Simon's Journal

Marie Myers  I believe you would only be sedated if you were still intubated , ventilated, and not ready for extubation yet, or if you were unusually disoriented and in fighting mode. Otherwise, as you will be slowly waking up from the anesthesia, and when ready for extubation, the sedation is stopped. General ongoing sedation during the ICU stay is not the norm. 

Simon Mezz  Thanks Marie, what’s the purpose of sedating a patient while intubated? It seems this is standard practice rather than allowing someone to wake up and then be managed for pain while intubated. I just have fear of becoming confused if Im sedated and having to deal with a tube down my throat, as well as the many other tubes etc. I think I’d cope better if I was allowed to orientate myself without being sedated while intubated. Seems there were lots of intubated people during Covid that we alert and not sedated so just wondering if it’s ever like that in icu after surgery..

Rose Madura  I think you are worrying too much about it.  I would discuss it with the anesthesiologist when the time comes.  That being said, I had the breathing tube in when I woke up but don't remember if I was sedated or not.  I was aware of everything going on from the moment I awoke.  

Simon Mezz  Thanks Rose, I will discuss when the time comes however I’d like to just have the same experience you had where you were aware from when you woke up. Do you know how long it is (average if all is ok) from when you wake up to when you’re extubated?

Marie Myers  It Isn’t always easy to be awake and intubated. It will bother some people more than others. If you are tolerating it well, they will not probably give you ongoing sedation. And yes, there are plenty of people who are intubated and can manage it with nothing, or only with the as-needed pain medications. Every case is different , and depending how your case goes, how you react, and your vital signs, you may not get sedation in ICU. The goal is letting you wake up from the anesthetic, not to keep you sedated.  Some people get extubated in the OR, and some people go to ICU intubated. Once again, it all depends on how your surgery goes, your condition and vital signs, and the preference of the surgical team. Hope that answers some of your questions.

Robert Miller  I am not sure I understand the question. If you go through heart surgery, you will get full sedation. There is no other way around it. I am not sure about minimal invasive surgery but I suspect you will also get full sedation. You will be in an ICU room for probably 2-3 days. They don't keep you sedated there. Check out the learning center. https://www.heart-valve-surgery.com/learning-center.php

Yumiko Ishida  I would talk to the anesthesiologist as Rose suggests. Sedation always knocks me out, so I make sure I communicate my concerns before any kind of procedure. As Robert says, there is no way around general anesthesia with heart surgery. Pains meds affect your brain, too, so it really comes down to having to weigh risk vs benefit. Compared to anesthesia, sedation’s effect on your brain is minimal in the long run. Being in pain or frightened or having elevated anxiety is not good, either. The good news is you will recover eventually. I knew I would need help after my surgery, so requested neuro therapy ahead of time. 

J Alexander Lassally  I believe you're speaking of the grey zone between surgery completion and extubation... many patient, myself included, do have to be sedated further to keep calm while waiting for key breathing parameters to normalize...  Each patient is different - many, myself included, could not follow commands for a period of time. Extra drugs keep things safe. I would not behave for a period of time and needed these drugs. This was in my best interest, and I am grateful for the drugs... 
You can talk about it - but honestly, amnesia will be the least of your problems in the 24 hours post surgery!!!! 

Simon Mezz  Thanks for the feedback everyone. This might not be an issue and is something I’m trying to understand. Yumiko, what is neuro therapy and did it help you?

Robert, I am referring to the time in ICU between coming out of the general and being extubated. I don’t have concerns about the general but after some research Dr Google has provided differing views about what happens in ICU and some problems people can have during this time. I’ll check out the learning centre too, thanks for the link. So far, this forum has been awesome as there is nothing better than sharing real experiences.

Simon Mezz  I just read the “emotional changes” after surgery in the learning centre. This is what I’m trying to learn about and to see if there’s anything during recovery that could mitigate this. I might be wrong, but do feel the stage between waking from general and being extubated is important and could create longer term issues depending on drugs used, patient reactions etc…

Susan Lynn  Seek out a surgeon and anesthesiologist who believe in early extubation.   There are some who remove the tube in the ER.  
I'm not sure if you're referring to cardiac depression when you say emotional changes.  It does happen to some people,  but I'm not aware that it's been scientifically tied to post-op sedation.  Good question. 

