I had an aortic valve replacement three years back and was given the choice of going mechanical or biological. I was told that if you are under 65 you should go mechanical and over 65 biological. I was 65. The only other thing I was told was that mechanical would mean popping a blood thinner every day while a biological valve may wear out and need replacing later in life. I take a statin every day, so another pill didn't seem like too big a burden and wasn't keen on being opened up again, so went mechanical. Nobody warned me about the dietary and medical restrictions, the constant blood tests or the serious risks if your INR drifted too high or too low. God forbid if I lost my medication while on holiday. I now deeply regret my choice as my box of Warfarin feels like a ball and chain. Just wondering how others, confronted with this choice, feel about their decision.
Mechanical or biological valve? - British Heart Fou...
Mechanical or biological valve?
Me - I would take the tablets rather than go through that again.
Blood tests (pin prick!) every 3 months - no biggy there
As for losing tablets it could happen - put some in hand luggage, some in suitcase, other than that I am sure where ever you go they will have some warfarin.
As for dietry requirements - as the warfarin clinic said to me "your over thinking it, we will adjust your dosage to suit"
A pin prick every three months? Blimey, I have mine done every couple of weeks and my INR swings all over the place. Not sure why as I eat an identical diet every day (Cooking was never my strong point.) with no alcohol. And, as for travel, I've promised to take my sons to Japan for a month's holiday. Japan only allows you to take one month's supply of any medication into the country. I'm sure that Warfarin is available in an emergency but only if you're good at charades.
I don't cook either. I eat alot, always have but a good metabolism has kept me skinny. I try to eat pretty healthy, I'm missing green leafy veg. I need to introduce it, this restriction is not sustainable.
Dear ticker
I went for biological. I had time with both a TAVi consultant and an OHS consultant and that was entertaining. I was 72 at the time, (2020) and the consensus was biological OHS. But it was marginal, so if I had been mid sixties then it would have been mechanical.
I am very happy by the outcome, but have little idea about what might be the situation in ten years. Since then, my current version of the biological valve, now has a facility to accept a TAVi . Progress is continuing.
I would not be phased by further OHS. It categorically saved my life so another bash wouldn’t be so bad.
But you did the right thing for you.
My surgeons explained that they really want six years of experience with these valves and by then, the valves would have improved hugely.
Just think on the lines that we would both be dead without the replacement, so both our decisions were good.
Best wishes
Sooty
When you say they want six years of experience with these valves, which valves are these? I had a (bovine) tissue valve replacement 9 years ago (age 60) and have been fine since but now its been found to have a tear and I need another replacement. My (new) surgeon has said he will use a valve type that has a good longevity record this time but I'm interested to know of the options there are these days.
my valve was fitted three years ago. So far it’s perfect. It is an Edwards Resilia. Yesterday I had a thorough check by my local hospital and they gave my heart including the valve, the all clear. I have heard but can’t verify, that the Edwards Resilia now has an additional feature whereby a TAVi can be used . Mine did not have that option.
I had two surgeons to advise me and they explained that they wanted six years to prove things before they would routinely use a product.
I was advised that the valve would have a limited lifetime, I think 15 to 20 years was mentioned. I was given the option for a mechanical valve and I had the final say.
I was 72 when the valve was fitted.
Best wishes
Sooty
Thanks for info. Glad you are doing well. I certainly was since my AVR, until the recent apparent hiccup.
Hi, I’m curious as to how your diet is restricted? My husband is on warfarin for his mechanical aortic valve and was told to adjust the dose, not the diet. He misses cranberry sauce with turkey but that’s about it. He eats a green leafy veg or coleslaw every day as vitamin K intake has been shown to aid INR consistency. Heres a link and I’m sure I’ve seen a more up-to-date on somewhere too but can’t find it just now
sciencedirect.com/science/a...
Self-testing at home makes life more convenient too. He bought a machine for around £300 directly from Roche and gets the finger prickers & test strips on prescription from the INR clinic. He has the machine calibrated at the clinic once every 6 months. He collects a prescription every 3 months for the actual tablets.
When you go on holiday, check where the local warfarin clinics are - it’s an international service. As far as I know it hasn't changed since Brexit but maybe someone else on here knows. Photograph your yellow book on your phone so if its lost you still have an up-to-date record.
