Aortic valve replacement

[Carrotcakemad]

I would like to hear from anyone who has had either a mechanical or biological aortic valve replacement. I have a basic information but finding it hard to choose which one is best for me. The surgeon said it was up to me and cannot help to decide. It would have been easier if I was under 55 or over 70, the mechanical would have been the only choice. I am 63. Thank you.

[Taviterry]

When I clicked on your post, links to a number of previous relevant threads appeared on the right. A mechanical valve requires the chest to be opened up for it to be inserted and recovery takes a couple of months. In my case I was 77 and judged sufficiently frail NOT to have surgery for a mechanical valve; there was little or no discussion and I was offered a cow-tissue valve that was threaded through a vein from my groin in a procedure that took an hour. The next day I accumulated 70 minutes of walking in half-a-dozen stages around the ward, then the hospital, with 90-minute accompanied walks in the countryside during the next few days. I might have been discharged after one night, but was kept in for a second just to confirm that I didn't need a pacemaker.

If all goes well, the mechanical valve is for life, but a tissue valve may last only ten to fifteen years, after which it may need to be replaced. I gather that the op can be riskier the second time around.

[Carrotcakemad in reply to Taviterry]

Thank you Taviterry. At this point I have all the info from my surgeon and the group. The problem is choosing which one to go for as both have almost equal pros and cons. I will be asking myself these questions: Can I handle blood thinners, avoid certain foods and get my blood tested every month? Do I want a second surgery to replace my old valve after 10 years? I will keep reading the posts and probably have another consultation with my surgeon. Thank you.

[PadThaiNoodles]

The TAVI vs open heart surgery question wasn't on the table for me as I also needed mitral valve repair -- so it was OHS either way.

I went with a mechanical valve mostly because that's what my surgeon recommended. (I'm 60.) But I also have major depressive disorder, and while it's pretty well treated, sitting around dreading the next operation was still a potential issue.

Warfarin has been pretty easy for me. Once I got within my therapeutic range I've never been out of it. I get a blood test once a month now, but I think that might even move out to every 6 weeks.

Either way, don't second-guess your decision. They can both work really well.

[Eewee]

hello, I have a tissue aortic valve replacement because I wanted a better lifestyle of not having to manage warfarin. I know it will need replacing in about 10 years or so but so be it. I had OHS in April 23. A mitral valve repair and this. I must say life is completely back to normal except I am on entresto and a couple of other meds which is fine. So you need to weigh up blood tests every few weeks with a mechanical valve against a TAVI procedure in 10 to 15 years time. I chose the latter. Im now 63. Hoping this is helpful.

[Carrotcakemad in reply to Eewee]

Hi Eewee. I could go for the biological one but what scares me is that the second surgery after the tissue has worn out, is said to be dangerous. I'm still on the fence, not sure of what replacement valve is best for me. I can't help being anxious.

[Skiffrower]

I was 67 when I had aortic valve replacement and mitral valve repair so like padthainoodles it was open heart surgery for me. My surgeon was happy for me to have either but was inclined to go for a tissue valve so that I didn't need to have blood thinners . I have a cow tissue valve . My daughter had her aortic valve replaced at 18 with a tissue valve and it is still fine at 35 and after all the stress of pregnancy.

[pigeonCl-HU in reply to Skiffrower]

Thanks Skiffrower, the info about your daughter having the tissue valve in situ for 17 years(!) is certainly very helpful.

It just goes to show that the valve placement after a decade is not cast in stone, and one can live happily with a biological valve for way over 10 years, including pregnancy🙂

Personally i would also be inclined to choode a biological valve.

pigeon

[Coper10]

Hi, I had an AVR by OHS when I was 52 and my surgeon suggested a mechanical valve due to my age. My INR took a little while to settle initially but is now very stable and usually only needs testing about every 70 days. I don't find it really impacts my life negatively. OHS is a major operation and takes a while to recover from, so I didn't really want to have to go through it again if it could be avoided. Wishing you all the best.

