Mechanical or Tissue AVR - The difficult decision

[Munkyboy]

Hi all,

Got diagnosed with an extremely leaky bicuspid aortic valve mid last year to the extent I need to get it replaced. I'm reasonably asymptomatic I think. I've had this condition all my life apparently and not really noticed it/got on with my active lifestyle, but every doctor I've seen has said it needs to get fixed and I will definitely get severe symptoms in the next 6 months if not before. I'm 41 and I'm going in to hospital on the 17th to have the operation to replace it. I have a very active lifestyle and 2 extremely active young monkeys.

I'm not asking for people's opinions on which flavour of valve to have. There are plenty of posts on here that cover that off nicely and thank you all for those posts and responses, it's made some good reading and although there is no definitive answer as to which I should go for it has helped me come to terms with that fact. It's nice to know that you aren't alone in making these decisions and it's great to see everyone's opinions.

The last week has been particularly testing both for me and my partner as we've been flip flopping between the options and getting knarky at each other as it weighs on our minds. Thanks to this site and the advice I've had from my GP who instigated a communication with the surgeon and Cardiologist (GP and cardiologist champion the mechanical valve and assured me the warfarin would be no issue to manage and I'd still be able to lead an active lifestyle as long as I didn't take up boxing again and surgeon was more measured) I've come to the conclusion that either option could be a good option for me and I think I'm ok with that now. Especially after sitting, reading and talking through all the pros and cons of each.

Currently I still don't know which to go with but I think I'm through the turmoil part. I'll be having a chat with the surgeon again before I have my operation and plenty more with my partner.

I'd be interested to here of how other people have dealt with this difficult decision, or if it wasn't a difficult decision.

Cheers

[Maisie2014]

My friend had a tissue replacement. He’s had a number of operations over the years , none of which were expected, and his cardiologist’s advice of tissue over mechanical was proved correct. He would have had major difficulties with warfarin. My aunt had three tissue valves before being given a mechanical one and lived well into her eighties. She managed well with all of them. Don’t stress you’ll be fine.

[FreedomOne]

I found out I had an issue last year which was a shock and everything happened very quickly for me, from initial issue of identifying to two months later having the op.

As for choosing this was made easier as I was advised that a tissue one wouldn't last long for me being as I was so active, likely only 10 years at best! I personally did not want to go through the op again. In addition to this the mechanical valve had a target INR range of 1.5 - 2.0 which by all accounts is very low so I opted for this.

[MichaelJH Heart Star]

Hello and welcome to the forum! At 41 you are young enough to have a tissue valve and go mechanical in 10/15 years time. As people approach 60 I would always say mechanical as age related issues can increase the risks of surgery and affect recovery. The real question is how do you feel about a second avoidable surgery down the road? Only you can make that call!

[Shar28]

Hi, my husband needed a replacement Aortic Valve at the age of 55. He chose mechanical because he wanted peace of mind as he didn’t ever want any more surgery, especially open heart surgery, he’s active (motorcycling, on and off road, going to the gym, cycling, playing with young grandchildren) and tissue valves seem to wear out sooner the more active you are so he would be too young for a TAVI when it needed replacing and a mechanical valve will outlast him (ie 30 years or more) according to his surgeon.

He can’t hear his valve unless he’s close to and facing a hard surface like a mirror or wall. Our grandchildren can though, but they think it’s funny. The Warfarin isn’t a problem, he doesn’t bleed loads if he cuts or bangs himself and he knows that if he bashes his head to get checked at hospital.

It’s a very personal decision and really you can only go with your gut feeling.

All the best to your and your partner. It’s a tough time for both of you in different ways. What ever you and she do, don’t suffer in silence, get help from your GP or BHF nurses to come to terms with it and in establishing a new normal going forward.

[Chrijan]

My son 22 had a mechanical back in aug . Like yourself they think he was born with it and only got picked up after what he had thought was a pulled muscle also very active healthy person . Obviously he now has to take warfarin for life . He’s doing great . Now back being active

[Munkyboy]

Thanks for the replies everyone. Booked in for today. I'll post an update post op and let you know how it's gone.