Simon Mezz  Thanks Susan, agree that early extubation would no doubt be very helpful. I'm grateful that I have time to research and ask about all these details. Next step will be finding a good surgeon...

Yumiko Ishida  Early extubation probably is key, as long as it is safe to do so. I was already breathing on my own when I woke up, or if I was awake during extubation I don’t remember.

There are usually three kinds of neuro therapy - physical, occupational, and speech. Physical and occupational therapies help for balance issues a lot of people have post surgery. “Speech” is not a very descriptive term but it focuses more on cognitive issues, including but not limited to speech. I got all three kinds after a stroke and more or less recovered from the condition but still have aphasia that is worse when I’m tired, so I received a second round of speech therapy after my valve surgery and it helped a lot. It might be hard to get a prescription for one if you are not already seeing a neurologist, but any kind of activity that is supposed to support your brain should help - physical exercise, nutrition, hydration, mindfulness training, playing games, etc.

Jeff Williams  I received an On-X in 2023. I was 39 at the time of my surgery. Everything is going well now, and I'm back to my pre-surgery fitness levels, if not better. I'm happy to answer any specific questions if you have them.

Simon Mezz  Hi Jeff, interested to know your thoughts on the sound of your On-x and how you have found controlling INR. Is your INR level between 1,5-2  as they say is possible with the On-x or do they suggest a higher INR directly after surgery? 

Jeff Williams  So I have a loud tick, I know others with almost silent valves. I can hear it if I focus on it but I've gotten so used to it it doesn't bother me at all. 

Inr has been a non issue. My cardiologist keeps me between 1.8 and 2.3 and I've had no issues other than bruising easier. I still do all of my normal activities including woodworking, coaching baseball, lifting weights, and other physical activities and haven't had any issues. 

I've made videos along the way. Check my profile and you can get the link and see my experiences. 

Simon Mezz  Thanks Jeff and J A. I've researched a lot, and feel I'm getting closer to locking in a plan. INR scared me a bit but does seem it might not be so bad. Do you need blood checks every week or two weeks? 
Does diet have to be very stable or is it just being sensible? 
Wondering if anyone here has the Medtronic valve as they say its quieter, but I'm not really sure....

Martin Smith   Hi Simon, yours sounds very similar to mine (bicuspid aorta and ASR) with one exception, I'd been going through life (61) completely oblivious to any condition whatsoever. Nobody had ever detected it and it had never presented any problem. I went from initial diagnosis (Apr 2025) to post surgery in just 4 weeks, which suited me as sometimes, thinking about things, can mentally, make matters worse. I was also concerned about taking anticoagulants long term. My surgeon suggested the 'Edwards Inspiris Resilia' A hybrid material valve with good long term results...so I did! Now it's only a week after surgery and well, obviously I can't comment yet, but I'm alive! Good luck.

Rita Savelis  I've had 2 mechanical valves (aortic and mitral) since heart valve surgery 10 years ago. I was 53. Ticking is really not a issue. It has to be very very very quiet for me to hear a sound. Sometimes if I was reading in a very quiet room I would put a pillow on my chest to muffle sound.  I haven't done that in years. I have been on coumadin for 10 years with no problems. Of course I was nervous the first year but now I don't think about it. I test at a nearby lab whenever I want to, usually once a month and handle any changes in meds. I eat what I like, have not changed anything in my life because of coumadin. I have a high target INR (2.5 to 3.5) because the mitral valve is a much trickier valve than the aortic valve. I didn't have any mechanical valves marketed to me because I live in France (I'm American) and cardiac surgeons pick valve brands, not patients. My surgeon was the head of the cardio-vascular dept at Hôpital Européen Georges Pompidou, a public teaching hospital. My valves happen to be Italian-made. I'm sorry that you have to go through this because valve choice is hard for everyone. There is no right answer and whatever you choose will be right for you. You can't look back. Just make a decision and move forward. If you trust your surgeon he or she should be able to advise you. 

Simon Mezz  Hey Martin, I hope your recover well. Having just gone through it is there anything that you think would have been good to know about the stay in hospital or was it all pretty good for you? Did you have any issues with memory, delirium etc in ICU?

