I am having surgery in 2 weeks time to replace my bicuspid valve and a section of my aorta.
They are going to attempt to repair my valve, but if this is not possible (having a TOE to assess) I need to choose between a mechanical and a tissue valve.
I am 43 with no other health issues. How do I decide? I have done lots of research and understand the pros and cons of each but it appears to be 50:50. Please can I ask: What advice or resources helped you to make your decision?
Thank you in advance for your help.
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DotD
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I had to make the same choice, it was very difficult and eventually chose to have the mechanical valve.
I spoke to the lovely people at the British heart foundation, they have specialist nurses who can give you the pro’s & cons of both types of valves.
I had my valve replaced 3 weeks ago and yes it takes time to recover, but very happy with my decision.
They told me that the mechanical valve would outlast me. But I would have to on warfarin for the rest of my life. I felt this was a small price to pay as I would not have to go through the operation again.
With the tissue valve there is a life span of 10 to 15 years (this would still open heart surgery). So I then have to go for another operation, which would probably be keyhole surgery. The life span was around 7 years for this operation. Then if I was still around, I would have to endure open heart surgery again…
As I said before I feel I made the right decision for me.
The best thing I done was phone the cardiac nurse specialist/ advisors at the British heart foundation. They tell you the pro’s & cons and are very knowledgeable.
This is an incredibly difficult decision and a very personal one for you AND your family. No one can tell you what is right for you. Get all the information you can and then go with your own feeling.
Generally for people under 65 the consensus is to go for a mechanical valve, as these have the longest lifespan and usually outlast the patient. However there are cons to this approach.
Warfarin - You will be on medication for the rest of your life. Currently this is warfarin, which is taken daily and you must go for regular INR checks. These checks can be done at home and if you maintain your INR level within range, can be spaced around 6-8 weeks apart. They aren't a big deal though - a trip to the INR nurse at the doctors, finger prick and result in 30 seconds. They may then alter your medication to keep you in range. There are home testing kits available and these mat also be funded by the NHS in some cases.
There are new medications, less complicated, on the horizon and these may end up just being one tablet a day, no checks. Apixaban is an exmaple, although this is not currently approved for mechanical valves.
Bleeding - you are at a higher risk of bleeding, so future surgery etc is more risky, even a tooth extraction can be an issue. I did have a tooth extraction and it took a while to stop bleeding, even with stitches. The professional will help with all of this.
The noise - Some people can hear the clicking as the valve opens and closes. These tend to be the 'thinner' people with less sound insulation, if you get my drift. I can hear mine, but it doesn't bother me and I only hear it at night infrequently, my wife used to hear it too and now she doesn't, more sound insulation added maybe...lol.
Another operation? - Highly unlikely, but you can never say no.
For older patients, 65+, a tissue valve may be a good choice. These are usually cow or pig, but there are others available. Theses tend not to last so long, particularly in the young and there have been cases of only a few years. There are some more modern valves that quote up to 25 years, however these have not had long term testing to verify the likelihood of this. If they do need replacing then some can be done via a TAVI (sent up the vein in your leg rather than more OHS) This does sound better, but does have other risks associated to it.
Medication - Some patients still require medication, usually just aspirin daily, but could be others.
Another operation? - Highly likely, so if you don't fancy it again then think carefully and speak to your surgeon about your options for the future.
I had this decision a couple of years ago and forgot that my wife and kids needed input too. I spoke to them all in the end and I am glad I did as it's easy to think it's just you. My wife and children had a terrible time, probably worse then me in some respects. After all I was being well looked after, them less so.
I was 49 when I had my op, bicuspid valve too. Went for a mechanical valve. If you want to know more, please don't hesitate to as.
Peter an excellent summary. I’m 57 and had a metal valve ( to replace bicuspid valve) and aorta repair last year. It is a personal choice but a no brainer for me to minimise need for further operation down the line, The clicking sound and warfarin are a small price to pay for me and only a minor inconvenience. My warfarin settled in range after a few months and has been in range now for 9 months with no real diet changes. I was worried it would affect eating but pleased it didn’t. Modest alcohol is still fine and even managed a bit more at Xmas and holiday. Happy with my choice.
