mechanical or organic?

[lockwoodfolly]

Hi, all. 45m here, married, two kids (6 and 6 months).

A pretty significant aortic valve regurgitation and a slightly dilated aortic root means I will be having both replaced early next year.

The question I have to decide is to opt for a mechanical or organic valve. I was told the organic valve would need to be replaced in ten years.

At this point, I am basically settled on the mechanical valve, so as to get it all taken care of for good and to not have to wrestle with a failing/ faulty valve and another open heart surgery in ten years, but I suppose I am curious (quite naturally, I think) about living with the mechanical valve.

Is the warfarin a big deal? The ticking that some have mentioned is something, too. Anyone miss cranberry juice terribly badly?

I guess I am wondering about what it's like with the inorganic valve. Has anyone regretted their valve choice and wished they'd gone for the other one?

Thanks for any insights anyone can share. Just trying to get my head around this whole thing.

Thanks very much!

[Cliff_G]

Hi,

As you, if I had had a choice I think I would not be wanting to have anyone go back into my chest after 10-15 years. Mine was an emergency, though, and quite complex, so the surgeon popped a mechanical one in.

Being retired, managing the warfarin has not been a problem even though it means regular trips to the INR clinic - but then I see it as an important part of my social life 🤣. My GP's surgery won't consider me self-testing using my own Coaguchek, for reasons I don't know. As you're a lot younger, you would probably find self-testing would be better, the details are on the NICE web site at nice.org.uk/guidance/dg14/c... . Also allows you to test whilst travelling. I think you generally have to buy the machine yourself, but the strips and finger-prickers can be supplied on prescription.

The clicking has never bothered me, although it has made my arrhythmia more noticeable (a long history of Afib and ectopics), but I'm back in rhythm now and it's fine. Quite comforting, really.

Hope that helps

[lockwoodfolly in reply to Cliff_G]

Hi, Cliff. Thanks so much for your thoughtful response, and for the link. That's helpful.

I appreciate your insights and sharing your perspective. Very helpful, somehow, in trying to anticipate what's ahead. At this point, it seems like there's got to be a very good reason not to get a mechanical valve, and I don't think I have one of those. It's also good to hear such a cheerful and helpful tone after emergency valve replacement surgery. Encouraging!

[bikebabe]

I had open heart surgery for mitral valve replacement and removal of surplus muscle and opted for an organic mitral valve so I wouldn’t have to be on lifelong warfarin (though having cancer was a factor in that I was unlikely to need it replacing). Had warfarin 3 mths then off it for 3 mths and now back on lifelong warfarin due to arrhymia and higher risk of stroke. The warfarin isn’t too bad the second time around as i was dosed to accommodate my dietary choices but I’ve still struggled to stay in range due to changes in my polypharmacy/ treatment and find weekly visits to INR clinic very restrictive. I finally relented and purchased my own machine £300 so not tied to hospital. Warfarin means a lot of other common meds can’t be used ie ibuprofen which is also challenging when dealing with other comorbidities / cancer treatment side effects. However mechanical valves have a higher risk for infection but last longer- It’s a difficult choice.

[Cliff_G in reply to bikebabe]

Re the risk of infection, when I was editing our AD patient guide (see my bio) the consultant on our medical verification team corrected my wording (page 63) that you needed antibiotic cover for invasive dental work if you had a "mechanical" valve, to the same but for any replacement valve, tissue or mechanical. So I'm not sure what the relative risks are, but a tissue valve is not zero risk.

[bikebabe in reply to Cliff_G]

I think that’s why when my CRP rocketed to 172 I was given gentamycin, rifampicin (orange devil as far as warfarin concerned) and vancomycin. Afterwards it may just have been a simple UTI

[Okayletsgo in reply to Cliff_G]

This is really useful and important information. Good to have clarity and real risks for both types of valves document.

[lockwoodfolly in reply to bikebabe]

Hello! Thanks for your reply, and for being so plain about the difficulties of it. I'm sorry to hear of your other troubles, and that managing it all is tricky. The clarifications below, too, are great to know. No need to sugar coat.

[LinE68]

Hi lockwoodfolly. I think a lot of us have grappled with the mechanical vs tissue valve choice. I had heart surgery 8 weeks ago to replace my aortic valve. I opted for the mechanical valve because I couldn’t face the idea of a repeat surgery within 10 years. Whilst it is still early days I can share my experience to date. I have an On-X mechanical valve and pre surgery I was worried that I would be able to hear the valve. My valve is however very quiet and I can only hear it if there is no other noise around, I am sat against a cushion and I am actually deliberately trying to hear it. So no issues at all in terms of noise. I really didn’t want to take warfarin however I am getting used to it and my local anti-coagulation clinic team have been brilliant. I have made some small adjustments to my diet, however your clinic will work with you to adjust your dosage in the light of your food preferences. I wasn’t bothered about giving up cranberry juice. I hope this helps. Best wishes for your surgery in the new year.

[lockwoodfolly in reply to LinE68]

Thanks so much, Lin. That is very helpful and heartening to hear. I, too, think another surgery is something to avoid, and this time waiting for the surgery with a bad valve is no fun, either. Nice, too, to learn that the warfarin of it all is kind of a sliding scale, or gets tuned in.

Thanks for the well-wishes and perspective, and I hope your recovery continues to go well!

[BorderCollie2024]

Hi. I had a tissue valve replacement in June, I'm 63 and didn't want warfarin. With the tissue valve you can have it replaced via TAVI. I have a friend who has had her tissue valve for 15 years and it's still working perfectly. Have a good chat with the surgeon. Hoping all goes well.

[lockwoodfolly in reply to BorderCollie2024]

Hello! Thanks for the reply. The surgeon is pretty convinced that the mechanical one is the way to go, but yes, I will have a good talk with him about it, and the ramifications. Glad your friend is still going strong, and I hope you're fully recovered and better than ever from your replacement.

[PeterJG]

Hi

Sorry to hear you're faced with this at a relatively young age. I'm not quite in the same situation, as I am hoping to have a mitral valve repair, but my surgeon has already warned that if it does not go well I need to be prepared for valve replacement. As I am in my 40s too, I would have no hesitation going mechanical. Tissue valve replacement, even with a skilled surgeon, will have to be replaced at some point (they use pig or cow valves.. animals that just do not live as long as humans). I am also a GP, and I have patients as young as you with mechanical valves - they are not bothered by the sound and warfarin soon becomes a way of life.

Hope this helps and good luck!

[DonDaddy]

Hi there,

I am facing the same choice, albeit at 53, I have 1 kid of 9.

It's an incredibly difficult decision. It seems to me that the standard line from the NHS is under 60/65 then mechanical (this is what the registrar said) however when I asked my surgeon who's the same age as me what he would have... he said "it's personal choice but I'd have tissue..."

Their team have suggested that the new tissue valves used (NHS btw) have a longer expectancy, and I've been told 20 years plus (as I understand it, the tissue valve deteriorates faster in a healthier/younger immune system). With the potential of a TAVI in the replacement valve when required (potentially another 10-15 years). However I don't see much in these threads that support that...

Since I had my first consultation I've instinctively been erring towards the tissue valve, not because I'll miss extreme sports or cranberry juice but ultimately I find the idea of a more medicalised life concerning. It really seems like such an existential equation

Sending you all the best...