[Redfloyd]

I had a biological valve last year at 61. Because mine was an emergency and I literally met my surgeon a couple of hrs before the op I had less than 5 mins to decide. I was told I might hear a mechanical one and would have to be on warfarin for the rest on my life and have to monitor that. Biological one would have to be replaced after 10 years or so. So far happy with my choice, ask me in 10 years time.

[Carrotcakemad in reply to Redfloyd]

Hi Redfloyd. I wish I had your courage and positivity. One moment I think the mechanical is ok for me then the next I want to go for the biological one! I still have a long time waiting but hopefully as soon as I get the date I would have made up my mind. It's so hard to decide.

[Survivor1952]

We are all different will be my first comment, circumstances differ for each of us.

I was 70 when I had my bovine valve. I didn’t want to be on blood thinners for life, a decision that I feel was correct for me. I was very glad to finish the year of blood thinners I did have.

I was told that my valve should be good for 18-20 years although I am aware that they can fail at any time. There is always, with a tissue valve, the option of TAVI for up to two further valves so OHS may be avoided a second time.

I’m now 21 months on with my valve, I feel great and certainly not my calendar age of 72+. I do a cardiac circuit gym session weekly and also parkrun (a 5k walk/jog/run) where my age grade is currently around 45%. I did my first parkrun exactly 3 months after surgery.

At the end of the day it is a personal choice and not one where individuals can be slotted into a box according to age.

[Carrotcakemad]

Thank you all who have responded to my post. Having blood thinners and clicks on a mechanical is still on the same level of worry and anxiety as having a second risky replacement after 10 years for a biological. The decision is mine but I am still on the fence. Hopefully by the time I get the surgery date, I would have made up my mind. It's so hard and not straightforward. The positive thing is you are all doing well.

[Hythe123 in reply to Carrotcakemad]

I went for Edwards Inspiris tissue valve as the claim is that it will last 29-25 years.

[Carrotcakemad in reply to Hythe123]

Hi Hythe123. May I know where you had the surgery done? My surgeon ay BHI and other sources said the tissue valve lasts 10 years.

[Hythe123 in reply to Carrotcakemad]

Edwards Inspiris Resilia is claimed to last 20 to 25 years, it is relatively new, so has not been around for that long. I had mine done in Southampton last year.

[Carrotcakemad in reply to Hythe123]

I am glad to have found this group 😃. My surgeon did not give me that information at all. Unless it's not done in Bristol? I will ask him about it as that would make my decision easier. Thank you Hythe123.

[Hythe123 in reply to Carrotcakemad]

Your welcome. I have read that they don’t really push the Inspiris Resilia as it is quite expensive. I told my surgeon that that was the one I wanted, he had to check that it was available and permitted and luckily it was. I think unless you ask… I did research this one so I was certain that was the one I wanted. Good luck, let us know .

[Carrotcakemad in reply to Hythe123]

Thank you Hythe123. I will update you.

[DilatedAortaRunner in reply to Carrotcakemad]

I am a very light sleeper and never even used to get to sleep with the ticking of an alarm clock by my bedside. The mechanical valve i have fitted (I’m 53) ticks but incredibly has never bothered me during sleep. My surgeon recommended mechanical valve my age. Best of luck

[Lexi72]

hi Carrotcakemad, I would really recommend using the search function and looking at previous trails on this subject as they will give you a really wide range of points of view on this subjectThere are some really good posts which show that both choices are very legitimate choices particularly for someone of your age. Between 60 and 65 the NICE guidlines indicate that both are reasonable choices. There is a trade off between reoperation risk given the expected lifetime of tissue valves(which has improved)and the risks and practical issues of being on a lifetime of warfarin. Some hearties on the site consider that they would only ever want OHS once and they should never put themselves or their families through it twice. Others are prepared to accept that they may need a second operation but if they are suitable for a TAVI (not everyone is) they will accept this risk. I am 64 and waiting for OHS for valve and aortic root surgery. I discussed with the surgeon and am currently still intending to go for tissue but did have a wobble recently about whether this was the right decision. Most people on the site who have had their valves replaced are all very comfortable with their choices. Many say that warfarin monitoring is not too difficult but others (not everyone)cope very well with it with a home monitoring machineI would do some further research (maybe not read research studies like me you end up in a loop) and then discuss with cardiologist and surgeon and also your family best wishes ps am not worried about the problems with eating a consistent level of broccoli if I was on warfarin as I hate broccoli best wishes Lexi71

