Born with a bicuspid valve I guessed this day was coming…just not so soon! I will be 56 when they open my chest on August 15th. I would much rather have the TAVR procedure but at my age the long term planning doesn’t support that method at this time. So, OHD it is. I have significant procedural anxiety so this should be interesting.
Anyway, I have a decision to make - biological valve or mechanical valve. The mechanical valve is supposed to last a lifetime but will require I am on one of the old anticoagulants for life. The biological valve will likely last 10-20 years then need replaced. Because I plan to be very active after recovery (biking, hiking, weight lifting) I am guessing the valve will probably wear out faster - so closer to the 10 year mark. The valve could then be replaced through the TAVR procedure (and be more successful because the valve they use to replace my bicuspid valve will be round and the valve they will use during TAVR will be round - as opposed to using a round TAVR valve now to replace an oblong shaped valve typical in humans). A big benefit to the biological valve is no need for an anticoagulant.
There is more…during this OHS procedure the doctor said he will also do a Maze ablation for afib, clamp the left atrial appendage (LAA) and take care of any blockages that I may have.
Looking for thoughts on OHS in general, which valve type I should choose, tips to deal with excessive anxiety and any actions I can take now to improve my recovery (lung capacity exercises, etc.).
Thank you in advance!
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Jafib
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I'm sure you will get a lot more answers to your post on the BHF forum I have put it below. Let us know how your ablation goes please and good luck with all that you have done.
64 yr old male. I have a BAV and had OHS for a thorassic aortic aneurysm at 5.2. Mild regurg and thought valve might be changed but TOE at surgery revealed good leaflets and openable area at valve so that was spared. Had elected to have Edwards redpoll us if it was needed. Operation not as bad as you think though other than slight one day problem with one lung, I had no complications and operation Thursday and out Monday. Had LAA clipped which is good. was on ACs anyway after one 12 day bout of Afib three years ago. Hope it all goes well
Wow what a difficult decision to make.A biological valve but no anticoagulants that lasts for 10-20 years and needs replacing when you'll be nearly 70.A mechanical valve lasting for ever but you'll have to take old coagulation like wayfaring and the side effects on your kidneys/liver. You did say that you plan to exercise which will be good for your overall health,but don't overdo it.
May I ask did the bicuspid valve cause aortic valve stenosis and the aortic valve is being replaced ? And I assume it became severe aortic stenosis ?
Reason for asking is I have moderate aortic valve stenosis and will someday face the same.
I would suggest keep consulting with the doctors (perhaps a second opinion) do personal research and make your decision. As mentioned, there are likely patients in the BHF forum who have experienced the same. Personal opinion only, at your age I would lean toward the mechanical valve. Being on anticoagulants is not the worst thing and as you age there may be other conditions that appear which would make a replacement procedure more complicated.
I was born with the bicuspid aortic valve, which means it has two leaflets rather than three. That configuration, for some, stiffens over time and does not open properly. Once the stiffening/stenosis reaches a certain level it places stress on your heart and can cause other issues - including death if left untreated too long. I'm not sure if that answers your question...
Following with great interest as I too have a bicuspid valve( I'm 64 though) with ' mild stenosis. Annual echo next week.I only found out when an echo was done following AF diagnosis at 53
I don't fancy going onto warfarin ( can't understand why the NOACs are not suitable) and also dad said he could hear it clicking like a clock. Since a ticking clock dements me I don't fancy that either.
But then again I don't fancy going through OHS more than once!I'm not even sure my hospital does TAVR
On the whole, at your age and fitness I'd be inclined to go the biological route. You seem to be well supported with information from your team
You might find more responses on the BHF forum, but please let us know how you get on.
Hi Dawn. Yes, UCHW does perform TAVI/TAVR but I think, only from about a year ago as when I asked about it 2 years ago, re my mitral valve, they didn't.I think much depends on your anatomy regarding performing it on patients under 65.
I'm hoping for a repair, rather than replacement as I was told replacement would be mechanical rather than tissue due to my age.
I too not keen on the ticking idea as I find its like dragging nails down a blackboard so fingers crossed for a repair (still no date).
