Heart valve: biologic vs mechanical

[Tree-dweller]

Seems that I will be a candidate for aortic valve replacement sooner rather than later. Research (reassuringly) suggests it is getting to be a fairly routine procedure, but one of the biggest issues is deciding on the type: mechanical vs biologic (pig/cow) valve. I’m in my mid60s, so I guess I’m in a gray area, since mechanical is usually recommended for under 60, biologic for over 70. I’m told mechanicals can last “forever” but require a lifetime of Coumadin maintenance, while biols usually need replacement anywhere from 7-20 years later, but no Coumadin. My gut reaction is, a lifetime of Coumadin maintenance would suck, always concerned with monitoring and internal bleeding, and I’d rather risk another replacement in the New and Improved future. If anyone has experience with Coumadin maintenance or valve replacement in general that they want to share, I would be so very grateful!

 

[calmloki]

Seems that I will be a candidate for aortic valve replacement sooner rather than later. Research (reassuringly) suggests it is getting to be a fairly routine procedure, but one of the biggest issues is deciding on the type: mechanical vs biologic (pig/cow) valve. I’m in my mid60s, so I guess I’m in a gray area, since mechanical is usually recommended for under 60, biologic for over 70. I’m told mechanicals can last “forever” but require a lifetime of Coumadin maintenance, while biols usually need replacement anywhere from 7-20 years later, but no Coumadin. My gut reaction is, a lifetime of Coumadin maintenance would suck, always concerned with monitoring and internal bleeding, and I’d rather risk another replacement in the New and Improved future. If anyone has experience with Coumadin maintenance or valve replacement in general that they want to share, I would be so very grateful!

I do Coumadin. Pretty uneventful except for remembering to take the prescribed dose of Warfarin every day. And keeping a pretty constant diet, being aware of suddenly having lots of spinach or eating grapefruit. The monitoring itself is vastly improved by getting a self-test finger stick device (like Coaguchek - see youtube). Much better than going in for a blood draw as needed. If my balance is out of whack I might test once/14 days, mostly it's once every month or so.

 

[Ian S]

My brother was in a similar situation and age a couple of years ago although the doc thought it might be repairable. Still he had to decide before going under and I believe he chose the biologic. Fortunately, his valve was repairable. I think I might be inclined to choose the biologic too especially if I was in otherwise good condition and no problems with anesthesia.

 

[kcowan]

Two friends chose pig valves rather than bother with daily medication. Both early 60s.

 

[OldShooter]

Sorry to throw a rock in the pond, but if you trust SGOTI over your cardiologist, you need a new cardiologist. The plural of "anecdote" is not "data."

 

[Tree-dweller]

Thanks to urban dictionary, I now know what “SGOTI” is, so thanks for that. I guess that’s what constitutes this, and most other, online forums, so all contributions are welcome.

 

[Ian S]

Sorry to throw a rock in the pond, but if you trust SGOTI over your cardiologist, you need a new cardiologist.

The problem is that, in this gray area, the cardiologist didn't make a firm recommendation one way or the other in my brother's case; the decision was left up to him. In other words there was no right decision. So I think it makes sense to poll others who might have gone through the procedure to see how things worked out.

 

[limeyx]

The problem is that, in this gray area, the cardiologist didn't make a firm recommendation one way or the other in my brother's case; the decision was left up to him. In other words there was no right decision. So I think it makes sense to poll others who might have gone through the procedure to see how things worked out.

I agree and appreciate this thread since this is something probably in my future with no chance of a repair (Bicuspid aortic valve)

I'm finding this discussion helpful although hoping to not have to do this for some time!

 

[ivinsfan]

65 is the general cutoff for mechanical vs tissue...

