Mechanical Or Bioprosthetic Heart Valve Replacements?

Adam,
FYI: There is one other problem with mechanical valves. If anything goes wrong they cannot go in and safely fix the problem.With human like tissue, they have more options. This is especially important for people who have small heart valves to begin with since they are at risk for patient-prosthesis mismatch.
Children can have many redo replacements throughout their lifetime…….therefore
they replace them with tissue and not mechanical valves.
I never read about patient-prosthesis mismatch when choosing my valve.

i am a truck driver. Wil i be able to drive big rigs or not? They are going to replace the valve in feb, 2009

Has anyone out there who had a pig valve implanted undergone a subsequent valve replacement surgery? If so, was it worth it the first time to get the pig valve, skip the Coumadin, and have the second operation, or would you have rather had the mechanical valve in the first place (with the Coumadin) and skipped any subsequent surgeries?

Hi Lucy, I made the decision to have a pig (aortic) valve put in in 1987 (I was 48) and I was coumadin-free and able to do everything I wanted to do for 18+ years, when the valve started to go. In 2005, I had the aortic valve replaced with a calf valve (while they were there, they also replaced the mitral valve, which was wearing out, with a calf valve) — Cleveland Clinic rocks!!!. Because I developed a case of atrial fibrillation, which couldn’t be eliminated, I have had to be on coumadin for the past 3 years. It’s not as annoying as I thought it might be, going for regular pro-time checks. If I had to do it all over again, I’d do it exactly the same way. Hope this helps you make your decision. Good luck! -joe-

Your information, Adam has always been of great help to us all, and your comparison of tissue vs. mechanical valves is right on target. I opted for the tissue (bovine) valve and have not regretted it. I hope it lasts me 20 years before I need further treatment or surgery. Keep up your good work and support for us all ….we appreciate all that you do.
Bill

Mechanical valve verses bioprosthetic valve. My cardiologist and surgeon explained it this way “A preserved animal valve will last around 15 years which means that at 61 years old you will be 76 years old. You may not want to go through open heart surgery again or you may not be well enough for us to perform the surgery. On the other hand a mechanical aortic valve will see you out but on the downside you have to take warfrin religiously every day for the rest of your life.” I wasn’t too keen on taking “rat poison” but as my good wife rightly said, “Aliitle price to pay. Get over it!” The surgery was a breeze even though my surgeon said, “I would feel like I was it by a Mac truck.” Both choices have their fores and against – be guided by your professional medical teams advice. After all they are offer you life!!!
Roger

I was just told I need a double bi-pass and a new heart valve. I am 60years old and have my own handyman business… which means I tend to have minor cuts all the time. I am concerned that if I choose a mechanical heart I would then be on coumadin. Should this be a concern?

Thanks for the input
peter k

mecanical heart valve since 1995 implanted at the same time as I had a single coronary by-pass. On Coumadin with regular anticoagulation checkups every 6-8 weeks. I am 64, male. I have a couple of episodes of bleeding, one of which possibly led to a stroke which affects ny right side.

i

I am a heart surgeon.To answer helia’s dilemma ..I would choose a Bioprosthetic valve,reason being I will have to put my patient on low dose anicoagulation,they can have a very normal life style,can plan pregnancy,without the risk of discontinuing warfarin and starting on heparin.
Secondly even if they do undergo structural deterioration ,patient gets ample time to plan the re-do surgery which is quite safe vesus the risk of dropping dead if the disc of the mechanical valve were to just fail to open.This is a class 3 indication but a strong one as against the uncertainty of mechanical valve and risk of high dose anticoagulation!

I had asked for a tissue valve three years ago – the surgeon put in a mechanical valve against my expressed wishes and I have had problems with INR levels ever since. I am sensitive to most medications, including warfarin, but have no choice. I tried low molecular weight heparin for a few months with no lasting improvement in symptoms.

