Aortic Valve replacement options - British Heart Fou...

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Aortic Valve replacement options


What sort of noise can I expect from a mechanical aortic valve replacement ?

Got a choice of mechanical with warfarin or pig/cow without.

Mechanical not need replacement, cow/pig will do so

Came across QOL research that suggests the noise of the valve can be annoying for some

23 Replies

I think everyone has different opinion. I used to have cow valve and now I have mechanical. I chose this because I don't want to take surgery again (although there are possibilities that you might need). If you have facebook join the aortic valve replacement group there are many people who have post tissue valve VS mechanical valve or you can ask their opinion. My caw valve lasted only for 4 years so I had to replace it. Other people say that it lasted more than they expected.

As regards warfarin and ticking I don't really mind it. You are getting used to it! You can buy a machine that you can check your inr at home or you can just go to your GP. The only thing that makes me anxious is that I always must have my tablets with me, I need to have a balanced diet and also I am very careful with knifes, car accidents etc.

Usy if you are more less than 60 the doctor recommend mechanical valve because it lasts and you don't have to get another surgery again (if everything goes well) I'm happy to share with you any other information you need!

Good luck 😊

I have had arv (mech) for 47 years. I find the ticking very reassuring its the chiming every hour that drives me mad, if you do not swing from one extrema to the other. Diet wise warfarin is not a problem. I also have my own machine I costs £300 you do not pay vat. That's just the price of a washing machine. My wife is quite happy with her scrubbing board

Ps check with your gp that you can get the strips on prescription before you buy the machine

Yours drew

James_son in reply to werd

How loud is it, or what is it comparable to and is there an issue with sleeping ?

werd in reply to James_son

A few years ago I was fishing at a lochan(Loch skeen) overnight. 3 of us were in a tent 1guy was my brother in law who knew my history the other guy was his pal, we were trying to sleep when his pal said who the hell brought an alarm clock with them, I just chuckled

I usually get interviewed every year by third year medical students from Glasgow uni my party trick for them is they put their ear to my mouth and they hear it cuming up my windpipe, after that I've got them hooked

Yours drew

James_son in reply to werd

am a light sleeper, so trying to find out the noise, so it is like a ticking battery clock ?

kefalonia1 in reply to werd

Hi, its wonderful to hear you have had your AVR mechanical valve for 47 years!!! mine is only 3years 4months old so your words have made me feel very positive and happy. Thanks, take care, Sue.

Ghost84 in reply to werd

I've had mine replaced 6 months ago aged 36. So it's reassuring to hear your story mate. Just wondering what (if any) problems you have faced during those 47 years?

verysmallnosies in reply to werd

You are hilarious! :D

Hi James

I had the same choice almost 5 yrs ago

Oct 15 and it was an AVR plus a pre-emptive double by-pass!

In the end I chose an OMX mech valve.

The reason being that, as you elude to, the mech valve will last far longer than the bovine one.

I was 57 yrs old and active so a bovine would probably need to be replaced twice over. 20 odd yrs max!

The problem ,for me, would be access to give a replacement may be totally restricted by the scar tissue that would grow around any repair!

Hence I felt the choicse was made for me even with having to take warfarin for the rest of my life. It at least have me a baseline for the rest of my life!

With regards to noise

Yes it was noisy at first, until the scar tissue dies become a friend and quietens the sound

At first my family could hear it if we wenin s very quiet room and closes together

In fact the joke was the had put in a very expensive Swiss watch and that I should audition to be the crocodile in Peter Pan

That doesn't last nor does the feeling that everyone can hear

Yes, I am ware of it as Online in my bed but now rarely standing up and NO different to bring aware to a "normal" heartbeat

I find it reassuring to hear now

And of course what we hear in our bodies always fits into stage whisper syndrome

My by-pass was harvested from my arm

Ensuring a less painful and quicker recovery than if from my leg

After 6 weeks, I joined 19nek rolling physio classes which was great for confidence and meeting fellow hearties and of course getting fit

Also after getting home I did daily lampost walks using the lampost as simple distance markers

The warfarin doesage quickly settled and it was monthly check ups

Now 2 monthly and results immediate where as 5byrs ago it was a case of a lab phonecall

Over 5 yrs I have been to Thailand, Indonesia, USA, France and Spain etc.

