Hi I’ve posted before reference the mechanical valve V tissue valve. My husband is 64years old and he has been offered either . We have been on the internet to research them and notice both have pros and cons. It would be nice to hear how others have progressed since having theirs done and if there is anything we need to be aware of. The surgeon says it’s upto my husband which he feels he wants but that is such a big decision to make.
Thanks.
Hi, I had tissue AVR nearly 4 years ago along with a bypass, have had no problems since having it done have a yearly echocardiogram done to check my pressures. I was 68 at the time. I suppose you look at the people here and see what they think. Some don’t like taking warfarin and having their bloods done some don’t find it a problem. We are all a little different. Hope you can make an informed decision.
Wishing your Husband the very best when he as his surgery.
Thank you for your reply. What did your surgeon say to you reference the longevity of the valve, for example how long did they say the valve will last before possibly needing another one .
Thank you
Hi about 15 years, so we shall see. Maybe by then something completely different will be available! Though I would be in my late 80s !! As I said there are pros and cons for both, and he just needs to weigh up what he thinks will be best for him. Being honest I took my surgeons advice. The last 3+ years have been good, and have had my life back. So no matter which one he decides on look forward to having a really good life again, and a mended heart.
Best wishes
At his age I would personally go mechanical as he may not physically be up for further surgery in 10 - 15 years time. For fit active people under 50 happy to face further surgery a tissue valve can be an excellent choice though. Some members have had mechanical valves for 30/40 years. Please note this is my personal opinion.
Hi Jewel7. I was like your husband - "surely that should be what you, the highly trained surgeon, decides"! I had an AVR in Dec 2018 aged 50, so a bit younger than your husband and went for a tissue Edwards Inspiris Resilia valve. The first thing to say is there is no "right" answer; it is a very personal decision at the end of the day. But met me explain my thinking if it helps.
I had assumed at age 50 I was probably going to have no option but to go down the mechanical valve route and so was resigned to it, even though I was not that taken with the whole notion of having to take Warfarin for the rest of your life. So I was pleasantly surprised when I was given the option, even if as I say even more surprised the decision is left to the patient!
My reasoning for going the tissue route was:
- I wasn't, as I say, that keen on Warfarin, the risk of bleeding, diet restrictions and need for regular blood testing, especially as we want to travel in the next few years, or the idea of having something audible ticking - Captain Hook-style - inside me. Don't get me wrong, people manage perfectly well with mechanical valves - especially now there are home testing kits - but I just wasn't keen on the idea. By comparison, I take one low-dose dispersible aspirin a day, and that's it (apart from candesarten for blood pressure but that's separate to the valve).
- The main selling point with a mechanical valve is that you shouldn't need another operation, ever, it's a for-life valve. However, my surgeon made the point that you can't actually guarantee that. Yes, the chances are very good that you won't need another operation ever again but, like anything in life, there's no absolute guarantee.
- We then discussed the Edwards Inspiris, which I had heard about on this forum. It's essentially a next generation tissue valve from the US that has been coated in a special anti-calcificant that means it "should" last 20-25 years before needing to be replaced. I say "should" because it is so new no one really knows for sure and so, to an extent, it is a bit of a gamble. But that compares with 10-15 years for conventional tissue valves, so quite a difference.
- So my thinking was: yes accept that I will need to have a second op at some point but, with the clock ticking from age 50 I should hopefully still not be "that" old by the time I need to have a second operation. Of course your husband is starting from an older age, and so that may be something to consider/talk to the surgeon about.
But at the same time, my hope is to get even 10/15 years (hopefully many more) Warfarin-free and then see how the technology, in valves, in anti-coagulants and in keyhole variants to open-heart surgery (the TAVI/TAVR procedure), has developed in that time. It may well be that I'll need a mechanical valve next time, or a variant of whatever "mechanical" is by that point, but that's a bridge I'm happy to cross when I get there.
One final point, which my wife made, and which I found really useful. Whatever decision your husband makes - and, as I say, there are genuine pros and cons to both - the key is not to do what-ifs; accept that's the decision you've made, for good or ill, and own it; make it your life, your next post-operation life. What that means is that, whichever valve type he goes it will, by definition, be the "right" choice, because it is the choice he's made and you've made together.