Furthermore, being a vegetarian who can no longer enjoy the Vitamin K enriched foods I used to be able to eat freely, it is very difficult for me to control my weight. And no, increasing my warfarin intake does me more harm than good – my INR stayed low for weeks when I upped my intake and ate leafy green vegetables. I was at 9 mg daily a year ago, (when I was 40 pounds heavier) and now am up to 12, without being able to eat salad daily as I used to. I have a resistance to warfarin. It took a month for my INR to go up to normal after being off warfarin for 6 days prior to my angiogram this past October.

To add to that, after three years of begging for answers as to why I never felt better after my operation and why I have no stamina, it seems likely that I have severe patient prosthesis mismatch. My surgeon did not even discuss this possibility with me before or after my operation when I asked why I felt worse instead of better. Cardiologists told me my valve sounded just fine. The attitude was that I had my operation, so I had no reason to complain.

I was also born with an interarterial left main artery, and this was re-implanted during open-heart surgery. No one was interested in doing an angiogram to review the results of re-implantation. I had to go out of province a year ago to get a CT angiogram which showed a severe kink in that artery and I was told I needed immediate surgery to bypass it. I could not face another surgery – I then met with another heart surgeon in Winnipeg who insisted on a conventional angiogram. Tests showed my blood flow to be above .8 so he told me I didn’t need another operation to bypass the kinked artery, but suggested I should lose weight because my valve is too small for my body size.

I thought he was being patronizing as I had already lost a significant amount of weight (I gained 80 since the operation and have lost 40 to date) with no improvement in my symptoms of chest discomfort and extreme fatigue. Just a few days ago, I saw a new cardiologist who told me to look up “patient prosthesis mismatch” on the internet. I did and found that this is a very real condition that was named in 1978, but in 2007, my surgeon did not do his homework.

I am a tall woman, 5′ 10″ with a very large bone structure. The cardiologist told me that even though I should lose the extra weight and more, I will still have severe patient prosthesis mismatch. The surgeon who told me to lose the weight seemed to think that is all that I need to do to feel better. I would not have gained that much weight if I had been able to be physically active as I expected to be. I gained 30 pounds in two months a few months after my operation, in spite of trying to be more active.

If I had it to do over again, I would have taken my chances with my original valve. My life is worse, not better. There seem to be a lot of studies discussing “survival” rates from a medical point of view, but very few that I’ve seen discussing quality of life in relatively younger patients. The ones I did read say that patients with a large body size younger than 60/65 should never be given a valve too small for their relative body size because it increases the likelihood of ‘cardiac events’.

I was 53 when I had the operation, and it seems the surgeon should have enlarged my aortic root rather than put in a valve that can’t support my size. I didn’t know this condition existed. Since my operation, I have had several episodes of severe chest discomfort, and it seems this will get worse instead of better.

Please do your own homework before having open-heart surgery. I wish I had.

i am 52 ,living in Ireland,have to have aortic valve replacement and am trying to decide on which valve .at the moment i am thinking of getting the pig valve and would like to hear more stories about people that had to have a second replacement,what it was like,hown long first valve lasted and what choice they made the second time..i also have a pacemaker which was fitted 7 years ago for complele heart block .I do not know yet if a bovine valve is available here ?

Hi my son is 17 and needs a valve replacement ,I think we are going to have the pig tissue , I feel he is to young to start being on blood thinners .Iam hoping this is a right way to go . we feel if it has to be replaced later in life than we will deal with it then ,at least if it needs to be repaired they can ,mechanical your stuck with it ,we are scared for our son , he wants to get back to sports and will not be good at taking his meds being 17 and wanting to go to college .
Do you think this is the best thing to do?His surgery is on March 15

I am scheduled to have AVR in about 3 weeks. Deciding between the biological valve and the mechanical valve has been a real adventure in prayer and research. I have gone back and forth a few times, but have decided to go the biological route. When I asked my surgeon what his choice would be, if he were having this operation, he said he’d go mechanical. However, he also said his partner IS having Aortic Valve Replacement, is my age (50) and has opted for the bulls heart valve.

