Which type of aortic valve replacement is right for me?

[Nickw1]

I have just found out that I have severe aortic stenosis and have been referred for a replacement valve. I am a keen climber, bouldering mainly. Should I get mechanical or tissue? Can you climb hard on warferin?

Anyone got experience of this?

[Ageingfast]

welcome to our forum

Your surgeon will carry out a demanding operation , so listen to his advice.

You are young to go for the tissue, but do discuss the life span of the latest valves. They are improving very fast. I went tissue and it’s been perfect, but I am 75 so the valve should outlive me. I believe the current tissue valves have a capability to accept a later additional TAVi operation. This wasn’t available for me three years ago.

I have no experience of warfarin.

Good luck

[Nickw1 in reply to Ageingfast]

Thanks

[Rhinos67]

Hi

I was 55 last year when I became the owner of a mechanical valve. My surgeon made the decision for me, basically mechanical in the hope that I won't need another surgery, but there's no guarantees.

I'm on Warfarin, and the only thing that I was told to avoid was anything like boxing or contact sports.

I'm a member of a Facebook group UK Aortic and Heart Defects Pre and Post surgery if you want any more advice from those who have been on or are on the same journey

Joanne

😊

[Nickw1 in reply to Rhinos67]

Thanks for your advice

[Cat04 in reply to Nickw1]

Excellent small, private, friendly & knowledgeable f/b group. We have all be through it or awaiting it. Great advice & support & I certainly recommend joining

[Hanibil]

I had a mechanical aortic valve in 2005 age 48, surgeon recommended a mechanical valve as he said the tissue valves would require replacement at around ten years where as a mechanical valve should last a lifetime, I must say it was the right decision I have been able to live a completely normal life both mountain biking and skiing, and of course hopefully I want have to face another surgery.

[Still_Breathing]

I went mechanical for longevity, I was 55 when they did the procedure.I wouldn't want to go through it again. The choice is yours......

Good luck

[swingyourpants]

Insperis Resilia all day long for me aged 55.

No blood thinners and should last 20-25 years before needing a service. When the time comes it’s a non invasive procedure to replace.

I am very active with the gym and my mountain bike and I’ve never felt better.

Do your homework as there are pros and cons for each valve type. Good luck.

[Ageingfast in reply to swingyourpants]

I too have the similar valve to you, three years ago..when was your valve fitted? I am unclear about the possible replacement. How is this achieved non invasive ?

[Cat04 in reply to Ageingfast]

By catheter - TAVI/TAVR

[Nickw1 in reply to swingyourpants]

Thanks.Where did you get it done?

I am going to Liverpool.

Waiting now in hospital in North Wales after blacking out last Saturday playing football with my young son, after which they diagnosed severe aortic stenosis

[Cat04]

The tissue valves are lasting upwards of 20 years now and then accommodate catheter procedures later if required.Very fast moving area of cardiac medicine.

[Nickw1 in reply to Cat04]

Thanks Cat04. Have you had one?

[Cat04 in reply to Nickw1]

Yes I had AVR by OHS 10 weeks ago for severe stenosis. I choose a tissue valve as I have previously had trouble maintaining a stable INR on warfarin (3 visits per week to INR clinic) & my choice was endorsed by the surgeon.I had an Edwards Lifesciences C-E Perimount Magna Ease valve

edwards.com/healthcare-prof...

[Nickw1 in reply to Cat04]

Thanks again. This is really helpful. As I will have to decide in the next few days and it feels like a very big decision.Did you get done on the NHS?

I don't know exactly which valves are available in Liverpool, but my consultant here in Wales said they have many different types, including mechanical, porcine and bovine.

[Cat04 in reply to Nickw1]

Yes I'm an NHS patient. The leaflets of mine are made from bovine pericardium.

[BicuspidBloke]

I had the same surgery last year, at 50. I'm a keen runner (flat and occasionally obstacle course) and cyclist but also very clumsy & always falling or bumping in to stuff (so always bruising). I went for the tissue valve as I didn't want to be on warfarin (the bruising is basically internal bleeding, I figured). And I had had enough of medical appointments so didn't want the regular warfarin check-ups. I figured I could have a less invasive procedure in 15 years time (this last one needed to be open heart). So since then... running within a month, times getting back to normal (six months) and happy with my decision. I get a lot more random bruises from absolutely nothing so can only imagine how bad it would be on warfarin. On the flip side rehab & recovery has been great so I occasionally think I won't be as lucky next time and should have gone mechanical but then I realise this current recovery might not be as good. Once you make up your mind, and it isn't easy, you have to be happy with the decision. Good luck.

[andy110519 in reply to BicuspidBloke]

You did well, back running in a month. I think I was nearer 5 before I did anything much beyond a fast walk although I was doing plenty of that and yet my recovery is better than quite a few I've heard about. In my defence I did have cpr the week before my op.Take care.

Andy

[Nickw1 in reply to BicuspidBloke]

Thanks, that's useful. What medication do you take? Just aspirin?Was it a particular kind of tissue valve? Just wondering which ones can be replaced by less invasive procedure.