Simon Mezz  Hi Rita, its great to hear things are going well for you with your INR and that your valve is quiet. I've had nearly 20 years of annual checks so there's been a lot of thinking time, not sure if that's good or bad., At this stage I'm learning from other peoples experience which is very helpful. Have you found that your INR stayed steady with a regular diet or did you have to cut out a few things to get into a steady INR state?
Now I'm at the stage of selecting a surgeon, the ross is not an option for me so in the next few weeks I will meet with a couple of surgeons and will lock something in. At this stage it will probably be around this time next year before I get it sorted.

Martin Smith   Simon, there's nothing I can think of really, all the staff were kind and patient...apart from the questionable food offering in the hospital 😂. I'd definitely take some instant noodles or something, but hopefully it's not gonna be for a long long time.
From the first sedative jab to waking up...nothing! Like it didn't even happen.

Simon Mezz  Wow, good for you Martin. I hope it’s like that for me. Sedation in ICU worries me a bit as I understand a lot of stress can be created when intubated and sedated. I’ve wondered if a better option might be just light sedation so there’s more chance to communicate how you feel. Did you have a family member support you while in icu while being intubated? Or is that something you just don’t recall..

Martin Smith   Intubation isn't a particularly pleasant thing, but that's just common knowledge. They didn't 'stick it in' till I was under. Yes I remember waking with it, not the most pleasant but it's not for ever either. Just try to relax. The hospital didn't allow any visitors as a health precaution, which suited me fine.

Simon Mezz  Thanks Martin, once you’re in hospital it seems fair to say that you are truly relying on other people to get you through it and you just have to trust the system

Adam Pick  Simon, Keep doing what you're doing. Ask lots of questions. Get lots of answers. That will help you build a great pros and cons list that will ultimately lead you to the right valve choice for you.

Rita Savelis  Hi Simon. INR does not stay steady. That's it's nature - it goes up and down. I eat whatever I want. I want my INR to adjust to my average pattern of eating and not the opposite. What makes INR change is when you eat something (like broccoli) that you never eat. But it will readjust. Trying to eat the right food is too much work. My INR changes when I have too much alcohol or when I travel across time zones (9 hr time difference with California) or when I am hospitalised. At some point one understands ones own body. Some people's INR is very stable. Mine took a long time to get stable when I first started. Also every time I go off coumadin for surgery, it can take 10 days to go back to target rate. This is me. Everyone has a different body. I had chemotherapy on coumadin and the oncologist freaked, but it was fine.

Rita Savelis  You will be way under before intubated. No family member around. You're asleep! And the tubes are often removed before you are really awake, just groggy and unaware. Many patients, like me, did not feel the intubation tube come out. I had no pain after a sternotomy. Let your anasthesiologist know about you and your experiences and fears - she or he will adjust doses and add nausea medication, etc Waking up I was exhausted and in discomfort. No pain. I took morphine to relax. They will keep you comfortable in ICU. Be vocal about pain if you have it. The exhaustion can last as your body heals. As far as food goes, I was not hungry in ICU and wondered why I was served so much food. I just wanted to rest. And eat some soup.

Jeff Williams  Simon, I have as doing checks every week for the first few months. Now I go every 4-5 weeks. I don't think about it daily and eat whatever I want. So far I haven't been bothered by them at all. 

kevin comras  I had a st. jude titanium valve aortic put it in 2000. while was supposed to be 20 year valve my cardioligst has now told me should last the rest of my life. the last thing you want to do is have to go in for another surgery in your old age. the clicking disappeared after a few years as i believe biological matter grows on the valve after a while. the blood thinners were not a really a problem just have to get tested on a regular basis and they adust your dosage accordingly. you can eat whatever you want just need to be consistant.

William Trankle  I've had an OnX aortic valve for 12.5 years now, and it is audible to my wife when things are quiet--internally, I've had a cardiac metronome as the soundtrack of my life, and I don't mind it at all.  As far as blood thinners, don't let them scare you off--I'm on a pretty high dose of warfarin due to a clotting disorder (a great thing to have with a mechanical valve), and I live a normal life.  

