Mechanical aortic replacement or tissue valve...help

[Flymetothebeach]

I'm literally in hospital for aortic valve replacement...surgery postponed for 24 hours because of ITU beds. When signing the consent for the junior doctor said ' aged 55 ..you sure you want mechanical valve'. I have been awake all night wondering whether to go with mechanical but all the warfarin stuff...or take the risk on tissue valve knowing I will be back .. anyone been in the same boat. Heart and arteries very good...I've got a calcified bicuspid aortic valve

[Hidden]

OK, tissue or mechanical is an old argument.

When I signed my consent form - an AVR was an option and I chose the Mechanical Replacement.

Why? Well, I was 57 and did not want to undergo this surgery again in 10 years time because the tissue version had become life expired. Also my plans were, on recovering from the operation, to get back out cycling and enjoying long walks and enjoying photography - activities that would likely reduce the lifespan of a tissue replacement valve.

Were I to have an AVR tomorrow, I would still choose mechanical over tissue, even though my circumstances are a bit different to what was envisaged.

Your choice has to be for you, not the surgeon, not the junior doctor and not anyone else on here. We can advise you based on the thinking we had to undertake in your situation, or even experience with a specific type of AV replacement.

If you were confident with mechanical before - what has changed to make that choice questionable?

[Flymetothebeach in reply to Hidden]

I am with my original calcified one right now...see what tomorrow brings. So very grateful for you taking the time.

[080311]

Hello,

I had my Aortic valve replaced and bypass done nearly 5 years ago, had a tissue valve, went with what my surgeon recommended. I was 13 years older than you at the time. I know it as a shelf life but so far so good. As I said surgeon said it was my best option at the time. He said by the time I needed a replacement things will have moved on he said things are moving so quickly in replacement valves.

If you had talked it through with your surgeon, surely you came to the right decision.

I realise you are laying in a hospital bed awaiting surgery and your brain is going over and over things, with the delay it’s not helping.

You will soon be on the mended heart road, I wish you a great recovery.

Best wishes Pauline

[Flymetothebeach in reply to 080311]

Thanks Pauline, very grateful. Such wonderful nurses here, but just left feeling hopeless with the decision. As you say science moves on all the time.

[Shar28]

Hello, my husband had his AVR 3.5 years ago at the age of 55. His reasoning was that he never, ever wants to have another operation so he went for the “once and done” approach. The valve used (Sorin in his case) has been in use for many years without any issues, so it gave him confidence in his future (re his heart and possible operations). Warfarin hasn’t really been a problem. A few ups and downs but overall ok. He’s happy with his choice.

All the best to you and your loved ones.

[Flymetothebeach in reply to Shar28]

Thank you...reassuring

[Hidden]

Hi, I've had both tissue and mech.

The tissue Aortic went on for 19 years.

I now have mech Aorta and Mitral valves fitted when I was 53.

Decision was based on longevity, nothing more.

I've never found Warfarin a problem.

Good luck

[Flymetothebeach in reply to Hidden]

Cheers

[Hanibil]

Definitely a mechanical valve I had one in 2005 at age 48 no way did I want another operation in the future to replace a worn out tissue valve, best thing I’ve ever done it’s been brilliant as for warfarin nothing too it you can get a home tester to keep an eye on it

[Fergy1]

Hi had a mechanical aortic valve fitted just 16 months ago don't fancy having that op again !!! Im 45 so hope it lasts

[andy110519]

Hi, I only had a week to come to terms with things and decide what type, I went with the mechanical as advised by the surgeon.I'm glad I did as whilst the recovery etc wasn't as bad as I had expected I don't fancy going through it again! I was 49 at the time.

Hope all goes well.

Andy

[Coper10]

I had an aortic valve replacement aged 52. I chose mechanical valve on the advice of the surgeon as I didn't want to go through the major surgery a second time if possible. I was daunted by the idea of warfarin but it's working out ok. Early days for me (op was March) but all seems to be going well so far.Hope it all goes well for you.

[Templar889]

Hi, was in same boat in January at age 56. Ent for biological valve for lifestyle reasons and possibility of valve in valve replacement when required. Didn’t fancy warfarin and sound of clicking of mechanical valve. Been very pleased with my choice so far.

[swingyourpants]

edwardseducation.com/inspir...

I hope the link works? I had an AVR done last year aged 54. I did my homework and went with the Inspiris Resilia tissue valve. No blood thinners and no ticking. It should last 20+ years and its a non invasive procedure when it needs a service. It was a no brainer for me.

[Hidden in reply to swingyourpants]

It's an interesting choice to make, and I don't think enough credence is given to post-op lifestyle.

