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British Heart Foundation
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Tissue vs mechanical valves? Help!

Hello everyone. I'm new to the forum, joined today, but would be really keen to get feedback. I'm 50, severe aortic stenosis and seeing the surgeon in a fortnight to discuss AVH. So tissue or mechanical? Drug free for 10-15 years but then accept need for another op or no need for 2nd op but Warfarin, clinics, worrying about bleeding and/or strokes? We like to travel, so do people have any views on that? Also have seen things about new gen of tissue valves that can last 20 years (Edwards valves?) does anyone have any views on those? I'll obviously be discussing all this with the surgeon but want to go in prepared! All feedback really welcome and many thanks in advance

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Hi Nic25 qnd welcome! A discussion on this was started earlier today:- healthunlocked.com/bhf/post...

My view would be if you are physically active go for a tissue valve with the expectation of replacing it with a mechanical in ten years, otherwise a mechanical now. Surgery carries more risk as you get into your seventies so best avoided if you can but that is a personal opinion.

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Thank you Michael. That's really helpful. And I'll definitely take a look at the other conversation!

N

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Hi, l had a mechanical AVR 18 months ago and it is fine. The only thing which is bugging is the ticking, rather like the crocodile in Peter Pan but you get used to it and it fades after about a year. As for the bleeding business with Warfarin that has never been a problem but getting the levels right are a pain. You are less likely to have a stroke and can fly but wear flight socks and don't drink booze on the plane. Also according to Doctors mechanical valves last longer so you can travel the world and enjoy a new lease of life! Take care, Sue.

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Thank you Sue! That's a really helpful answer and definitely food for thought. Appreciated. Nic

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Hi Nic. I am in the same position as you. I had decided on mechanical but really don’t want the Warfarin side of it. At my last scan, I was assured that although I will have open heart surgery this time, if I need a replacement, it can be done through my groin next time. That has sealed the deal for me. Bovine for sure. I hope this helps and good luck on your journey.👍

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Thank you Winston. Good luck! That's great. I have lots to think about! Nic

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Hi Nic25, you need to ask the question of your surgeon if the replacement would be minimally invasive as this could depend on the specific heart alve and if it is a direct tissue replacement or mechanical upgrade. BTW the sports I mean are ones where bruising is quite likely like football, rugby, hockey, etc. I knew someone who played rugby until their mid-fifties (by then they spent more time injured than fit) and a friend who played in goal for his Sunday team till sixty (he was fitter than the rugby guy but decided it was probably sensible not to push it).

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My Heart Story (or How I came to this site)

Oct 2015 (age 57) Underwent a pre-emptive double by-pass and AVR replacement Prior to this had three angiograms to monitor BP symptoms. AVR is a titanium ON-X valve

An tissue valve was not an option as it would present a risk in creating difficulty in replacing it over time. Interfering with the double by-pass etc. to replace.

Warfarin took a while to get settled readings but is now okay, the ON-X requires lower Warfarin reading than other valves. Am on 4mg a day with an INR of 1.5 which is what the valve dictates and can perform with.

Noise is only the sound of a quality ticking watch in a silent room with someone's ear close to my chest!

It is louder to me because it is in me also a good indicator when i am tired and need to rest!

The deciding factor for me was the fact that, all being well, this was a "one off" op. A bovine valve would probably need replaced in 10 years time and is "tricky" with scar tissue that I have had and may lead to a deterioration in future lifestyle.

My other own considerations were future NHS treatment and waiting times and the effect any future waiting times may have on the rest of my heart and body.

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Thank you Alheart, quite a story! Good luck with everything. That's really helpful again, much appreciated. So impressed with everyone on this forum; you're all really inspiring!

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Hi Nic25 , I have had my operation 10 years ago. I have two valves replaced and I am on Warfarin. I had the choice of mechanical or the tissue one. Dr suggested the younger age patients are better off with mechanical valve. The ticking of the valves and having blood test can be annoying. Also just wanted to say that if you go with mechanical version make sure you are safe to use MRI machine. if you needed in future. Best of luck.

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Thank you so much Parisa1. Appreciated. Good point on MRIs, I'll make sure to ask that! How if I may have you found being on warfarin? Nic

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Hi nic, I’m 47 so not too dissimilar. I am scheduled for valve, root and hemiarch replacement next month. I have decided to go for bio at this stage to give me a fleeting chance of ten years without the tick and warfarin and living life to the max. In 10 years I’ll still be young for the next op in theory whatever the advances in surgery are. It’s all about crap and we are in a position to make decisions we never thought we’d have too. Each to ones own on the best solution for you nic... all the best

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Thank you Markhig. Good luck with yours!

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Good luck markhig. I hope it all goes well for you and enjoy an uneventful and quick recovery. Keep us posted.

Isabel

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I am, at last, having my surgery on Tuesday all being well. 3x valves and triple bypass. I have been recommended by the surgeon to have tissue valves, pericardial, I think Edward's. He's the surgeon, I train dogs, what do I know?

Feeling extra, ultra apprehensive, I shall definitely be requesting a happy pill.

I certainly agree with Winston below.

I wish all of you the very best of success with all your operations and surgeries.

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Good luck Roamie and please keep us posted on how you are doing.👍

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I will, thank you.

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Hi, it is now 10 days since my Op. I am home, but my legs are very swollen (water tablets) I ended up having a pacemaker as well. My bad right hip restricts all movement, as I need a Zimmer to walk. Where the pacemaker is placed in the muscle below my left shoulder, it seems to be protruding and painful. It was done last Monday, will it improve and get less painful?