Medical restrictions - that of course depends on each individual. My husband needed non-heart surgery last year. He just stopped the warfarin 5 days beforehand, no additional anticoagulant cover via injection needed as he has a modern heart valve.
I hope these tips help. Best wishes to you and your loved ones.
Thanks, that's really helpful advice. I do avoid food with vitamin K and have also stopped drinking alcohol and my INR swings all over the place. Maybe I'll try introducing more green vegetables into my diet to see if that stabilises things. I just got a home testing kit. Best £300 I ever spent. I think I was spending more time in my local hospital than most of the nurses.
As for the modern heart valve, I assume you're talking about an On-X. I asked for an On-X before my surgery. After the operation, the anaesthetist came to see me and said 'We couldn't fit an On-X but used something equally good'. I was too groggy to ask what the alternative was. A few days later I was given a card saying it was an On-X. I really have no idea if I have a modern valve or not which is kind of frustrating.
hello,
I wasn't aware of the INR international service. Could you perhaps advise how to access this service.
Many thanks
Your travel insurance may be able to provide guidance or google INR testing in … (where you’re staying/thinking of travelling to) and a list of clinics should come up, with costs etc. I’d suggest preparing a few phrases in the local language beforehand too so you can ask for what you need.
Hi Tickertalker,
When I read a number of posts on here re- valve types, its often contrary to my own experiences, particularly the bit about age relevance.
I had my first AVR in 1994 age 33, and went for a Tissue Valve. The conclusion came after full and honest chats with my Cardiologist and Surgeon. I'd known for years surgery was coming my way, so I was neither fazed by or feared it. Anyway, I was fully expecting the valve to last at least 14/15 years, so my plan was to have another Tissue when I was 48 or so. Best decision I could have made and never regretted it for a minute. In the event that Tissue Valve lasted for 19 years before it was replaced, it actually worked too well and put me in no-mans land for my plan as a third Tissue surgery would have put me in my late sixties or therabouts.
So at age 52, I opted for a Mechanical valve pure and simply so my family wouldnt have to go through it again. Unfortuntely, my second surgery had many complications, including contracting Endocarditis, which led to a 3rd surgery within 4 months.
To be honest, I'm of the opinion, there is no right or wrong choice, you just have to learn to live with the choice you make. Believe me, I've been there, got the T-shirt second guessing my own choices and its not worth it. What I would say when asked is that my complications werent due to the Mech valve that was coinicidental.
Warfarin is something of a nuanced drug, and you learn what you're body can take diet and drink wise, I changed very little over the years. Ive changed more due to HF than warfarin by a country mile. That said when Warfarin goes wrong, in my experience it can be a nightmare.
I dont see the problem being on holiday, I always take more than one batch in different bags.
Again reading much on here I do wonder, why this age issue seems to be common practice, I'm of the mind, much of its down to available resources, better to have people having surgery the once, so more can be done, besides that, medics seem to more cautious sticking to a script.
All I can suggest is for you to live with your decision and get the best out of it whilst your able, as most of us do.
I’ve been on Warfarin since 2008 after an Aortic Vale replacement. It was my choice as, having been born with a faulty aortic valve, I only wanted to go through open heart surgery once and did not want to go through it ever again. Yes I have to have frequent blood tests to check my INR but that is no big deal. I probably have my blood tested more often than most as I am one of those unfortunate people whose INR never has stabilised and I often have blood test ever two weeks and some times every week. But I would rather go through that and known I am being protected from having a stroke or blood clot. Nowadays it’s just a prick in the finger.
Hi,
I had a new mechanical valve as part of an aortic dissection repair 5 years ago. I've not found managing it difficult, though I'd admit if the INR is wobbly then I do need to visit the clinic more often. On average I'm around every 2 to 4 weeks intervals. Self-testing is an option, unfortunately our local surgery doesn't do self-testing. So it helps being retired but if I wasn't, I'd be pushing much harder for self-testing.
Mechanical valves are a common thing with AD and our patient guide has information on warfarin management on pages 72 to 74 of aorticdissectionawareness.o...
Hope that's useful. Bottom line is it doesn't bother me.
