What type of valve is best for me?

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Prem

New member
Joined
Apr 27, 2014
Messages
2
Location
Houston, TX
Hi, I am scheduled to have aortic valve replacement surgery on 5/7/14. I am 49 years old male. I don't have any symptoms but the stenosis is at a critical level and have been told not to do anything that will get my heart rate up, therefore I am having the valve replacement surgery on a elective basis at this time.

My question to the forum is what type of valve would be the best for me. I like to ski and play sports and the tissue valve makes sense except for having to have a replacement surgery down the road. If anyone else has been in my position I would like to hear from you on what decision you made and whether you thought you made the right decision. Thanks in advance for your reply.
 
I had AVR surgery last year in June at age 49. I chose mechanical because I'm so active that the doc didn't think a bio-prosthetic valve would last past 8 years. I didn't want to go through another surgery, at least not that soon. Taking warfarin is not a big deal for me and hasn't changed my active lifestyle at all.

Remember, any valve you choose is the right one.
 
The Big Question

The Big Question

Prem, you have asked what is perhaps the most often discussed single question. Most of us have asked this question and only with time can we know what our choice brings. Whether fortunate or unfortunate, there is no way to know the best long term valve choice for any individual. Your surgeon knows more about your heart while you know more about your own life what you want to be able to do after surgery. It takes these two elements to arrive at a decision so you must discuss the options with your surgeon.

That said, by now you are familiar with the two basic directions - mechanic or tissue. They both come with baggage. Still, all the statistics available cannot predict your personal outcome. Mechanical valves should last indefinately but they are rigid and things such as tissue growth can degrade their performance although for most people the chance of this happening is small. Here, your surgeon may be able to shed some light on this possibility as he prepares for your valve replacement. As well with mecanical valves, into the near future, it will be necessary to use anticoagulation therapy to avoid blood clots but as you read of people's experiences here, you should know that anticoagulation isn't a great problem for most. Tissue valves do not require anticoagulation therapy other than a daily aspirin and in the presence of tissue growth can continue to function but the valves themselves are at greater risk for damagage caused by bacterial infections. Mechanical valves cannot be damaged themselves but the suture sites are more suseceptible to these same bacterial infections known collectively as endocarditis. For most people endocarditis is not a major concern but it can happen and some individuals are more prone to developing these infections. Reviewing your medical history with your surgeon may possibly be of some assistance in highlighting any particular risk you might have. Finally there is the question of how long a tissue valve may last and the answer is that no one knows. Some have failed in a short amount of time but there are many functioning still at 15 to 20 years. As well, some tissue valves can now be replaced without open heart surgery but this is new and no one will know how effective it is for some time to come. Mechanical valves have a much longer track record because they have been used since Sept. 21, 1960 Philip Amundson became the first successful valve replacement patient.

What you can be certain of is that any valve choice will reduce your risk is death now and let you live a normal life. We all live with risk every day of our lives. Philip Amundson lived for 17 years with his mechanical valve until he fell from a ladder while painting his house. We drive cars, we ride bikes, we do all sorts of things that put our lives at risk. When you choose a valve type, you can only make your choice by balancing the different types of risk with which you are most comfortable. Sadly, there is no simple equation into which we can plop variables to arrive at a completely satisfactory solution and, more frustrating, the variables are somewhat different for each individual. Assuming there is no reason that you have no obvious health issues that would indicate one valve type over another, I think you must consider which risks are most troubling and which you can live with most easily.

My surgeon expressed concern about tissue growth around my new valve because this very thing happend to my Uncle a few years ago causing his mechanical valve to fail so my Doctor recommended a tissue valve. I had planned on a mechanical valve but how could I discount my surgeon's knowledge and years of experience so I went with his recommendation? As you read about different valves and peoples' experiences, you may find that you develop your own preferences. Discuss them with your surgeon and the two of you should be able to arrive at a valve choice with which you are comfortable.

Larry
 
Larry pretty much summed it up. No one can tell you what is right for you (except you!). You could easily make an argument for either tissue or mechanical. There is tons of info on VR.org on the pros and cons of each and its documented pretty exhaustively in many threads. I went mechanical and am happy with my decision. I'm 48, live a very active lifestyle and play alot of sports etc. If you play contact sports alot, or are in a line of work like law enforcement, those types of variables certainly can tip the scales in one direction (tissue). But you need to go over all the factors, pros/cons and see what's most important to you.
T
 
Mike and Larry, thank you so much for your thoughtful answers. If I go with a mechanical valve there are 2 options, st.jude and on-x. Seems like the advantage of on-x is you can eventually get on plavix as opposed to warfarin down the road and the INR for plavix is 1.5 vs 2.5 to 3.5 for warfarin. Are there advantages to st.jude valve outside of its long history?
 