I'm congenital, knowing that surgery was coming one way or another, it was only a matter of time. My parents rejected surgery for me as an infant in the 60s, which I'm happy enough with. When it finally came in '94, I was 33yo. I opted for a Tissue AV, expecting 10+ years or so out of it. My plan was always for three OHS events, with a tissue valve each time. Basically no.2 at about 45/46, with no.3 in my late 50's accounting for advances in surgery techniques etc.

Back in '94, although a Tissue AV was being quoted at 10 years, mine actually lasted for 19 years, which threw a spanner into the works. Timing therefore changed, so at 52yo, I chose the Mech AV, simply as I didn't fancy the 3rd Op in my mid 60's, 10 years was still being quoted for Tissue AVs in 2013. There was also the obvious benefit of probably getting away with two ops instead of three.

As it happens, due to complications during that surgery, I ended up with both Mech Aortic and Mitral valves, which in turn were replaced/repaired 4 months later, so I've had three ops in any case, just not how I would have preferred.

If I had the choice today at 60yo, I wouldn't think twice about it, and would opt for the Tissue without hesitation, more so after reading the link from swingourpants.

[Flymetothebeach in reply to swingyourpants]

Really interested to hear this. It was the valve I wanted but the NHS won’t pay for me to have it ...

[Hidden in reply to Flymetothebeach]

I take it the Inspiris Resilia tissue valve is non-standard?

[Hermanm]

Hi ,

I'll relate to you what my consultant said to me when I was considering which type of vale to have ,

(I was 57 at the time,)

At your age I'd recomend a mechanical valve,

Tissue valves only last about 10 years , so you will probably need more than one operation.

"And believe me , you dont want this operation twice"

That was about 6 years ago ,and being on warfarin isnt a problem ,

My On-X valve will definitely out last the rest of me!

Take care either way

[Simonrainbow]

So had major valve replacement in March this year in Spain in Vinalopo Hospital one of the most advanced Cardiology centres in Spain , they do more than 3x the number of heart transplants than the UK BTW!!!I was very ill was rescued by an amazing team of Cardiac Surgeons. Their comments on the relative merits were straightforward ( and not a little brutal). Mechanical Tavi type valves are easier to replace and are reckoned to be very reliable - but you will need to take blood thinners for the rest of your life to prevent clotting and there is a small chance of rejection, whereas animal based valves are a little more difficult and can lead to some side effects but are very reliable once settled.

the issue is that they don't know how long mechanical vales will last as the procedure is relatively (8 years) new so for younger patients , under 65 they recommend animal based valves. Its that simple, unfortunately for me they had to start with mechanical but reverted to porcine valve as the hole in my Aorta was 28.5 MM and the largest valve on the market is only 30MM so not a lot of wriggle room, 5 surgeries later external blood processing and 11 days in a come , spending a total of 88 days in hospital 9 63) years old) I would listen to your surgeon and take his advice

[Flymetothebeach]

Well...got sent home after 2 days of trying to get to surgery. Jr doctor came and said ICU full of A&E referred stuff because of covid surge. No beds basically. 3rd time cancellation....there was me worrying about tissue or mechanical...lol...almost given up caring about getting it done at all. Can't believe they think there is a valve out that bridges to mechanical tissue debate..but the NHS won't buy it. The NHS seems very happy spending billions on treating people who won't get vaccinated. Sorry...a low day.

[Hwxguy]

My new tissue valve has an estimated 20 year life. Its the latest greatest supposedly from Edwards Life Sciences. Im 58 and 4 months post op. The new tissue valves are usually available now to be "repaired" when they fail intraveniously/transcathater. Be sure to ask if going the tissue route as i did. What no one told me was the thumping in my chest neck after surgery. Im still in the process of trying to sort this out. Seems common after heart surgeries but im very certain mine is due to the location of the valve/conduit combination proximity to something its touching upon inhalation..thats why im here. to get answers to a question i never expected. had to get done, but would have been nice to know...good luck !

[Flymetothebeach]

Thank you...let's battle on.

[HenningLob]

Hi you may by now have had the op so at last the choice has been decided. My husband had replacement valve at age 57 and was essentially advised/told to have mechanical valve because of its longevity and open heart surgery is not something one wants to go through again. The op went smoothly and he returned to fitness within months. However he has unfortunately suffered with the thumping sensation caused by the mechanical valve. However reading on this website this does seem a rare issue so hopefully you would not be affected. It did take over 18 months for INR to stabilise but now his INR remains pretty constant so Warfarin is not really a problem. I do hope you make good recovery and feel at one with your new valve.