good morning all , I am on list for AVR due to severe stenosis.
I have to consider whether mechanical or tissue valve. The surgeon who is carrying out the procedure uses the Edwards inspiris tissue valve. I am really undecided , mechanical and warfarin but at least the valve will probably outlast me or this new generation of tissue valve which is allegedly longer lasting and has the capacity for insertion of another valve via TAVI if and when it fails.
thoughts and experiences of others would be grateefly received.
I am hoping to discuss it with the surgeon soon.
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wodehouse123
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I had a mechanical valve fitted 14 years ago and it’s still going strong. I took the view that I didn’t want to go through open heart surgery again when I was older if my valve failed, yes, I’m on Warfarin but, to me, that has been no big deal. I’m glad I went for the mechanical but it’s entirely your decision. For me it was the right decision.
I'm 61 and whilst I don't fancy the warfarin for life I even less fancy the thought of a potential 2nd operation in my 70's. And it's a horrible thing to say but who knows the state of the NHS and wait times by them. Barring cancellation i'm due in on 1st Feb and will go with whatever my surgeon recommends, he's the expert. The only thing for me is i'm getting both AVR and MVR and I think I read that mitral is harder on the valve over time than aortic so that may have a bearing.
I had a mechanical aortic valve implant in 2005 at age 48 on the recommendation of both my cardiologist and the surgeon, the reason they recommended a mechanical valve as against a tissue was the fact that tissue valves often require replacing at around ten years and a mechanical would normally last a life time. I had absolutely no wish to go through another operation if I could avoid it.
I have to say it’s been a brilliant decision my valve was checked a couple of weeks ago and I was told it was working perfectly, yes I have to take warfarin but that has presented no problems whatsoever. Get yourself a home tester for your inr . And your hospital visits will be cut to around two a year.
Hi , thank you. The tissue valves my surgeon use are the new Edwards Inspiris Resilia valves which are treated to prevent calcification and are alleged to last 15 to 25 years if they fail then a new valve can be placed inside the old one using TAVI . No I don’t want to have to go through further OHS especially not in my 70s or 80s so sm erring towards mechanical as the new valves have only been in use in humans since 2017. I was hoping that someone who has the new valve may have responded.
Yes if I have mechanical I intend to purchase a coagucheck.
I had the Edward’s inspiris valve in 2022 at age 69. I was undecided but I saw 2 separate surgeons (independently) both of whom recommended that Tissue valve to me. They placed weight on the lifestyle advantages of no warfarin (I also do a lot of cycling, skiing, tennis etc all of which I’ve been able to resume), plus the TAVI replacement option.
I’m currently not on any meds at all.
Definitely listen to any leads that your surgeon gives
Hi, Unfortunately, I can't really say anything on the new generation of valves, however, I do have experience of both Tissue Valve and Mechanical valves - Aortic and Mitral.
My first AVR was over 29 years ago, I often hear about the valves needing replacing after ten years or earlier, which was utter rubbish in my case as mine didn't need replacing for 19 years. We made the decision knowing full well I'd be having further surgeries down the line given I was 33 at the time. I was fine with that but, key to that decision was I expected surgery in my 40s or 50s, so still relatively young and expected advances in surgery techniques/types of valve.
When it came to the second op, I changed to Mechanical, for the simple reason that I felt it wrong to put my family through it for a third time. In the event complications and Endocarditis meant I had a third surgery in any case within four months. Had the Edwards Inspiris been available to me 11 years ago I dare say I'd have been tempted to say the least, but, thats by the by.
What I would say is do not go for Tissue unless you are 100% committed to the possibilty of further surgery, which can often be more riskier than the initial surgery. I wont suger coat Mechanical valves, as there are often problems with them, but, it should last for your lifetime.
Thank you so much for you very honest opinion , I certainly do not want further surgery and I think that is my number one priority. I can learn to live with warfarin
Hello My surgeon made the decision for me - mechanical in the hope that I wouldn't need surgery again. This was mainly due to my severe anxiety around hospitals.... I was a wreck! Yes I'm in Warfarin for life, but it's not a big deal. I go to a local clinic every 6-8 weeks now to get my INR checked and I live a normal life.If you aren't already a member of UK Aortic and Heart Defects Pre and Post surgery Facebook group then I would highly recommend it. Everyone is or has been on the same journey.
