Jovan 's Journal

Valerie Allen  Well I just had this discussion at cardio rehab today and your age is a big factor. So I’m 71 and it would be different for you. They have an algorithm.

Darrell Malone  This topic came up last week and it seems like depending on your facility, procedure and many other factors it is different for all. I had a stress test last Friday and they set my rehab based on that. But some folks are doing rehab with no stress test. I posted my personal framework last week from my rehab team. 
This is my exercise guideline it is not a one size fits all. 

J Alexander Lassally  RPE - the nebulous metric. Pulse is a hard measure and it is nice to see actual quantifications. Good for Canada!  120 seems a good all around number, and there is nothing wrong with staying the 100 teens at first. 

Correspondingly, 30 plus resting heart rate still works well for me and I stick to this. 

Valerie Allen  Darrell - interesting. Yes since I am 71 my target heart rate right now  is 98 and I’m supposed to slow down if over 123

Ana Brusso  Welcome to recovery Jovan, great smile of relief. Continued good health and God bless you ❤️‍🩹🙏❤️

Rose Madura  Wonderful news. Susan is right! That smile says it all!  Congratulations. Stay strong. 💪🪖❤️‍🩹

Dan Fouratt  Jovan,  I am the 21st for the a aortic valve replacement! I am looking forward to getting it behind me.  We will both do great!

Rose Madura  Jovan, sounds like you have everything under control. Oddly, for me a travel pillow was essential.  You life will be altered, as you say, yes - but in time, you will feel much better! Godspeed.

Barbara deLoache  Rose.. did you use the travel pillow in the hospital? The kind that wraps around the back of you neck??

Rose Madura  Yes, it was so nice when I would nap in the chair.  They called me the pillow lady. Someone on this site recommended it to me. I would have never thought to bring that.  

Robert Miller  I assume you checked the learning center of this forumm, i.e. https://www.heart-valve-surgery.com/learning-center.php Scroll down a bit and you will see a lot of information. The general consensus is that

a) try to fix the valve rather than replace it and
b) if it's a replacement, it's really not that hard to control the INR.

Unless you do some dangerous sport or work, it's not an issue. The clicking is another issue. I got a valve repair so I can't comment on the clicking. I was told that it's similar to a wall clock and that most people's brain will start to ignore it after a while. I guess it's kind of similar to my constant noise in my ear. Most of the time you ignore it but it's always there and you can't do a thing about it. But it's not changing your life. 

Rita Savelis  I've had 2 mechanical valves for 9 years and don't know of any food that "causes blood clots". I eat everything in moderation and don't think about my diet. It is better to not be a heavy drinker.  Getting used to anticoagulants takes some time. And after that you carry on. You do need a blood test once a month or once every few months. But yes, it's another pill you have to take. I hear you. Whatever decision you make will be the right one for you. I remember wishing I was in my 70's rather than my 50's when I had to go through all this. So I feel for you. Take care.

Rob G  HI Jovan my surgery is this Thursday and im still working out my decision. Im leaning towards tissue but like your surgeon, mine was making a case for mechanical. Its a tuff spot being 57. I feel like its no mans land and Im stuck in the middle with no right or wrong choice. I need to decide by tomorrow so will sleep on it and meditate in the am and see what my inner being tells me. :) I feel for what you're going through as well. 

tracy west  No one but you to decide what valve you're going to have to do your comparisons for what valve is best for you. I got a tissue valve because I didn't want to take blood thinners, I might have to get a replacement valve in ten years, the doctor said to me they can go up the groin area. so with that said do what best for you, please read and compare what's best for you and your life style.

Jovan Dumas  Thank you Tracy! Everything I’ve read says that a mechanical valve is a huge lifestyle change. The diet, the INR check ups, and most of all the clicking. If the mechanical valve didn’t come with one of those things it would be an easier choice. I asked my surgeon if the groin was an option in the future and he said it was but something I his voice didn’t make me feel confident. I think it’s because of my age the mechanical valve made better sense to him. Of course in the end it’s my decision.