I hope that helps, at least a small bit. And good luck! I found the whole waiting, the build-up to the operation almost the worst bit, almost worse than the actual operation itself, which, while a big operation, is a very standard one these days.
I'm sure he'll be in good hands and on the mend in no time at all. But do use this forum, as there are many of us who have been through this and are more than happy to help as best we can.
Good luck again
Nic x
Hello Nic, I had an inspiris Resilia valve fitted in summer 2018. Wasn’t sure whether to take low dose dispersal aspirin , but did take it for several months until a consultant (who saw me just after the op) suggested it’s not now necessary for me. Have you been advised differently? Best Wishes
Hey Ian. Hmm interesting! I was just told to take it after the op and nothing was mentioned either way at the 6-8 week check-up, and to be honest I never asked (maybe I should have!). So I've just carried on? I'm only seeing the cardiologist in Nov, so will now have to have a think? To be honest, in lieu of an alternative opinion, I guess I'll just carry on and ask in November as I guess being low dose it's probably not hurting? But thanks for the heads up. Lots of food for thought! Nic x
Hi Jewel7. Me again! Just to add on your progression question. I'm admittedly only 14 months or so on from my op, but doing great! No issues at all - I could still be fitter than I am, and could still do with losing a few pounds, but that's down to me not the valve! And the difference/improvement in heart function has been very noticeable. But in many respects, as I say, I am still quite early days.
Nic x
Hi Jewel7, I had a tissue valve for my first AVR, but unfortunately it started leaking so second time I’ve had a mechanical valve. My choice was because I didn’t want yet another op at some point in the future (hopefully) especially as between my two heart ops I had had to have my spleen removed, which comprises my immune system. The downside is being on warfarin for life, but I’ve been able to keep my INR levels stable since I left hospital.
Wendy
Hi my wife had a tissue valve replacement last year and was told that the life s OK an of the valve use had been documented to be about 25 years. She is 64.
Also the surgeon did the replacement valve so that the next time he could do it by TAVI.
She has been fantastic since the op. Another consideration for her was the size of the incision the tissue valve allowing the surgeon to do it by minimally invasive procedure will a much small incisions in the breastbone
Bob
Hi Bob, butting in here but really good to know I have mine tomorrow. Thanks Tess
Hi, just wanted to wish you well for tomorrow, everything will be fine, just remember baby steps when you get home.
Let us know how you go. Best wishes Pauline
I remembered your getting op tomorrow. Wanted to wish you all the best. Mine is 2 weeks away. How are you feeling today?
Hi, very scared to be honest but trying to keep the BP down. I think it could be a long night tonight. 🤣Thank you, hang on in I think the waiting has been horrible. So keep calm and don't read stuff about the virus. X
Aw I can only imagine how you feel, I'll be having a meltdown in 2 weeks. Overall I've been very calm. Enjoying life while I'm still fit 😁
Obviously when your feeling up to it, let us know on here how your doing. x
Haven't been fit enough to do a proper walk even. So know this is the only way to go. X
Hi, just to support the excellent advice here. I had a mechanical mitral valve fitted in 2002 and have been absolutely fine. Taking Warfarin isn't really a big deal (except for having to keep getting my INR checked). I think it is very much a personal choice which valve to go for, but good luck to your husband whatever his decision.
Hi jewel7, I've just turned 42 and am just 2 weeks out of an avr. I also went through the turmoil of valve choice. I ultimately came to the conclusion that they are both good choices and got slightly strong armed into the mechanical valve choice by surgeons (3), cardiologists(2) and GPS. If there were that many health professionals advocating the mechanical valve for me they might be on to something. I lead a very active life and wanted to make sure I could do all the activities I wanted to which was my main concern and was assured with the new on-x valve and lower inr management it wouldn't be a problem. I'm still in recovery and having to take things really slowly but have had a reasonably straight forward exit from hospital. I can honestly say I don't want to go through that experience again and it was hard for my family too. I'm pretty young and would potentially have to go through that 3 or 4 times if I went tissue. That said investigate the inspiris Resilia valve mentioned previously not only is it meant to last longer but has been designed to take a tavi for replacement which goes in through the leg. I've heard of ultra athletes in their mid 60s going for this valve.
As said previously don't get caught up with what ifs. They are all good valves and good decisions.