Hello, This is so hard and I have been there! I am due anytime within the next month or so to have a new aortic valve. I am 64 and well, other than the pesky valve. The feeling from my consultant was to go for a mechanical but a few weeks after that appointment I knew that I was worrying about the responsibility of lifelong Warfarin and not just taking it, which is the easy bit, but monitoring the levels all the time, watching certain foods etc. Being female I have the advantage of that wonderful thing called women's' intuition and I just felt I wanted to go for a bio valve. I know it won't last forever but I will face that when it happens and it will be a familiar thing. The choice depends very much on your psychology and , in your case, your youth! If I were as young as you I would embrace the mechanical and all that goes with it but nobody can make that final decision except you, of course. Good luck and when you have decided, know it is the right one because it is the one you chose. You can change your mind right up until the last minute. All the very best and all will be well.
Thank you so much for taking the time to reply to my post. I wish someone could just make the decision for me! I will call the BHF for their advice as you have suggested. Thank you
Hello DotD,
It's a difficult one to answer, as everyone is different and it comes down to personal expectations. Research is great to an extent, but, a lot of the figures thrown around are generic.
I would consider a couple of factors if you haven't already done so. Firstly, what are your life expectations following surgery. Do you want to a lifestyle without limitations for the best part or one with potential of being controlled by medication.
How old would you be on a redo, at 43 now, would you be happy with surgery again in your 50s, 60s or 70s. Bearing in mind, risks are greater 2nd time around.
Also consider that Tissue valves are forever changing as are surgical techniques.
I've had 3x AVR, the first at 33, it was a no brainer for me, and I went for a Tissue valve that lasted 19years.
I'm currently with Mechanical Aortic and Mitral valves, which I'm fine with, but, I don't let Warfarin control my life.
Having had both types I've had the experience of living with both and do have a preference, but, have no regrets either way.
Which ever one you go, just be comfortable with the decision you make.
Helpful advice from other posts. Good site isn’t it.I thought carefully about which valve but the best advice is to listen to the surgeon who will operate.
I was 72 so a nice Edwards Resilia was the one for me.
At your tender years perhaps mechanical will be more appropriate.
Ask about newer valves because your medical team will, quite rightly, rely greatly on historical performance.
I wasn’t given a choice. The surgeon used a tissue valve and in many ways I was pleased as I trusted his experience. I suspect that at your age a mechanical valve would be most appropriate as tissue ones have an average life span of 20 years. Good luck with your surgery.
Is the Ross Procedure an option that the surgical team can offer ?
I was in a similar position (aged 40) and even after the TOE it wasn’t clear that the Aortic Valve could be repaired. The surgeon said he’d only know when he could actually see it himself once he’d got in there.
I wasn’t keen on a mechanical valve with the added reliance on blood thinners and a biological valve would lead to reoperation at some point and possibly within 10 years.
We agreed pre-op that Plan A would be a Valve Sparing Root Replacement with Aortic Valve Remodelling and Reimplantation and if he realised the valve couldn’t be repaired then he would do the Ross Procedure.
Fortunately the valve was repairable once he visually inspected it and he went with Plan A.
Hopefully, I am having my mitral valve replaced tomorrow morning. I am 45, fit, work full time, and have no other health issues other than mitral valve condition. I decided to go with the mechanical valve. I have a friend who had the same op 12 years ago had his one changed with mechanical one and very happy with it so far. I hope it helps.
I’m 58 and had a mechanical valve last year. I picked it principally because I didn’t want to risk a second round of major surgery 15 years down the road.
I was concerned about life on Watfarin, but in reality it has been no trouble at all. I eat and drink pretty much whatever I want: of course I don’t ever get totally drunk, which is probably a good thing all round!
