Aortic valve replacement

[Carrotcakemad]

Hello. I have been given a very short notice, 7 days, for my AVR surgery. I am running out of time and still have not decided whether to go for the mechanical or tissue VR. I would like to hear from anyone who has had either valve. I have read thoroughly the pros and cons for both. I am 63 so the surgeon and leaflets say I could have either. Your experiences will help me decide. Once it's done I have to live with it, that is why this is very important. Thank you in advance.

[Taviterry]

I'm not sure that there's much that we can add to your similar enquiry of a month ago, which had 40 replies. Early on in that discussion, you stated "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 can't recall if we addressed the first question , but the first two issues apply to both operations, and I've never had the need for monthly blood tests after my TAVI. In the past 18 months I've had plenty of such tests for haematological reasons, but none directly for cardiological ones. As I understand it, a mechanical valve is usually for life, with different estimates of how long a tissue valve will last. Valves are being improved all the time, but I've noted authoritative statements that they may start to deteriorate after eight years or so but may not need to be replaced for 20. I also gather that while a second TAVI is usually successful, a third is more complex.

These are my own observations, for what they are worth.

[Carrotcakemad in reply to Taviterry]

Hello Taviterry. Yes, I failed to retrieve the old messages. I suppose I am asking again and again as I am terrified so I am using the "voting system". I have never been in a situation where I have to decide what's the best procedure to keep me alive! Thank you again for getting back to me.

[PadThaiNoodles]

I went with mechanical, because that's what my surgeon recommended for my age (I was 60 at the time). To be honest, when he said "warfarin for the duration", I thought "what's one more pill?" -- I wasn't cognisant at the time of the extra monitoring, etc. required by warfarin.

That being said, I haven't found it onerous. They put the warfarin people to the front of the queue at my hospital so when I do have to go in for bloods I'm in and out in 5 minutes. You can also get home-monitoring machines, but I haven't bothered. I'm happy enough to pop in and have a quick chat with the nurses in the phlebotomy dept.

Having not gone the other route, I can't say if requiring a re-op in 10 to 20 years would weigh on me. I have generalised anxiety disorder, though, and while it's reasonably well treated with an SSRI, I was happy enough not to poke that bear....

[Carrotcakemad in reply to PadThaiNoodles]

Thank you padthainooodles. I remember you replying to me but I could not locate the old posts. I think I may be losing my mind through anxiety and inability to decide. The short notice has put me off balance. I need to be emotionally prepared. I'm terrified.

[Fastlane2007]

If you go into your profile you can access your previous posts from there and you will see all the replies. My brother had his aortic valve replaced and mitral valve repaired in August and he hadn’t made the decision right up until the evening before his op! He went for a bovine valve in the end, mainly because he didn’t want to be on warfarin for the rest of his life. Our Mum had her mitral valve repaired and the repair only lasted two years and then she decided to have a mechanical mitral valve. She struggles with warfarin, mainly because her inr levels were never stable, this probably contributed to my brother making the decision he made. He was 54 when he had his op. Good luck with whatever you decide. It really is a difficult decision to make!

[Carrotcakemad in reply to Fastlane2007]

Thank you Fastlane2007. The more posts I read the closer I am getting to making a decision.

[highburyted]

hi

I had my aortic valve replaced in 2023. I was high risk due to COPD and weight gain due to inactivity caused by the valve.

The surgery was totally successful. They know what they are doing. My valve is absolutely fine.

Today I’m leading a good life although still trying to get the weight off

Try not to worry to much but I know it’s difficult, I did for 3 years until they got to me

I’m 69 by the way

highburyted

[Carrotcakemad in reply to highburyted]

May I know what valve replaced, tissue or mechanical? Thank you.

[highburyted in reply to Carrotcakemad]

My Aorta valve it was tissue not mechanical done by keyhole surgery. Surgeon was brilliant

highburyted

[Bookworm60]

It's hardly surprising you're feeling the way you do. It's big surgery. But you will see there are dozens of us on here who have been through it and are back leading life to the full.I agonised over which way to go. Simple answer is that both have pros and cons and there's no real knowing if you made the right choice 😂. I went for a tissue valve as not having to take warfarin and have associated checkup s was important to me. I didn't want to be 'medicalised'. And that has been good. Also I hated the thought of hearing it ticking...i thought that would mess with my head. But I'd probably have stopped noticing after a while ? But of course I now face the possibility of another procedure at some point. I occasionally think they was mad thing to do! I was 61. I cashed in a small work pension to go private as there was a long waiting list post COVID in 2021. As a result was able to pay for a valve that allegedly will last up to 25 years. Who knows. Neither decision is right or wrong they both have pluses and minuses. Choose your pluses! Sending positive vibes. It's not as bad as you think. Tough yes. But we can do tough things ❤️

[Carrotcakemad in reply to Bookworm60]

Thank you Bookworm60 for the useful information. I was told the tissue valve lasts up to ten years, so which one lasts to 25 years? I am getting closer to picking the tissue one.