MY DH was 64 and a half when he had a mitral valve repair and they told him they would use a mechanical if a good repair wasn't possible . .Didn't even offer the option of a tissue. The repair failed after 5 years (not uncommon I guess) and he was told he could have a choice of either valve. He took tissue but mitral valves can be repaired and soon even replaced thru the groin which probably wouldn't require another open heart surgery. Metal valves require a high INR at least 2 plus ranging to 3 plus and is not to be taken lightly minor bleeding incidents can cause big problems.

Having said that my DH had no problems at all with his first surgery, the second one was done by the same surgeon and he almost died on the table. There is no doubt 2nd surgeries have more complications then first surgeries.

If you trust your surgeon and cardio doc I would ask straight out what would you tell me if I was your Father.

 

[Tree-dweller]

If you trust your surgeon and cardio doc I would ask straight out what would you tell me if I was your Father.

Thanks for sharing your experience. I’ve had all of one consult with the cardiologist, and none with a surgeon yet. Hopefully they both liked their Dads! (Although the cardiologist is older than me ;->)

 

[ivinsfan]

Thanks for sharing your experience. I’ve had all of one consult with the cardiologist, and none with a surgeon yet. Hopefully they both liked their Dads! (Although the cardiologist is older than me ;->)

My DH's surgeon was 70, so he asked the doc "What would you do"..I wish you all the best and do not mean to scare you with surgery horror stories but a second surgery is not a trifling matter especially if you are 75 or older.

 

[OldShooter]

The problem is that, in this gray area, the cardiologist didn't make a firm recommendation one way or the other ...

Yeah, I get your point but I still think the problem is the cardiologist. He/she is the person here with detailed knowledge of the OP's situation and extensive (hopefully!) experience with customers who have made the decision either way and have reported the consequences. To leave the OP needing to beg for anecdotes on the internet and then to make his decision is just plain wrong.

To the OP: I would either schedule another appointment with this cardiologist and insist on getting specific advice (it's still your decision) or, better, I would use your network of friends and acquaintances to find a better cardiologist, then schedule an appointment for a second opinion. Docs are not interchangeable like light bulbs; there are good ones, marginal ones, and bad ones. It's worth the effort, IMO, to find the good docs, whatever the specialty.

And in the unlikely event that your insurance won't pay for this second visit, so what? This is important stuff and if you have to write a check, it's worth it.

(Incidentally, I deliberately used the word "customer" in the first paragraph. The medical industry tends to forget that's what we are. I try not to.)

 

[ivinsfan]

Yeah, I get your point but I still think the problem is the cardiologist. He/she is the person here with detailed knowledge of the OP's situation and extensive (hopefully!) experience with customers who have made the decision either way and have reported the consequences. To leave the OP needing to beg for anecdotes on the internet and then to make his decision is just plain wrong.

To the OP: I would either schedule another appointment with this cardiologist and insist on getting specific advice (it's still your decision) or, better, I would use your network of friends and acquaintances to find a better cardiologist, then schedule an appointment for a second opinion. Docs are not interchangeable like light bulbs; there are good ones, marginal ones, and bad ones. It's worth the effort, IMO, to find the good docs, whatever the specialty.

And in the unlikely event that your insurance won't pay for this second visit, so what? This is important stuff and if you have to write a check, it's worth it.

(Incidentally, I deliberately used the word "customer" in the first paragraph. The medical industry tends to forget that's what we are. I try not to.)

Really, the OP clearly says he has seen the cardio once and has not yet met with the surgeon and he is simply trying to inform himself on the pros and cons of both type valves. No, a surgeon won't order you around he is not your boss... every single person undergoing heart surgery is unique. I want a doctor that clearly lays out the pros and cons of both and has an informed discussion with me.

The OP is not begging for anything he is asking people for real life examples of why they made the decision they did.

 

[ndlex]

My Dad had a mechanical aortic valve that was put in during the early 1990's when he was 58 years old, and was on Coumadin the rest of his life. Overall, it was a great story as he lived until 85 with no further heart procedures needed. That said, the Coumadin was not ideal and eventually played a part in his death. Obviously, he had all the regular testing and easy bleeding which worsened with age as his skin got thinner.