Valerie Allen  Talk to the surgeon about putting in a valve large enough to do the TAVR procedure next time. Hesitancy may be your age as I think they are comfortable only doing two subsequent TAVRs at this point. 

Jeff Williams  Definitely something to research and feel good about before you decide. I went mechanical and haven't had any issues with INR, diet or activity. I had mine done at 39 and am hopeful to only have one. 

Yumiko Ishida  You will find people in their 30s that chose tissue and people in their 50s that chose mechanical on this site, so it really is a personal choice. I’ve been on warfarin for a couple of years since having a stroke, and when considering valve replacement, I thought I CAN keep on taking it, but in the end I decided I don’t WANT to keep on taking it, so I chose a tissue valve. Either way the surgery is going to change your life. If you do decide on a tissue valve, make sure you talk to your surgeon and come up with a longterm plan. Ask them which valve (brand, size) they think are best for you, if there is anything they could do during this surgery to prepare you for your next surgery, and what they are going to do if the first choice valve doesn’t fit.

Dan Fouratt  As others have said it is your decision and only yours.  I was being treated for a brain tumor last fall.  There were two options to treat it.  In my research one doctor said, "both decisions are right, choose the one that is right for you.  After you choose do not look back and second guess yourself."  Out of everything I heard that was he most useful thing anyone said to me.

Jennifer Fuller  Agree with what everyone here has said. It’s kind of too bad you can’t take a trial run with blood thinners to see how they affect you before committing to a lifetime of them with a mechanical valve. I had a bio valve, but still took Plavix for 3 months post op, which I think is fairly standard. I was so happy when my course was over. I know it’s not the same as Coumadin, but it’s similar and I did not like taking it. 
Do keep in mind if you get a bio valve that the size of it could impact choices down the road. My valve is a 21, which is kind of small, and I might not be able to have a TAVR for my next valve replacement. I guess I’ll cross that bridge when I come to it. Just something to keep in mind.

Darrell Malone  Hello Jovan. Have you researched the Ross Procedure. This maybe another option for you to explore. Be well and good luck.

Larry Peterson  My choice was the Inspiris Resilia tissue valve in a large 27mm size with the hope that should I need a replacement in the future it can be a TAVR replacement.  No right answer here; I didn't want to take blood thinners but others take them for many years with no issues. 

Mark Fetheroff  I had to make the same decision last summer at 39 years of age. I ended up going with the tissue valve & 8 months post surgery, I still feel like I made the right decision for me. My surgeon was also of the mindset that when it needs replaced, it can be done by way of TAVR.

Teressa Phillips  Hi Jovan, I didn't really get much counseling/choice on my valve type. It was strongly suggested I go with a mechanical valve because of my age (50). I too was afraid of the warfarin. The type of valve I have (On-X) has a lower INR need, so the amount of warfarin I take is lower than many people. The first few weeks after leaving the hospital I had to be checked every 2-4 days. I stabilized quickly after surgery and have been on the same dose for almost 8 weeks now. I was told that once I am stable for 3 months, I can get a home testing machine, which is similar to a blood glucose monitor, but requires a bigger drop of blood. I've only had one mystery bruise on my shin. I also do not have any hobbies that would be dangerous with anticoagulants. 

I can hear my valve clicking. I can hear it internally through the vibration in my ear, I also have a slight pop in the back of my throat from the vibration, and in a quite room, I can hear it externally. That said, I have been SHOCKED at how little it bothers me. When I lie down at night, it is most noticeable, but it has not prevented me from falling asleep. I know other people have had adverse feelings about hearing the ticking, but I'm lucky it isn't impacting my quality of life at all.

I'm sure you will make the right decision for yourself. Best of luck with your upcoming surgery.

Teressa Phillips  I also forgot to mention, at least with my care team, they are not concerned if I eat high Vit K foods, they just want me to eat a fairly consistent amount. Talking to the dietician, she said the philosophy has changed from trying to control the intake of nutritious veggies to managing the dosage of warfarin. I'm still eating broccoli, cabbage, brussels sprouts, etc. I'm just careful not to eat a ton one day, then not eat any. Most of the research online is still the older philosophy of avoid the veggies. Obviously, every person and situation is different.