I eventually got a machine to test my blood at home and it’s really liberated me.
It helped that my surgeon was by far in favour of a mechanical valve. It’s a personal decision. Thr avoidance of future surgery was the deciding factor for me.
Hello, I had AVR last year aged 52. I opted for a mechanical valve due to my age and I don't really want to go through OHS again if possible. So far, warfarin hasn't been too problematical. I was aware of a slight clicking noise of the valve at times to start with, usually when in bed but whether it's settled or I am more used to it I don't notice it now. So far so good. I wish you all the best whatever you choose.
Hey DotD, first off good luck! The hardest bit for me was the waiting in limbo. Sure you'll be in good hands. It's a big operation but these days a very standard one - I was absolutely terrified but in the event was in and out of hospital in a week with no complications whatsoever, just sore and tired. So hope it all goes well and we'll all be rooting for you.
You've had some great and really helpful replies already here but just if it helps to give you my thought process, as I went tissue at the age of 50 when I had my AVR back in 2018. I'd assumed I'd have no option at that age but to go mechanical, though wasn't hugely happy with the idea of taking Warfarin from then on (though those who go mechanical do say it isn't a problem once you've got used to it). So I was pleasantly surprised when my surgeon gave me the option, and following a bit of research and discussion I ended up going for the Edwards Inspiris Resilia, which is a new-generation tissue valve that is supposed to last 20-25 years (and I have read 30) before needing to be replaced.
Obviously that decision does mean I've made a decision that I will need another op "at some point", potentially at a much older age. But my take was get 10-20 years without the hassle of having to deal with Warfarin, let the technology and treatments continue to develop and then see how things are? For example, even in the period since my operation the TAVI (keyhole) procedure has become more commonplace on the NHS and, in fact, the Resilia is as I understand it designed to be replaced by TAVI, as long as it is above a certain size. My very ill uncle in his 80s had a TAVI procedure last year and it all went very smoothly.
Clearly, it's a very personal decision and there is no "right" answer. But I'm so far very happy with my decision - I just take a low-dose dispersible aspirin once a day for the valve and that's it (although I am also on BP medication but, I guess, that isn't specifically to do with the valve). As many have said here, mechanical is very much a viable option and it does mean you're done and shouldn't ever need another op (although one of the things that did swing it for me was my surgeon pointing that, of course, that can never be totally guaranteed in life).
I'm not for a moment suggesting take the decision I did - and who knows if I'll feel different in 20 years time when a new operation is looming! But maybe it's something at least to discuss with the surgeon to see what they think and whether it might be a viable option? The other bit of advice I'd suggest (which my wife came up with) is, whatever decision you do make, don't try to second-guess it or do 'what ifs' after the event, as it will just tear you apart mentally. As I say, there are pros and cons to both and so, by definition, whatever decision you do make will be the 'right' one because you made it for yourself and your body!
Hope that helps and, as I say, best of luck and keep asking questions as that's what we're all here to try and do for people - my first post on this site back in the summer of 2018 was almost exactly yours! Also very happy to answer any questions you may have via DM if you prefer.
Hi I had an Edwards resilla - and am on blood thinners as well but I was told only for 6 months - I wasn’t suitable for a mechanical one as couldn’t be on warfarin being too anaemic - but the new valves are coated and as yet they don’t know their longevity. At 62 I am super happy with mine 7 weeks post op it’s doing it’s job and I feel amazing !! Do your research take the advice - these people are incredible!
I had my aortic valve replaced in December 2020, aged 55, no health issues but, without even knowing I had a bicuspid valve which was leaking.
I was also given the options of mechanical or tissue valves. The tissue valve, has at best a 15 year lifespan and that, from what I read is the best you can expect before it needs replacing. Obviously mechanical valves don't need replacing.
As for pros and cons, with a tissue valve you don't need blood thinners but you will need it replacing. With mechanical, you have to take blood thinners for the rest of your life but it won't need replacing.
