Artificial valve + lifelong warfarin, or less durable animal valve?

[PetSounds]

I have a choice between an artificial valve and a biological tissue valve.

My understanding of the pros and cons -

Artificial valves last forever, so the surgery will only need to be done once.

Biological valves (from cows I believe) wear out faster than the human valves we are born with. As I had a v active lifestyle and intend to continue with this after surgical recovery, a tissue valve will probably last around 10 years for me. Worst case scenario.

Thus requiring another round of major surgery when it wears out again in 10 years. With all the risks of repeated major surgery in the same location.

Artificial valve requires constant warfarin to thin the blood and prevent clots. Regular monitoring and constant impact on lifestyle, diet. Also larger risk of various haemhorrage problems, and unstoppable bleeding in an accident.

No warfarin for the tissue valve.

I'm 49 years old with a severely leaking mitral valve.

Has anyone with experience of the artificial valve, the tissue valve, or the warfarin got any advice? Anything you wished you'd known beforehand? Any other factors I should consider?

Many thanks 😊

[Traveldreams]

I was given the same choice although luckily ended up with my repair. My consultant suggested that under 50 they usually suggest mechanical, over 65 animal, in the middle choice. I had opted for mechanical. I knew it was a possible issue for sound from the valve and the warfarin but for me personally I couldn’t stand the idea of needing another ohs in 10 years (55). It really is a personal preference. I read reports on here from people who had both operations and their experiences. Best of luck

[Sion52]

Hi there, I opted for a mechanical mitral valve in 2017. I was 51 at the time and both surgeon and cardiologist steered me towards a mechanical valve because I have an excellent fitness regime. However, I understand your concerns. I made some adjustments to my lifestyle, no contact sports, gave up alcohol and after a year my GP agreed I could self-test my INR at home. I do this every 4 to 8 weeks. I have had no problems with warfarin, apart from the odd bruise on my leg after gardening and avoid cranberry and grapefruit juice. Life is good and I am thankful for my replacement valve. All the best.

[rubyred5051sew]

i had a MVR at the age of 53 that 21 years ago i choose the metal valve yes sometime there is a little problems with warfarin and bruising but the thought of not having a second op is worth it i know of people who chose the animal one and had to have the second op my aunty was one and she died waiting for her second op hope this helps good luck

[NotanAstronaut]

I opted for the mechanical valve and Warfarin. There’s no way I would want to go through open Heart surgery twice. I have a Roche Coagu-check machine that enables me to do home testing and email in my Warfarin results to the local hospital every few weeks. They then advise on dosing. This makes Warfarin treatment and testing much more convenient. My GP prescribes the testing strips. If you’re in the UK, you can buy the machine from Williams medical supplies for around £300. They are not available on the NHS generally. There’s no VAT to pay as it’s for personal use. With an On-X valve and by taking low-dose aspirin too the Warfarin level can be run quite low (1.7 target), i.e. less than double normal peoples clotting time. This means that your chance of complications from bleeding are lower. Complications from bleeding are one of the main reasons why people fear taking Warfarin. In truth insufficient Warfarin is much more dangerous than a slightly high Warfarin levels because insufficient Warfarin means you may develop blood clots on the valve which can cause strokes or damage elsewhere in the body. A slightly high Warfarin level you may develop nosebleeds or notice blood in your wee or just bruise more readily . It is unlikely that you will suffer major haemorrhage unless the Warfarin level goes very high and if you’re doing regular checking and your diet is stable, including alcohol consumption, then the risk from warfarin are fairly low . Historically some patients have had to aim for much higher levels of anticoagulation (3.5 target) and of course that is associated with a much greater risk of bleeding. That said I have known patients with Warfarin levels at 8 or higher and with rapid treatment they don’t come to any harm. The key is to test regularly and if you have any symptoms of bleeding e.g. a nosebleed, then test again. With the home test machine that’s quick and easy.

I hope this helps your decision-making. I skied 6 months after surgery and cycle regularly. Don’t let it hold you back.

[Cat04]

I was unable to have a mechanical valve as it was already known that I could not take warfarin so my surgeon chose a tissue valve which has a life span of 20+years and if further intervention is required in the future in can be done by catheter not OHS.

[Elmertheelephant in reply to Cat04]

Hi Cat04 Great news you don't have to take wayfarin but also prolong the possibility of more surgery, I'd hope to go down that route. Can I ask what tissue valve it was please ?where did you have this procedure?

[Cat04 in reply to Elmertheelephant]

My valve is a Carpentier-Edwards Perimount Magna Ease Aortic valve. I had my op at St Anthony's in Cheam courtesy of the NHS.

[DonDaddy in reply to Elmertheelephant]

Hi there, I have been told that the INSPIRIS RESILIA has similar expectations, I am 53 and am making the choice pre-op in January/February in Kings College. They have suggested a potential 20 year lifespan with a TAVI procedure when necessary with a further 10-15 year, does that reflect anyone else's information?

[Az37]

I had mitral valve replaced and have mechanical valve im on lifelong warfarin ,warfarin not caused me any problems I never thought at 37 I would have mechanical valve , the mechanical does tick but I got used to it ,the warfarin you have to have inr checks and adjust to things you can't eat ,

[Paul7777]

I'm 43 looking at mitral valve repair but need to choose back up option of metal versus tissue valuve so also interested in reply or advice. Hope you doing well petsounds