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“Is There A Trend Favoring Tissue Heart Valve Replacements?” Asks Jenny

Posted by Adam Pick on June 25th, 2011

When evaluating surgical options for a heart valve replacement procedure, a common patient concern is selecting the “right” mechanical or tissue valve. Specific to this topic, Jenny recently wrote to me, “Hi Adam – I’m 38 years old and need aortic valve replacement surgery. The durability of a mechanical valve is attractive but it seems like so many people, of all ages, are getting tissue valves. Is that a trend that I should be paying attention to?”

I was very fortunate to ask Dr. Richard Shemin, cardiac surgeon and the Professor and Chairman of Cardiothoracic Surgery at UCLA Medical Center, this exact question. Here are the highlights from our discussion.

Thanks to Jenny for her question and a special thanks to Dr. Shemin for taking the time to discuss this important question with our community.

For those patients who are hearing impaired, I have provided a written, video transcript of my discussion with Dr. Shemin below.

Adam: Hi, everybody. It’s Adam and we are coming to you from the AATS convention in Philadelphia. I’m thrilled to be standing next to Dr. Richard Shemin who is from my hometown of Los Angeles. He’s the professor and chairman of cardiac surgery at UCLA. We’ve got a great question for Dr. Shemin. It’s from Jenny and she writes in, “Adam, at 38 years old, I need aortic valve replacement. The durability of the mechanical valve is attractive but it seems like so many people of all ages are getting tissue valves. Is that a trend that I should be paying attention to?”

Doctor Richard Shemin: Well, Jenny, I think at 38 years of age, clearly you should consider, if you need an aortic valve replacement, a surgeon that can do it minimally invasive. The second thing is, valve choice is a big decision. And I don’t really recommend looking into both pros and cons of tissue valves versus mechanical valves. There is no perfect heart valve, but if you’re undergoing a heart valve replacement surgery, whatever valve you choose should be better than the one you currently have. At 38 years of age, if you’ve finished having your family, you have so many wonderful years ahead of you, the mechanical valve will give you the durability that potentially you will never need to have that valve replaced but you will have to take lifelong anticoagulation and studying pros and cons and how to safely take anticoagulation is very, very important. Many of us recommend home testing devices in addition to follow-up with your doctor. The tissue valve, obviously, will give you the opportunity to have a valve which is almost maintenance free. You don’t have to take any special medication except for maybe an aspirin but, over time, that valve may deteriorate and a heart valve reoperation is standard. It can be done with low risk 10, 15, or 20 years later and some of the newer technologies that we have to percutaneously have advanced a catheter based valve in to the position and within the tissue valve that you may have implanted at this time would probably be a viable option. So, do your homework and I think you will get a good result. (To learn more about valve replacement, click here.)

Adam: Great. Well, I hope that helped Jenny. I know it helped me understand a little bit more and learn more. Dr. Shemin, as always, thanks for coming by. We really appreciate seeing you again and we’ll be talking to you hopefully in the near future.

Dr. Shemin, MD: And thank you for the service you provide to all of our patients helping to understand heart disease and how to find the right surgeon.

Keep on tickin!

Adam Pick
Written by Adam Pick A dad, a husband and a patient, Adam Pick founded this website in 2006 to educate you about heart valve surgery from diagnosis to recovery.
You can get the latest updates about heart valve surgery from Adam at his Facebook, and Twitter pages. Click here to email him.

 


Shari Shoufler says on June 26th, 2011 at 9:06 am

Jenny… I am 44 years old and in February of this year underwent mitral valve replacement surgery. Like you, I faced the same decision and, for me, the choice was a tissue valve. My surgeon was able to do a partial repair/partial replacement with a bovine (cow) valve. Here are my reasons why I made the choice:
1) Although medically you are told that you will have a longer “shelf life” with a mechanical valve, there really is no “guarantee”, so
2) That did not outweigh the risk of having to be on anti-coagulant therapy. At 38 years old, you, like me, are possibly perimenopausal. My ob-gyn advised this would adversely affect my already heavy menstral cycle. Combine that with the fact that I am TERRIBLE about remembering to take medicine, and I really had grave concerns about having to be on Coumadin or another similar medication.

