Urgent AVR

[JJL15]

Hi, I had my CT angiogram yesterday and a call with the surgeon this morning. I am on the urgent wait list for my 2nd AVR surgery. I was told they are trying to set up ‘clean’ site with no COVID patients and surgery will happen there rather than the hospital in London because they have COVID patients. He said within weeks I will have it done, so I still don’t have a date, which is super frustrating but I totally understand their reasoning. We spoke about types of valves and he said to me I did really well to get 9years out of this one for someone my age (36). Made me think am I making the right choice to choose tissue over mechanical. I know there’s no right or wrong answers but interested to hear your thoughts. It’s the idea of the lifelong warfarin I don’t want right now. Anyone got any insight? Confused.com now 🥴

[Blackcatsooty]

I had AVR in the first raging lockdown 2/5/2020. The valves are vastly improved and reference to even 25 + years for tissue certainly made up my mind towards tissue. But i am old, so have different perspective. With hindsight, i would leave the decision to your surgeon. Only he will see whats involved and he will be placing the valve, no one else.I was extra urgent, being given just weeks to live.

Was due at West Brompton, i think, and it closed as i waited. Harefield was a good choice but not ready. I got in to the fabulous Cromwell, which was quiet as their overseas clients were not coming here.

I felt so safe. Nurses and other staff were fabulous. Only single rooms used.

Probably safer in there than at home.

My experience was good. I did spend a lot on a private ambulance to take me home, but that was my choice. It might have been 3 hours by car. Ambulance sliced thru the quiet roads.

Waiting was the worst bit.

Colin

[JJL15 in reply to Blackcatsooty]

This is comforting to hear. I just hope we can get it done ASAP and I can start to recover for my kids sake. The surgeon said to me today that the tissue last a lot less due to my age and I guess activity with kids so young but I still think I may go for the tissue valve right now unless they can tell me some really good cons with the mechanical valve . How are you feeling now almost 8months on?

[Blackcatsooty in reply to JJL15]

Can i answer by saying that, in August, about 4 months post op, i was feeling wonderful. I needed rehab but just made it up as i went along. Everything closed.I had a stroke a few years ago and the stroke issues hide and overwhelm any heart issues. BTW i had an edwards inspiris resilia . That was what the surgeon recommended. I was 72. I did get quite a lot of very experienced surgeons advice. The gist is that science moves so fast that there is no history for the latest valves.

[Samgeorge]

Take a look at the Edwards Inspiris Resilia as a tissue valve option. Everyone’s decision is a personal one but I’ve gone for it although I am 52. Unfortunately there is no right or wrong answer.

Take care and hope all goes well without too much wait.

[JJL15 in reply to Samgeorge]

Thanks for your reply Samgeorge , I have heard of this valve , is it on the NHS? Do you need to take any form of anticoagulants?

[Samgeorge in reply to JJL15]

You should be able to get it on nhs but will have to specifically ask for it. No anticoags after the first 3 months I believe. Worth a discussion with your consultant.

[francesw47]

Hi I had second AVR in 2019 and opted for an Edwards Inspiris valve but had to ask for it. Unlike you I am older, so yours is a very different decision. Lets hope that the clean site is quickly established and you get your surgery very very soon. Keep us posted and stay safe in the meanwhile. Frances

[Milkfairy Heart Star]

Hello,

If you are a younger women and contemplating having a baby this is a consideration in the choice of tissue or mechanical valve.

[Nic25]

Hey JJL15. You've had lots of good answers already here but, for what it's worth I went tissue at age 50 in 2018, again the Edwards Inspiris Resilia. As others have pointed out, it's supposed to last 20-25 years, so longer than conventional tissue valves (but we'll see I guess!). I just have to take low dose dispersible aspirin for it. So I'm personally very happy with the outcome so far. So definitely worth asking about with your surgeon at least I'd suggest.

Obviously your young age and the urgency may end limiting your options anyway. But there have been a lot of improvements in mechanical valves too in recent years I believe (though am no expert).

Either way there's no 'right' option and so I guess be led by your surgeon and your gut if you do get a choice. Not that that helps with your dilemma I appreciate!

But very best of luck with the operation, especially in these Covid times, and whatever you end up with inside you I hope it all goes smoothly and you're on the mend and recovering quickly.

