Susan's Guestbook

Rita Savelis  This is a hard decision for everyone and there are no right answers. You are very young so it is understandable that doctors might recommend a mechanical valve as tissue valves do not last long in young bodies. But the choice is up to you, and there is no right choice. Both tissue and mechanical valves have their good points and bad points. I have 2 mechanical valves which I got 6 years ago at age 53. It was not advisable for me to have repeat surgeries so I followed doctor recommendations for mechanical valves. Wishing you the best as you face this difficult decision.

Susan Richards  Hi Travis! My cardiologist strongly recommended the tissue valve. He’s also the director of the TAVR clinic at my hospital so he’s very familiar with the valve in valve procedure if/when a second replacement is needed.
My surgeon told me the medical community recommends, solely based on age of patient, 65 yrs and older- get the tissue valve, under 65 -get the mechanical. Well I would fall in the mechanical group but these standards were set forth before the TAVR method was FDA approved.
I was very averse to the idea of lifetime powerful blood thinners, monthly blood tests, and also the “clicking” sound of the mechanical valve.
My surgeon used an inspiris RESILIA valve that is large enough to accommodate a valve in valve procedure. That part was a little bit of a gamble and a worry but he was able to do it and I’m pretty comfortable with my choice.
You’re a little younger than me so that could influence your decision.
They say the tissue valve should last 12-15 years (with regular use, lol), and possibly up to 17. They can usually only do one valve in valve replacement.

Travis Ederer  Thanks for all of the information Susan! I've been staying in touch with the science for a couple of decades. It doesn't hurt that I've been a paramedic the whole time, either. I have also read some studies that think since the Resilia is stored in a dry setting, versus a liquid container with a preservative, it is less likely to attract calcium - which is one of the main factors of tissue valve deterioration.
Hopefully yours will last forever! If I have any more questions as time goes on, I may reach out.
Travis

Susan Richards  Thank you for your comment. I'm glad you are doing good! Best of luck with your continuing good health!

Susan Richards  Hi Ann,
I'm having my surgery at Kettering Medical Center with Dr. Peter Pavlina on July 24th. I'm getting the tissue valve but he didn't say it was Inspiris Resilia. I've been reading about that and think I should call and find out about it. Did you specifically request that or did they give you different options as far as a tissue valve?

Susan Richards  Hi Ann,
I'm having my surgery at Kettering Medical Center with Dr. Peter Pavlina on July 24th. I'm getting the tissue valve but he didn't say it was Inspiris Resilia. I've been reading about that and think I should call and find out about it. Did you specifically request that or did they give you different options as far as a tissue valve?

Ann Crone  Well I first asked my surgeon what valves he used - he said Edwards bovine tissue valves and Onyx mechanical valves. He said he didn't prefer porcine valves because over the years he had seen a couple fail or degrade. So when I asked about the Inspiris Resilia valve - he said - yes it's a good valve and has a few new "high tech" features and he kind of chuckled and gave an eye roll. From what I can tell, the companies that make these valves probably tweak a few features and then market the heck out of them to the doctors or hospitals as each valve has a cost of something like $4000 to $7000. Anyway, he said it was a good valve and he would use it. However, I later realized it was not written down on my consent form which just says "aortic valve replacement" and some other stuff as the procedures. So I am going to pursue trying to get it in writing. However, I'm guessing that any surgeon would also reserve to right to do some kind of switcheroo at the time of surgery if the valve you had chosen wasn't a good fit or not. He also seemed to like the Edwards valves because they come in a lot of sizes (guess they can get a good fit?). Even though the inspiris resilia is new, Edwards has been doing valves for a long time. Anyway, my surgeon said it was a good valve and he would use it, for what that is worth. I'll have to say I didn't get a long lengthy discussion about valves from my surgeon, or a long lengthy discussion about any one aspect. The time we had to meet went really fast and he seemed hell bent on getting me to sign the consent form by the end of the meeting. It was a "good enough" meeting with the surgeon so unless I reconsider, he is the one I'm going with. I still wake up at 5 a.m. wondering about what about this, what about that, though. I don't know how we as non-doctors are ever going to be sure about the choices we are making.

Susan Richards  Thanks for the info! I have a meeting with my surgeon again on July 22nd, so I will ask him some more in depth questions then. I was just kind of flustered at my first meeting with him because my blood pressure was high and it's usually not, and he told me that, as a rule, solely based on the age of the patient, the mechanical valve is recommended for "younger" patients, but my cardiologist had told me I should get the tissue valve. So I was kind of stuck on that for most of the appointment. I still decided to go with the tissue value and the surgeon said either was fine, they each come with pros and cons and that I can change my mind at any time about which one I want, all the way up to being wheeled into the OR. It's just that the medical community rule of thumb is "under 65 should get a mechanical value and over 65 should get a tissue valve". I'm counting on having the TAVR procedure when/if I have to have the tissue valve replaced.
You're right, it's so hard to sift through all the information and make decisions when we don't have the MD! And I also wake up early every morning and this is the first thing I think of. I'm really ready for it to be behind me!

Ann Crone  Susan, it's frustrating that your cardiologist told you tissue while the surgeon said mechanical. I would ask your cardiologist to explain as he/she may be more accessible than your surgeon. There is this article that I read : https://academic.oup.com/eurheartj/article/38/28/2183/3746020. It takes time to weed through this especially because they use terms like "non-inferior" as in option a is non-inferior to option b (basically, option a is the same as option b but they can't say exactly that). Anyway, some younger people getting tissue valves vs. mechanical valves I guess are betting that technology will speed along and valve-in-valve procedures and TAVR will become more common place so that if another valve replacement is needed, then it will be less invasive than open heart. There is a mechanical valve called the On-X valve that is supposed to be good. At my age, 60, my surgeon was shrugging as I'm right on the edge and sure enough, some articles I've read show me right in the "unclear" range as to whether to choose a biovalve or a mechanical valve. I've read 2 articles now that state 60 yrs as the breakpoint age, not 65. I'm unsure as well really which valve may be best.

Ann Crone  And by the way, my surgeon not "liking" porcine valves is purely anecdotal on his part and may or may not be supported by any current medical research. It was just an offhand comment he threw out there.

Susan Richards  Hi Donna,
Thanks for the post! It's nice to know I'm not the only one going through this. When I had a consultation with my surgeon a few weeks ago, he told me "from the medical field perspective", they have been recommending a mechanical valve for anyone under the age of 65, based soley on the longevity of the valve itself. And a tissue for over that age. But my cardiologist is recommending the tissue valve. My cardiologist is also the director of the TAVR clinic at my hospital and sees a lot of TAVR procedures done and predicts that most valve replacements will be done with the TAVR method eventually, which is really no more invasive than a stent. So he feels that when/if this new tissue valve needs replaced, it will be done via the TAVR method. That's what I'm holding onto with my decision to go with the tissue valve.
I have been reading about the Inspira Resilia tissue valve, which is designed to make a second replacement using TAVR much easier. I'm going to give my surgeon a call and find out more about that and if it is available for me.
I found out today that my surgery is scheduled for July 24th. Of course I had to cry a little bit. Until it was scheduled it sort of seemed like something that maybe wasn't going to happen! :)
Best of luck with your surgery! Hope all goes well!!

Donna Letendre  So sorry. I just saw that you wrote back on this post. Best of luck tomorrow. I'm sure everything will go well and you'll be back on your feet in no time!