AORTIC VALVE REPLACEMENT

[sarum1967]

I'm 50 and due an aortic valve replacement soon. What are people's thoughts on mechanical vs animal tissue?

Thanks

Phil

[Advice1]

Hi Sarum1967 in regards to the Aortic valve replacement there is i link i provided with some helpful advice below

You could also contact email a Heart Surgeon or their secretary who are normally very informative although they can't tell you what you should do they could help in your own decision making

I remember before my mitral valve repair the registrar came to my bed to give me 5 mins to make up my mind if the repair did not work in the operation which would i prefer ,mechanical or tissue ,i told him no way was i going to give an answer that quickly and i would think about it over night ,and in the meantime contacted a very well known Heart Surgeon who's secretary agreed to discuss this issue with him and he kindly replied with the options pros and cons which was very kind.Most Heart Surgeons in the UK or USA are very approachable .Do you have a date for surgery yet?

If you need any help just message me for tips even on getting seen earlier if you have a bit of a wait.

If you want to visit a very good website go to heartvalvesurgery.com by adam pick who had same surgery that you will be having an excellent site.

Good luck Phil hope all goes well and your back to good health very soon.

ncbi.nlm.nih.gov/pmc/articl...

[sarum1967 in reply to Advice1]

Really useful information on the website, thanks ever so much.

I haven't got a date yet even though I was told it was urgent back in May. Surgeon has suggested it could be another 3 to 4 months even though they've suggested they'll try and get it done asap!!

Meanwhile symptoms are getting worse which is causing me much anxiety. MRI in Oct last year indicated severe regurgitation to my aortic valve and worried the longer they leave it the more damage generally to my heart condition?

So any tips on getting seen earlier would be most welcomed.

Cheers Phil

[Advice1 in reply to sarum1967]

Hi Phil

First thing i would say is try not to get too anxious and avoid stress, not easy i understand.

Also you will be at one of the top Hospitals for Heart surgery in the UK and great hands to be in too.They have one of the Top Mitral Valve High volume surgeons Mr Francis Wells and many Heart Surgeons have trained there and gone onto other great hospitals in the UK and also places like Mount Sinai in New York.

I was urgent too, like yourself, but the Cardiologist did explain Severe Mitral Valve regurgitation (Prolapse) or in your case Severe Aortic Regurgitation usually progresses slowly and in my case i had probably had it for a few years so i was refered for Elective surgery as although they say urgent there are always more sick people to treat with Heart conditions, that's what the Cardiologist explained to me.

You stated ""BMRI in Oct last year indicated severe regurgitation to my aortic valve and worried the longer they leave it the more damage generally to my heart condition?""........ this is a question to ask your cardiologist as they won't mind answering any of your questions as they are normally extremly helpful and approachable from my experience.

If you feel that you symptoms have become a lot worse i would contact your Cardiologist by phone or email their secretary and explain your situation they will understand your concerns.But also don't hesitate to get to hospital if your symptoms were [ in the unlikely event] at this time, to get much worse.Do you have High Blood pressure or coronary artery disease with your condition this could help getting seen quicker, possibly?I'm not a doctor, so i cant give out medical advice, just an idea though.

The NHS Elective Pathway to be seen is normally 18 weeks but can and does go over that time, mine was longer after i was diagnosed a few years back in month of Dec, but there was Norovirus at many Hospitals which caused Bed blocking so i eventually had my Operation in Mid July .It would of been June but i did in fairness i changed to another Surgeons wating list as he had a high volume of Mitral Valve Procedures and my Cardilogist referal did not and was more focused on and expert on other procedures.You could ask to change to another Surgeons wating list to be seen quicker, possibly, you can also check the amount of Aortic (AVR)Procedures , here in this link.you can see your Surgeon here:

scts.org/hospitals/

click on the east of England on the map and you will get Papworth on the list and you can get a profile of each individual Surgeons Profile how many procedure they do in a 3 year period. I found all of this very interesting, the stats etc, gave me a focus while i was waiting too!The Blue Book on this site explains a lot also.