Enjoyed hillwalking etc

The ticking sound is very much part of me and everyday I am so happy to wake up and know I have another day if life Infront of me

I hope this all makes sense and helps

I regret that I didn't become aware of this site and great family until after my op so you have a wonderful advantage and start in your journey to the rest of your life

Enjoy it

Here if you need more

Take care and enjoy all that is to come



I understand the decision you have to make and how it feels like a big decision. I had an aortic valve replacement two years ago and opted for the mechanical valve. As I was only 37 at the time, this was what my surgeon recommended also. Whilst I would love to have had the tissue valve instead, the overall deciding factor was that I never wanted to go through open heart surgery more than once if I can help it. I guess your age is a deciding factor too.

As for the ticking of the valve, I very rarely notice it. The only time I hear it is when I’m lying in bed but it doesn’t bother me and I also see it as a good sign that my valve is working well! It’s surprising how quickly you get used to things like that. The sounds reminds me very much of the ticking of a second hand of a watch.

Whichever type of valve you choose, I wish you well for your surgery and recovery. If you would like to know anything else or have any more questions please just ask.


Very expensive watch tick lol

And yes I agree with Cath, it is both reassuring and inspiring to hear at night

Sorry for all the Bovine Valve holders if the MAV's are scaring and dictating

The advancements being made in key hole surgery and valve by-passes are amazing (some thanks due to BHF and worldwide heart research)

Wish everyone out there long and happy lives

Thanks again


Having been in the same boat as you 5 years ago,

I know the feeling !

Speaking with hindsight,

Undoubtedly go mechanical,

I was 57 /58 at the time,

So I would (hopefully ) have needed another OP if I'd went down the pig road.

and as my consultant said,

" you dont want to be having this OP twice!,

I had a new type of valve fitted , the , ON _X,

It's made of carbon ,not steel ,

and the design of it means, a lot less blood gets trapped inside it at each beat ,

So the chance, of blood clots is greatly reduced,

so your dose of warfarin is also reduced, ( my INR is 1.5) , I take 4mg , five days week and 3mg the other two,

As for the noise ,

the only other person who's actually heard it ,is my partner, when we are in bed ,

She sometimes comments, that I'm clicking well tonight!

The only real down side is your ability to drink alcohol,

I still have a pint or two , and the odd G and T, without problem.

The OP is ok , never felt a thing,

Spent about 12 days in the Freeman,

got home ,

felt rough as ,for about 2 weeks ,

Had my first night out , playing snooker after about 6 weeks ,

Was back to work ,in 3 months.

Hope this helps , whichever way you decide to go,

But good luck anyway .



James_son in reply to Hermanm

cheers paul, looks like the on-x valve is from america, so not sure if it is an option over here, but something to ask when at the clinic

alheart in reply to James_son


The valve is available over here!

I got mine 5 years ago and it was no problem

Carbon and will be ok even after I am dust lol

The noise is like a stage whisper

You think everyone can hear but so rare it is the case

Hermanm in reply to James_son

Well I got mine ,on the NHS at the Freeman in Newcastle,

So I'm guessing they must be the valve of choice now,

Cant hurt to ask,

Shy bairns get no sweets ,

as we say up here.

Good luck whatever way you go.

James_son in reply to Hermanm

Certainly going to ask, got a sheet of paper with pros and cons, if this valve is available, it does make more sense and not a huge fan of major surgery

less warfarin is also good, currently on apixiban ? and that does seem to be a more advanced version of warfarin

My story is almost identical to Yota’s one. My first tissue valve failed and I had a mechanical valve the second time. In my case it was also because we didn’t want to risk having to have further surgery of any sort as I had had a splenectomy between heart ops (wanted to get my monies worth out of the NHS!).

There is another valve available now, Inspiris, which is supposed to last much longer than a normal tissue valve but doesn’t require warfarin.

I’ve had no problems with the ticking and rarely hear it. My husband can only hear it if he puts his head on my chest 😜. I have a machine to home test my INR levels and haven’t had any problems since I left hospital.

All the best with your op.


Hi there, I'm 42 and just had my avr in February. I went for the on-x carbon fibre mechanical valve after advice from 3 surgeons, 2 cardiologists and a bunch of GPS. My issue was with warfarin and my active lifestyle and the chance of a bleed. Which lead me to the latest tissue valve inspiris resilia which was a good choice in that it is more resistant to calcification. But with my age I was still looking at several operations throughout my lifetime. And being through it once I do not want to go through it again. My valve ticks it's pretty high pitched. No one else really notices it. It bothered me initially but after a couple of weeks I didn't mind. Also things like mindfulness practice helps settle your mind and gets you past the noise. Good luck with your decision. It is yours and it will be correct for you.