JOHN SORENSEN  There are no perfect choices. I am 72, born 1952. My bicuspid aortic Valve was replaced in 1976 with a Porcine valve. It had no clicking, very quiet, no blood thinners, but eventually it calcified, tore a leaflet after 16 years and was replaced in 1993 with a mechanical St Jude valve.  That valve is still going strong after after 32 years. However, it clicks, but wife and I get used to it. It requires warfarin, which I've managed for 32 years with cardiologist (most GP want to have the cardiologist do that). The St Jude will likely last me a lifetime, BUT I now have 5.8cm aneurysm in my ascending aorta. It will require an implant. Surgeon will likely install a new tissue valve if and when that surgery becomes necessary when the aneurysm reaches 6.0cm. Problem with tissue valves is they wear out, although sometimes, the first tissue valve replacement can be done with TAVR! All imperfect choices.

Simon Mezz  Thanks Adam, your site has so much great info and the ability to share ideas with other patients is so helpful.

Simon Mezz  Rita, thanks for sharing your experience about INR, it’s made me feel better about going down the warfarin road. It’s good to hear that you didn’t have a bad experience in ICU, I will raise my concerns when the time comes as I just don’t want to have bad memories of that part of recovery. 

Simon Mezz  Hi Jeff, your feedback and others on INR is helping a lot. I’m much more confident that it won’t be as bad as I first thought 

Simon Mezz  Thanks Kevin, I have read about the St Jude valve , does seem like there’s a few different versions of that valve, I’ll do some more reading as I hadn’t heard of the titanium version.like you I only want to do one major op if possible

Simon Mezz  Hi William, thanks for sharing your story and that warfarin probably isn’t as bad as some people make it out to be. Just made me think about valve noise relative to INR level, do you ever notice the valve noise change if your INR goes high or low for any reason?

Simon Mezz  Hey John, wow, sorry you have had to go through so much over the years. I hope getting your aneurysm fixed is a smooth process. It’s incredible the things that medicine has achieved these days, gives a lot of us a better life. I’m grateful to live in a era where we even get to learn from others before choosing what we feel is the best surgery for us

Jennifer Barnett  Hi Simon, I had mitral valve replacement surgery in Auckland New Zealand 8 years ago. I was 54 years old at the time and have a mechanical Medtronic valve. At first the clicking sound seemed loud but now I only hear it when I'm lying down to go to sleep and it doesn't bother me at all. 
I am on warfarin with a target INR of 2.5 to 3.5. It goes up and down but usually it's fairly stable around 3. I eat similar foods each day and about the same amount of Vitamin K which helps. I exercise daily but don't do anything with an injury risk like cycling on the road and wear a medic alert bracelet. I just have a monthly pin prick blood test at my local pharmacy so it's all fairly easy to manage. 
I found the surgery difficult because I was so ill beforehand with endocarditis and took longer to recover after the surgery than most  people. I spent 7 weeks in hospital. About 4- 6 weeks after the surgery I started to feel alot better and made a good recovery and returned to work after 8 weeks. 
Good luck with your decision 

Brian Leonard  On X here for me Simon the clicking can actually be comforting and most of the time not even noticeable- blood thinner has been easy just done get into any knife fights !!

Got mine in 2019 and all had been good - had to slow down on my Jiu Jitsu but believe it or not I still train with people I trust - I lift weights and jog regularly my recovery time improved with the new valve 



This site is a wonderful tool 

Simon Mezz  Hi Jennifer, thanks for sharing your experience with your mechanical valve and INR. I’ve been told that the Medtronic is a little quieter than the On-x. Is the medic bracelet something that everyone with mechanical heart valves have? Good to hear you got through it all.

