Hi I’ve recently been diagnosed with aortic stenosis which I’ve had from birth. I’ve been told I’m lucky they’ve found it and I am having my aortic valve replaced in 4 weeks. I’m absolutely shxxxng myself! I’m 45 years old and have a huge decision to make in which valve to opt for biological or mechanical???
Please help
Indeed a difficult decision! Here is a link with an extensive discussion of the tradeoffs.
acc.org/latest-in-cardiolog...
Surgical Aortic Valve Replacement: Biologic Valves Are Better Even in the Young Patient
"The current American Heart Association and American College of Cardiology (AHA/ACC) guidelines recommend that biologic valves are reasonable in patients aged 70 or above (Class IIa recommendation), whereas a mechanical valve is reasonable for patients below 60 years of age (Class IIa recommendation) 1. While the guidelines make clear that patient choice and willingness to take anticoagulation should be the major factor in deciding valve choice, these two recommendations reflect the dominating dichotomy in surgical valve replacement – young patients preferentially receive mechanical valves while older patients receive biologic valves. We provide the rationale for consideration of biologic valves as a primary choice for aortic valve replacement in adults below 70 years of age."
Hi, l didn't have a choice as my AVR was an emergency but l'm glad l had the mechanical one. lt will last longer and apart from the ticking at night l forget its there. Warfarin can be a pain getting the levels right but it sorts itself out after a while. l am sure you are scared but the marvellous NHS surgeons do these operations every day with great success. Please keep in touch with your journey news, you will feel like s**t for a while afterwards but then you will be a member of the "mended heart club" just like most of us on this site. Take care wishing you loads of luck, Sue.
Thanks. The sound is a big concern of mine! ❤️
You so get used to it honey, don't worry.
Did your surgeon just leave the choice to you without discussion or advice ? The present biologic valves now have a much longer life I'm told possibly twenty years plus . If so that would probably mean just one replacement in the future and who knows what advances by then. Personally I would not want a lifetime on Warfarin.
Whichever valve you have there is a possibility of developing AF and needing an ablation at some point in time. It seems to be a more difficult procedure in patients with mechanical valves so you should ask about that.
We discussed options but surgeon recommended mechanical for durability as I’m 45 but the ball was left in my court❤️
Hi I had the same decision to make back in 2005 at the age of 48, my surgeon didn’t want me to have a biological valve as it would need replacing meaning another major operation in around ten years. I fully agreed with him and chose a mechanical valve, it’s been fantastic and I haven’t had to have it replaced. Yes I have to take warfarin but it’s easily managed especially if you invest in your own home tester. I would also mention a post that was on here a couple of months ago where a persons biological valve was failing after approximately 18 months as I remember.
I had mine done Six months ago at the age of 59. I'm out for a 25 mile cycle as I write this, you'll be fine 😀 I went for mechanical as I didn't fancy going through ohs again. Good luck
Hi there, I’m 54 and had valve replacement back in May. Went for mechanical valve as I didn’t want to go through Ohs again. As for the noise, I rarely hear it and when I do it’s really quiet! All the best x
I was diagnosed with aortic stenosis in December and had my valve replaced in March. I’m 68 but have always led a very active and fit life which stood me in good stead when going into my surgery. I too felt just like you but I was over the whole thing well within six weeks and now I never think about it! I opted for a biological valve as they can last over 20 years now. Didn’t want a mechanical because of the need to take warfarin and the audible presence of the valve. Also my surgeon steered me in the direction of a biological valve as the best option, so that helped my decision making. Have faith, you will be over this in no time at all and your life will be so very improved as a result. Go for it!
Thanks for your help my surgeon is steering me towards mechanical but I’m not keen on the life on warfarin and the noise the valve will make. It’s a tough decision ❤️
I have a mechanical valve and can hardly hear it. My INR levels stabilised very quickly and I home test, so none of the hassle of taking time off work for anticoagulation appointments, just have to go twice a year to get the machine calibrated.
Wendy
Hi, my husband is 57 and had an AVR about 18months ago. He opted for mechanical as he definitely doesn’t want OHS again and there is no guarantee a tissue valve would last 10-15 years then TAVI. He has a Sorin mechanical valve which will last for 30+ years and has not had any issues in the decades it’s been available according to his surgeon. He was told that some people hear their valve and other don’t, it’s seemingly random. He could hear his valve to begin with but as he recovered and healed and then regained muscle mass the sound vanished. Our 9 year old grandson can hear it when he listens for it but not otherwise. Warfarin brings up and downs from time to time and has the drawback of being more done to bleeding but he’s far more comfortable with that than a tissue valve. The AF forum on here and their website has lots of information about Warfarin too.
My husband found the worst bit of the AVR was the waiting time. Loads of people say they feel just as you do now beforehand. He found it comforting to know that the surgery is considered “major but routine” because the surgeons do so many of these operations they’re well practised at it.
All the best to you and your loved ones.
Sorry, there’s a typo in my post above...I meant “prone” not “done”.
Hey Fletch73. Hope all's ok. I was in almost exactly the same position as you this time last year - my first post here in fact was very similar! Ditto aortic stenosis and needing an AVR (at age 50) and, having assumed I'd have no option but to go mechanical, was given the choice by my surgeon. I eventually went tissue - Edwards Inspiris, which they say could last 20-25 years, which I had done in December. My reasoning was:
- wasn't overly keen on managing Warfarin though many do find it straightforward (plus keen to go travelling)
- I was happy to gamble 10-15 years Warfarin-free perhaps even 20-25 if the Inspiris lives up to its billing and then see how the tech has developed around valves and anti-coagulants
- at age 50 I still shouldn't be too old (at somewhere between approx 60-75) for the second op
- as my surgeon said while the hope is with a mechanical valve you won't ever need another op, that can of course never be guaranteed, which kind of swung it for me. Some people I know also struggle with the ticking/noise of a mechanical valve - though others find it reassuring.
So I went tissue and so far yes has been great. I take low-dose dispersible aspirin each morning but that's it for the valve though also on low-dose Candesartan for BP. And heart function massively improved. I'm fitter than I was before I reckon.
But the main thing to recognise is there is no 'right' answer here. There are genuine pros and cons to each. And so whatever you go with, 'own' it. Don't do 'what ifs?' or regrets. Your choice will be the 'right' one because it's your choice, for you.
But good luck. For me the emotional and mental build-up, terror basically, was one of the toughest parts of the whole process - so s****ing it is normal! So feel free to DM me if you want any specific advice. It's a scary old time but AVRs, while a big operation, are very standard these days for the surgical teams, almost bread and butter, even id a big deal for us. So sure you'll be in good hands.
Nic x
Btw Fletch73 looking at the other answers there was indeed a post on here a while back from someone whose tissue valve was failing within 18 months (can't find it tbh on a quick search but I know I did reply). Made my hair stand on end (or what little of it I have)! So these things can happen. It was hard to tell but there may well have been other heart issues going on. But clearly a concern and so something to consider. The Inspiris is also so new there is no clinical data on it as yet so, as I say, it is a bit of a gamble. But personally I feel I made the right decision for me. Nic x
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