He was pretty susceptible to pneumonia in his later years and his lungs would fill with fluid. He had this happen again when he was 84, and in order to drain his lungs they had to lower his Coumadin and allow blood to thicken in order to avoid the internal bleeding risk. They did the draining procedure and it went well. However, he had a stroke the following day due to the lack of Coumadin. Unfortunately, that sent him in a spiral that he never recovered from. My point in this story is just to point out a real world risk.

Overall, his decision to go with a mechanical valve was the correct one as he would have certainly needed the tissue valve replaced again as he lived so long. Who knows the toll a second open heart surgery would have taken on him. From my point of view in his situation, avoiding the second surgery with a mechanical valve was the correct decision.

Best of luck with your decision and surgery. I had open heart surgery myself three years ago, and it's a challenge but one that I'm thankful I had. I'm fully recovered and in a much better place than before my surgery.

 

[kcowan]

He was pretty susceptible to pneumonia in his later years and his lungs would fill with fluid. He had this happen again when he was 84, and in order to drain his lungs they had to lower his Coumadin and allow blood to thicken in order to avoid the internal bleeding risk. They did the draining procedure and it went well. However, he had a stroke the following day due to the lack of Coumadin. Unfortunately, that sent him in a spiral that he never recovered from. My point in this story is just to point out a real world risk.

Do you have any insight into why there was fluid buildup in the lungs? The reason I ask is that both MIL and Bro died from that because they had lung disease and were deemed to weak for the draining operation.

 

[ndlex]

Do you have any insight into why there was fluid buildup in the lungs? The reason I ask is that both MIL and Bro died from that because they had lung disease and were deemed to weak for the draining operation.

He was a smoker for many years from his teens to his late 50's. It's my understanding that it was related to him getting pneumonia and his COPD and congestive heart failure made it hard for him to fight off the fluid buildup. Each time he got pneumonia it was harder for him to fight off. Think the pneumonia getting worse each time was due to the antibiotics they had to pump him full of to get rid of it combined with his advancing age. He also wasn't as proactive as he should have been when he felt like he was getting pneumonia again, and by the time it was addressed it was pretty advanced.

 

[kcowan]

Yes the problem with COPD is that it saps your energy as it advances and that in turn works against draining the lungs through exercise. It also reduces the body's ability to withstand general anaesthetic. A vicious cycle.

 

[Tom57]

My TAVR experience

I had a new AV installed 2 years and 1 week ago when I was 67. The new AV is bovine/cow. The AV was installed by TAVR which is like an Angiogram- through the femoral artery at the groin site.
TAVR is about a 6 year old procedure used on people who already had a sternotomy like I did in 2009 for a CABG. Therefore I did not have any choice but the TAVR because of the risk of a second sternotomy was too high (stroke/mortality).
The day I had my TAVR there were 3 other patients who also got a TAVR. Those patients were 89, 91 and 94 years old. I meet with the Cardiologist who performed the TAVR every year because nobody knows how long the new AV will actually last because of the newness of the TAVR procedure and the advanced age of the typical TAVR patient.
Questions for OP - have you had a sternotomy (chest crack)? Is your existing AV having stenosis?
Good Luck.

 

[kimcdougc]

Yeah, I get your point but I still think the problem is the cardiologist. He/she is the person here with detailed knowledge of the OP's situation and extensive (hopefully!) experience with customers who have made the decision either way and have reported the consequences. To leave the OP needing to beg for anecdotes on the internet and then to make his decision is just plain wrong.

To the OP: I would either schedule another appointment with this cardiologist and insist on getting specific advice (it's still your decision) or, better, I would use your network of friends and acquaintances to find a better cardiologist, then schedule an appointment for a second opinion. Docs are not interchangeable like light bulbs; there are good ones, marginal ones, and bad ones. It's worth the effort, IMO, to find the good docs, whatever the specialty.