Hi Prem, welcome. Spend some time on this forum and, hopefully, you will find a lot of info that may help with your decision. I got a mechanical valve when I was a young, very active man and "blood thinners" have seldom interfered with my life style. Mostly it only requires using common sense. The plus is I still have the same valve I started with and that, to me, is a
BIG plus. Either valve choice will correct the current problem and, like you said, it does boil down to warfarin therapy vs additional surgeries.
 
Welcome Prem, you've been given good answers, but one thing should be mentioned; plavix is not recommended for mechanical valves as there is no treatment 'if' you have internal bleeding. If such an event was to happened while on warfarin the ER ppl would give you vitamin K.
 
Seems like the advantage of on-x is you can eventually get on plavix as opposed to warfarin down the road and the INR for plavix is 1.5 vs 2.5 to 3.5 for warfarin.

If you have only an aortic valve replacement, the INR range is usually 2-3 for those with an On-X mechanical valve. This is what my surgeon told me, and also what many others on this forum have experienced. If you have additional complications (like mitral valve replaced) then the INR range can be higher.
T
 
Welcome Prem, you've been given good answers, but one thing should be mentioned; plavix is not recommended for mechanical valves as there is no treatment 'if' you have internal bleeding. If such an event was to happened while on warfarin the ER ppl would give you vitamin K.

Just a quick note of response on this. Of course different surgeons have different opinions on this issue, but as far as I understand Plavix and aspirin are used sometimes with On-X valves in Europe, and as it sounds like you know On-X is conducting a trial in the US on Plavix use with its valves. Plavix and aspirin are used in the US and Europe as a replacement anticoagulation therapy for some pregnant women with On-X valves. As far as I understand it is true that Plavix isn't as easily reversed as warfarin, but I wouldn't go so far as to say it's not recommended (at least at this early stage, when still in trials). At the end of the day we all have to decide the level of risk with which we're comfortable, and if Plavix becomes approved for use in the US for On-X valves then that's another choice we'll be fortunate enough to get to consider. For what it's worth, many, many elderly people are now on Plavix and as far as I know they're not dropping like flies from use of the drug.
 
Mina - it's not recommended in Canada, and as you said: 'As far as I understand it is true that Plavix isn't as easily reversed as warfarin'.

I suggest you start another thread on Plavix if you wish, so this thread doesn't get 'highjacked' from Prem's initial question.
 
Prem - You've come to the right place to ask questions like this. You probably will not receive a definitive answer ("pick this one"), but you will get a lot of additional information to help you to discern which valve type makes the most sense for you.

At your age, the conventional wisdom would recommend a mechanical valve. This is because tissue valves deteriorate more quickly in younger patients. Cleveland Clinic and other hospitals have been moving down the "age of choice" for tissue valves, but that age still seems to be in the patient's mid-to late 50's. They feel that the newest generation of tissue valves will last longer than the previous, and that they will likely last the remainder of the natural lives of most patients if the implant is done in the mid-50's or later. If tissue is selected for a younger patient, they caution the patient that it is likely they will require at least one more replacement during their lives.

As Larry (Mentu) said, mechanical valves are usually said to be able to last "forever" -- barring other complications like pannus (scar) tissue growth that impedes the motion of the valve, etc.

All that being said, nobody can predict how it will go for any one of us. Some folks have valve failure in short order - both tissue and mechanical. Others have long valve lives with either type. All you can do is consider all the pro's and con's and make your choice. Your surgeon can help in two ways. First, they can help you choose between tissue and mechanical valves. Then, they can help you choose which brand/model of valve is your preference. They will, however, tell you that they reserve the final decision as to which valve to use until they actually have you on the table and can see all the intricacies of your heart. Then they will choose the valve that they feel is best for the patient. In other words, you can make your preference known but if they find that your preferred valve is not best, they will make an alternate choice. Might be worth a discussion with your surgeon about the back-up plan, too.
 
I could be wrong, but I don't think the Cleveland Clinic guidelines would be to use mechanical valves until a patient's 50's. I thought the recommended age cutoff had been lowered to 40 or 45.

