Valve Replacenent

[Sunshine2023_]

I am awaiting a mitral valve replacement and am in the age bracket where either a mechanical or biologic valve would be suitable. Looked into pro’s and con’s of each but still struggling to make my decision.

Any advice please.

[Rosie1066]

I think a lot depends on what age you are. Mechanical last a lot longer. I went for a mechanical vale replacement back in 2008 and haven’t regretted it. OK, it means I’m on Warfarin but that’s no big deal for me. I just couldn’t face going thru OHS again as the tissue type don’t last as long.

[Sunshine2023_ in reply to Rosie1066]

This has been my concern but now understand that if it needs replacing it is done with a catheter. Still lots to think about. Thank you

[Bobbers950 in reply to Rosie1066]

I had it done at 59 so last year . I’m mechanical as I believe the natural one lasts about 14 years and I couldn’t face having the surgery again . Warfarin is a very personal thing and everyone has a different experience with it . Only you can make the decision. One thing with the mechanical is that it does make a bit of a noise . Apparently it gets less obvious as you get used to it but in my case it’s yet to happen . Good luck , life is precious and having the surgery is a game changer . Rob

[alvida15 in reply to Bobbers950]

Noise? How loud, what does is sound like, if you don't mind me asking?

[Bobbers950 in reply to alvida15]

its like an internal tick . I only hear it at night or at times of stillness which are few and far between living with two working cockers and a jack Russell. I'm still struggling with the Warfarin being stable . As I said each persons story is different and its a tough decision . 👍

[alvida15 in reply to Bobbers950]

I have 2 Jacks 😊

What is involved with the warfarin, figuring out the right amount to take? It's my aortic valve so I'm just hoping when the time comes it will be tavi not ohs. 🤞

[hihannula in reply to alvida15]

Alvida15. If you are young, like I was, I went for the mechanical valve. The warfarin can have serious side effects you must throughly educate yourself. I’ve developed calcification throughout my arteries, hence severe heart disease. I’ve had many emergency visits for INR too high, too low. I’ve developed osteoporosis, another side affect. Everything you eat, over exercise, too much heat/cold, stress, cold/flus, supplements, and so much more. Not trying to frighten you. I just wish the cons were explained to me about this drug! In saying that, my life was saved and extended for 25 years now. As far as the sound some valves make, mine is unusually loud. It sounds like a clock ticking. While standing in line ups at Walmart etc, I’ve been asked numerous times for the time, I’ve also been asked point blank, what do I have ticking in my purse. When I tell them it’s my mechanical heart valve, they are in shock and curious at the same time. It always ends up in a good laugh. Its a difficult decision either way, but I do know, that if I were older, like late 60’s or older, I’d definitely have the pig valve, but being that I was very young, the mechanical valve was my best option. Best of luck with your decision!🌻👍❤️

[Blackcatsooty]

Dear Sunshine

best thing I did was to let the surgeon decide. He is the one working under the bonnet.

I veered towards biological. Pleased with the result. Indeed very very pleased. I have an Edwards Resilia. Since mine was fitted they now come with the option to TAVi should it be needed later. I also note that the expected life of the valve is going up. Which suits me perfectly.

Marvellous op. Fabulous staff and superb equipment. Nothing like the more routine ops.

Now all I need is to find out how to turn off the bold type on this iPad.

Best wishes

Sooty

[Blackcatsooty in reply to Blackcatsooty]

Ok I can now turn off bold. Still don’t know how, but it’s off. I really wasn’t shouting at you.

Sooty

[Drummer20 in reply to Blackcatsooty]

I liked the bold type it’s easy to read x

[Sunshine2023_]

Hi Sooty, thanks for your reply. My Surgeon told me that he couldn’t make the decision for me so this left me a bit confused about things. I’ve been indecisive about it and about making the right decision. I was concerned about the mechanical and warfarin so veering towards the biological. It was just the fact that it didn’t last so long and the thought of going through it all again worried me. Your reply has helped considerably. Thank you.

