Aortic Valve replacement, mitral valve repair & possible by pass

[Fastlane2007]

Hi, I’m writing this post on behalf of my brother who is 56 and is otherwise fit and healthy! He found out at the beginning of this year that he needs his aortic valve replaced, mitral valve repaired and possibly a by pass (they won’t know for sure about that until the operation).

He has his date for the op, which is next Tuesday. He still hasn’t made the decision about whether to have a mechanical valve or a bovine valve. His surgeon and cardiologist have said they can’t guide him and have just given him the options. How do you make that decision without guidance from the surgeon?

We are familiar with a mechanical valve because our Mum had one and she really struggled with keeping her INR levels consistent. She unfortunately passed away 11 years ago, partly due to her taking warfarin.

The thought that if he opts for a bovine valve he might need another operation is a worry, or could he possibly have that procedure by TAVI.

I know ultimately it’s his decision, but I wondered if anyone had experiences of either of these options - good or bad! Thank you.

[Hanibil]

Hi I had a mechanical valve at age 48 in 2005 under the recommendation of my cardiologist and surgeon, as they said a bovine valve would only last around ten years where as a mechanical valve would last a lifetime. Who would want to go through that traumas again after ten years I don’t know.I believe having the mechanical valve was to best decision I have ever made. Almost twenty years now and at a recent check up I was told the valve is working perfectly. I do have to take warfarin each day but it presents no problem whatsoever don’t believe any of the stories you may hear. You can buy a self testing machine you use at home. Cutting hospital visits to two a year. As for activity with a mechanical valve I mountain bike and ski.

[Fastlane2007 in reply to Hanibil]

That’s really helpful thank you. I think the thing that is making it a harder decision is that the bovine valves are now lasting a lot longer than maybe 20 years ago, but there is no guarantee that this will definitely be the case!

[Hanibil in reply to Fastlane2007]

Say it lasts 15 years is he going to be fit enough at 71 to go through all the trauma again.

[Fastlane2007 in reply to Hanibil]

That is very true and would be my main worry!

[DodgyTickerMum]

Hi, having been through O.H.S last year to replace my mitral valve with a mechanical valve aged 49, like Hanibil , there’s no way I would be signing up to potentially repeat the process again with a tissue valve any time soon! I wasn’t even offered a tissue valve because of my age.

Like your poor Mum, I have had real trouble regulating my I.N.R. It’s supposed to be between 2.5 - 3.5 but recently fluctuated between 4.1 down to 1.7 in just 5 days. Fortunately, I invested in my own Coaguchek machine, so I can test at home and then advise the Anti-coagulation Nurses of the result. They then dose accordingly. It is a nuisance, but not insurmountable.

I think your Brother wld need to ask his Cardiac Team re the possibility of having a T.A.V.I procedure in the future, if a tissue valve were used this time around. Would he be even be a suitable candidate in a few years time? There are just so many unknowns, until he’s in theatre. My Surgeon advised I would be having a repair. I woke up 12 hrs later to the news I’d had a replacement and wld be on Warfarin for the rest of my life. Apparently, the repair wouldn’t withstand my blood pressure (which is low at the best of times).

At the time, I felt a bit cheated - because that wasn’t what I’d signed up for. But looking back now - having read my post op notes re quite how badly damaged my own valve was and the damage it has caused to my heart, I’m grateful that a mechanical valve was used. If I hadn’t had the op when I did, I may not even be here now.

I hope you get a few more answers and then your Brother can discuss with his Surgeons. Wishing him a speedy recovery from his surgery, whichever option he decides.

[Fastlane2007 in reply to DodgyTickerMum]

Thank you for your reply. Really interesting insight. Unfortunately his surgeon and cardiologist seem very reluctant to offer any guidance which is slightly frustrating! It’s good to know that you can now check your INR at home!

[Rhinos67]

Hello - I had OHS in April 22 to replace my Aortic Valve and root. My surgeon did make the decision for me based in my anxiety around hospitals and went with mechanical in the hope that it won't ever need replacing. Of course there are no guarantees and he said that if I'd insisted on a tissue valve he would have gone along with my decision.I'm sorry to hear about your mum.

I was really against Warfarin, but I'm coping fine with it. My valve is an ON_X and my INR range is 1.5 - 2. It took a little while to stabilise, but now it's absolutely fine. I walk around 5 miles most days and go to the gym regularly. I had to have a pacemaker fitted due to going into heart block as a result of the surgery but all OK and I'm very grateful that my heart defect was picked up and treated in time.

May I also recommend a Facebook group for you and or your brother to join.

UK Aortic and Heart Defects Pre and Post surgery. I got so much support and reassurance up to and after my surgery

Wishing him luck for his surgery

Joanne

😊

[Fastlane2007 in reply to Rhinos67]

Thank you do much for replying and sharing your experience! I’m sure it will help my brother to read them x

[HenningLob]

hi

My apologies if this is too late.

My husband was given a mechanical valve over 6 years ago. He was not given a choice really as he was 56 at the time and was advised mechanical was needed because of his still relatively young age. He does find that the valve thumps a lot and really struggled with this in the first few years as it caused him so much worry as he kept thinking something was wrong when actually it was ok. He still finds the thumping very invasive but tries not to worry as much. I have read up a lot onmechanical valves and it does seem that my husband is unlucky as not many seem to be troubled by the thumping. You are on warfarin for life with a mechanical valve. My husband's INR does fluctuate quite a lot and he does tend to have to have it checked every three weeks.

I hope all goes well for your brother and that you feel you manage to arrive at the right decision. It is difficult of course as there are pros and cons for both tissue valve and mechanical valve. My thoughts are with you and your brother.

[Fastlane2007 in reply to HenningLob]

Hi, thank you so much for your reply. He’s having surgery this morning, so he had to make the decision yesterday. It was a very hard decision for him, but he decided to go for a bovine valve in the end. Mainly because he has a very active job and was worried about being on blood thinners with his job. Fingers crossed it all goes well today! 🤞🙏

[HenningLob in reply to Fastlane2007]

I hope all is going well. I can see from comments that not all was straightforward but did read that your brother was feeling good! Remember the healing process is a marathon not a sprint ...!

[Fastlane2007 in reply to HenningLob]

Hi, thank you for your message. After the first “blip” he’s done amazingly well and he went home yesterday! He’s shattered, but very happy to be in the comfort of his own home where he’ll hopefully get some better sleep and be looked after by his wife and children!!!!

[Mandntong]

We are having the same dilemmas at this moment too, my husband is 52 and we have the decision to make of biological valve or mechanical , however our professor advised that due to my husbands age the biological would wear out quicker and another operation would be needed within the 10 years. My husband is swaying towards the mechanical and warfrin. When consulting with his drs they did mention a new drug which is going through final test for being passed which does the same job as warfrin without all the complications. It's such a big decision to make. I wish your brother luck whatever he decides and hopefully his recovery is as quick as possible, pain free and gets back to living his best life .

[Fastlane2007 in reply to Mandntong]

Hi, thank you for your reply! He opted for a bovine valve on the end. He has quite an active job outside and does a lot of cycling and was really worried about the warfarin. It really is such a hard decision to make. He had his op yesterday and it seemingly went well, but then he had a bleed abs had to go back into surgery to be reopened up again! This morning though he was sitting in his chair and is feeling good! Quite amazing really!!!!

[Mandntong in reply to Fastlane2007]

So pleased he's doing ok, after his set back. Amazing to think he's sitting up today. Sending him health and happiness 😊

[Fastlane2007 in reply to Mandntong]

Thank you! Our bodies are quite amazing!