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
Tissue vs mechanical valves? Help! - British Heart Fou...
Tissue vs mechanical valves? Help!
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Nic25
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MichaelJHHeart Star
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.
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.
Thank you Sue! That's a really helpful answer and definitely food for thought. Appreciated. Nic
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.👍
Thank you Winston. Good luck! That's great. I have lots to think about! Nic
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).
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.
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.
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
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.
Good luck Roamie and please keep us posted on how you are doing.👍
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?
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
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,
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
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.
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?
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
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?
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
Thank you Madgranny2. That's really helpful, appreciated. N
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.
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
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.
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 ❤
.
Thank you Meashamfox, and glad to hear your op has gone well. That's again helpful and lot to consider. Appreciated. Nic
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.
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
Hi there
I noticed your post and wondered how you're getting on? Really well I hope. I am 48 and need to make decision on mechanical or tissue in next two days. Despite cardio experts leaning towards mechanical, my gut feel says I will struggle with warfarin/ticking and feel I maybe should take a punt on getting a good 10 years out of a tissue valve. Ive been told redo surgery will be essential at some point., no guarantee on the TAVI as yet unproved but it could be possible. Any advice greatly appreciated.
Hey headorheart. Good luck! I'll come back properly tonight (am on a train). But I'm doing well thanks. Tissue valve (Edwards Inspiris) just before Christmas. All went very smoothly. If of interest search my posts as I've outlined my thinking on this to various people a few times (and always happy to do so) plus posts called How my AVR is going so far, in which I've detailed my progress. It's a big decision and does ultimately come back to a gut thing - there is no right or wrong choice. But as I say I'll give you chapter and verse later tonight. Stay strong! For me the build-up was probably worse than the actual operation so I feel for how you're feeling. Back soon x
Hi headorheart, I'm back home now and the fact that almost three months to the day (it was Dec 13) that I had my operation I have spent the day travelling for work speaks volumes I hope.
First off, if you've not clocked it - as I think they inadvertently replied to me rather than you on me on this thread - have you seen these two really useful replies?
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
FreddieFred
Hi Nic,
Had Starr Edwards mechanical valve in place 26 years ago when I was 36 😊 still going strong.
If you can, get your own inr tester for the warfarin if you go for mechanical - in all these years mine has never been stable for long - and I don’t drink, regular habits etc etc. I’ve been able to go where I like with own tester, it gives more freedom, especially in these days of crowded GP surgeries and hospitals and long waits for blood tests.
The ticking was a nuisance at first ( you don’t notice after a bit) but even tho mine is an antique now and there’s loads of options today, it’s good to know I’ll not need it replaced and have to go through it all again.
Good you’re finding the options and asking questions. Hope you get the best solution for you. Very best wishes to you
In a sense this, to me, sums up the difficulty of this decision - it is a very personal one and, as my original post from last summer shows, I was in pretty much exactly the same position as you. As I say I ended up going the tissue route but many who go mechanical equally swear by them, and there are genuine pros and cons to each.
My thinking if it helps was as follows:
I had assumed, at 50, it was basically going to be decided for me and the likelihood was I would need to go mechanical and lifelong Warfarin. But, to my surprise, I was given the option by my surgeon. After a lot of reading up and soul-searching I decided to go tissue, and got an Inspiris valve (which is one of the new generation) just before Christmas.
My reasoning? Yes the mechanical valve "should" (and probably will) be lifelong but, as my surgeon pointed out, in anything like this there's no guarantee that you'll never need another operation at some point in the future.
I also, like you, just didn't like the idea of having to manage Warfarin. Don't get me wrong, many people manage it perfectly well - as the other posts here have shown - and swear by it, but it is a life change that takes time to adjust to. By comparison, I'm on a low dose of aspirin each morning and a blood pressure tablet (but that's not actually connected to the valve).
I also reasoned that, even if I get 10-15 years Warfarin-free well a) that would be good in itself - among other things I'd like to travel a bit and not need to always be worrying about it - and b) who knows how the technology will have developed by then (and there are new generations of both valves and anti-coagulants coming through apparently) plus new procedures like the keyhole TAVI up the groin are gradually becoming more commonplace, though won't be for everyone (kind of depends what size of valve I believe). So essentially I was happy to take a bit of a gamble, knowing if I went tissue I was accepting I would need a new valve "at some point" but weighing that up against the whole Warfarin issue.
So the gamble, as you've identified, is that things fail and need replacing sooner and, simply, that you are committing to another procedure of some sort and some stage. And that could happen to me - and I accept that. Having said that, the Inspiris is new valve from the US that is so new there is no clinical data about it yet but it's coated in a special anti-calcification coating that, supposedly, could mean it lasts 20 even 25 years. But I guess I'll find out! Not all hospitals offer it apparently, too, so it is worth asking (I was at Guy's and St Thomas's in London).
Another thing that helped me was that, after much toing and froing and going one way and the other mentally and getting in a right confusion, I sat down my wife (on the way back from seeing the surgeon in fact) and she pointed out a great thing. The point of which valve to go for, as I said in the pevious post, is that there isn't a "right" choice. There are genuine downsides and upsides to both.
So whatever choice you make, make it your choice, own it - don't regret it or think "what if?". That way, whatever happens, ultimately it will end up being the right choice! if you see what I mean.
Just, to end, on the ticking issue. I obviously cannot speak from experience. But I have seen quite a few posts on this site from people who have had mechanical valves who have said that, once they've got used to, they've actually found the sound reassuring. Just something to throw into the mix?
Sorry by the way for the length of this, but I hope this all helps.
Just to add too, if you get a chance check out the posts by Pete (ticktock61). He had an AVR last autumn and did a (sometimes a bit graphic) blow-by-blow account of his time in hospital (also GSTT) and recovery which I found really helpful. I've tried to do a bit the same, but mine aren't nearly as good. Finally, Channel 5 last year live-streamed an AVR being done at St Bart's. I wasn't going to watch it as I'm squeamish about these things but ended up doing so and was completely glued and actually found it really reassuring because for the surgical team it was bread and butter, almost mundane. I think it's here and you can watch it online rather than "live" my5.tv/operation-live/seaso...
So good luck, I really hope it all goes well for you. The operation is a big deal - and the first few days afterwards aren't fun - but it is nowadays a really standard procedure for the doctors and their teams and I'm sure you'll be in good hands. Hope you're out the other side and back on your feet quickly and do use us "hearties" on this forum to help you with your recovery (and for me the main thing was intense fog-like tiredness for about a month). It's what we're here for and if we can help we will. We'll all be thinking of you.
Nic x
Nic, what a kind post. I'm 49 & facing a similar dilemma - this helps so much.
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
Hi Nic,
Had Starr Edwards mechanical valve in place 26 years ago when I was 36 😊 still going strong.
If you can, get your own inr tester for the warfarin if you go for mechanical - in all these years mine has never been stable for long - and I don’t drink, regular habits etc etc. I’ve been able to go where I like with own tester, it gives more freedom, especially in these days of crowded GP surgeries and hospitals and long waits for blood tests.
The ticking was a nuisance at first ( you don’t notice after a bit) but even tho mine is an antique now and there’s loads of options today, it’s good to know I’ll not need it replaced and have to go through it all again.
Good you’re finding the options and asking questions. Hope you get the best solution for you. Very best wishes to you 👍
Nic25• in reply to
Hey FreddieFred. Thanks. It's not me you need to be replying to on this one (as original post is old) but headorheart who is looking for advice?! I'll be doing the same shortly. Nic x
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