That being said, I researched some more, talked with people who had replacements and made my decision. I figure that with the blood issues, the coumadin, the easy bruising and bleeding, the monthly lab work and the possibilties of mechanical failure, as well as the tweeking that would be involved with any future surgeries for other conditions (all possible as we age) that the biological valve made more sense for me. I am still a young 50 years old. I lift weights, ride my bike, and participate in sports, all of which would change some – at least the intensity level- if I had to take coumadin. I have a horse that I enjoy riding, 2 labs and a Great Dane, all of who accidentley bump me from time to time when the are greeting me. Not good if you’re taking coumadin.

By the time I need to think about replacing the bio valve (12-15 years), if my life style has changed then I can always get the mechanical valve then. Who knows what strides will be made in medicine in the next decade. Maybe, then, the surgery that is being performed on patients needing AVR (valve is placed through the Femal Artery, in the leg) but are too weak for surgery will be perfected and common. Even today, we don’t always need the 8 inch sternum break but can often elect the 3 inch mini operation. Bottom line, I’m getting the biological bulls valve.

Deborah,
Can you download the interview- chat Adam did with Dr Guilinov? He mentions some of his preferences for pig valves, but I can’t remember the ages. I am older- 62- and feel that when my pig valve starts to fail, (if)- I will have lots of forewarning. They are putting in aortic valves through the veins now- not so common, but will be.. Who knows what other advances by 15-20 years from now. I am not sure what s thought about someone so young as your son, who would need a few replacements in his life. Can you find out if he gets a pig vlave now- can a mechanical valve be the replacement when he is older and more mature?
Both of you might get some info from the blog site heartvalvereplacement.com. There are middle aged men active in answereing questions who are out there doing lots of sporty and athletic stuff with a mechanical valve- living happily with coumadin.

hi there!
my dad who is 63 had his heart valve replaced in june , i know recovery wont happen over night, but he has become more breathless an tired,so after alot of moaning from me to get checked out he finally did, his xrays an ecg i beleive have come back clear although he was informed that his heart is now bigger,and that he has gained weight, i thought maybe the weight gain could perhaps be causing him to b breathless an tired but his doctor is not convinced,

can you gave me an advice…? i have a mitral valve stenosis and what is the longest spand of time and year of the bioprosthetic valve. i and whats the difference between the pig and cows valve and does cow valve tissue available in the Philippines? pleas help me im so scared and confused…and by the way ive been taking lanoxin and coumadine..

by the way i am 27 years of age and i want the cows valve …coz i want to have kids..and does cows valve fit for my age?

I was diagosed with bicuspid valve am 51 and am going for aortic valve replacement in July. I was also born with 1 kidney and now think maybe my recent rise in creatine to to stenosis. I am torn between which valve to choose. Cardiologist pro mechanical and surgeon pro tissue. Does anyone know if and how coumadin affects the kidney? I really need to protect the one kidney I have.
Thanks

Hi,

I would actually like to know what kind of operation my brother may need. I’ve been asking some doctor in my country but unfortunately they are not so certain to let me know what operation he needs. My brother was diagnosed with a Rheumatic Heart Disease & Chronic obstructive Pulmonary Disease. I wonder if you could help me which kid of action we may need so we could organize ourselves as well for the necessary arrangements may required.

Hoping your prompt reply.

can you gave me an advice…? i have a mitral valve stenosis and what is the longest spand of time and year of the bioprosthetic valve. i and whats the difference between the pig and cows valve and does cow valve tissue available in the Philippines? pleas help me im so scared and confused…and by the way ive been taking lanoxin and coumadine..

by the way i am 27 years of age and i want the cows valve …coz i want to have kids..and does cows valve fit for my age?
plsss..reply me….