Hi Jewel,
I am having the tissue Inspiris valve as I had researched it and when I saw my surgeon at Harefield he too thought best for me. I am just turned 61. I really didn't want the ticking. Honestly spent hours looking at videos etc. It is more expensive.. Still relatively new. I figure I'm worth it! 😂
I am having the op tomorrow. 🙏🤞💖
Good luck to hubby, Tess x
Quite a decision to make! Two years ago I was in the same position at 76. My surgeon at Manchester Royal, who was brilliant, preferred older patients to have tissue valves. I took his advice and have had no problems whatsoever. I was part of the TAVI trail but was selected for open heart as I also needed a double bypass.
Best wishes and good luck going forward.
Hi
I received an ON-X mechanical valve last year. The surgeon advised me to go mechanical as I am 50 and it will probably {fingers crossed} last me the rest of my life stopping me needing another surgery. Also even though I need to take warfarin this valve has a lower INR target of 1.5 to 2. Downside you can hear it tick when you are sitting somewhere quiet and in bed but you get used to it. I also recently discovered tbat any dental treatment below the gum line requires a large dose of antibiotic before hand. Hope this helps a bit and wish your husband good luck with his surgery.
Hello there, it’s a very personal decision. Each clearly has it pros and cons. I am 62 years old and chose to have a mechanical valve. I intend to be around for a long time and didn’t fancy the thought of a further operation in some 10 to 15 years time, even with the possible advances in technology by then. If you choose a mechanical valve then you will be on warfarin for the duration. I don’t mind this at all. The only side effects I wasn’t aware of until after the operation was the actual ‘ticking’ sound of the mechanical valve. It is very noticeable in a quiet environment. Luckily this doesn’t bother me, however some of my fellow patients really struggled with coming to terms with this noise after the operation.
I had AVR,4 years ago,
58 at the time.
I was recommended to go for the mechanical type.
My consultant said at my age ,I'd probably need another op ,if id had a tissue valve fitted.
as she said, " you dont want to have this operation twice"
(Shes not wrong there!)
So I have a nice new ,carbon valve clicking away in my chest.
Never looked back ,
Of course I'm on warfarin for the rest of my life,
but the new valves are made of carbon, not steel ,
so you dont need as much warfarin,
I'm on 4mg a day,
Any way that's my 2 Bob's worth.
Hope it helps you .
BTW, I've had the,
ON/X valve fitted.
Cheers ,
Paul
I had a tissue AVR 8 years ago at The Newcastle Freeman Hospital. My choice, I was 64, and it was a wonderful success. Haven’t looked back once and got my life back. The Consultant said it could last about 20 years but if and when it needs replacing it’ll be a much less invasive procedure as it’ll be keyhole surgery implanting a new valve using nano cameras and tools. He is expecting massive changes in the way the operations are performed. I’m on 2.5 mg Bisoprolol and a soluble aspirin daily. Apart from a runny nose no other side effects.
Hi I had a mechanical valve implant in 2005 at age 48 surgeon said tissue valve would only last ten years who would want to go through the operation again and you husband would be around 74 he might not be strong enough to have it done again. There seems to be a fear of having to take warfarin amongst some people, let me tell you there is nothing to it. Hope this has helped good luck.
Bioprosthetic valve nearly 2 years ago at 65.
Hoping for ten good years and have heard reports of 20+ years so fingers crossed.
For me the warfarin and dietry/lifestyle concessions meant my decision was to go bio, which fortunately my cardiologist agreed with.
So far, life enriched and cardiovascular function enhanced, so physically fitter, faster and with improved stamina.
Quandary is though, how good can the new me be? Beta blockers to protect the ageing and CVD limited heart together with the largely unknown detrimental effects of statins?
However, I'm in no way ungrateful for my new life and extended life expectancy.
Once aortic stenosis goes 'severe' statistically, there's a 50% mortality after 2 years.
Mightily relieved to have dodged that bullet !
Good luck with your new valve - it is a life changer and my personal experience was the reality of surgery and post op recovery was nowhere near as bad as I had imagined.
Hi iangordon,
Thank you for your reply... it’s is very helpful. The statistics is that mortality 50% after you have had it for two years.
Regards.