Simon Mezz  Hey Brian, thanks for the info. I’m not into knife fighting but I am into higher risk things like off road mountain biking as well as road and off road motorbikes. So I’ll need to slow up and stop some of the higher risk things I do. All this info here and hearing from different people is so helpful. People’s real experiences is so much better than just reading from MR Google… 

Gregory Nihon  Hi Simon. I am 3 months post surgery. Age 49 and received an On-X Valve. Jeff Williams was such a great support to me ahead of my operation. Shout out to him. I think choosing the valve was one of the hardest decisions of my life. I was debating with the surgeons in Cleveland right up to the morning of surgery. I do think there is some wisdom to the idea that there's no perfect choice and there's no bad choice. One of my doctors told me that it's the nature of congenital heart disease that we may need repeated interventions. But to remember that if one is needed i the future, there will be options available. And the options in the future will likely be different than those available today. I had aortic resection 15 years prior so this was my 2nd OHS and I was not keen on signing up for a 3rd. And it seemed like high odds that I might need one more OHS if I went with a tissue valve and expected a normal life expectancy (that is the valve would wear out before sole reliance on TAVR to take my to the end of the line). I got the On-X. The ticking bugged me when I was discharged. It's either quieted down or my brain has adapted. It's a nothing burger. Warfarin is a bit of a pain but honestly a small price to pay for me. I haven't bruised yet. And no bleeding issues at all (yet). Warfarin is a stubborn and weird medicine but I have been able to stay in range and the On-X option does offer more leeway. I wanted the ON-X because the lower INR threshold reduced the risk of major bleeding risks, IN MY EYES. A lot of this is marketing and FDA navigation. But it's a good valve. The St Jude is probably just as good if not better and I know surgeons really trust it. I was worried that a mechanical valve would turn me into a delicate and frail man and  that coumadin would ruin my quality of life. I can tell you that for me those fears were unfounded. Good luck to you and to others and may we all have good health and success with the options that we chose. It all works. 

Simon Mezz  Hi Gregory, I relate to what you have said. I’ve known about my condition for 20 years now and still I have not locked down on the type of mechanical valve. Once the Ross procedure was no longer an option I was set on the On-x, now after talking to an experienced surgeon I’m thinking about the Medtronic valve. As you say, it’s a tough call and there’s no real right or wrong. But for me and I’m thinking for most of us, it’s important to understand all options and each person just needs to do what feels best for them. For me, I had my cardiologist also saying I could consider a tissue valve, that’s just not an option I want at my age as I would be signing up to a second surgery before I even go under the first time around.
If there was a warfarin replacement that meant no INR issues or testing the decision would be very easy. Thanks for sharing your experience and I’m glad you have maintained your quality of life. For me, I’ll choose quality over quantity anyday

Gregory Nihon  For what it's worth, I am not sure my own personal choice would've been the same if it had been my first surgery. This Resilia tissue valve may be super durable. The problem is I didn't have the proof and it's so patient-dependent at younger ages. And then you have to consider one's family situation as well. Just keep searching and the answer will come to you. Keep an open mind. I flip-flopped a lot. Most important thing is to make sure you're in the hands of an experienced surgeon. Good luck and have faith you will do well no matter what. 

Simon Mezz  Thanks Gregory, I plan to see another experienced surgeon in the next month or so and will see what he thinks and recommends. At the moment I’m leaning towards the Medtronic valve and second choice would be On-x. I’m fairly sure that the ticking won’t bother me and like you said, for many people your brain seems to adapt to it.

Jennifer Barnett  Hi Simon regarding the medic alert bracelet I was advised by the hospital after surgery to get one so I joined the Medic Alert Foundation in NZ similar to the Australian one and purchased a bracelet. It's mostly necessary because of being on warfarin in case of an accident.

Simon Mezz  Hi Jennifer, I didn’t know about the bracelet but it makes sense. I see you can get them with QR and can also be attached to a watch band. I’ll definitely keep it in mind.
Have you had any issues with your Medtronic valve? Does the valve itself create any issues with airport scans, magnets or other things like x rays or similar?

Jennifer Barnett  Hi Simon 
I've had no issues with the Medtronic valve. My last echo was in September 2023 and showed it to be normal and functioning well. I've travelled 4 times to Australia since surgery and had no issues with any airport scans X-rays etc.

Simon Mezz  Hi Jennifer, I’m glad it’s going well for you. I’m going to continue to research the Medtronic valve but at this stage it’s my preferred option. I’

Simon Mezz  Thanks for everyone’s input, this forum has already provided me with a lot of comfort knowing there are many others who have first hand experience with the same condition as me. 
I’ll continue to provide updates and no doubt with have more questions as I get closer to surgery..