I only got a date for my operation 2 weeks before my operation and at that time i was first on the list for operation all was good to go but an emergency came in and had priority to my surgery slot.But i was happy, as that patient needed the priority to me but i came back week later and had my operation.This does happen sometimes.

You should of at your Pre-assesment been given some info on the Bed Manager phone number what you need to do is phone them or the secretary of your Surgeon and explain you are flexible and are available at short notice within 24 hrs for your operation from any cancellations and woud like to be put on the cancellation waiting list.

PALS is always another contact at Papworth that can help things move more quickly if you contact them phone or email to complain .

You have to get everyone involved in knowing your name off by heart

phone up the Bed Manager a couple of times a week to see if you have been given a date for your operation that's what their job is and they normally are very helpful.Try not to get stressed or angry as it can have a negative effect on your condition.Avoid heavy lifting and take things more slowly if you can.

Well i hope you get seen soon ,don't hesitate to message me if you need any other help with anything.As for "mechanical vs animal tissue?"You can always contact Surgeons secretary at Papworth and ask this question to be referred to the Surgeon for the Pros and Cons although they cannot make the decision.

Best of Luck.

[ajosse]

I had a a valve replacement three years ago. Since I have a.f it was best for me to have biological valve. I am seventy six years old. It is working well.

[ChrisE1975]

I had metal one this May as only 41 and should outlast me BUT warfin is a pain to sort out taken 15 weeks to get my INR constant so weekly bloods. They are not quiet and that tick tick does take some getting used too but overall the metal one should mean no more repeat surgeries which is great. My surgeon couldn't give me a choice due to endocarditis however it would have been the metal one if I did simply to avoid more surgery in the future ... There are a few YouTube vids of the ticks so you can hear them.

Good luck pls message me if you have any questions concerns where are you having it done ?

[sarum1967 in reply to ChrisE1975]

Hiya I'm having it done at Papworth. I'll check out youtube!

[Roamie in reply to sarum1967]

Have you now had yours done? How are you, how did it go, how did your rehabilitation go? I need a hip replacement as well, so exercise may be difficult!

[mewg in reply to ChrisE1975]

hi chris im on my 5th werk of warfrin and its headwork but because of the mechanical valve it has 2 be right im on 2.9 at the moment and 6 warfrin tabs a day so fingers crossed it stays like it.i agree the ticking does take time 2 get used 2 but i tend i dont hear it unless im in a quiet room.

[Fredders]

Hi Phil, I had AVR in 2011 aged 52 and had a tissue valve as was told they lasted about 15 years, however I am now having to have it replaced already. As I don't want to have more operations in the future, I will probably have a mechanical one this time, especially as I have the added complication of having my spleen removed last year resulting in a high risk with infections. My only concern is the warfarin but I guess I can get used to that. My surgeon said they tend to recommend mechanical valves for younger patients. When you have your pre-op assessment you should get the opportunity to discuss the pros and cons of the different valves, I'll be having a good chat with my surgeon about it next month when I have my assessment. If I can help you with any queries, especially about the op itself and afterwards, please don't hesitate to get in touch.

[Midgeymoo17 in reply to Fredders]

I am not sure that it is routine practice to recommend mechanical valves for younger patients. In fact my surgeon said the opposite. He said where possible in young people- particularly young girls- the use of mechanical valves is seen as the least favourable option. This is because they can not use warfarin in pregnancy also if you have any further health problems (such as needing a hip operation) you are far more likely to be denied treatment if you are on anti-coagulation and this can severely limit the quality of life one gets (I actually met someone in that position and it was not particularly nice). Also some of the risks that come with warn such as brain haemorrhage (I know some one who experienced this) can be completely devestating.

This said (and stating the obvious) as you have already found out tissue valves in the Aortic position do tend to wear out much quicker than tissue valves placed in the other positions due to the heamodynamic constraints of its location.