And in the unlikely event that your insurance won't pay for this second visit, so what? This is important stuff and if you have to write a check, it's worth it.

(Incidentally, I deliberately used the word "customer" in the first paragraph. The medical industry tends to forget that's what we are. I try not to.)

I had an aortic valve replacement in May of 2013 at the age of 53. A good doctor will not tell you which way to go - mechanical verses tissue. You are your own best advocate. I did hundreds and hundreds of hours of research before I chose my On-x mechanical valve. I did interviews with three cardiac surgeons and educated myself before I spoke with the doctors.

You can private message me if you have any questions or concerns. It is an individual decision.

 

[kimcdougc]

Seems that I will be a candidate for aortic valve replacement sooner rather than later. Research (reassuringly) suggests it is getting to be a fairly routine procedure, but one of the biggest issues is deciding on the type: mechanical vs biologic (pig/cow) valve. I’m in my mid60s, so I guess I’m in a gray area, since mechanical is usually recommended for under 60, biologic for over 70. I’m told mechanicals can last “forever” but require a lifetime of Coumadin maintenance, while biols usually need replacement anywhere from 7-20 years later, but no Coumadin. My gut reaction is, a lifetime of Coumadin maintenance would suck, always concerned with monitoring and internal bleeding, and I’d rather risk another replacement in the New and Improved future. If anyone has experience with Coumadin maintenance or valve replacement in general that they want to share, I would be so very grateful!

I sent you a private message about my experience with an aortic valve replacement 5 years ago.

 

[ivinsfan]

I had an aortic valve replacement in May of 2013 at the age of 53. A good doctor will not tell you which way to go - mechanical verses tissue. You are your own best advocate. I did hundreds and hundreds of hours of research before I chose my On-x mechanical valve. I did interviews with three cardiac surgeons and educated myself before I spoke with the doctors.

You can private message me if you have any questions or concerns. It is an individual decision.

It is personal but I'm guessing not many surgeons would use a tissue valve on a 53 year old patient.

 

[Bestwifeever]

65 is the general cutoff for mechanical vs tissue...

MY DH was 64 and a half when he had a mitral valve repair and they told him they would use a mechanical if a good repair wasn't possible . .Didn't even offer the option of a tissue. The repair failed after 5 years (not uncommon I guess....

How did you know the repair failed—were there any symptoms? DH’s mitral valve was repaired two years ago and I worry about that.

 

[ivinsfan]

How did you know the repair failed—were there any symptoms? DH’s mitral valve was repaired two years ago and I worry about that.

Is your DH having annual ultrasounds under the care of a cardiologist? In my spouse's care it began leaking in another part of the valve, so I guess saying the repair failed isn't 100% accurate. But his cardio said that it's common but you usually get a good 10 years before problems start occurring.

As I said they never offered the option of replacement until the first repair wasn't working. I don't know if this is a medical thing or an insurance thing.

 

[Bestwifeever]

Is your DH having annual ultrasounds under the care of a cardiologist? In my spouse's care it began leaking in another part of the valve, so I guess saying the repair failed isn't 100% accurate. But his cardio said that it's common but you usually get a good 10 years before problems start occurring.

As I said they never offered the option of replacement until the first repair wasn't working. I don't know if this is a medical thing or an insurance thing.

Thanks—he sees his cardiologist in October but they don’t “look” at the repair (which was open heart). I’ll have him ask about that. It was monitored with echos based on an increasingly loud heart murmur over 20 years but since the repair, the murmur is gone. I hope your spouse is doing well.

 

[ivinsfan]

Thanks—he sees his cardiologist in October but they don’t “look” at the repair (which was open heart). I’ll have him ask about that. It was monitored with echos based on an increasingly loud heart murmur over 20 years but since the repair, the murmur is gone. I hope your spouse is doing well.

Are you saying he doesn't still have an annual echo? You might ask if that is possible for your peace of mind...because they do have more options if the catch renewed leaking before it gets to serious..ie groin repair.....