Page 30 of this report says that in 2011, Cleveland Clinic used tissue valves in 92.7% of valve replacements. I had my valve replaced with a tissue valve at age 41 and my surgeon told me that's what he would have done in my situation.

http://my.clevelandclinic.org/Documents/heart/Outcomes/2011/05-valve-disease.pdf
 
I had my AVR at age 47. I had always been active physically and although I had been diagnosed with a BAV when I was very young, I hadn't exhibited any symptom until less than a year prior to my surgery.
Both my surgeon and cardiologist strongly urged me to go with a mechanical to reduce the probability of future repeat surgeries. I agreed with and followed their recommendation.

It has all worked out well for me and will have my 14th anniversary on Dec 15 of this year. I live a very active lifestyle with no restrictions. The Coumadin/Warfarin has not been an issue for me, except maybe for the inconvenience of doing a Lovenox bridge prior to colonoscopies.

I feel very lucky and blessed, since I know of others who have experienced complications and limitations post op.

All that being said, I think valve selection is a much more difficult process today than it was for me 14 years ago. There are more choices of proven mechanical valves, and there has been a marked improvement in tissue valves in the intervening years.

More choices are a good thing, but so many options can be overwhelming. It is all the more important to educate yourself to be an informed consumer and to find medical professionals who you trust and who truly have your best interests at heart.

Good luck and best wishes.
Mark
 
The best valve is the one they use to replace your bad one. No one can decide which is best for you other than you yourself, not even the doctor. Please read all the positive and negatives on this forum and think about what is best for you.
 
I personally chose mechanical valves as I had two bad valves which meant to me then the need for two more OHS surgeries, had I chosen tissue valve then. I was 57 and was not sure what my health condition would be when I needed to be reopened!

So, six years later, My personal opinion is to ask your surgeon about the method he will perform when you may need a replacement! Will he, by then, be confident to replace your valve with the Transcatheter Aortic Valve Replacement (TAVR) method.

Here is info about TAVR: http://www.nmh.org/nm/heart-valve-transcatheter-aortic-valve-replacement

Good luck with your choice.
 
Hi, I am scheduled to have aortic valve replacement surgery on 5/7/14. I am 49 years old male.
...
If anyone else has been in my position I would like to hear from you on what decision you made and whether you thought you made the right decision. Thanks in advance for your reply.

I'm 50 and picked a mechanical. It was my third OHS, I wanted no more.

I can not guide y decision but can express my view on myths about mechanical valves and warfarin.

Rigth now I am sitting in a pub in Dublin having bangers and mash and my 2nd pint of Guinness. I have packpacked here from Finland. I spent the winter in Finland cross country skiing and will go back to Australia next month. I self test and self dose my warfarin.

I can only say my experience on the last two years is that warfarin is a zero problem issue for me in every way you can look at it. I feel sorry for my American cousins who are apparently entrapped in a system that frowns upon self management and instead seems to force worst outcomes on people by forcing them to be trapped in clinic paradigm which seems to only benefit the service providers.

I eat what I want and drink what I want and rarely need to do more than tweak my INR.

No choice offers certainty, only probabilities. To me with mechanical valve the probability of needing replacement is soooooo much lower than tissue. I personally am willing and able to manage my INR.

Best wishes and I hope you are able to make your decision and find peace in that.
 
Either choice saves your life...very personal.....I started out thinking tissue...but the more I researched... the more it made sense for me to go mechanical.
The fear of multiple re-ops was greater than my fear of being on Coumadin.....I choose the ON-X valve. Coumadin has not been an issue...I am now locked in at 2.3 as my INR.
I test once a month at a lab. Do your research and you will make the right choice...the good news is there is really no wrong answer.
I have yet to read about anyone on this forum who believes they made the wrong choice.:thumbup:
 
I have yet to read about anyone on this forum who believes they made the wrong choice.:thumbup:


We had one just this week, I think there have been others too.

http://www.valvereplacement.org/for...ave-choose-tissue-valve-instead-of-mechanical

http://www.valvereplacement.org/forums/archive/index.php/t-1549.html

Some people have a rough time with the surgery recovery and regret the tissue choice because they fear another operation.

Some people have tissue valves wear out in 5-10 years and regret the tissue valve.

Some people have strokes or bleeding episodes or loud ticking and regret the mechanical valve.

Most people do pretty well after valve surgery either way, so they well strongly defend the valve choice they made, but some people do have regrets.
 
I am 49 and just had AVR because of bicuspid stenosis. I chose a tissue valve because I didn't want to take blood thinners the rest of my life, I love to cook and my full time job involves cutting fruit & veggies for a huge grocery store. My surgeon said the tissue valve could last up to 20 years, I figured if I need a new one in 20 years, there may even be something new by then, my surgery went great and I had a mini incision so just a 3" horizontal scar on my right chest, not that bad!
 
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