mind.

'AL'
 
Valve Type and Coumadin

Valve Type and Coumadin

Jeff:

I had a valve replacement about a year ago and I have a Medtronic. So far, I have run in to no one who has a Medtronic valve. But my heart surgeon told me they have fewer troubles with the Medtronic in the first five years after implant.

I take Coumadin every day. It's no problem. I haven't had any issues with conflicts and, since I quit eating meat to lower my LDL Chloresteral, I haven't had to address many Vitamin K issues. Somehow my liver is better able to handle it when I inconsistently eat high Vitamin K foods but I still test within my approved range.

I test my blood with a home testing device once a week and match it to a lab test twice a year. Again, no problems.

Hope this helps?
 
Hi Randy.

Welcome.

Well, your not alone. Have a Medtronic 33 Mitral. Going on four years. Valve is functioning perfectly they tell me. Seems like we are the minority, at least on this site. If I am recalling, there may be four of us with Medtronic valves here at VR.com.

Once again, welcome. You will thoroughly enjoy the support and friendship. Truly a rare blessing.

Looking forward to your future posts.
 
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