British Heart Foundation
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Heart valve replacement

I’m 50 years old and having a aorta valve replacement on 9th April and I’m undecided which one to have the metal one or animal one?im dubious about having to take warfarin?with eating drinking etc.does anyone have experience of valve replacement?

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Mechanical advantages - will last your lifetime

Mechanical disadvantages- warfarin, ticking

Tissue advantages - silent, no warfarin

Tissue disadvantages - at 50 you will definitely need a reoperation

Only you can choose which of these aspects is most important to you.

If you choose mechanical I would strongly advise getting a home tester and monitoring your blood weekly (the testers use a finger stick). The more you are in your therapeutic range the safer warfarin is. NICE recommends home testing but practices vary as to how supportive they are of this and whether they will pay for testing strips. With diet you just have to be consistent, and binge drinking is a bad idea!

If you choose tissue I would strongly advise finding out how large your valve annulus is. If you have a 25mm annulus the tissue valve will be large enough for a catheter based valve replacement - TAVI- in the future (23mm will do at a pinch but 25mm will be better). 19mm and 21mm tissue valves are not large enough for future TAVI.

It is also worth considering the new Resilia valve, which it is hoped will last considerably longer than normal tissue valves, but this is only available in a few hospitals at present.

Nevertheless at 50 with tissue you are extremely likely to need a re-operation at some point and so a mechanical would generally be recommended at your age unless you were very against it. What does your cardiologist / surgeon say?

I didn't want warfarin or ticking and I was OK with re-operation. Others feel the reverse! I was also 10 years older than you.

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Hi Lyndon,

The above reply is excellent and gives an amazing amount of information.

I had an urgent AVR last May, I was in hospital from diagnosis to operation and was not well enough to do any research . I made my decision purely on the facts my cardiology team gave me as I did not meet the surgical team until the day before operation.

I was told that a tissue valve would last 10-12 yrs and then need to be changed. At 56 years old my mantra was I would have this surgery once, do the rehab well but not again.

So I had a mechanical valve fitted,it is a new generation valve fitted by open heart surgery. Regarding the ticking, I only hear a quiet ticking as I go to sleep and wake up which I find quite reassuring. Occasionally if I am working very hard going up a hill I can hear it but it really is not a problem

I am now on life time warfarin or until other drugs are licensed. There are rules to keep which seem like a lot to start with but they really they are not. Advices not to have cranberry or grapefruit, be careful about green veg, but I still eat plenty for a healthy diet. You do have to be careful about alcohol. It's all about balance and moderation, the prize being a stable INR and fewer blood tests. My INR took a while to settle but now it is stable and I am tested every 4 - 6 weeks. I have not yet investigated home testing. Warfarin is a bit of a nuisance but for me it is a small price to pay.

I am happy with the decision I made on the limited information I had at the time but I think I probably would make the same decision today. Hope that helps.

Mary

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Appreciate that thanks.how old r u and do u live a full and active life?

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I am 56yrs old, I had my AVR last May, I am now back to work and normal life. Because I was seriously ill my recovery has been more protracted than normal so I still get weary at times. On saying that I am taking my recovery very seriously and ensure that I either walk 10,000 steps and or go to the gym(something I did not do previously.)

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Surgeon said metal one.just worried about warfarin

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Hi Lyndon

I had a tissue valve the first time as a I didn’t fancy being on warfarin, at the time I was 52. I was told it would last 10-15 years but actually only lasted 6 and I had to have it replaced at the end of last year. This time I had a mechanical one as I had my spleen removed nearly two years ago and wasn’t worth the infection risk of further ops.

The only time I hear the ticking is at night or if it’s very quiet, but I find it relaxing.

As has been suggested, if you go for a mechanical valve get a home testing kit, especially if you work as it is much more convenient than having to go to the clinic. I just do my test, ring the clinic with my reading and they ring me back with my dose. I have managed to get my levels steady very quickly and must admit that I don’t eat a particularly healthy diet - not a great veggie eater but trying to eat a bit more. The only thing I really miss having is liquorice, it’s no use saying it’s okay if I have a couple of pieces cos unless they take the packet away from me I’ll eat the whole lot, 😉. Drinking isn’t a problem as I only have one or two once a month, but they do say don’t binge drink if you’re on warfarin.

At the end of the day you are the only symptom be who can make the choice of valve and Fortepiano has explained well the pros and cons of the different types.

Hope it all goes okay and f you need more help/info there are plenty of us n here who have had AVR ops.

Wendy

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Do u live a full and active life now?thanks

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I did after my first AVR but it’s taken a bit longer this time. I think there are several reasons for this - I am older, I’ve had a splenectomy, I ended up with a pacemaker after this AVR and because the weather has been so bad I haven’t been able to do as much walking. Having said that, it is only the breathlessness that is a problem and then only when outside in the cold, indoors I’m fine. I’m back at work full time and feel fine, getting out with friends again. Looking forward to getting out to watch some motorbike racing soon.

Wendy

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Thanks appreciate that👍

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At 50 you will need further surgery in 10 - 15 years with a tissue valve and even two if you live to a decent age - it's unlikely that a tissue valve would see you through to retirement. In the end it is your decision - talk to the cardio team.

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Thanks just worried about warfarin

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I spoke with someone who has had a valve replaced and work to two others. Their thoughts are tissue. If it needs replacement you should be young and fit enough for surgery - not something they would say if you were 75! With advances the life of the tissue valve could be considerably extended and/or advances made with mechanical valves. Have a talk with your cardiologist and then make a decision.

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I had AVR replacement in May last year and aortic graft after being diagnosed only a few months earlier. The diagnosis itself was a major shock as I was leading a very active life, going to gym regularly etc - just like you I was 50.