Cheers Mike

Hi. Another thought maybe to ask about an Inspiris Resilia valve. I had never heard of this until I went to meet the consultant who was doing my valve replacement last year and almost straightaway decided that it would be the right one for me!

Also you may find plenty of the blogs on this site of people's journeys through having their valve replaced of interest. Have a google on the Inspiris valve and good luck with whatever you decide.


I’ve had my mechanical valve for 38 years. Initially it took a few weeks to get used to the ticking and the fact that the heart ‘misses’ beats. After this time I simply got on with life- work, play and family.

My Warfarin dosage does vary. I like a couple of whiskeys and this can upset my INR Level (International Norm Ratio for blood clotting) but I haven’t found this a problem.

I was 28 when I had my new valve and so a mechanical valve was obviously the right choice for me. I can’t remember if tissue valves were an option back then😀

Hope this helps.

Hi James_son. I see you've had a lot of great replies here already but just, if it helps, to add how I sorted out this conundrum. I went tissue in Dec 2018 (at age 50). The Edwards Inspiris Resilia, which is a new generation of tissue valve that - the theory is - should last 20-25 years because it has a special anti-calcificant coating on the flaps. So worth asking your surgeon about that as an option at least perhaps.

I'd assumed I would have no option at my age but to go for mechanical, even though, like you, I wasn't overly keen on the whole Warfarin idea or the ticking. From posts I've read on here, people do manage perfectly well with the Warfarin - especially now that there are machines that you can do home blood level checking rather than having to go to clinics or the GP all the time. With the ticking a lot of people seem to find it reassuring or just get used to it or say it fades gradually over time (probably a combination of getting used to it and because of the breastbone healing).

For me, I was happy to take a bit of a gamble in the hope of getting 10, 20 or more years Warfarin-free and then see where we were in terms of any advances around valves, the procedure itself or anti-coagulants. But ask me again when I'm being prepped for the next op I next guess! I have to take a lose-dose dispersible aspirin and then candesarten for BP (so not specifically to do with the valve) and that's it - no other restrictions on diet etc or drugs involved. So, for me at least, it has all been very minimal, which is great.

I was also lucky in that the operation itself was very straightforward and with very few complications; so it was mostly just a question of rebuilding with strength and stamina and getting on with recovering.

The other thing I found helpful was to recognise that because there is no "right" answer here, each option has its pros and cons, it's important not to do "what ifs" about whatever choice you do make, whatever happens, as that will just eat you up mentally. So the decision you make will, by definition, be the right one for you. Though I appreciate that probably doesn't help much when faced with making it!

But either way, very best of luck with the operation and countdown to it. AVR is a big and scary procedure for us undergoing it but these days, for the surgical teams, it is a very straightforward operation, almost a bread-and-butter procedure. So sure you'll be in good hands and on the mend and feeling loads better (I certainly did) in no time at all.

Best to you. Nic x

Hi James_son,

This is not an easy decision for anyone to make between a Mechanical and Tissue value – it is a very personal choice and it can become very overwhelming. I was so glad to find this forum and see that I was not alone in making this decision. I decided to have a mechanical value as I did not want to have another op down the track, like many before me. I am now 5 months post operation and being on Warfarin has had its challenges, but it is settling down.

Yes, you do need to watch wait you eat, its different for everyone. As I get a better understanding on how Warfarin works and as to what I eat and how it affects my Warfarin levels I will become more comfortable. I have not really changed my diet as I eat pretty healthy anyway and have a couple of drinks on the weekends. I feel in time as things settle it will be business as usual – even though it’s a bit of a pain remembering to take my tablet every night – but its becoming second nature now. I do have my own machine which I test myself every week and chat with my GP every fortnight and again because its early days down the track hopefully the testing will become less.

As far as the noise I cannot say I really notice it. Now and again it is there but as others have mention it is sort of reassuring to know it is doing its job.

I have posted my story previously if you want to read it, it might be of some help – under “My Mitral Value Prolapse - Replacement Valve” – MiniMe.

If I can help any further let me know and know you are not alone out there.

What ever decision you make I wish you all the best.

Cheers from OZ!!!

I've had my Aortic valve replaced with an On-X valve after contracting endocarditis. The noise isn't loud and sounds like a chimey high pitched click which at times you barely notice. The only time you really ever notice the sound is in a quiet environment or when the heart rate increases i.e during exercise.

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