Hi Jewel7. Just to add if it helps, the stats do indeed suggest there is a relatively high average mortality rate for people with severe aortic stenosis, but - just to be clear - that 50% figure doesn't mean that if you get diagnosed with severe aortic stenosis you've got a 50% chance of being dead within two years! Just before everyone here starts panicking!
For eg I was "severe" for quite a number of years - I actually forget how many as it went on for such a long time but I think 6/7 in total - but the key was I was being closely monitored by a cardiologist, eventually at six-monthly intervals.
I didn't have, or didn't feel I had any symptoms as such right up to a few weeks before the operation, and was waiting for over six months from being told I needed to op to actually having it, so there was little sense of urgency even then. However, the difference I felt afterwards showed clearly that I had had symptons for some time. Which I guess is one of the scary things about this, that for many people aortic stenosis, even severe aortic stenosis, is asymptomatic, which is probably one reason for the high overall mortality rate, ie that many cases don't get diagnosed or picked up before it is too late.
Just if that helps to clarify for anyone following this thread. Clearly however, as with all these things, everything will come back to the lead and expertise of the cardiologist and the surgeon rather than us armchair "hearties".
But good luck again!
Nic x
No! If left untreated its 50%. The surgery risk is minimal in comparison. Seem to recall it's around 1%, but your surgeon will discuss this with you prior to surgery. In essence, the major risk lies with doing nothing. Don't worry. Open heart surgery is just another day in the office for your surgical team, although a major life event for you..
,after a heart attack and during a bypass operation afterwards My Aortic valve was replaced with a pigs valve. I wasn’t given a choice but am glad I have a pigs valve as I have heard that mechanical valves are noisy at night!!!!!!!
Hi jewel
There's already been a lot of good opinions offered, which I totally agree with.
I'm 57 and went for a mechanical valve at Papworth in November, as having had open heart surgery in 2016 to repair my mitral valve, I didn't want to choose to go through another major op like that and when I'm older.
Yes, the downside is the need to take warfarin for the rest of my life BUT it is a tried & tested treatment and been used for quite a number of years, so there is plenty of experience in its use and is not a prison sentence. I look upon it more as a different routine to get into and after the initial settling down of my INR levels, I now less than 3 months don't even think about taking the warfarin.
Having had infective endocarditis the first time around, I am grateful for life so the warfarin and at quiet times, my ticking valve, are just part of me and my life now.
Mark
xx
Just as as aside, there's a popular misconception that a pig or cow valve is just that, from a donor animal! The reality is that it is only partly sourced from animal tissue and not the valve, in its entirety. In my instance, the valve flaps are from a bovine pericardium, held in a a synthetic material frame.
So I'm part man, part cow, with no apparent dairy intolerance!
Hi. I had my valve replaced in June 2019 when I was 61yrs old and chose to have the Inspiris Resilia valve after hearing about it from my surgeon when I saw him. I hadn't heard of it beforehand (plenty of research after we got back home though!!) and from that it seemed the best option for me and my lifestyle. I am very happy with my choice. Your husband must do what feels right for him and as others have said, live with the pros and cons of that.
From the moment I woke up after having my surgery, I have felt so much better it is incredible. In truth, I don't think that would have been affected by the type of valve, just by getting it sorted. Mine was working at between 5% and 10% of capacity, so it needed doing. Yes, it is a big op. (although the teams doing it are so competent it is almost routine for them) and I was really scared about getting it done, so had kept putting it off as long as I could, but in the end had no choice but to go for surgery. As others have rightly said, I found out that the hardest part was the waiting and fretting beforehand. All the very best for the op. and whatever you decide. This is a great forum for lots of friendly advice and a kind word when it all seems very difficult.
I had mitral valve replacement but wasnt given an option. Had it done 2 years ago started on warfarin changed to Dabagatrin but had a bleed from a biopsy so was changed to Apixaban. Wasnt really told how long it would last so fingers crossed a long time! Good luck and hope all goes well.
My 65 year old husband had an AVR 6 weeks ago.
The surgeon told him that the mechanical valve sounds like the ticking of an old alarm clock, so with that and the warfarin issue, he chose the tissue Inspiris valve.
It’s too recent for there to be solid data on how long it will last but the rate of degradation indicated, he said, that it could last 20 years or more.
Hope all goes well
Catsncrochet
Aortic valve replacement
Mechanical Heart Valve
Warfarin after mitral valve repair surgery