Do note page 63 will apply to you as well, and the references arevat the back of the guide, should you want to read the detail.
hi. Like Heedio61 I had two mechanical valves within 4 months due to endocarditis. On both occasions my surgeon advised me to have mechanical valves as I was 51. I was happy to agree as I didn’t want to go through OHS again, anytime soon. My warfarin has been all over the place mainly due to medication changes and ill health. The INR team have been fantastic and although I go to my local surgery just about every week, it’s no big chore. I’ve also got a coaguchek monitor and test myself when I’m on holiday, I email the Inr team with my readings and they reply with any dose adjustments. Taking warfarin everyday is a reminder of my heart problems (Im very lucky that I have no other symptoms) and can get me down but in the grand scheme of things it’s completely manageable. I’ve travelled quite a bit and have never had any issue with taking 6 weeks supply of warfarin in my hand luggage.. In terms of my diet I avoid grapefruit and cranberry juice but everything else is ok in moderation. I understand that we all feel differently though. Good luck.
I had a mechanical aortic valve in 2005 I was told at 48 it would be the best choice as it would last a lifetime, I have to say I am delighted I took the advice. I eat and drink what I like though it is sensible not to overdo the alcohol. As for taking warfarin don’t have any problems whatsoever I do have a home testing machine so I can keep an eye on my INR levels, that cuts my hospital visits down to around two a year. You soon learn how to control your levels. As for going on holiday I take my tablets both in hand and hold luggage,again no problems have occurred. Even if i lost all my tablets I would simply go to any local pharmacy.
Hi,Another mechanical valve patient here. I had a terrible time with warfarin when I first started. Up, down and all over the place. I was even given heparin to inject myself with in the stomach...not something I want again. Anyway, after about 6 month it all stabilised and I have now been pretty much 'in-range' for 4 years. One thing that I think helped was just trying to forget about it, eat and drink normally and see where my INR lies. Then the medication seems about right. I feel stress and constantly analysing what you are eating and making changes makes things worse.
My home INR machine helps too. I rarely go into the surgey now, sometime once every three months. I actually like going in though, nice to have a chat and my nurse is great, very helpful.
Unfortunately my surgery don't support home testing, so I pay for the strips. It costs me about £70 per year.
If I were going abroad, I would plan any medication. I am sure you can get what you need while you are away or a special exemption for larger quantities.
At age 65 I went with a tissue valve as I had previously been unable to maintain a stable INR. I was visiting the INR clinic 3 times a week sometimes, every thing I ate affected INR, including just taking a paracetamol.
My tissue valve should last 20+ years and if intervention is required again can be done by TAVI
I was on warfarin for four years and I know what you mean about diet and testing although I managed it fairly well. They swapped me to Edoxaban during covid. Not testing just take your tablet every day, so much easier and I’ve had no side effects. Could you ask your gp about alternatives?
is it not possible for you to take Apixaban (blood thinner) instead? I went from Warfarin to Apixaban after my mitral valve (pig) and aortic valve replacement.
I'm 26 and 5½ weeks post MAV. I really didn't have time to consider this choice as my diagnosis and need for surgery was all made in a matter of weeks. I was born with bicuspid valve and severe stenosis but after initial surgery at birth, was coping well with my heart problems and lived a completely normal life accept for high grade competitive sport. My choice was for a Ross procedure to avoid the warfarin and all that comes with it. On the Monday night in hospital, waiting for surgery for Tuesday morning, the cardiologist came in and told me that they decided against the Ross and that mechanical valve surgery will be performed in the morning. Just like that. Now I am dealing with the pills, changes in doseage, restricted diet, no alcohol, going to the anticoag clinic atleast every week and it is frustrating. I'm grateful that I was given priority and the surgery was scheduled very quickly but I'm already fed up with all this and to add insult to injury, the pin prick tests are not accurate for me so far. I may be in the 1% of people that will never be able to rely on pin prick testing, as my anticoag nurse has said. I'd like to start introducing green veg into my diet but I don't want to disrupt the process of finding some stability at this early stage. Maybe I could have gone to a different hospital and had the Ross procedure and avoided all this or maybe I couldn't afford the time. Either way, I'm hoping things get better. I am currently on 7mg but feel it should be increased seeing as I am restricting my diet. INR was stable at 2.6 but I stopped taking painkillers which I had been on since surgery and the INR dropped to 2 but the clinic doesn't want to change my dose which makes me nervous because I've had the heparin shots after my INR stopped when my antibiotics finished. I read that alot of people figure out their own doses but I'm not sure there is a formula to follow. All I can say is I know exactly how you feel and I'm 26, have always travelled alot, study part time and work full time. I don't want to put the brakes on my life.
hi I have a copy of a self dosing chart although I haven’t got the confidence yet to abandon my inr clinic visits at the moment. I’ve been on warfarin for 18 months and self test when on holiday. The Inr clinic emails me any dose changes but I have the chart incase I’m in a WiFi free area. I’m happy to send you a copy for reference but at such an early stage I would keep going to the clinic, especially as your testing seems a bit complicated at the moment. Good luck.