[Bookworm60 in reply to Carrotcakemad]

The Edwards Inspiris Resilia valve. It can - allegedly - last up to 25 years. But it hasn't been around long enough for that to be proven and that was made clear to me. So it's definitely still a gamble. Wasn't available via NHS when I had my op in 2021 so that was a positive effect of having to go private to avoid a year's wait..I still sometimes wonder if I made the right choice, but my feeling is you just have to pick one then get on with your life and don't look back. Let us know how you get on xx

[NikPark]

hi, I am late 40s and recently had my mitral valve replaced via OHS. I decided on the biological valve because I didn’t want to manage warfarin appointments etc and also I do a number of out door activities like horse riding where there is a greater risk of a fall which isn’t good for the blood thinners. I will need the valve replaced in 10-15 years time but I understand from my surgeon this will be keyhole rather than OHS so check that with your surgeon. From my perspective I decided that my lifestyle favoured the biological valve even though my age means a new valve will likely be needed. And in a funny way it is really making me focus on being even more fit and healthy over the long term to keep my current biological valve going as long as possible and be in good shape for the surgery whether it is keyhole or for some reason ends up being OHS. Which can only be good for my overall health and other potential medical conditions - so for me the biological valve is now a useful reminder that I need to look after my body and health is a priority. My husband and I have also started to save a separate pot of money so I can go private - so being able to plan over time and give myself more control over timing etc. The choice was still difficult as going through surgery twice is very daunting but I feel comfortable with the mindset it has given me . Hope this helps.

[Carrotcakemad in reply to NikPark]

Thank you NikPark. The tissue seems to be winning. For you it was easier to choose because of your age. I will be having an OHS and will get more information on the second surgery.

[Redfloyd]

This is the link to your previous post

healthunlocked.com/bhf/post...

My AVR was a bit of an emergency, I met my surgeon 2 hrs before my op and that was the first I knew about about having a choice. I went for a tissue valve solely because I didn't want to be on warfarin. My father in law is on warfarin and while it was ok when he could drive now that he doesn't he has to rely on the family to take him for blood test. I didn't want to be a burden to my children. Also I'm only 62 and assumed I would be going back to work so appointments would be difficult to attend. As it turns out I'm not going back to work because my employer gave me the option to leave due to ill health and I have found out since that home testing is an option. That said, I've no regrets about my choice.

[Carrotcakemad in reply to Redfloyd]

Thank you for the information. The tissue is still in the lead and my confidence is building up.

[Hythe123]

hi, I had Edwards Inspiris Resilia as the claim is it can last up to 25 years and I didn’t want Warfarin hastlw. Also tissue can be replaced by TAVI if needed. Good luck

[Carrotcakemad in reply to Hythe123]

Thank you, again, Hythe123. I need to ask my surgeon about this Edwards Inspiris Resilia and TAVI.

[john5438]

For what it's worth I have a tissue valve. I took what was offered and did not have a choice. Apparently. but on say so, you can hear a metal valve "click", but as I do not have one am not sure if this is so.

[Carrotcakemad in reply to john5438]

Thank you john5438. The tissue valve still in the lead. I am getting closer to making a decision.

[Lexi72]

Hi carrotcakemad am still going for tissue valve although I had a wobble recently ( am now 64) so either is reasonable for me under current guidelines. The way I approached the choice was I don’t want to be on warfarin as I don’t think I will cope but really don’t want a second open heart operation.- am worried enough about the first . I am told I should be able to have a TAVI as second operation (not everyone can if you are little they sometimes don’t fitand sometimes you still end up with OHS even if they start off doing a TAVI) if I outlive the valve. So am going to go for that given tissue valves now last longer on average Surgeon confirmed this was a reasonable choice. But mechanical as also still reasonableMost people on previous posts seemed comfortable with their choices which were all made for very valid reasons. There is generally no right or wrong choice. Interestingly there is a huge variation in choice amongst different hospitals and take up of tissue is higher than guidelines .Good luck for your operation - take care Lexi

[Carrotcakemad in reply to Lexi72]

Hi Lexi72. I agree, there is no right or wrong decision that is what makes it very difficult especially at short notice. Thank you very much. I am a stroke away from making up my mind.

