Anxious about what valve to go for?

Hello I'm new here. I'm having my AVR next week and still undecided about what valve to go for. I'm leaving towards tissue as I don't really want to manage warfarin for the rest of my life and I don't think I could manage the "ticking" I've been offered a new procedure where they use your own tissue to make the valve . Any thoughts on this. I'm 57. Thanks in advance I'm very anxious about this

[Smarticus]

Hi, firstly good luck for the op next week, as far as the choice goes between tissue/metal that is a personal choice between you and your surgeon. Both options have pros and cons. Controlling your INR (Warfarin) is very straightforward and can be done at home now. once you get your INR stable you just take the same amount for weeks/months until you test again. Personally (and this is very personal) My question was do I want to go through the same procedure in 10-15 years time? what will my health be like then? Hopefully there will be new developments in that period (or not)? Only you can decide... HTH

[IrisCarter]

Hi, I had a mechanical mitral valve replacement done six weeks ago. I chose a mechanical valve because I want the replacement to last as long as possible. Having been through the surgery I definitely made the right choice. There is no way that I could accept going through it again within 10 - 15 years. The warfarin is problematic for me as they are having trouble stabilising my INR, but I am still certain that I made the right choice. The ticking really doesn’t bother me and I know that eventually I won’t even notice it.

[Smarticus in reply to IrisCarter]

Hi, thats exactly why ("There is no way that I could accept going through it again within 10 - 15 years") after just under 2 years I am going for a metal valve!! I am told the ticking does quieten down once it sort of has some "deposits/layer of?" on it, someone I know personally said he doesnt notice it at all but his wife likes to listen to it in bed at night to get to sleep... strange world LOL

[Calliope153]

In my reading, when I was thinking about the replacement valve, I read a research paper somewhere which said think about age of patient (although it should be patient choice) younger than 60 mechanical is preferable and over 70 tissue . But it all depends on the person and what they want...... the surgeon apparently usually has an opinion. Well he did in my case and we didn;t agree!!

[Smarticus in reply to Calliope153]

Just to add, yes, ulimately it is 'your'choice and they will do what you ask for. I think we sometimes forget that...

[Calliope153 in reply to Smarticus]

But you do have to argue your corner..... well, I had to. funny looking back but not so amusing at the time.

[Hanibil]

Hi I’ve had my mechanical valve since 2005 absolutely brilliant managing warfarin easy get a home tester cost around 300. As for noise i can’t hear it and I did not want to look forward to another operation when the tissue valve fails after approximately ten or so years.

[Reuben52]

Hi,

I presume the new procedure you refer to is the Ozaki method where they use your own pericardium tissue to build the valve.

It wasn’t an easy decision, but I went for this and had the operation on 26 February this year.

I got the impression that this is offered to relatively fit “young” patients (I was 68 last week) as the revisit rate is very low and the long term results are looking really good.

Clearly, there is not yet a huge body of evidence for this, but I considered that the benefits outweighed the risks.

Interestingly, I had an echocardiogram just before being discharged and the practitioner was explaining the procedure to a student nurse. She said that the results were consistent with a heart functioning perfectly normally, which was extremely encouraging at that point!

Obviously time will tell and it’s early days for me and the procedure, but so far I have no regrets.

Hopefully, this provides some reassurance for you on this option, but the decision Is a finely balanced one for each individual and entirely yours.

I wish you all the best with whatever you decide.

[Sunnie2day in reply to Reuben52]

As eventually I may need an AVR, I read your reply with great interest and went looking for more information on the procedure you talk about. Sadly for me I don't think it will be an option when my time comes - I have recurrent pericarditis with scarring, thickening, and 'resistant' minimal pericardial effusion - but wow-wow-wow what a game-changer for those with a healthy pericardium needing VR, WOW!

pubmed.ncbi.nlm.nih.gov/294...

[Reuben52 in reply to Sunnie2day]

I’m not a medic, but it does sound like this wouldn’t be suitable for you. So sorry if that’s the case.

I do feel very very lucky to have been offered this procedure.

I do wish you all the best with whatever option you choose.

[road2ruin]

It is a tricky conundrum to have. I was 49 when I had my AVR and went for the mechanical valve. I was the same as another poster I really didn't fancy going through this again once, or maybe even more times in my life. 9 months on my INR is relatively stable, I test at home, and with regards to the ticking I barely notice it now, my wife not at all. It's there I wont lie, but it doesn't bother me that much anymore.

Good luck

[Munkyboy]

Hi there, like pretty much everyone here and yourself I had anxiety about which valve to go for. My choice was mainly between the newer inspiris resilia tissue valve and the on-x mechanical. I didn't fancy the ticking, warfarin and as I'm very active didn't like the idea of issues with potential bleeds from warfarin (tho the on - x mitigates this to some extent). Thought my mind was settled as I went into to hospital then after advice from 3 surgeons, 2gps and a cardiologist ended up going with the on - x. I'm 42 and would be looking at potentially several operations if I went the tissue route and after being through that once I don't want to go through it again. To myself and my family. I tick but got used to it pretty quickly some mindfulness practice helped there. I'm on warfarin and struggling to get stable due to associated gout issues but we're working through that with the doctors and we'll get there.

The pre op anxiety was probably the worst thing about the whole experience. The doctors can only advise you not make that decision for you. But don't worry what ever decision you go with will be the right decision for you. Good luck next week and let us know how you get on.

[Fredders]

I had a tissue valve for my first AVR, but that started to leak within a couple of years and I eventually had my second AVR. After discussing it with my surgeon I had a mechanical valve the second time, (a) because I didn’t want to have to face the prospect of another op further down the road and (b) because I had had a splenectomy and didn’t want to run the risk of infection a further op might cause. I have no regrets. I rarely hear the ticking and you do get used to it. I am lucky in that my warfarin levels have stayed level since I left hospital. My clinic supports home testing, so I have my own machine, do my test, ring the clinic and they tell me what dose to take. They took me through the procedure when I first got the machine and I just have to have it checked against their calibrated one every six months.

At the end of the day it is down to personal choice if there are no specific reason to go for a particular valve, it’s what’s best for you.

All the best for your op.

Wendy

[swingyourpants]

I'm 55 and had an AVR in March this year. I really did my homework and went for the Inspiris Resilia. No blood thinning drugs or ticking and the claim is this valve could last 25-30 years. When the valve needs a service its a non invasive procedure to replace.