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British Heart Foundation
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Organic or Mechanical Valve - This is the Question?

Hi, Severe Aortic Stenosis & Paroxysmal AF. First diagnosed 2013, now scheduled for Valve replacement surgery in next 3 months. Yet to decide Organic or Mechanical valve? I read Organic valves increasingly popular despite their longevity possibly linked to improvements in minimal invasive surgery and Transcatheter valve replacement? So whether to go for a mechanical valve with the increased longevitiy but life long Warfarin Therapy? I'm also scheduled to have AF ablation & Atrial Appendage procedures during the op. FYI I'm approaching my 60th birthday. I'm also interested in Self testing of Warfarin having read the NICE research and findings. However I've not yet discovered whether this is supported within either Wye Valley or Shrewsbury & Telford NHS trusts. Due to have chat with GP in the about a month! Any opinions/views would be welcome. Thanks

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Hi NeedsMJ. I had severe aortic stenosis and mild to severe mitral leakage. My cardiologists and surgeons at my local hospital recommended a mechanical aortic valve and they told me that the Papworth surgeon who specialised in mitral valve repair would want to see whether he could repair the mitral valve rather than replace it. I wasn't looking forward to taking warfarin for the rest of my life (I'm 57) but I wanted a valve to last as long as possible so that I didn't have to go through open heart surgery more than once.

Well, I met my very clever surgeon on the morning of my op and he talked me into having a tissue valve saying that yes, perhaps it would only last up to 10, maybe 15 years but the advantage was that if they did a mechanical valve and there was a problem they would need to open me up again but if I had the tissue valve, they could do a replacement or repair via the new procedure they call the "TAVI" which you've described. They go into through an artery in your groin. I'm told the TAVI is an expensive procedure but it's become more commonplace. And, of course, advancements are being made all the time.

I should say that there are no guarantees and my surgeon warned me that if something went wrong, my mitral valve could only last a few years. All our bodies react differently to some degree.

I am only 2 weeks post discharge. My surgery was the 24th of April at Papworth and I was discharged on the 29th. So far so good. And, I'm happy with my decision. I do have to take Warfarin for 3 months post-surgery but only for 3 months. I was relatively fit prior to surgery having been a jogger and visitor to the gym to use the cross trainer and bicycle. I also walk a lot. My problem was congenital as I was born with a bicuspid rather than tricuspid valve and I was diagnosed with mitral valve leakage (mild) around about 1990. My aortic valve went from mild/moderate to severe in 2 years.

Good luck with your decision. There is a lot of misinformation out there on the internet but also some excellent advice - as published by the British Heart Foundation. Take notes at your consultations with your cardiologists and surgeons so you can make the best informed decision.

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Lifelover55,hi. We share the same congenital bicusped valve issue, surgery date and tissue valve choice although my surgery was a simple aortic valve replacement. Like many, I did the reading and even tracked down a couple of contacts to get some real life Wafarin feedback. There was also the ticking issue as the mechanical valve is audible - there's even a sound clip on YouTube for the curious. Two things clinched the decision for me. Firstly, the prospect of reliance on my GP practice for INR adjustment through Wafarin levels; they frequently fail to get the small stuff right so trusting them with my blood clotting was just too risky for me - just one clot is all it takes. Secondly, it was my surgeons recommendation. He inspired enormous confidence in his knowledge and ability so it was an easy choice for me. I had also begun to focus on 'ten good years' as target with no real fear of repeat surgery, although he spoke of 12 -15 years as not unrealistic. We also discussed the recent availability of the Edwards Inspiris Resilia tissue valve being fitted at a number of UK hospitals with some forum recipients. This promises a 25 year life from specially treated bovine tissue which resists calcification - hence the extended life. Needless to say there's not one been out there very long, but encouraging that this and other research continues to make headway.There's a certain appeal to the fit once and forget of mechanical valves but then there's the simplicity of tissue, so it's a personal decision taken in the company of health professionals to give you the best possible outcome.

Good luck with your discussions NeedsMJ, surgery and subsequent recovery.

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I think I saw your/our surgeon on the 26th April and he is going to be doing my triple valve/triple bipass. He thinks that due to various problems (their end) that I may have to wait 4 months, although apparently I am P1..priority 1. How long did you wait? When were you first referred? Were you able to be offered short notice? I am a little concerned that the move from Papworth to Addenbrookes may hold things up?

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Hi Roamie. I was brought into hospital by ambulance when my partner found me semi-conscious with a very high fever. I either had sepsis or pneumonia - they couldn't tell for sure because they were so busy pumping me with antibiotics. When they took me out of the CT scanner to check if anything was going wrong in my brain, I suffered a cardiac arrest. The priority was to save my life so it took several days before I had an echocardiogram and then I was diagnosed with severe aortic stenosis and both a leaky aortic valve and leaky mitral valve. I was in hospital for 5 weeks because they wouldn't allow me to be at home due to the high risk of my having a serious complication - they wouldn't allow me to do much of anything really and getting me a date for surgery was an emergency. At the end of those five weeks I was transported to Papworth. I understand that outpatients are waiting about 4 months. My surgeon was Frank Wells and he is an expert in mitral valve repair. Papworth is run very tightly and expertly - they are very serious and I think they are under a lot of pressure. I really couldn't say about whether the move to Addenbrookes is holding anything up. I'm sorry you have to wait so long. Have you been told to take it easy and rest?