[DilatedAortaRunner]

I’m 53 and had aortic arch / ascending aorta replacement and new aortic valve 15 weeks ago. I went for a mechanical valve as I didn’t want to face crest surgery down the line. The warfarin and testing is quick and straightforward and can often be done at your local surgery as well as smaller hospitals. I have maintained same diet and have been very stable but stress and increasing exercise regime has recently given my INR a small wobble but it’s been straightforward to deal with. As I up my running I’m sure it will be impacted again. I now go every 2 weeks but was every 4 weeks and once my running is back to normal they envisage it will be every 6 weeks. Since I get a feeling of PTSD every time I go back to the hospital I had my surgery done in I feel happy with my decision . The only lifestyle change for me is stopping at 1 1/2 pints down the club rather than 5 or 6 which I actually don’t miss !!!!!

[Carrotcakemad in reply to DilatedAortaRunner]

Thank you DilatedAorticRunner.

[Petitlady]

you must be feeling very anxious, but as others have said a lot of us have been through this. I’d try not to focus on the valve choice. To be honest I think the surgeon has usually decided and just steers you in that direction. I have a tissue valve and was told that the more modern valves last a long time and if it needs replacing should be suitable for a TAVI implant. Wishing you well!

[Carrotcakemad in reply to Petitlady]

Thank you Petitlady.

[PadThaiNoodles]

Here's another way to think about it: easy decisions are those between a good and a bad choice. This one is hard because they are both good choices.

But that also means it doesn't really matter that much; you'll do fine with either.

Good luck with your decision making!

[Carrotcakemad in reply to PadThaiNoodles]

Thank you again, PadThaiNoodles.

[andgrant1]

hi, I am coming up to 1 year since AVR and ages 58. Opted for the mechanical valve as would not want to face going through the same surgery again in my 70s and was told that the mechanical valve will last for the lifetime. I bought the home testing machine to check my INR level and it is very simple to do this. The ticking noise is difficult to describe as it is louder to me than others hear it and it can take some getting used to at night in particular. I just am very grateful to still be here really. I hope you make the right choice for your own circumstances and wish you the best for a speedy recovery. If you look on my profile I wrote a blog of my story in recovery which may help you to read also.

[Carrotcakemad in reply to andgrant1]

Thank you andgrant1. I think at this point I am getting very close to making a decision.

[Anon2023]

hi. I have had two mechanical mitral valves fitted. The first lasted 3 months but only because I contracted endocarditis. The most recent one is going well and I had a heart scan on Thursday confirming this. Warfarin is a nuisance but totally doable. I have a good relationship with the inr team and get great support from them, in fact they are the only medical professionals that I have regular contact with. I also have my own coaguchek machine which I use for holidays etc and it's very easy to use. I went with mechanical because I was told it would last longer and because my surgeon recommended it. Both types of valves have pros and cons. Good luck.

[Carrotcakemad in reply to Anon2023]

Thank you Anon2023.

[Bikafella]

Had a TAVI a year ago - it went just as the the guidance pamphlet said. Was not a major op but a common procedure at Barts London. I was already taking a daily 75mg Aspirin and no other medication required. Took about a month to get my fitness back from worst it had been to being able to cope with steep slopes and many stairs. My cardio man said that he always uses a bovine type of valve as they're the best. I wasn't worried about any of it as my active life had been seriously affected.

[Carrotcakemad in reply to Bikafella]

Thank you Bikafella. I will look up what TAVI is as my surgeon or leaflet didn't mention this. You did not say if you had a mechanical or tissue. I have 5 days to decide.

[Bikafella in reply to Carrotcakemad]

TAVI = a minimally invasive procedure to replace a damaged or narrowed aortic valve with a new one without open-heart surgery. It is minimally invasive - the replacement valve is deployed through an artery in the groin directly up and into the old aortic valve. I was awake the whole time and it was overall painless. But you may not be s candidate...

[Carrotcakemad in reply to Bikafella]

I suppose I just take what I am offered. I will still ask questions about TAVI before my surgery. Thank you.