[Anon2023]

hi. I’m 52 and I’ve had two mechanical mitral valves. I have no wish to go through ohs again and was encouraged by my surgeon to have the mechanical valve for its longevity. The first one lasted 4 months but I was extremely unlucky. The second one seems to be doing well, 18 months later. The tissue valves are lasting longer but it’s whether you want to take a chance on needing another valve in your lifetime. Mind you, neither valve can be guaranteed to last forever which I know isn’t very helpful of me to say. Warfarin is a nuisance, but manageable, and if I’d been in my 80”s I would have opted for a tissue valve. At 63 though, you’ve got years ahead of you so it’s a tough call. Please don’t rely on TAVI being absolutely available to you in the future to support your decision as it depends on how suitable you would be at the time. I’m sorry if I sound negative, I don’t mean to be but both valves have their downsides. Saying that, either one is going to save your life and that’s the main thing.

[Sunshine2023_ in reply to Anon2023]

Hi, thank you for your response and advice it is very much appreciated. A lot to think about but having some advice from a recipient is helping. Thank you.

[Hidden]

Hi, It's not an easy decision to make, same operation but fundamentally different post-op in my experience. My first replacement Aortic Valve was a standard Tissue type in 1994 at age 33. It lasted 19 years before it was replaced. Second time around I decided on Mechanical to avoid my family going through it again. In the event I had redone again four months later, I now have Mechanical Mitral and Aortic Valves.

The Tissue Valve was low maintenance, but, I was young and was happy enough to have it done again. No regrets, but, I knew the implications. Whereas the Mechanical requires more care in my opinion.

If you decide on the Tissue, you need to be clear in your mind, that its likely to need replacing at some point, but, when is the question. That said, medical procedures and valve technology has moved on significantly and evolved in recent years, so who knows what it will be like in years to come. Either way, you just have to be comfortable and live with the decision you make, and it's the right one for you in your circumstances.

Take Care

Heed

[Sunshine2023_ in reply to Hidden]

Hi, thanks for replying to my question. Big decisions to be made but your input has helped. Wishing you all the best for the future.

[Cat04]

At age 65 I chose a tissue valve because previously having taken warfarin, I had never been able to maintain a stable INR with it veering widely out of the required range for no apparent reason. I was having blood tests and warfarin dosage changes three times a week and did not want to be in that situation again. When I mentioned this to my surgeon he immediately put me down for a tissue valve which lasts for 20+ years and should future intervention to it becomes necessary that can be carried out by catheter (TAVI).

[hockeyfanice]

I had the same op in 2018 at the age of nearly 62 and I chose the tissue replacement valve, yes it's true they don't last as long as the mechanical valve, but I didn't fancy the idea of being on warfarin for the rest of my life, with the associated problems that can bring, for instance, I had a tooth taken out last week and the dentist was concerned if I was on warfarin, there might have been a problem with the healing process where the tooth had been removed.

[Bookworm60]

I was 61 and chose tissue Aortic Valve. Borderline decision but didn't want the 'faff ' of warfarin and hoped to avoid feeling 'medicalised' once I'd recovered from the op. I chose ( and had to pay for, so bang goes retiring before state pension age) the Edwards Inspiris resilia valve which theoretically could last till I'm 87. Tavi supposedly an option then. Tough call. I sometimes wonder if I did the right thing but only time will tell ! Good luck with it all. Not nearly as bad as I feared. 💪

[Clairealou]

hi sunshine. I had a tissue mitral valve in 2014 and by 2021, was advised it had already worn out and needed replacing again. Having already had 4 OHS, I had a mechanical valve fitted by minimally invasive (my surgeon advised TAVI is only for aortic valves and not mitral due to the position in the heart). Minimally invasive is still a reasonable size scar but it doesn’t involve opening the chest up so recovery is much quicker. I was dreading being on warfarin but actually found it to be much easier than I thought it would. I test my blood at home so can make sure I stay in range and despite the fact the ticking takes a bit of getting used to, wish I’d have gone for the mechanical in 2014. Hope that helps

[Clairealou in reply to Clairealou]

btw, I’m 55 now

[Drummer20]

Hi Sunshine,initially the cardiologist recommended a mechanical aortic valve but I started to feel I preferred the tissue valve.I didn’t want to take warfarin,I’m clumsy and I like green vegetables and I would have to be careful.The surgeon recommended a tissue valve and I was relieved.He was happy that I had decided on this too.I’m 68 though so that influenced my decision too.