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I went to the doctors thinking that I had a slight chest infection on February 20th this year. She arranged for me to go in to AMU in hospital. I was admitted at midnight after lots of tests. I was discharged on Thursday the 22nd having been told that I had Aortic stenosis and needed a weeks holiday in Papworth.

Over the next period of weeks I had ultrasound, CT, echoes, angiogram etc. and now have been told that the shopping list has expanded and I need triple heart bypass, aortic valve replacement, mitral valve replacement and tricuspid valve repair or replacement. This is now a six hour operation, and it appears that I might have to wait 4 months for it to be done at Papworth, although I might get a last-minute cancellation before then. Frank Wells also, I was told he is super capable, and when we met him, we have been filled with his confidence.

Back in 2017 I had 2 failed shoulder operations, which I was told would need a reverse shoulder replacement to sort out.

Then in January was told that my hip had severe osteoarthritis, and it would be replaced at the Spire under NHS in April, which had to be done before the shoulder! However the antics from February have now postponed both, but I had a phone call on Friday offering me a date for the hip replacement – I don't think that that will be happening anytime soon, unfortunately!

So I am waiting… Believe me, I do not go very far, very quickly!

On the big plus side, I have a wonderful partner who has taken up all my slack..my horse down the road at a farm, my German Shepherd for constant company, a wild garden full of birds singing and feeding babies, seeds growing, sunshine, no work, and some brilliant friends all mucking in..everything to try and keep me sane.

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So sorry you've been through so much Roamie. Enjoy life as much as you can while you rest up for your op. I hold Frank Wells in high esteem but all of the surgeons I met at Papworth were positive and confident and caring.

I'm now 3 weeks and 3 days post-op and I am now walking an hour a day. I'm so thrilled with my recovery. Some pain in my shoulders but controlled by paracetamol.

Best wishes for a successful surgery Roamie and may you recover quickly!

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Thank you ever so much for your best wishes. It sounds as though you have been through the mill also. What type of valves did he fit for you? All the same, or a mixture? He has said to me that he wants to use bovine tissue - is that an Edwards? If not, do you have an idea or shortcut to the one he's proposing?

I hope that you're feeling better every day..how well/fit were you prior to all of this?

Best wishes,

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I had a tissue aortic valve fitted and he was able to repair my leaky mitral valve. I didn't ask what type of tissue because the less I know the better - I have a tendency to over-think the details and then worry. Mr Wells was very respectful of my wishes. Also, the morning of the surgery after we talked about my choice of a mechanical valve, I told him to do whatever he thought was best once he opened me up.

Thank you for your kind wishes - I was fairly fit prior to my surgery. Until I became breathless, dizzy and started to become tight in my chest, I was running gentle 5K's and using the cross trainer and bicycle at the gym.

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Thank you, I have found everyone on this site to be so helpful, it seems to take a lot of the worry out.

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Edwards Lifesciences produce bovine valves. They have a typical lifespan of 10 - 15 years if the patient is sensible (and has a bit of luck on their side) although they expect this to extend to 20 years. It is thought this limit occurs because of the natural lifespan of cattle.

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Thank you, I have looked at the Edwards site and seen the valves that they produce. There seem to be a lot of people in the lab making quite a few different ones, the differences probably beyond my need to know!

The life span makes sense. I think I have read that, should they need to be replaced, then in the future it can be done through keyhole surgery? Although some people seem to have required o/h surgery on 2/3 occasions, not what I want to contemplate.

Thank you for taking the time to reply, all the best.

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The type of surgery required for a revision depends on a number of factors such as it calcified, is it leaking, etc. and the cardiologist needs to carry out scans and tests to determine this. There is no simple answer. A healthy lifestyle will aid longevity.

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Thank you for this..I think I'll concentrate on keeping calm for this one, and my eyes on the light at the end of this tunnel first!

Contrary to the advice given in my post op leaflet, I shall neither be marching up and down, nor going up and down stairs, a few days after my op, with the best will in the world!

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I know the feeling. My path has been quite slow. The journey started over a year ago and after referral to the urgent chest pain clinic (6 weeks wait) and an angiogram I was told that I needed stents and this would probably be done in four weeks. But no it was a CT scan and more weeks on an echo cardiogram. Another wait and a call out of the blue about a quadruple bypass - it was assumed I had received a letter about this but it did not arrive for two more days. Anyway time moved on and after more delays and tests I am awaiting a quadruple bypass. No long walks for me as I have PAD and balloon angioplasty failed after eighteen months. I rarely get cramp from the PAD now - probably a result of the anti-angina drugs and the fact that I have no energy to walk any distance at all. Currently I am discharged from the vascular clinic whist I await my bypass! It never rains but....

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Thank you for your reply, I hope that the wait is not too much longer for your bypass operation. Then I suppose you will hopefully be able to build up your fitness whilst I wait until they allow me to have my hip replacement.

