Hi Cory: Hey I just went in today and had blood work done and an ekg and a physical. I will be operated on Thanks Giving wee. Dont know date yet. I meet with surgeon on Monday November 8th and have an angiogram November 11. I have decided I will go with a cow valve. Someone on this site quoted 82% of aortic surgeries are biovalves at Mayo Clinic. That study on Coumadin could go wrong and you may be stuck taking it for much longer than 2 years. Clinical trials never seem to go smoothly. Besides the technology will move on and probably they can replace out valves just like they put a stent in now. I now they are doing that in India as we speak. I'm glad you getting this all taken care of now - You will feel so much better. Blessings to you JoAnne
I have been reading your posts buddy and I went back and forth like you on the type of valve I wanted the surgeon to use.
I settled on a mechanical valve two days before :-)
I am almost 9 weeks out from surgery and have had NO side effects from coumadin. I am 38 and the thought of doing the surgery at least three more times did not appeal to me, but neither did taking a drug for the rest of my life so I get where you are mentally.
I am a healthcare facilities consultant so I came at it from the approach that ANY invasive surgery is risky and only gets riskier as you age. If you think about, hospitals are places where society puts things we don't want around us. Granted this is not an infection situation in your case but even in the cleanest facility there is a risk of infection and it is quite high in open heart surgery patients. So, more surgery...more risk.
There are no guarantees in life and I am sure at some point I will have to have something else done to my heart as the geometry of the heart changes and my valve stays static. Yes they MAY be able to do things via catheter in years to come but like anything in medicine you can not count on it till it has been tested and through the pipeline and even then sometimes in the mass healthcare market they may pull it years later after large scale clinical outcomes are examined.
As for the new class of blood thining drugs they are at least three years out according to my surgeon and cardiologist.
It might help you to ask what valve your surgeon has more experience placing in his patients and what his experience is in repeat surgeries with the different valves. I will tell you as someone who deals with doctors and hospitals for a living if your surgeon is pushing you toward one way or another I would be concerned about his neutrality, especially if he mentions a particular brand name.
As for calcification and infection risks you can find studies defending both sides of the argument between the valves. The two true things are: a tissue valve will where out in a younger patient faster, and the risk of a bleeding incident will increase as you age if you are on a blood thinner.
As for myself I recovered very quickly and was back to work a two weeks out of the hospital. I was able to get my protime and INR set pretty easily. I eat pretty much whatever I want including all the stuff with Vitamin K and have not seen any major changes in my numbers. I still have a drink or three when I want and frankly it is just a non-issue for me. As for the blood testing most insurance companies are paying for home monitors within 90 days. I wish you the best of luck going forward.
The few weeks prior to my surgery were filled with confusion and anxiety. I added a lot of undo stress on myself and my loved ones by over thinking things. Cory, Believe you will get through this and you will. Best of luck and again if I can offer any advice please ask.
Hey Cory: Thanks for responding to me. I read some of your guestbook entries and the one on tissue valves makes a lot of sense. I am 64 and I have gone back and forth on this issue. My main concern was calcification on a tissue valve. It sounds like this is not an issue for animal valves and you know the technology will be able to replace a bio-valve eventually like they put a stent in an artery to open it up. I am envious of where you will be getting your surgery. I live in Oregon. MY cousin lives in Cottage Grove Oregon. Are you going to the cath lab? I would love to hear about that if you have time. Looks like your a boatman. We sail and love the water. Take care of yourself. Bless you and I will ask the man upstairs to take care of you. P.S. you have a great smile! JoAnne S.
Hi Cory. My thoughts and positive vibes are with you. I am day 2 at home after 8 days in Hosp. I am a tough it out person and swore to myself I could handle this pain. After 2 days of this my very wise and respected cardiologist sat on my bed looked me in the eye and said, "it is ok to take the pain meds. it is not a competion to be better than the day before, one day may simply hurt more that the next." She went on to say, trust the number smiley face system, it works. A copy of this hung on my wall across from me. Every time a nurse comes in they ask, "how is the pain do you want meds?" These are two very difficult questions to answer. Once I stopped responding with fine, and ok's and started to say at this moment I am a 6 it became very easy for myself with the help of the nurse or doc to decide about what and how much to take. 4 hours later you do it again and again. My Cardio doc had a wonderful sense of humor, "your are here and we can monitor your every gurgle, go ahead and use the pain meds."
I hope this helps.