I had minimally invasive surgery and CANNOT say enough about it. I highly recommend you seek out a surgeon perfoming it in your area. Also, like the surgeon Adam quotes in this story, I am banking on the advances in valve surgery to be there for me in 15-20 years when this one needs replaced.

At less than 5 months post op I am back to doing all the things I love to do (including riding rollercoasters) and have no regrets about my valve choice!

 


Joe Fresch says on June 27th, 2011 at 8:50 am

Jenny, I am a 53 yr old male and went through aortic valve replacement last October at the Cleveland Clinic. They do 82% (at that time) tissue valve replacements due to patients not having to take Coumadin for the rest of their lives. Taking anticoagulants means you are at greater risk in case of accidents and at 38, that is a long time to have to take these drugs.

I cannot tell the difference in me other than the 6″ scar on my chest, but I am absolutely back to normal. Do yourself a favor and go tissue, mine was a cow valve, and other than the occasional urge to stop at a field of green grass and graze, I am fine! :)

Joe

 


Kerrigan says on June 27th, 2011 at 12:16 pm

At 65 the choice of a tissue valve, with it’s expected “life span” of 10-15+ years was the correct choice. No additional meds required.
Were I a lot younger, it might not have been a good choice over mechanical types.

 


MJ says on June 28th, 2011 at 12:13 am

I think the pros and cons were explained well by Dr. Shermin. I’m 64 and had a tissue (bovine) tricuspid valve replaced two years ago. I am having some problems now and will need more tests done, as it may be deteriorating. It seems too soon and the doctors are surprised, too, because it’s on the right or low pressure side of the heart, which is why they want to watch it closely. Does anyone out there have a replacement tricuspid valve? If so, what kind and how long have you had it?

To Jenny, probably if I were 38, I’d choose a mechanical valve for the longevity factor, but your cardiologist and surgeons can give you the best advice.

 


Amanda Tuttle says on May 31st, 2012 at 8:26 pm

Hi Jenny I am 37 years old, at 33 I had a aortic replacement with a cow valve and my mitral and tricuspid repaired. We went with the tissue valve because of the coumadin factor. I am glad we did , the six weeks post op that Iwas on blood thinners was no fun, my levels were never right and lots of blood draws. I enjoy living life, playing with my kids and husband, and having a beer now and again. I was worried about not having the quality or joy of life that I did before surgery if I was tied to the blood thinners forever. I know I will need to replace the valve and possibly others but like others mentioned I am hoping the advances in this area will be there. Good luck with your decision. Mandy

 


Ann says on July 18th, 2013 at 12:45 pm

I am 39 years old. Had a mitral repair four years ago, ended up creating mitral stenosis with severe pulmonary hypertension. It was recommended to me that I have a mitral valve replacement with a mechanical valve. Didn’t give it much thought. It’s been two years and living on Coumadin has been hellish. Took me 6-9 months to get in target and now take 65 mg of Coumadin daily. Since then, I’ve had to have my PM removed in order to have an MRI which led to being dx with Chiari malformation and EDS type IV (Ethlers Danlos Syndrome, type four is vascular) and during my PM extraction I almost died from a subclavian vein burst and the ep had to call in a cardio thoracic surgeon to save my life. They ended up removing my left subclavian vein. This was do to the EDS. Since my Chiari dx (brain is too big for scull and compresses brain stem and leads the brain to heritage down into spinal colum and block cerebral spinal fluid. I’ve had two brain surges and a spinal surgery for tethered cord and while off Coumadin developed a clot. Needless to say I want to ask my cardiologist/surgeon if they would replace my mechanical with a tissue as I would feel safer and will require additional surgeries in the future for CM. any thoughts?

 

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