A few years before my AVR I was unable to maintain a stable INR on warfarin. When I mentioned this my surgeon he immediately said to have a tissue valve, it lasts 20+ years and any future intervention required could be done by TAVI
spent most of last night awake feeling anxious abt my naughty fluctuating heart rate and blood pressure, neither as bad as I've had in past but still the worry kept me up. Recovery is a game of snakes and ladders and I hit a big wiggly one lol x
You are still in the early stages of recovery, your heart has been through serious trauma and is still settling down. Keep aware of your symptoms and consult your GP/111/BHF nurses if worried, and also your medical secretary. You'll soon be having more 🪜🪜🪜(one rung at a time) than 🐍🐍 😊
I have the Edward’s valve and so glad I have it, I’m 55 had it a year ago now I’m on zero medication, train every day - bike, running, weights and going skiing in a couple of weeks. Definitely the right valve for me. My surgeon a prominent professor in London said it will probably last 30-35 years and if I’m still going then it’s just a TAVI through the groin. I’d rather have the lifestyle now but it’s all a personal choice.
Good luck and make the decision for you, life is there for living.
All I can add is mechanical valve 35 years ago, on Warfarin ever since, no problems with either and fully active, even worked in a safety critical role around 14 years ago after my op when I got promoted.
I had a tissue valve because I couldn’t go on warfrin - 2 years ago . I’m very happy with it and my neighbour whose 90 had her tissue valve fitted 20 years ago and hers is going strong too . Talk to the surgeon/ consultant they are the super hero experts be guided by them .
Good luck focus on recovery and how much better you are going to feel !
I had the same conundrum where I had mine replaced in October 2022. My cardiologist recommended the tissue valve for the reasons you have outlined above. For me the blood thinning medication for the rest of my life was the thing that seeing it for me. My tissue valve is currently serving me well, I’m 60 this year and the chances are that it will need to be replaced at some point by keyhole surgery but I’m happy to pay that price. Good luck.
Thank you yes , it is the warfarin I’m concerned about The initial stabilisation period and how it affects in the long term . My late mother was on it for the last 25 years of her life snd although she was stable most of the time , in the end her skin became so friable that just a mere rub would cause blood blisters and I find those last few years of watching that distort my rational thoughts.
Hi, I'm surprised no one has mentioned the third option that might be available to you, the Ross procedure, which has pros and cons against the other two options you mentioned. It's what I'm scheduled to have this spring. I'm an otherwise fit 59-year-old and having it done at the Brompton in London. Worth a Google if you haven't heard of it.I agree with all the others who have suggested to Facebook group. It's a life-changer, quite literally got me. Such a supportive group of people.
I went for a tissue valve. I didn't want to be on warfarin and, most of all, I couldn't stand the idea of hearing a mechanical valve when trying to get to sleep. I'm very happy with my choice, but either one works, of course. Good luck.
It's normally decided by age due to the limited life of organic replacements. Please don't worry about warfarin. It's no big deal, particularly if you buy a Coaguchek machine. I basically monitor myself but the surgery insist I must still dose through their instructions although, now I have proved I "understand" how it all works, I discuss with the nurse and we agree what, if any, changes of dosage are required but nowadays changes in dosage are rare!
I may add that very soon after surgery, it is a rare event to actually hear the valve ticking. I presume one gets used to it and ignores it.
At age 61 I had a tissue AVR fitted just over two years ago. Like yourself I was very uncertain which option to take. Even with a tissue valve I took warfarin for 12 weeks after surgery to allow the valve to bed in etc. Unfortunately a few days before I stopped I had a very severe nose bleed which required an overnight stay in hospital. I know the valve will need replaced at some stage but I was so glad to get away from daily doses of warfarin. Perhaps very rare but every choice will have its + and - . As it stands I’m keeping very well and I’m so pleased to have had a new lease of life. It’s a big but routine operation these days. Best wishes to you on your health journey.
hi, I had the edwards inspiris resilia fitted almost a year ago in 2023 at 48yrs old. I wasn’t in a great state of fitness and had symptoms for my regurgitation for more than three years leading up to it. It just took a long time to get noticed despite asking and having congenital valve disease lifetime monitored. Long story!!My LV was dilatated and I also had aortic root (oversize criteria) and ascending aorta replaced in that op.
Generally the op valve wise etc is successful. No leaks anymore.
But my body itself has struggled with recovery with several setbacks throughout, including a tooth abscess and extraction, numerous chest infections etc (almost 4-6 week recurrences), sternum inflammation, and then covid end of last year, that then rebounded back as pneumonia with hospitalisation. After that pneumonia i have now got afib (and its continuous palpitations) and for that I’m now on blood thinner (apixaban) and beta blockers for the stroke risk. Until the afib i was on aspirin. I didnt want to be on blood thinner esp warfarin, which was part of my valve choice. but this path has led me this way anyway it seems. Apixaban has been ok tbh though.
So, i am happy I got my choice tissue valve. I still feel the same. I took the chance i could live better on it. I dont know if a mech valve would have made things any better in my recovery with the same setbacks and infection history.