[sarum1967 in reply to Fredders]

Thanks for the offer of advice

[Roamie in reply to Fredders]

I am 63. My surgeon has recommended tissue valves.. at Papworth..do different hospitals/surgeons prefer different valves? Do they have different outcomes as well as life spans?

[Fredders in reply to Roamie]

Hi, not sure whether the hospitals or surgeons have any preference. I’ve had both, I had a tissue valve in 2011 at 52, mainly because I didn’t want to be on warfarin. I was told it should last 10-15 years but sadly only lasted 6. Had ny second AVR last year but this time had a mechanical valve. Discussed it with the same surgeon I had the first time and because I had had a splenectomy the year before we decided a mechanical one would be better to reduce the risk of having to have further surgery and the increased risk of valve nfection.

Both sorts have the same outcome ie replaces the faulty valve. A tissue valve should last 10-15 years and you will then need another operation, although by then they may need to do it with keyhole surgery. However there is a new valve on the market that is supposed to last longer, but I don’t think all hospitals are offering them yet. A mechanical valve should last your lifetime but for aortic valves does mean you have to take warfarin for life.

If your surgeon has suggested a tissue valve he must think that is the best for you.

Hope this helps.

Wendy

[Roamie in reply to Fredders]

Wow, thank you for your reply, I'm sorry I didn't reply before..it was put in my junk!

I had not realised/found out before finding this website that the mechanical valves required warfarin afterwards. The stabilisation seems to be a problem..is yours ok?

How long did you wait? Where did you have yours done?

Do you/everyone need weekly blood tests? ..holiday problems?

Looking back on Midgeymoo17's post, I need hip and maybe reverse shoulder replacement soon/afterwards, so perhaps that is the reason for him recommending tissue?

I wonder why yours only lasted a shorter time?

Thank you again for your contact, it helps keep me sane!

R.

[Fredders in reply to Roamie]

Thankfully my INR levels settled down very quickly and I only have to test once every four weeks. Thankfully my anticoagulation Clinic support home testing, although don’t help with the cost of the machine. However some do and some gp surgeries also may help by prescribing the testing strips, unfortunately mine doesn’t. Having the machine and self testing means I don’t have to take time off work to attend the clinic and makes holidays easy. I just have to test, ring the clinic and the nurses tell me what my dose should be.

I think I was just unlucky with my tissue valve failing so quickly. If your cardiologist knows about your other ops that could be why he’s suggested the tissue valve, plus hopefully by the time yours needs replacing they will be able to replace them like they do stents. The only reason I had a mechanical one s because I didn’t want to run the risk of having to have open heart surgery again and the bigger risk with not having a spleen.

Hope everything goes well for you.

Wendy

[Roamie in reply to Fredders]

I had a phone call on Friday, offering me a date in the Spire for my hip replacement! I had to tell them about the deterioration of my heart and proposed surgery. One hand not knowing what the other is doing, perhaps?

When I saw my surgeon on the 26th of April, he told me that he was proposing bovine tissue valve. Would this be the Edwards valve? I seem to be learning a little bit at a time in jumps and starts.

It seems that there are very different ideas about the plus and minuses of mechanical versus tissue and warfarin versus non, but until I started reading these blogs, I had no idea that I would be in anyway allowed to choose between what valves I was given. – Having said that , What an earth would I know, and how would I be a good enough judge?

As I need a mitral valve, an aortic valve and maybe a tricuspid valve (if he cannot repair it), would they all be mechanical/all tissue/or a mixture of both?

What sort of price is the blood testing machine? I am 63, so would I qualify for this on the national health, and/or the strips?

Thanks,

R.

[arethusa_12]

Hi Phil, for my aortic valve replacement I opted for the mechanical over animal because the Mechanical lasts apparently a lot longer. The animal one only lasts about 15 years and I didn't want to go through another similar operation. I am 63. Regards Bob

[Rosie1066 in reply to arethusa_12]

I had my AVR nine years ago and I went for the Mechanical one as I did not want to go through the Op again. Had no problems with Warfarin- my only problem is that my Warfarin levels cannot be stabilised so I do have to have regular tests every week or so. To me this is not a problem and I can cope with it. I am told that I have a very narrow margin which my results have to be within. I know lots of others that have stabilised and have no problems at all and don’t have to have as many INR tests as I do.