[Carrotcakemad in reply to Lexi72]

Lexi72, thank you for the detailed information. That is going to help me think deeply and decide. My surgeon was reluctant to give me the choice.

[john5438]

I was 86 when I had a TAVI with a cow hide valve and am feeling great. I can walk about 2 miles, on steep hills I may need a rest or 2 but can only recommend the procedure

[Ageingfast]

hello Carrotcake

I had my valve done during covid. Nurses and surgeons had loads of time to talk to me before and after. I had an TAVi specialist and an OHS surgeon on hand.

I opted for the Edwards Resilia tissue valve. But be aware different hospitals may well not have all the options.

These valves are improving all the time and the suggestion is that a tissue valve is now likely to last for 20 or 30 years. As I was 73 it made the choice easier.

As you have already mentioned, most of us are pleased with the outcome. I am thrilled with my new valve. And I did not find the op too bad. The recovery time is long, about 14 weeks for me, but it’s not bad. Got better every two days. In any case, my option was new valve or die. After the op it was intimated I only had a few weeks to live, so it’s a pretty desirable operation.

Can I clarify that it’s tissue or metal with OHS, but tissue only for TAVi. You can have either valve at an older age.

Mine is five years old and so far so good. Since then, the valves now have an option for TAVi at a later date ie a second op.

You will probably be very stressed beforehand. I was terrified. But once I got to hospital the stress melted.

I had no visitors whatsoever and, to be frank, that was a better option than visitors, you are highly likely to have your own room, which is rather nice.

I was in central London (Cromwell) a long way from home. So I got an ambulance home, which was cool.

My scar was no problem, although us males have a much better deal than the females. And removing the “stitches” was best ever. They aren’t normal stitches so they came out very easily.

Before the op you are likely to have appointments for three pre op tests. Because of Covid, I had these tests as an inpatient. That was really good.

I can not express the wonderful moments when I realized I had my life back. If only all ops were like this !

Sooty

[Carrotcakemad in reply to Ageingfast]

Hello Ageingfast. Thank you for your reply. I have never heard of Edwards Resilia or TAVI. I need to find out more.

[Ageingfast in reply to Carrotcakemad]

Dear Carrotcake

There are two main ways of placing a new valve. OHS is open heart surgery. Major surgery to access your heart.

TAVi is where they place a tissue valve without full surgery, often via the groin area. I think it’s trans catheter aortic valve insertion but you need to check my wording. You get a local anaesthetic. Recovery is much much faster. But the procedure is not 100% reliable and ideally an OHS surgeon needs to be on standby.

Edwards Resilia is one make of a tissue valve. Highly recommended but there are other makes. Generally, each cardiac hospital has its own preference.

I personally don’t want to know the gory details, which I find is the preferable option.

Best wishes

Sooty

[Classof1988]

Carrotcakemad, I can see your dilemma and the choice really is yours to make. Personally, if I was in your position I would choose a mechanical valve. They do last longer and are better suited for an active lifestyle. My valve will celebrate it's 37th "birthday" in a couple of days! Though open heart surgery isn't really that bad, I still wouldn't want to have the worry of having to go through it again at a more advanced age. Warfarin is not an issue at all for me, I have rarely gone out of range and I eat whatever I want to (including grapefruit, which is a delicious refreshing breakfast essential). I know that tissue valves are much improved now but I have no regrets about my choice of mechanical. The most important thing is not to worry about the surgery itself, mine was virtually painless, and I was back driving after 8 weeks and at work after 12 (would have been 10.but had to wait for Occupational Health to see me first. You should feel much better once your new valve settles in, whichever type you go for.