Take care and feel free to ask any specific questions, or connect/DM, as happy to help if I can. Cheers Nic x

[Cowboy72]

Just had my first AVR 6 months ago at 48 and the recommendations were for mechanical, opted for an Edwards valve because of warfarin and my fathers experience with it. No one has said age or activity leads to their decline, at my post opt the surgeon said I could resume swimming after 12 weeks and to not be afraid to give it a push so dont think physical activity that I am aware of influences longevity. Others might know more than me on that subject. Only advice I can offer is the decision is yours based on your personal circumstances and you are the one that lives with it, so while surgeons can provide advice they will tend to follow specific guidelines based on statistics. Make sure you discuss your lifestyle and reasons for your preference and write them down before the consultation when you have to decide. That helped me and once the surgeon knew why I had made my choice and that I had looked at both sides he supported my decision. My hope is to get 15 to 20 years or more out of this valve and by then TAVI should be progressed to the point that they may have similar longevity or ease of replacement etc... who knows technology is advancing all the time.

[andy110519]

Just to even things up a bit I had a mechanical valve May'19. I had less than a week to decide what type and just went with the surgeons recommendation of a mechanical one.They have improved and although I will be on warfarin for life the level is down on previous valves so not such a worry about bleeds. I also live 5 minutes walk from the Dr's so 4 weekly monitoring visits not a problem. I think it's an On-x valve I've got and wouldn't want to go through the surgery again, I was only 49.

[IanGordon]

Opted for a tissue valve in April 2018 at 66.Surgeon agreed with my choice and as the new Edward's long life valve was in his view unproven, steered me away from this choice, although with hindsight, I should have perhaps been more insistent. However, I'm told that there are tissue valves out there with over 20 years function.

My choice was driven by both my active lifestyle and wanting to avoid being tied to regular GP visits and ingesting rat poison !

No regrets so far and no physical limits on exercise levels - cycling, walking, tennis, windsurfing and snowboarding all part of my lifestyle and enjoying the new lease of life gifted to me by surgery. Once beyond the 12 week recovery and rehab, all was good and continues to be so.

Anxiety can distort reality but any risks associated with surgery will be significantly less than leaving things as they are.

Good luck with whatever you decide.

[gladliz]

Can't comment on replacement valves but I have been on warfarin for 9 years and likely for the rest of my life (73now). I have never had any problems with it, apart from being more susceptible to bruising.My INR tests are every 8 to 10 weeks depending on my readings and my dose adjusted accordingly.

A couple of surgical procedures had me stopping a week prior to them being done and tests were done more frequently but back to normal within a month. Other than avoiding cranberries/juice (not keen anyway) I have not made any other dietary changes, not necessary unless you start to eat broccoli 24/7. Good luck with what ever you decide.

[road2ruin]

Just to give you another mechanical valve opinion. I was 49 too when I had mine done. It was a decision between me and my wife. I did discuss the Edwards valve with the surgeon, but he was not convinced by it's longevity claims. He also said, as you may be aware, valves deteriorate quicker when you are younger. Anyway, I opted for a mechanical valve. I just didn't want to go through the Op again if possible. My wife too was very distressed and probably it affected her more than me. I wouldn't want to put her through that again either.

With regards to the warfarin, I barely think about it now, at 6pm I take tablets. I get tested sometimes every two months, but I do self test at home in between.

I am just as fit, possibly more, than before too.

In the end, you have had the op before, so you know what to expect. You will have another op if you go tissue, so if you are ok with that, then go for it. Please speak to wife, kids and parents too.

[mewgy1234]

im 43 with mechanical valve warfrin not 2 bad after you get it balenced u learn wot u can and cant do.the ticking is sort of comforting hearing ur own heart beat going 2 be blunt id pick mechanical everyday because wot i rem from surgery my pain was horrendoueos by doc blamed me for that 4 being so strong upper body lol.goodluck if u need any other advice or just a cgat let me know

[JJL15]

Thank you all for your replies, I have taken on board everyone’s comments. I have just had my call to start self isolating so I imagine it will be soon. It’s going to be done in private hospital in London due to too many Covid patients in the hospital they normally do it at.

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Best of luck and I do hope you get to hear from them soon.