Bluesea24

[Bluesea24]

Hi I had a biological valve replacement 4 years ago but unfortunately after a year it was picked up that I had HALT. I am now going to have another valve replacement and need to decide whether to have another biological valve or mechanical. Has anyone ever had the same situation and what valve did you choose. I am mid 60’s. Thank you.

[PadThaiNoodles]

Are they doing open heart surgery either way, or only if you go mechanical?

I needed my mitral valve repaired as well, so it was open heart surgery either way for me. I didn't really have a strong opinion one way or the other, but my surgeon recommended mechanical (I'm 60). Are you already on warfarin for the HALT? That's one of the bigger downsides of mechanical, so if you already know what that's like then it might make your decision easier.

[Hidden]

Hi, An interesting question for New Years Eve.

Sorry to hear about you having HALT and the consequences.

Whilst I've not been in the same situation, my experiences are similar.

I've always seen it as a numbers game, I started out with my first AVR at 33, so I had a plan for three surgeries with Tissue-Tissue-Tissue all the way. What I hadn't expected was my first valve going on for 19 years, putting my plans out of sync, so I was sort of in no mans land at 52 for the redo.

A few days before my second AVR I changed my mind and decided on Mechanical, for the simple reason that I thought it unfair on my family to go through a 3rd surgery especially in my late 60s or early 70s. In the event a number of complications occured including also replacing the Mitral and contracting Endocarditis which meant I had to undergo a third AVR and MV repair 3months later.

As you've already had a biological valve and the uncertainty of life spans, I'm assuming you had a plan for potential further surgery in a few years in any case.

One matter that rarely gets mentioned is the greater risk of surgery the 2nd time around and more so a 3rd as you get older.

[Mitchum]

Having only been 54 when i needed a new mitral valve I was advised to go mechanical because if not I would have needed another major surgery after 15 years or so. It also saved the NHS money! I think at your age it is normal to have organic as statistically it will last you for life anyhow . If you do have a choice, please don't let warfarin use become an issue. The myths surrounding it are legendary! I think the medical team will probably advise organic but you are borderline. Good luck.

[Lexi72]

Hi Bluesea I am not quite in the same situation but am having open heart surgery in the next few months to replace my aortic valve and probably the aortic root as well. I am almost 64 and after discussing with the surgeon was going to go for tissue not mechanical but had not factored in HALT risk . The NICE guidance says mechanical is a reasonable choice if you are under 60 and tissue over 65 and either is reasonable between 60-65. The main downside of mechanical is being on warfarin which creates a bleed risk but wit tissue you have reoperation risk ( as on average they typically only last 10-15 years although the New Inspiris ones may last longer)which skews the outcome statistics if you need further operations. My thinking was that I do not want to be on warfarin as I do not think I would manage it well but did not want a second open heart. The surgeon says that I would be suitable for a TAVI . Effectively by going tissue if I have a reasonable life expectancy I am choosing a TAVI ( with a reopertion risk) On that basis my surgeon said in my case choosing TAVI is reasonable but he would also not have advised against mechanical also reasonable. The problem with all of this is that all the studies look at average outcomes including average valve life Even mechanical valves can fail in some circumstances. After reading far too many studies I concluded on the advice of the surgeon tissue was best for me. However if you look at past posts on the subject everyone who has made a choice of tissue or mechanical made very valid choices suitable for their personal and family circumstances. In most cases the decision was linked to not wanting to go through or put their family through a a reoperation versus the risks and hassle associated with warfarin. Many hearties manage warfarin really well. I would talk to your surgeon and family and then decide what is best for you. I am now however going to ask my surgeon about HALT before confirming my earlier decision Best wishes Lexi

[Tlyna in reply to Lexi72]

Interesting on the longevity of the valves. Both my parents had aortic valve replacements. Dad had tissue in his late 50s and mom had mechanical in her early 60s. Dad lived over 20 years with his but then died because of his own bullheadedness. He had problems with fluid buildup and was on Lasix. Decided it was too irritating to have to urinate so frequently so stopped taking it and ended up dying. The valve was still working fine to the end. Mom is in her 90s now and still going even with advanced emphysema. I just had a TAVR in January and am in my 70s. Will have to see how long I last on it.