Cory, on your tissue valve decision, good choice! There is a reason the Cleveland Clinic does 82% tissue valves. As for your question, My surgeon's feeling is that in 15 years they will have perfected catheter based valve replacement, they are doing it in Europe now, and tissue replacement valves are NOT subject to the same calcification issues that plague human valves, so
Much less chance of stroke. I firmly believe the FDA will approve this procedure within 5 years and I won't have to go through this again for the aortic valve!
This is my belief, not to be confused with fact! Great luck to you Cory and thanx for the kind words to me.
I rationalized exactly as you did and chose a tissue valve. My main reason was I felt that 40 was too young to be on a blood thinner for the rest of my life. However, I think at the next operation in rougly 20 years I'll probably choose a mechanical valve just because I don't think I'll want to do all this over again a 3rd time when I'm in my 80's or close to it. I will say once I made the decision I was at peace with it and do not regret my decision. Best of luck!
Hi Cory. I chose a tissue valve for exactly the reasons you've indicated. I'm 58 now so I'll very likely need another one in 15 to 20 years. On the other hand, there are many on this site who have chosen mechanical valves & are content with their decision. You just have to go with what feels right for you & don't look back. Joy
I chose a tissue valve for my AVR earlier this year, becasue at 49 I knew I did not want to deal with Coumiden the rest of my life, and it's issues. My surgery was via a median sternotomy, as I had an aortic anuerysm that had to be addressed. I do expect that AVR in the next ten years will be primarily through a catherization procedure, but if I do have to go through an invasive surgery again I am comfortable in doing that.
Most of us look back at the surgery and think it was not as bad as we anticipated. It really helps to research and read so that you know step by step what is going to happen, and to go in as relaxed and confident as possible. Adam's book, and this site should really benefit you.
Hi Cory. I had a median sternotomy & took the prescription pain medication for 2 days after the surgery. I couldn't keep food down with the stronger stuff so I went with just plain Tylenol after that & it worked just fine. Keep your heart pillow handy too as it will be helpful when you cough, sneeze or get in & out of bed. Take care, Joy Vera
Hey Cory, I had a median sternotomy six weeks ago for my AVR and was in good shape before the surgery. I will be honest. I maxed out the pain meds the first three days and then tapered down considerably the last two days in the hospital.
By the end of the first week at home I was down to maybe one or two every other day and now six weeks out its RARE that I need one. What really helped me was actually Flexeril which is a muscle relaxer. My problem was spasms in my back and neck, translation KNOTS. It knocked it right out.
As my surgeon and nurses put it to me if you are not a pain med addict take the medicine. It helps you with recovery in that it makes it easier to walk, breath and move which makes you heal faster. Good luck and if you have questions feel free to ask.
I don't know what type of surgery you're planning on (i.e., median sternotomy, ministenotomy, or minimally invasive). I had a median sternotomy and my cardiologist said this type is more akin to having a boken bone. I've never had a broken bone, but I didn't think it was that bad (although sneezing hurt like hell). You'll definitely want to use the pains meds as you need to, to ensure you are able to keep up with using the inspirometer as long as needed after surgery. Hope this helps somewhat.
The pain meds need really vary from individual. You will read about people who were on them a week or so, to those who still needed them for many weeks. One thing my ICU nurse said to me was that patients who use the "drip" which they control during ICU seem to take longer to wean off of pain meds than patients who do not use the button control for meds.
I used pain meds till for one day after I was released then just Advil.
Welcome to HVJ. You are in agreat place to learn about your surgery, and how others have dealt with what you face in the upcoming months. I had AVR surgery about 5 months ago, and what I learned is if you prepare yourself, learn about the path you are on and what to expect your path will be much easier to negotiate.
I wish you a successful journey, as most of ours have been, and if you have questions or concerns just ask.
Welcome to HVJ, Cory. I had surgery to replace my bicuspid aortic valve in July & would second Kellie's comments about Adam's book & everyone who contributes to this site. Best of luck with your surgery. Joy Vera
I will keep the Donald Eckes family updated on your progress.I know Terrys wife Audrey worked with patients after heart surgery at Fargo Merit Care b/4 she started her on practice OBGYN. Cheri Eckes Klein
2 of the most important things that helped me get through this ordeal were reading Adam's book and the kindness of people I've only had the pleasure and good fortune to meet on this site. All are simply amazing!! Take care.
Hi Cory Welcome to HVJ and all the wonderful support you can rely on. If you have time read a few of the stories and journals. I am a 3 X congential open heart valve, septal patient. We are all here to encourage, give opinions, support, empthasize, celebrate milestones. Do not hesitate to ask if there is anything I can help you with.
Susan VandenBussche North Carolina