[Annaelizabeth]

Nearly thirty years ago I had a St. Jude mitral valve fitted. Because of the relatively short lifespan of the tissue type compared to the prosthetic valve, at the age of 44 this was the decision taken. Warfarin was, and still, is the only anti-coagulant used. I have a Coaguchek which enables me to check my own INR, the machine is calibrated annually against the hospital readings. The valve is also checked annually by the cardiologist. The valve after all these years has worked perfectly. No regrets and definitely the correct decision to have made. For you the final decision is yours, with I hope a little more input and guidance from your cardiologist than you have had at present.

[Zuzio1]

Hi Sunshine, a lot of mitral valves can now be repaired. They can even be repaired via catheter (no OHS required). The transcatheter mitral valve repair is called 'mitraclip'. you should research ot and challenge your doctors on why they are not recommending this route. Also, I would get a second surgical opinion. Even if you are not eligible for the mitraclip mitral valve repair, most mitral valve issues can be repaired at OHS. But the surgeon needs to specialise in this. Not all surgoens can do this. So I would challenge your doctors more.

Good luck

[Sally_Scott]

Hi Sunshine. I underwent OHS in January for a tissue mitral and Aortic valves. Are you a lady? Forgive me for asking but if you are, are you big breasted? No, I’m not a pervert lol. I’m a big lady and I wish I had known a few things beforehand. Let me know and I’ll give up some tips if u r.

[Sue-uk]

Hi, Well 35 yrs ago l was due to have a mitral valve replacement & it was planned that l had a tissue one to avoid being on Warfarin for life. When the surgeon operated it was decided that a mechanical valve would be more suitable (never did find out why) BUT absolutely no regrets AT ALL. I’m sure whichever one you choose your quality of life will be so much better & that’s what’s important. I was able to live a near normal life, able to work etc with just a couple of blips on the way. I wish you the very best of luck with everything 😊

I

[Leonardo1]

hi I had my aortic valve replaced in 2021 and because I had Haydes syndrome I couldn’t have a mechanical so my hand was forced to have a biological. As a life long vegetarian this was- tough one - but my family and friends gave me the decision . I love my biological valve it’s given me a whole new life and I am forever grateful to its donor . Apparently I will need a mitral replace and obviously that will have to be biological too and I’m ready for thst with no qualms .

The new biological ones have a great life expectancy and infact they arnt sure how long as they are still going !

Warfarin wasn’t an option for me and I am on blood thinners anyway so if you do go mechanical warfarin isn’t the only choice .

Get all the info speak with your consultant and surgeon be guided by them they are the experts and bless them it’s their day job and they are incredible .

Look to after the op because which ever valve you choose your future will be so much brighter and full of vitality - make the most of it !! Take care Ch x

[Cyprus12]

Hi Sunshine2023. I had a new aorta valve. I was 53 and decided on a mechanical valve because I didn't want to have OHS again after 15 years, as I would be older and less firm. Ok, I have to take warfarin, but not a deal breaker for me. I do my own INR and call them into my surgery. I'm fit, healthy and living life to the full 😀

[Reggaelover]

Hello Sunshine 2023,

I’m 63 and have been referred for mitral valve repair at the Freeman Hospital in my home city of Newcastle upon Tyne. I’m not yet sure when my surgery will be, but probably early next year.

My mitral valve leak was first diagnosed in 2014 and became severe in summer 2022 - although I am fit, active and well, without any significant symptoms. When I met the surgeon in January, he told me that he was virtually certain that my valve could be repaired, but in case it couldn’t, we discussed the two replacement options.

My preference was for a mechanical valve as it is longer lasting, but means you have to stay on blood thinners. With a prosthetic valve, you may need a further replacement 10-15 years down the line. One positive is that surgical techniques are advancing all the time and it may be that a future replacement is more straightforward and less invasive than now. I hope that blood thinning medication may also advance in the future, so that warfarin isn’t the only option.

So, apologies, as I haven’t said anything you probably don’t already know. I guess the two key questions are: first, what are your concerns about staying on blood thinning medication, and second, would you be happy with another surgery in the future. Good luck with your decision and with your surgical journey.

[Highlandmist]

Hi Sunshine, In 2020 I found my mitral valve needed attention (bit of surprise at the time), I went through the decision re whether or not I wanted a mechanical valve or a pig valve, I too didn't want to be on Warfarin (as my parents had been), so I decided on the pig valve. I asked what would happen in 10-15 years time and he told me they would just pop in via my groin and replace it. However, once my wonderful surgeon got in there, he actually repaired my valve! Hopefully you'll have the same result as I did. Ask your surgeon and let him know how you feel, they will reassure you.