You are asked about what valve you would like and initially I had no idea and couldn’t really believe that only having just been told I needed an operation I was now being asked what valve I would like! My initial reaction was simply to ask my fantastic consultant, you are the expert, what would you do? She was rather reluctant to reply directly but after I pushed her, given my active lifestyle, desire to lead a completely normal life after the operation and desire to continue drinking (!!) she agreed tissue valve would probably be best, which was my first reaction.

Fast forward 10months all is good, with the support of my family, I lead a normal life, get a bit tired occasionally but this is due to the lovely bisoprolol rather than operation. I go to gym, walk the dog and continue to drink!

Rightly or wrongly I take a positive approach to medical developments over the next 10-15 years, TAVI valves will become common and who knows what else might be developed in time for my next operation.

Hope this helps and good luck for the future.

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That’s brill cheers

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Morning Lyndon, I have read this thread with interest. I had my AVR last March. I am/was 62 and the way it was explained to me was a animal valve lasts about 10 to 15 years, so I would need another operation when I would be around 80. I realised it would be a large and slightly risky operation so opted for the mechanical valve, more so if I was 80. The operation itself went well but I didn't recover well, a year later I am quite back to normal and back at work. I still think I made the right choice because the taking of a couple of tablets a day is not really a problem. (my phone set off an alarm for me at the same time every day when I know I will be at home), I don't drink much and I would never want to go through that experience again. someone mentioned that in a few years time a procedure where they can insert a new valve via a vein to cover the old one maybe tried and tested (if its not already), so I'm not sure what I would do now with that knowledge! I don't hear the ticking often, its more like a pounding in my ears, but the medication is not a problem and the thought of never going through that again is reassuring. Good luck with your operation.

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Thanks very helpfull👍

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Hi Lyndon, I had a biological AVR in August last year following advice from the cardiologist. All seems to be going well - I am 65 so significantly older than you but told that the advances in techniques etc. mean the life of biological valves has continued to increase - time will tell I guess but I was not keen on warfarin and the restrictions that that seems to place on you as well as the need for such regular checking of bloods etc. But it is a very personal choice and only you know what will be best for you. Good luck with the operation etc.

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Hello Lyndon

I have just turned 50 too but had my AVR in November. Initially when I first knew I needed the operation I was very told I would have to have a tissue valve as I had problems with iron levels and would not be able to take warfarin. The surgeon told me my iron levels were not a concern and advised he would use an On-x valve which only needs INR of 1.5 therefore less warfarin. I am SOOOOO glad I had a mechanical valve as there is no way I ever want to go through that again! I'm a very tough old bird, have recovered and all went well but I hated feeling so useless for a few weeks and felt quite low (which is very normal).

Getting the INR stable has been a nuisance although I do still drink (occasionally over the guidelines) and this doesn't seem at affect anything. I'm very lucky that I'm not a worrier.

Wishing you well.

Claire x

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Thanks appreciate that👍

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Hi Claire,how did u find the op and recovery?how has it been on warfarin?are u back at work and fit and healthy?

Thanks

Lyndon

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Hello again

Before the op I was well, I wouldn't have known I had a problem if I didn't know (if you get what I mean). The first 2-3 days post op aren't great - I felt poleaxed but I was able to walk around by day 3 (a little). i could manage a flight of stairs fine. I would say by 3 weeks after I felt tons better and by week 4 almost back to normal. I went back to work after 8 weeks, part time for first 2 weeks. I've been back full time for 6 weeks now. I feel great but very tired by 9pm (but then that was the same before the op)! I have to say I don't feel much different to how I felt before but clearly my heart will go on!

Regarding the warfarin, I don't seem to be suffering much in the way of side effects except a bit of itchiness.

Please do ask if you have any more questions. Very happy to help 😊

Claire x

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Hi Claire,wot type of work do u do?do u hear the valve clicking?

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I'm an admin team manager for local government so sitting on my bum all day! I do hear it at quiet times and at the beginning it kept me awake but doesn't anymore, I sleep like a baby !

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How do u go on drinking alcohol?as I like a drink👍

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Did u have your ascending aorta replaced as well?ive been told it’s genetic as my brother dropped dead at 48 last aug!he was fit and healthy and had no previous problems

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Yes, I did have that part replaced too. And yes it can be genetic. My children have all had echocardiograms and thankfully they don’t have the bicuspid valve. I’m so sorry about your brother 😔.

Regarding drinking, I like a drink too. Initially I was very careful, less so now. I’m not a daily drinker by any means but have a few at the weekend. My INR does not seem to be affected by alcohol. I’ve been too low rather than too high all the time.

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Thanks

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Hi Lyndon68

I had a Resilia valve which lasts for 25 years. You only have to take aspirin daily.

I had a few set backs with Atrial Fibrillation but this is common with any type of valve replacement.

I’m back at work on phased return and exercising well. I get tired in the evenings and fall asleep by 8.30pm. However everything seems to be going in the right direction.

I’m not sure Resilia is available in all hospitals but due to your age you would be an ideal patient. It’s worth asking.

Take care

Lisa

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Wots a resillia valve type replacement?not heard of that one.thanks

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Hi

Here’s a link with some info

edwards.com/_layouts/Edward...

Hope that helps

Lisa

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I have had two Aortic Valve replacements, both of which were tissue. I had my first replacement when I was 55 and chose a tissue valve as I didn't want a life of being on warfarin, unfortunately things didn't go as planned and I suffered several complications which took it's toll on my replacement valve and nine years later I had to have a second Aortic valve replacement, once again I chose another tissue valve. This valve is now five years old and still performing well, unfortunately I am now on the waiting list to have my mitral valve repaired. Good luck and what ever you choose I hope all goes well for you.

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Wot were your concerns about warfarin?

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