For me, at 55, the thought of open heart surgery was scary enough but being fit, active and healthy, my recovery has been good. The thought of going through surgery all over again when I would be in my late 60's early 70's really wasn't an option.
Being on warfarin isn't really a bother, it just becomes part of your new life. Your INR is tested regularly to adjust your levels accordingly but apart from that I don't find it intrusive, even if we go out or go away somewhere.
It is a personal choice and you have to decide what you feel is best for you.
Good luck with everything, let's hope they can repair your existing valve.
Hi, I was 53 when I had my AVR. I was offered mechanical or animal. I chose mechanical because I didn't want to be opened up again, especially as I would be older and more frail? Animal lasts about 15 years! Also, having lived through the healing of the sternum, I wouldn't want that again!! Long process!Ok, I'm on warfarin, but it doesn't faze me. I bought a INR machine and do my own readings, so don't have to go in every several weeks, just ring my results through and they dose me?
I am 61 and had a AVR last September. I opted for a tissue valve. After three months on warfarin, with a tissue valve, the warfarin can be stopped. All went well until the week before I was due to stop. I had a serious nose bleed which required emergency transfer to ENT from casualty in another hospital. It wasn’t a very nice experience and I was so glad to get a satisfactory ECG and get off it. Perhaps a one off and an exception but something that needs to be considered. I’ve been told that if the valve ever needs replaced I’ll be able to get it without opening me up again. I’m well on the mend so take one one week at a time and you’ll get there. Best wishes.
Took a stear from my cardiologist which happened to reflect my wish not to be reliant on my local GP practice for blood tests and INR monitoring/adjustment that comes as standard with mechanical valves. Mine is a bovine bioprosthetic valve, installed in 2018.I'm an active 69 year old with all the benefits of AVR and no warranty issues!
I was 40 when I had to have my Mitral valve replaced I wasn't given the choice back in 1998 I just had the mechanical valve because of my age skip to 2015 and I had Aortic valve replaced again mechanical which they discovered after having my first operation both congenital but was reviewed each year up to 2015. I have been on Warfarin 23 years and as others say small price to pay taking tablets each day I go every three weeks to have my INR checked I do not watch what I eat I try to be consistent and for me works okay. I can only hear my valve at night in bed my daughter who is in her 30's can hear it and comments some-times mum your ticker is loud!! and occasionally any hospital appointments/dentist etc others can here it. I would say mechanical valve because they last longer than the tissue valve. Hope this has been useful. Best of luck
Pretty much what everybody else has said below. Personal choice. Different outcomes with either. I was 41 years old when I had my mechanical valve fitted along with aortic root and hemiarch replacement. Apparently valve will out live me, which is good news! Dental hygiene is a must, warfarin at the start is a pain but you soon get used to it. Ditto the internal clicking.
One of the hardest things for me was accepting that I was a fit, sporty and healthy 41 year old male who suddenly needed major heart surgery! It takes time to recover, I don’t remember the first few weeks at all, listen to your body, don’t rush back, take as long as you need, one step at a time. You got this!
I am 47, I went mechanical valve. I am glad I did.
All I would say is that having had the operation once, I would never want to go through it again. Thus having the mechanical valve should spare me this fear.
As a rule of thumb, it's recommended to go mechanical if you're under 65 and tissue if you're over. I was 65 when I had my surgery, so I was right on the cusp. I went mechanical and thank God that I did. Surgery is a risky business and I had a terrible time. I could write a very long post detailing all the things that went wrong but will just mention that I had a stroke which cost me an arm and a leg. Just prior to my surgery I'd been for a trek across Borneo and motorcycle rides around Myanmar and Vietnam and now, eighteen months down the road, a trip ten minutes down the road to go shopping is an ordeal. Yes, taking Warfarin and watching my diet is a pain, but nothing compared with the prospect of a second and maybe third operation when I'm older and more frail. At 43, it really is a no-brainer.
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