Thanks. I intend to trust the process until I am more confident but regardless, a copy of the formula for dosing would be very interesting because I have been feeling like the clinic nurses just guess and see what happens which is why I am not confident that I wont be on heparin shots again next week. To me, a drop of .6 in a week and a reading of 2, is not something to stay cool about over another long weekend. Third long weekend since leaving hospital and it feels like each one has been when I am nervous about my INR or have unusual persistent pain and needing to wait until Tuesday or soend hours and hours in emergency.
I had my surgery at Barts too. It went horribly wrong. I had a stroke that cost me an arm and a leg. That only happens to 2% of patients. Then, after that, things started to go downhill. The bad thing is, I'm waiting to hear if I need more surgery as they didn't complete the job. Fairly sure I'll say no thanks if I do. There's no getting away from the fact that heart surgery is a risky old game. Like you, I've always loved travelling and have lived in and visited over 50 countries and would love to dust off my passport, but everything seems an effort these days. Still, you can only play with the cards you're dealt and at least I'm still alive to complain. . Good luck with your recovery.
Hi. Mine was an emergency aortic dissection operation and aortic valve replacement, so didn't get a choice, but I was 66 so was given a bovine valve. They said the life of this valve is 10-15 years then needs replacing. Although I've been told by the Cardiac doctor in my local hospital that it's not another open heart surgery, it's done via a vein I believe.Best wishes to you. Denise
I know you have had many replies but I want to give you some longer term reassurance. I have been on Warfarin since 1988, after aortic valve replacement, and continue to live a healthy and active life with no restrictions. Admittedly my alcohol consumption before and after probably amounts to a couple of pints of lager a year, less now I have discovered alcohol free which I think actually tastes better! However I have had (too) many dental extractions (I don't fancy root canal treatment) with minimal problems regarding bleeding. A very strict regime of 3 shots of Gentimicin intra muscularly for dental treatment was only recommended for a year, now it is just amoxicillin cover prior to procedure. My anti coagulant clinic visits average every six to eight weeks unless my INR goes outside parameters in which case there is fine tuning for a couple of weeks. Mechanical valves are much better for anyone hoping to be around for the next ten years or more, you will soon get into a routine taking Warfarin and unless you are a heavy drinker (which isn't particularly good for you anyway) you shouldn't find Warfarin restricting you much.
I was 50 last summer when I chose biological through OHS. My drivers were that a) I'm pretty active and didn't want to be limited by warfarin, b) I'm clumsy so didn't want the danger of blood thinners and c) I was already fed up (after only 6 months) of being a patient (I wanted normality and to live my daily life on my terms). The op, recovery & rehab have been a breeze so I know I chose correctly but I do sometimes have that "buyer's regret" thing of "if it was so easy I could have avoided a second op" but I know it may not have been so easy with warfarin (and I get buyer's regret with everything ftom cars to houses to women!!). I'm also kind of counting on medical advances to move on so much over the next 15 years so that I can have the second op without OHS. You made the right decision for you at the time - that's all that matters. No-one can foresee every "what if". And let's face it, it's not the greatest choice in the world, is it. It's like the schoolyard bully thing of "do you want to be punched in the face or kicked in the nuts?"
Thanks, you made me laugh, always the best medicine.
My dad was on warfarin,same reason,over 20 years. He was told consistency is the thing,I.e.not having large amount of leafy greens or alcohol one day and none on others.
Is warfare the only suitable anticoagulant?
I take apixaban, one of the new anticoagulants,tablet twice a day,no blood tests except once a year.
Apparently the new alternatives to Warfarin don't suit mechanical heart valves.
Ah that's a shame. Just wondered. Hope the advice on here from.others either tin valve helps . I am bicuspid too so may he looking at same too.
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