[Carrotcakemad in reply to Classof1988]

Hello Cof1988. I am worried more about blood thinners than the mechanical valve. Thank you for making it lighter. I am getting closer to making a decision but unfortunately not the surgery date.

[Taviterry in reply to Carrotcakemad]

TAVI is the method of inserting a tissue valve, as I described in a previous post. The day after my op, I was told that my new valve was fully working, with advice to "take it easy" relating to the very few stitches in the groin area (and to recovering one's energy). One has to avoid putting any strain on them, they have to be kept clean and they eventually dissolved.

My understanding is that medication after having a tissue valve causes fewer issues than after a mechanical one. In the first case, aspirin and an anti-platelet such as Clopidogrel are often prescribed together, with the aspirin sometimes being discontinued after a while. I was only prescribed Clopidogrel, which thins the blood, making it difficult to stem the flow from a cut, and also means one can bruise easily. It can also affect the stomach, and there was disagreement among my health professionals about whether I should take an antacid such as Lansoprazole. (The last cardiologist that I saw agreed with my policy of taking it only when I had stomach discomfiture, which happens rarely.)

TBH post-op medication never concerned me, and the Surgeon's information sheet warned of various effects (as I'm sure briefings about mechanical valves do) that never materialised.

[Carrotcakemad in reply to Taviterry]

Thank you Taviterry.

[Classof1988]

I am glad to have been able to help a little bit. Having been on Warfarin for 37 years as from tomorrow it hasn't given me any side effects and I haven't had any problems. My blood tests for INR can be up to 10 weeks apart, though home testing is also possible. Even when I did go out of range this was picked up at my next test and adjustments made to the dose while I was unaware that adjustments were needed as I could continue life as normal (and that at one time meant early late or night turns at work with 25 hours a week commuting on top). My valve was fitted while I was still symptom free but even then I felt more energetic within a few days. I hope and pray that you get a date soon and can experience the benefits of whichever valve you choose. And if you get offered cardiac rehab post surgery go with it - I know a lot has changed since I had mine but it is definitely worth going on a course.

[Carrotcakemad in reply to Classof1988]

Thank you Classof 1988. I am getting closer to making a decision.

[PadThaiNoodles in reply to Classof1988]

Yep, I just finished my 8 week cardiac rehab course. Highly recommended.

[Mitchum in reply to Classof1988]

Good reply. The side effects and necessary changes to day to day living with warfarin are so minimal as to be almost irrelevant, provide you keep constant.

[Carrotcakemad in reply to Mitchum]

Thank you for the assurance. I hear so much negativity regarding warfarin. My husband even suggested I choose the tissue but would I want to go through a second risky surgery after 10 years of the first?

[Mitchum in reply to Carrotcakemad]

Your dilemma is your age, being on the borderline between young enough to necessitate mechanical and old enough for tissue without the need for further surgery! I do appreciate you have a difficult decision to make.

[Haggislover]

Did you ask the surgeon about the life span of the replacement valve. If you have this information you can make your own judgement.

[Carrotcakemad in reply to Haggislover]

Yes Haggislover. I have all the information. The hardest part is making a decision after weighing out pros and cons for either valve. Thank you.

[Mitchum]

Read all my posts regarding warfarin. It's virtually problem free!

[Carrotcakemad in reply to Mitchum]

Hi Mitchum. I have scrolled up and down bur haven't seen any posts about wayfarin. I am very much interested.

[Mitchum in reply to Carrotcakemad]

You are quite welcome to PM me with any specific questions whatsoever and I will answer you. I have, after 22 years, become adept at controlling it, even to the extent of giving tips, which were requested, to my cardiologist! Fire away.