[pmh131953]

Hello, I made the decision to have metal valve because the synthetic valve could 'wear out' in 15 years or so and I didn̈t fancy having the op again in my eighties.I have no issues with the valve, all fine after 6 years. However taking warfarin has complications. You have to have regular blood tests (3 to 8 weeks but varies on each person)to check you are in the correct theraputic range. If blood goes too ' thick' you need to first know this, and then be given injections to carry out injecting yourself with Dalteparin sodium with small needles and syringes . This helps thin the blood into the correct theraputic range.This is easy to do and not painful. If you have to have a surgical procedure/operation a plan from the warfarin clinic has to be put into place which may involve what I have explained above. Good luck with your research and asking questions to the right people. You still have time to get more info to help with making the right decision for you. Regards Phil

[Carrotcakemad in reply to pmh131953]

Thank you pmh131953. I have 5 days to decide!

[Taviterry]

Hi again. I hope I'm not muddying the waters, but you wrote above: "I will look up what TAVI is as my surgeon or leaflet didn't mention this." It's a TAVI that inserts a tissue valve, usually up a vein from one's groin See here: bhf.org.uk/informationsuppo...

As I understand it, one's likely to stay in hospital longer (a week??) after having a mechanical valve than after a tissue (perhaps one night - I was kept in a second to see if I needed a pacemaker - I didn't). I had to be careful for three weeks after my TAVI; a friend who's just had a mechanical valve has to be for three months.

Without adding to the pressure you're feeling, a decision now might help you plan your convalescence - I was advised to have company for five days or so after my TAVI just in case and arranged on-line shopping for a month because I wasn't allowed to drive.

[Carrotcakemad in reply to Taviterry]

Thank you for the information and help to decide.

[123isla]

I had a mechanical aortic valve replacement in in 2003 in my 50s. I don't think I had much choice except knowing that it would last and wouldn't need a replacement. Warfarin was difficult at first as it was a proper blood test and I used to get very bruised arms and spent hours waiting at blood department in long queues but then they changed to a fingerprint test and now it's so easy...two minutes and done at local surgery. Normally stable and can ho up to 6 weeks till next test. Eat almost normally except ecsesses of dark greens . Just need to be aware of things. As for the ticking of the valve..yes I still hear it but you get used to it. Worst is at night but we got over that ..mu husband bought talking books or audible and we listen nightly. Book lasts ages as it sends me to sleep very quickly. Still wonder though if it can be heard in a small space like a lift..don't really think so. .

Well good luck with the op and hope you make the right decision for you.

[Carrotcakemad in reply to 123isla]

Thank you for helping me to decide.

[Bluenose10]

I had an AVR six months ago. It was tissue, bovine pericardium, so I am now part cow. I have had no issues with it and my fitness and life in general has massively improved since the OHS. So, tissue, no clicking, no warfarin. But, I was 73 at the time of my operation so the tissue valve will presumably see me out; you are ten years younger thus, as I understand it, you might have to have a second tissue valve inserted whereas the mechanical valve would last your lifetime. The operation itself and the recovery were certainly not as bad as I feared, but I would not want to go through it again… So I appreciate your quandry; I cannot say what would be best for you but just be assured that your life should be better for going through the AVR process no matter which valve you select.

[Carrotcakemad in reply to Bluenose10]

Thank you for your support. I laughed at the "being part cow" and thought to myself "Good thing I became vegetarian since last year 🤣. It is the toughest decision I ever have to make. I will probably have regrets on choosing one instead of the other. I will be ok when the day comes.

[Summerlavender]

Hi, I went for a mechanical valve last May and was 49 at the time, I’m very glad I did as I’m a worrier and would have been a bit more anxious about when the tissue one starts to wear out. I’m sure either is fine or you would have been recommended which to go for by your surgeon. The warfarin is easily managed and I’m in and out in five minutes, i did buy a home test kit for my own peace of mind which I do once a month (in the middle of my hospital checks). The ticking weirdly I found not horrible, after my op it was strange but kind of reassuring that I could hear it working well 😆 you can only usually hear if you focus on it and it quiet.

Best of luck with whatever you decide and I hope it all goes smoothly.

[Carrotcakemad in reply to Summerlavender]

Thank you for the information and assurance. I would have the mechanical if I have enough courage to deal with warfarin and blood testing. A second surgery in 10 years time is not pleasant either. My surgeon said it was up to me. I will try to get back to him. Not hopeful to reach him as I have 3 days to go 😪.