Good luck x

[paulos7]

Its a tough one. My age (48 at the time) and the fact that I had OHS previously to repair my mitral valve was the deciding factors for me to go with Mechanical. They last for decades and you are unlikely to need OHS again. Blood thinners are a bit of burden but if you buy your own self-test device (Coaguchek) and get the test strips on prescription it becomes much, much easier to manage. It might be an idea to check with your GP that you can get test strips on prescription before as it may influence your decision.

[leach234]

Warfarin use may be associated with a significant increase in the risk of death after traumatic injuries, according to a report posted online that will appear in the May print issue of Archives of Surgery, one of the JAMA/Archives journals.

There was a story where I live that the anticoagulant needed to stop the major bleeding was not carried by the local hospital due to its high cost and short shelf life. By the time they flew the patient to a hospital that had the anticoagulant the patient bled out. If you plan to travel overseas you could be in the same situation. My friend has a mechanical aortic valve and had a hard time finding a dentist to pull a tooth due to excessive bleeding. If you’re at the age where either works I’d go with the organic tissue.

[Sunshine2023_ in reply to leach234]

I’m veering towards biological after long discussions with family. Seem to get side effects with medication so don’t want to be struggling with more medication.

May need a new hip in the future so would be more problems with bleeding on warfarin.

Thanks.

[Sunshine2023_]

Thank you to everyone for your messages regarding mitral valve replacement. Will be making a definite decision next week so lots to think about from all the advice given.

Best wishes to you all for responding to my question.

[Shazzy46]

I was the same as you. I couldn't decide. I asked others and decided on the bovine. For 3 reasons really. I didn't want to take Warfarin, my surgeon said there is more chance of blood clotting with a mechanical one, ( I know of someone going through it) and I am sensitive to metals. I know he said that the bovine will only last about 15 years but they are making advances all the time.

[Sunshine2023_ in reply to Shazzy46]

Hi, as you say 15 years is a long time for science to make big advances. I have an ICD fitted too so another metal object is a bit daunting.

I just want to have this operation and try and get on with living. I’ve had too many knock backs so time for a break.

Best wishes

[Shazzy46 in reply to Sunshine2023_]

I understand what you mean. I'm 61 and waiting any day for a call to get my new valve. I'm hoping to travel afterwards so I want to get on with it. My husbands friend has mechanical and over a year later still having INR problems.

[Sunshine2023_ in reply to Shazzy46]

Good Luck with your operation.

[Shazzy46 in reply to Sunshine2023_]

Thank you. Good luck to ypu too.

[Sunshine2023_ in reply to Shazzy46]

Thank you. x

[alvida15]

I only got my diagnosis I Feb so not something I'm faced with yet but what I looked into I'd prefer mechanical, as others have said lasts longer and I don't think I could handle animal tissue.

[Sunshine2023_ in reply to alvida15]

It’s the warfarin side of things that unsettles me and the fact you can hear the mechanical one. Just want it done and move on without always being reminded. Good luck.

[Pefki in reply to Sunshine2023_]

I don't think the sound is an issue, but maybe it depends on the type of mechanical valve that the surgeon decides on, once he has you open and able to measure exactly which is the best fit. I would say the warfarin is something that could take some getting used to but that depends on how organised you are-I am not, but have to change. The anticoagulation clinic staff are all great-you get to know them quite well. For me, it is still early days. Ideally, a drug which is not as sensitive to what you eat and drink, would be a God send.

[cappachina]

Hi Sunshine

I have recently had my aortic valve replaced by TAVI I know this is now been offered to younger people who may be suitable so another thing to ask your surgeon.I know that replacement if needed to be done in the future would be by TAVI which is a much easier option 2 days in hospital and a faster recovery time My experience was great and 8 weeks on I am well on the way to full recovery and I am 75

[Sunshine2023_ in reply to cappachina]

Hi, was that a biological valve? Lovely news to hear of your recovery time after the TAVI. Get well soon.

[cappachina in reply to Sunshine2023_]

hi Sunshine yes but at my age it should see me out they reckon at least 15 years and counting now Not sure if they can replace mitral valve via TAVI but know they can do a repair of mitral valve that way