I was told they will not use NOAC with mechanical, as there has not been enough studies performed as yet as to whether clot formation was a risk with blood adhering to the metal on the valve. They know this isn't an issue with Warfarin so continue to use that for the time being.
If I need replacement, then I personally would go down the mechanical route, rather than take the risk of having to have OHS again in 10 years if they were not able to do a TAVI at that point.
On reading your post, for or against, I think you feel the biological to be the preferred so I always say, go with your gut feeling, its usually the right decision. Good luck with your surgery and a good recovery.
Hi, I had OHS to repair 2 leaky valves in 2021 at age 71, plus ablation and LAA at same time. Concerns cos my EFR was low, whether I would need to be put in an induced coma. Had more stress tests and scans and it was all ok. Now 2 yrs later scans show repairs fine and EFR up to normal. Recovery you need to take care for about 2mths no lifting, pushing or pulling anything heavier than a cup of tea, no driving. So you need someone to care for you, meals etc.
As for anxiety can't advise I always expect worse so try to order my finances, will etc just in case. then trust in skill of surgeon. Might be reassuring to know who your surgeon will be and how many of your op they have done before. Good luck
Hi Jafib, my 67 yr old husband is due to have the same procedure as you, (apart from the MAZE ablation), a severely stenosed bicuspid vale replaced via OHS with some minor blockages being cleared at the same time. He has opted for the biological valve, as he doesn't fancy being able to hear the mechanical one clicking away all the time. We attended an info session held by the hospital last week. The speakers were Nurses, Physio's and a member of the Ticker club - someone who has had OHS in the past. If i was you I would ask your medical team if they do a similar session, and / or speak to someone from the Ticker Club. Wishing you all the best for your surgery and recovery. thetickerclub.co.uk/
I was ten years older than you when I had OHS. I needed an ablation, a bypass and a faulty valve repair.
The night before the op the registrar said if they couldn't fix the valve I'd need either a biological valve (about 10 years lifetime) or a mechanical valve (forever?) but I'd have to take Walfirin.
I decided on the second option as I didn't relish being opened up again. They managed to repair the valve and it's still going strong eight years later; could they perhaps fix your valve?
I'm in a similar boat but with a mitral valve repair/replacement and a Cox IV Maze at the same time. Much as I don't want ticking and Warfarin, I'd want OHS again even less, hence I'm hoping it can be repaired. I'm only in my 50s as well.
My anxiety is through the roof when I think about it so I'm seriously considering hypnotherapy.
I was given a pack 2 years ago (yes, waiting that long) with all sorts of info, including breathing exercises. Perhaps see if your surgeon has a similar pack.
All the best and please let us know how you get on.
Hi there Jafib , I can well appreciate your dilemma as I was in a similar situation 7 years ago except I hadn’t had any warning as I had an undiagnosed aortic bivalve so my first warning was when I developed moderate/severe aortic stenosis at the age of 47. I too was given the choice mechanical vs biological valve. At the time I had to weigh up a lifetime on warfarin with the mechanical valve or the probability of needing a replacement every 10-20 years with a biological with the risks getting higher with each replacement as the operation gets more complex due to scaring caused by the operation. I eventually opted for a mechanical valve and recovered well post op and have had no problems due to being on the warfarin. Though it really is a personal preference.
As to the ticking I personally don’t even notice it anymore though others do especially doctors it really is upto your personal preference.
On the 13th of July I had open heart surgery for four procedures. afib clip, repair of an ascending aortic anurysum, and the replacement of two valves, (both bovine/cow.)
I did not want to be on daily medication or the rest of my life. I had mine done at Shands (UF) hospital in Gainesville. Dr. Beaver, (one of the heads in surgical education at the hospital/college. GREAT surgeon. If I live to see the change of the valves, I will use him again...
I am 67 and last year had OHS for AVR, LAA clip and ablation. I was known not to be able to maintain a stable INR on warfarin so the surgeon used a tissue valve which can accommodate TAVR should this be necessary in its 20+ lifespan. I still take apixaban as not all stroke inducing clots form in the LAA.
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