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I'm sorry to hear you're feeling so miserable. I'm only seeing the surgeon on Tuesday so I'm afraid I can only guess and sympathise about how you're feeling as I have my hill still to climb! But I hope things start to improve for you. Good luck. Nic

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Nic, Wow, thank you for the quick reply! I'm not too miserable as I realise that it's not long since the op, but it is hard now waiting for the hip replacement, knowing that I've to go through the bad sickness that I get with anaesthetics again! I wish you all the best with yours, at least I'm out the other side, and I have to hope that each day is the worst that it is going to be! Good luck,

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Thanks Roamie. Glad to hear it! I guess it's just a case of taking every day as it comes and hoping for small steps improvement. But I think forums like this can be a real help so keep in touch. I really hope things go ok for you. Expect lots of miserable posts off me in a few months! Sort of just want to get on with it, and hoping to get some clarity off the surgeon this week. Yours Nic

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Let me know how the meet goes on Tuesday. Do you have a decision or operation date? I will try and keep looking at this page..I don't always get a notification that I have a reply.

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Hi how did your visit go? My chest is now less painful and more just very stiff, so am able to potter along with my frames! Friends before the op had thought that things would be miraculously better afterwards, not so..it's going to take a while, but I'm now back on the list for my hip replacement, so we shall see how soon he is brave enough to do it. What was the upshot of the consult?

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Thank you Roamie. Glad to hear you're improving, if slower than you'd like of course. Visit went ok thanks. I'm pretty much decided that I'm going to go tissue rather than mechanical and just see how things pan out. As my wife put it, there are pros and cons to each so it's really just a case of making a decision and accepting/living with the consequences! While timings are still a bit fluid, probably aiming the op to happen mid-Oct or thereabouts. Hope you continue to improve but, as you say, I guess it's about gradual improvement rather than an overnight miracle. Thanks. Nic

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Has your surgeon not indicated a mechanical/tissue preference for either his/her work, or your situation?

My legs are now fine. I think I shall have my follow up visit with my surgeon in a couple of weeks. The cardiac nurse rang to see how I was, and if I had any questions on Friday.

I am on warfarin for 3-6 months, on instructions from the surgeon, I've had 2 visits to the doctor's surgery to check that INR levels were between 2-3, they were, so continue with same level till next check on Tuesday.

Thank you for your reply..your next visit will be the preop?

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Good luck, too, Roamie. Hope it all goes OK for you. Thank you for taking the time to reply, really helpful. N

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Thank you also. (Why is there not a fingers crossed smiley?!)

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Hi Nic, I had a Branson Hicks valve and artery bypass last year at 70. I was given choice by my surgeon but didn't want the whole Warfrin thing as my younger brother had all that and it was a struggle.

Your surgeon will advise you but it's a personal decision in the end. Good luck

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Thank you Madgranny2. That's really helpful, appreciated. N

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I have had a St. Jude mitral valve for 23 years without any problem at all. I take warfarin which I monitor myself with two checks a year with the hospital to calibrate. In my case at the age of 44 a tissue valve was not an option as it would almost definitely have to be replace after 10 years, which is not undertaken lightly by surgeons. Hence the prosthetic. A word of caution, it is highly likely that in later years with a prosthetic valve that atrial fibrillation will kick in, whether that applies to all replacement valves, I know not.

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Thank you Annaelizabeth. I hadn't come across that about AF so that's really useful to know, and another question I will ask of the surgeon. Much appreciated. N

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Tissue valves are better but they do need to be replaced every 10 - 15 years of I look after ur heart or up to 3 years of u don’t.

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Thank you gal4God! Interesting....

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Hi Nic, I had my operation only 10 days ago, now back at home on the recovery trail. I had a mechanical on x valve fitted. For the reason that I didn't want to think I would need this surgery again when I'm approaching 80 I'm 67 at the moment. I also have AF and have been taking warfarin for 2 years and never had an issue. The ticking valve is nothing and I find it amusing but believe me you won't even notice it.

Hope you make the right decision for you!!!! Good luck ❤

.

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Thank you Meashamfox, and glad to hear your op has gone well. That's again helpful and lot to consider. Appreciated. Nic

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I'm 36 and have had mechanical mitral and aortic valve replacements and a tricuspid repair. I also have a pacemaker. The warfarin is no where near as bad as people make out. I self test at home (you get training on this but have to buy the machine yourself) and there are virtually no restrictions on diet. I get the occasional nosebleed but that's a small price to pay.

Do consider if you have any other conditions. If for example your kidneys failed and you needed dialysis, the tissue valves wear out very quickly under that strain.

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Hello everyone. Just to update those interested, as I saw the surgeon yesterday. We're working towards HVR probably mid-Oct. I haven't made the final, final decision yet on type of valve but am now leaning (probably 80%) towards tissue. My reasonings are that from the discussion with the surgeon a) there was a possibility (although no certainty) that any replacement could be done through the groin, b) I'd probably get 10 years at least (though again no certainty) with a tissue valve and so may be looking at replacement in early-60s which, for age, is probably OK and who knows what advancements will have been made in that time?, c) at 50 I'm on the cusp of where the heart function post-op would mitigate against use of tissue d) even with a mechanical valve there was no guarantee that another op won't be required because of issues such as calcification etc, although he did stress that was rare. So, as I say, while I am still mulling things over, that is where my thinking is going. If anyone has any thoughts on that? Also, can I ask, I'll be having my op in St Thomas' in London - anyone experienced it and what it's like and any thoughts? So I am on the rollercoaster and counting down.... Nic

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Hello I joined the group today.

I have a star edwards statistic ball valve. IT WAS FITTED AT THE LONDON CHEST HOspital 20 years ago, apparently it was known as “the work horse”; This is an excellent valve and works as well as it did when fitted

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