[BicuspidBloke in reply to Nickw1]

Mine was the Resilia tissue valve as I'm hoping that will last 12 to 15 years rather than the usual 10 to 12. A mechanical one shouldn't need replacing using the less invasive technique, it should outlast you! The meds are more than I had hoped, to be honest (considering I didn't want to be a daily patient): Spironolactone, Bisoprolol, Lansoprazole, Empagliflozin and Ticagrelor each morning (the Furosemide thankfully finished) and then, Atorvastatin, Ramipril and another Ticagrelor each night. The Ticagrelor is for twelve months then will be switched to Aspirin. None of it interferes with life but it does seem a lot.

[andy110519]

Hi Nick, I had a mechanical valve 4 years ago, aged 49, had less than a week to decide as emergency op. Went with it as should outlast me & the surgeon advised it but things have moved on, I know of someone 30 something who had a tissue valve 6 months ago, same hospital, as they can do a noninvasive replacement.As for climbing I was on a climbing wall last week no bother although I did overdo it a bit, I was racing my brother up it, and my chest did feel it a bit the next day. I think my chest isn't quite the same shape so isn't quite as strong.

I run a few times a week, still getting Parkrun pb's, swim weekly, no plodding and had a week skiing in France a few weeks ago.

Take care

Andy

[Nickw1 in reply to andy110519]

Thanks Andy. What hospital? I am going to Liverpool, Broad Green. Do they all offer the same valve options?

[Cat04 in reply to Nickw1]

The two choices of valve offered are mechanical or tissue. But I believe there are then choices within each group but that was decided by my surgeon. I did ask him whether it was coated to repel future calcium build up and also whether it would be suitable for tavi/tavr if ever needed and was told that - yes it is.

[Nickw1 in reply to Cat04]

Thanks.That is interesting. I am definate ly going to listen to recommendations of the medics in Liverpool when I get there, but at the minute am leaning towards tissue because it might interfere less with my life and my climbing hobby, and because things seem to have moved on regarding second replacements.

Very interesting that you were told it could be replaced using Tavi.

Thanks for the info

[andy110519 in reply to Nickw1]

I was Edinburgh Royal Infirmary and as far as I am aware it varies between NHS Trusts as to the actual valves on offer.

Andy

[road2ruin]

Hi There,

49 for me and had a mechanical valve. I did contemplate a tissue one, but they said there was no guarantee a non invasive procedure for replacement, it depends on the situation and individual. I was also told that the tissue valves deteriorate quicker the younger you are, so someone under fifty, they may only last 5-10 years.

Anyway, I have been on warfarin ever since and do home testing. I do go to the INR nurse once every two months, but it is a 5 minute appointment, prick, test, on my way.

Other than that, there is of course the ticking noise a mechanical makes. It doesn't bother me, but is does others.

Good luck.

Pete

[Nickw1 in reply to road2ruin]

Thanks Pete.Sounds like mechanical is working well.

[Bobkins99]

I'm 64 and was told a mechanical mitral valve would be a better option if I wanted to avoid repeat surgery later as tissue valves have only 10-15 year life span. However when I said I was a keen skier the consultant immediately said I would need a tissue valve. Luckily during the op they managed to repair the existing valve

[Nickw1 in reply to Bobkins99]

Thanks. Did they recommend tissue because of the risks of being on warferin when you ate skiing?

[JHPW70]

I'm 52 and went tissue valve earlier this year. Very tricky decision with no definitive right answer. In the end two surgeons steered me towards the tissue valve.

[Nickw1 in reply to JHPW70]

Thanks.Where did you have it done?

I am going to Liverpool Broad Green.

Why did they recommend tissue?

Was it your lifestyle?

[JHPW70 in reply to Nickw1]

Mine was done at Papworth hospital. I had an Edwards Inspiris Resilia valve fitted. I'd already done quite a lot of reading and was favouring tissue valve before they recommended to me. At our age it is a very tricky decision as we seem to be on the threshold of mechanical to tissue. Assuming I live a long life (and this is worth considering as there are no guarantees of this) then it will fail. When it does fail then TAVI or worst case open me up again. If I did have to be opened up again then atleast I would still be relatively young and I believe being young at first surgery has helped my recovery. Both surgeons thought TAVI would be the suitable though, so hopefully no need to be opened up again. My lifestyle is not particularly physical. I dog walk, DIY and dinghy sail, nothing that would prohibit a mechanical valve. In the end I went with what I wanted and the surgeons advocated.

[Nickw1 in reply to JHPW70]

Thanks so much for sharing your experience.It's really helpful to hear from others in similar positions to me.

Good luck.

[Etzel]

Hiya, i'm in the queue for both aortic and mitral in the next couple of months. My surgeon said at 60 it was a 50/50 choice, the tissue could need replacing/repair in my lifetime whereas (and I like his honesty) mechanical will almost certainly outlast me.

For me mechanical was the obvious choice as I will have double the chance of needing repair and i'm only a gym person so less chance of bruising etc.

I always say the golden rule is go with what they recommend, they are the experts after all.

[Blackwolf_7619]

I wifk in cardiac theatres, I don't know how your trust works, but in mine it's the surgeons who decide which one is best. They should have discussed that with you already.