I feel that my deconditioned fitness preop, that has contributed to the ability for my body to recover and fight the numerous infections more effectively. Its a chance thing, and the coin had landed more on tails for me than heads. But im hoping i will get to a steady state soon- im still ticking afterall ! Maybe i’ll get off the thinner in the future if my afib can be fixed…
I had valve repair which didn’t work and went back in to get the valve replaced. I was 50/51 years old . I opted for a tissue valve because I didn’t want to be on warfarin. They put me on it for 3 months after my second surgery and I was so pleased I had opted for the tissue valve. I absolutely don’t regret my decision.
hi I had a mechanical replacement for my mitral valve in 2016 and it’s been tricky to keep my INR steady. I need to be tested about every two weeks on average to make sure I stay on target because I’m very susceptible to tiny changes in dose. Everyone is different and I’m probably not typical but this is possible. Good luck.
I went for tissue in Aug 2022, aged 50. My thinking was:A) I was sick of being a patient & having appointments all the time and just wanted to get back to normality; whereas warfarin would have meant more appointments and (in my mind) a more severe treatment than the five pills I'm on under a tissue valve.
B) I run a lot, I cycle a bit, I gym a bit. The tissue valve seemed more natural and more likely for me to have it integrated well and back to fitness. Probably not backed by science but in my mind, to me, it was easier to push an organic valve to its fitness limits.
C) I'm pretty clumsy and bruise easily. With warfarin I was fearful of getting a nasty bruise and internally bleeding to death.
The surgeon left it up to me but, at 50, was surprised by my choice. My Heart Failure Nurse thanked me for making her a better nurse with my explanation - she will stop pushing mechanical on to younger patients. I made the right choices for me. Rehab and recovery has been a breeze. Fitness is back, half marathons are back.
Could it have been the same with a mechanical? Probably. But it was about my confidence BEFORE the operation.
I'm hoping the valve lasts 18 to 20 years. I'm hoping for a TAVI next time. I'm kind of hoping that science will have moved on from that and a second operation will be even easier.
Will a second operation be tougher? Yes. Rehab can't be as perfect. I'll be 70. My wonderful partner, who has been so supportive, won't be able to be as supportive. It will be scarier knowing what is about to happen at every corner.
So the important thing for me, for you and for everyone is not to make the 100% right choice between tissue and mechanical. In many ways it doesn't matter. The important thing is to not regret the choice; we need to work on the mantra "I did the right thing at the time".
I would personally opt for Mechanical, the thought it could fail over time or the thought it could actually be part of an animal turns my stomach. A friend 30 years ago was offered Mechanical or Tissue(From a Pig) She opted for Mechanical 30 years on she's still going strong.
I opted for a mechanical aortic valve, due to my age (54). I did not want to go through such a major operation again when considerably older. Being on warfarin has not a major issue for me. My INR is quite stable and I usually go between 50-70 days between checks. I lead a fairly active life. Initially I could hear a slight clicking sound of the valve when in bed and all was quiet. My husband lying next to me could not. Now I don't hear anything. I haven't regretted my choice. Hope all goes well whatever decision you make.
I had the Edwards insurance valve put in by TAVI in April I was 75 so was lucky that they agreed to use this method rather than open heart surgery This valve is expected to 20 to 25 years and if needed replacing another TAVI could be done I am not sure what age group you fall into but can say that if you had a Edwards valve now and did need another one later the TAVI is only 2 days in hospital abd recovery time is much quicker . The only blood thinner I am now on is aspirin Look on face book for UK aortic and heart defects pre and post surgery you will get loads of support from them
Morning, I opted for the Edward’s Inspiris Resilia valve at the age of 56yrs old. It has a future intervention of valve in valve when required. I chose this valve after a discussion with my surgeon. Warfarin and the risk of constant ticking on every heart beat put me off the mechanical valve.
Hi I had my Edwards inspiris tissue valve in August 2022, I was 51 at the time. I wanted to live a normal life plus I do travel globally with my job. I did lots of research on valves and Edwards inspiris tissue is the one that’s the most chances of lasting longer and the option to have a tavi in the future without OHS again. It’s an individual choice that is very hard to make. Its good that your surgeon is offering the Edwards inspiris tissue I had to push for it as it’s very expensive. Good luck and you’re in safe hands. ❤️
thank you . Yes I have looked at the available research on the Edwards valve which looks promising . I am at the moment compiling a list of for and against for both and it is the long term use of warfarin that concerns me especially as one gets into late 70s and 80s . Supposing I get that far .
That is what I did, making a big list of + & - . Put a pen and paper on your bedside table as I would wake up thinking of things and forget in the morning. I ended up taking my little not book everywhere.
I now feel like a new man. I have to be careful with infections this would be the same for tissue or mechanical. Happy to answer any concerns if you want to PM me. It’s a tough ride but not as bad as I thought, once you’re out of ICU every day is a big step forward. I was home in 8 days some even get home in 5/6. I am now living a full life, if it wasn’t for the operation I would not be alive. I am so lucky and I can’t thank the NHS enough especially my surgeon, she was amazing.
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