There is an alternative to both types of valves. My husband recently had to go through emergency open heart surgery for a triple AAA(Abdominal Aortic Ambolism) and the Professor made up an Aortic Vale for him from tissue taken from his own chest. He is on Apixaban and does not need regular tests. Unfortunately he suffered a Stoke during the operation and is still in hospital after four and a half months.

[Lyndon68 in reply to Rosie1066]

How do u go on for drinking eating etc on warfarin with alcohol etc

[Rosie1066 in reply to Lyndon68]

Drink in moderation as can effect the Warfarin.

[Lyndon68 in reply to arethusa_12]

How have u been with the warfarin?

[Rosie1066 in reply to Lyndon68]

I’ve been on Warfarin for over nine years and the only problem I have had been that it has never stabilised which means I have to have regular blood tests normally ever couple of weeks. Most people stabilise but there are some, like me, who never stabilise. Got used to it now and I feel reassured that my levels are being regularly checked.

[1234Chris]

Recently had AVR replacement as well. I went for tissue as I did not want to be bogged down with continually monitoring Wafarin levels. I will have to have it done again, but that will be in my eighties.

[Lyndon68 in reply to 1234Chris]

How have u been since?

[sarum1967 in reply to Lyndon68]

Hi Lyndon, I'm doing brill thank you. Had the op end of October and went back to work in January.

Fortunately the surgeon was able to repair my aortic valve and had a single bypass so no longer on warfarin.

Still have an issue with Blood Pressure being high and meds are being adjusted for that and only meds I take now are aspirin, ramipril, bisoprolol and statin.

Final rehab session at Papworth tomorrow and then I can join the gym 😃

[Lyndon68 in reply to 1234Chris]

Do you have to take any medication?

[Roamie in reply to 1234Chris]

Please read my reply to IanGordon..I hope that you are doing well.any advice/help would be much appreciated, thanks

[IanGordon]

Meeting the surgeon for my impending AVR lead to the valve discussion. I had decided tissue suited me and fortunately my surgeon agreed. This will give me 12 -15 years which at best means 80 for my next op. The thought of being tied to my local GP surgery for INR monitoring and no imminent Warfarin replacement was a big issue for me. Also, once I'd had open heart surgery, I wanted it over without the Warfarin overhang. But different folks different strokes (unfortunate phrase!) so it's what's right for you, your physiology and your lifestyle. Good luck.

[Roamie in reply to IanGordon]

Have you had your operation yet? If so, where and with/by whom? I am 63 and waiting for AVR, MVR, bicuspid repair and 3 xCABG IN Papworth. Worried, been told possibly 4 month wait but no advice given on self care do's and don'ts in the meantime.

[IanGordon in reply to Roamie]

Papworth would seem a good place to be, particularly with your shopping list.I'm exactly 2 weeks post - AVR surgery and although doing all the right things, feel as if someone has stolen 20 years - the sheer lack of energy is frustrating. Went to Liverpool Heart and Chest Hospital in the end, despite a 3 hr drive. Good people. Managed to dodge any complications so out in 5 - Result. Whatever your lead time, you will suddenly be there. Eat a well balanced diet, exercise moderately and sort any dental issues now. I brought forward my annual check-up. Good luck and a speedy recovery

[Roamie in reply to IanGordon]

Thank you ever so much for your speedy reply. This website has definitely improved my feelings. Frank Wells seems confident that they can tailor my post up recovery excercise, as I can't do much as I have a very poor hip with postponed replacement operation!

[HarryBell]

There are animal trials starting this April on a new composite valve which acts exactly as a normal valve, with no turbulence and no need to take blood thinners- Cambridge University are doing this. May take a few years, hey ho!