As I have already said, at least the sun is shining more and the birds are singing.

Keep calm and carry on!

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I had a mechanical valve fitted 12 years ago, aged 62, and have no regrets, you get used to the warfarin in the end, restrictions on alcohol, diet etc. I have always self tested, had to buy the machine, but the test strips and lancets are available on the nhs. I know there have been advances in procedures with tissue valves, best of luck with your decision, whatever that is.

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I had a tissue AVR in 2011, unfortunately this started to fail within a few years (severe regurgitation) and last November I had my second AVR (aged 59). I know it’s unusual to need another surgery so soon, I was told it should have lasted 10-15 years, but as I had also had a splenectomy in 2016, I am high risk if I get an infection, which would make me a higher risk patient if I had to have another operation. After discussing it with my surgeon I went with a mechanical valve.

Thankfully my anticoagulation clinic supports home testing and although I have to pay for everything, the machine, lancets and test strips, it is much more convenient especially if, like me, you work full time. Some GP surgeries do prescribe the testing strips but it varies from surgery to surgery. My INR levels settled down very quickly and I now only have to test every four weeks. You do need to watch your diet, but you soon get to know what you can and can’t eat.

Some people find the clicking from a mechanical valve a problem, but I haven’t found it a problem and only occasionally hear it at night when it’s very quiet and you soon get used to it.

Hope this helps.

Wendy

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I hope this will help and not make it more difficult to decide which way to go. I had a St. Jude mitral valve replacement just over 20 years ago at the age of 44. The reason for the artificial valve is that, all being well, it does not have to be replaced, and with a 10 year potential life span on a tissue valve, that was not an option. Warfarin was prescribed and I have been on it ever since. It has never been a problem, when the self monitoring became available I took that option, with the machine being calibrated every year. It has absolutely never been a problem and I am eternally grateful for the added protection it has given me. The new anti-coagulants are still not cleared for those with valve replacements, whether they be tissue or not. Whether you have a tissue or prosthetic replacement the chances that of developing AF are there, which I did, at the beginning of this year after several ablations and an intolerance to the various drugs, I had a pacemaker and AV node ablation. To date I have my life back to pre AF, and feel extremely well. Throughout the mechanical valve has kept ticking away. Whatever decision you make, please don't let the thought of lifelong warfarin affect you, it quickly becomes part of your life, I still enjoy my wine and eat healthily, just as I have always done, be consistent in your life and habits and warfarin will never be a problem.

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Hi

I too had a congenital bicuspid aortic valve diagnosed exactly a year ago. I was admitted with endocarditis and was discovered to have a severely stenosed valve. I was in hospital for treatment and tests and three weeks later had urgented valve replacement. I had the normal choice of tissue v mechanical. As I was unwell and in hospital I did not have the health or energy to do much research . My decision was done purely on the fact at 57yrs old I did not want to have further surgery (my parents both lived into their 90s) and I do not regret the decision. I had a new generation valve, I only hear the clicking when I am going off to sleep and find it more reassuring than disturbing. I have just started self testing my INR which once I took the plunge is very easy and convenient. I bought the machine and the surgery provide the lancets and strips.

Good luck with your research and making your decision, which ever valve you go with I wish you well and a good recovery.Mary

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Hi 👋 I had chronic Stenosis, total shock didn’t have any real symptoms till I collapsed (57yrs) Didn’t have to worry about which value to have, my surgeons advised a biological value, which I have to say I was glad about, didn’t fancy the life on warfarin or the ticking. I was told it should last 10 to 15 yrs and when it needed to be replaced it would be done by TAVI and also technology is advancing year on in and by that time some other procedures will be available .

I am 9 mths post op AVR surgery and last week had my 1st appointment with my cardiologist everything is perfect and I no longer need to take Beta Blockers I’m just on aspirin and statins. I recovered really quickly and life is back to normal. Shame I have to work, enjoyed my time off 😂

Wishing you the very best, and you will make the right choice for you. Kaz❤️💕💖

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I too had a bicuspid Aortic Valve which had to be replaced when I was 55 years old and went through the same dilemma as you. I decided to go for a tissue valve as I also didn't want a life of warfarin. My thoughts were, ok it may need replacing in 12-15 years time and by then it will be an easy to replace again using keyhole surgery. The trouble was I didn't know at the time things weren't going to go to plan and I had a year of infections and other complications. Because of the replacement valve was put under strain and went down in nine years and I had to go though another replacement and a further bout of open heart surgery. As strange as it may seem I went for another tissue valve and an engineered Edwards perimount valve was used. This valve is performing well but now my Mitral valve is going down and I'm waiting for surgery to repair or replace this and because of my previous surgeries the risks are considerably higher. I honestly don't think there is a right or wrong answer to your question I just wish we didn't have to choose and the decision was left to the experts but that isn't the way these days. I think it best you listen carefully to what the surgeon/cardiologist says to you and hope he/she guides you in the right direction.

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I have a valve made from my dna and I shouldn’t need them replaced often but I haven’t been cleaning my teeth so it’s Being replaced every 3 years.

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