Interested in views about Aortic valve replacement Mechanical vs Tissue

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I have recently been told I have a 5.4 cm ascending AA, with a stenotic Bicuspid Valve that need replacement. I am 65 years of age, with no symptoms - but lucky enough to be on a waiting list for Surgery, hopefully before the year end. I am looking for information about whether a Mechanical or Tissue valve replacement is the best option. I have been told that the Aorta replacement will be a piece of Dacron tubing. Any comments would be very welcome.

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  • Posted

    I just recently (7 weeks ago) had surgery for a dissecting aneurysm with an aortic  valve replacement.  I chose the mechanical valve because I was told that it would not have to be replaced and that tissue valves need to be replaced in 6-8 years.  Even if it lasted longer I didn't want to go through that again.  So far things have gone well.  I can sometimes hear it but no one else can unless they are listening with a stethoscope.  It sounds like my heart beating faintly in my ears.  I am 63 years old. 

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    • Posted

      Thank you for your prompt comment. I had been told that you (and sometimes your partner) could potentially hear the valve 'ticking'. I have been able to hear my heart beat in my ears for as long as I can remember and just thought it was normal. Your comment has been very helpful.

       

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    • Posted

      My husband cannot hear the ticking unless he listens with a stethoscope.  The heart beat does not really bother me.  Best of luck to you in making a decision.
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  • Posted

    Hi Ted,

    I was diagnosed with aortic incompetence back in 1978. This was due to a bicuspid valve. The valve was monitored on a yearly basis and I knew that sooner or later I would need a replacement. I gradually became more and more breathless, my heart enlarged to cope with the lack of aortic performance and eventually valve replacement became necessary. I was told if I did nothing then within 5 years I would go into heart failure and eventually death.

    So in 2005, at the BRI in Bristol, the valve was replaced with a mechanical valve. They said at that time that for someone of my age, 54, a mechanical valve would be the best option as it would probably never need replacing but the downside was that I would be on lifelong medication to reduce the chance of blood clots forming. They said that tissue valves are generally used for patients where a long lasting valve is not necessary.

    The replacement valve is a bi-carbon, bi-leaflet valve, it’s like a butterfly. Most of the time I don’t notice it but I have to say that it transformed my life and gave me back my energy and my joie de vivre. I do notice it sometimes at night if I lie on my left hand side. However in my case I have other factors that make it more noticeable. I had a cancerous tumour between my lungs and when they excised it my heart was, ahem, “repositioned” and now lies nearer my chest wall, so this may account for why the valve is more noticeable. If I am in a very quiet environment it can be heard by those with very acute hearing. A friend of mine’s son could hear it when he was young and liked to put his hand on my chest to feel it beating, it sounds like a finely tuned watch.

     As for the medication, I need to have my INR checked on a regular basis. INR is a measurement of how quickly the blood clots; I believe it is a measure of the prothrombin time, search for “blood-clotting-international-normalised-ratio-inr”. I have purchased a device to do the measurement myself, saves endless trips to the hospital/clinic, which I then communicate to my GP and he tells me how much Warfarin to take.

    I have not had any problems with the valve at all, I don’t notice it any more than I notice my breathing, it’s part of “me”.

    The aneurysm however is a different issue. I believe there is possibly a link between bicuspid valves and Thoracic Aortic Aneurysms (TAA) and, you guessed it, I now have a TAA and am awaiting surgery. Personally I would be more worried about the TAA than the heart valve. I have a 7.3cm saccular aneurysm close to the aortic root and my mechanical aortic valve and I can assure you I’m taking it very easy indeed at the moment!

    Ted, whichever type of valve you go for is up to you. You’re 65 so potentially you could be around for another 20, 30 years, so I guess you have to ask yourself “If I go for a tissue valve, do I want to have another replacement done at some time in the future? Or if I go for a mechanical valve do I want the inconvenience of checking my INR regularly and taking Warfarin (or similar) for the rest of my life?”

    Either way you’re in a win-win situation; you’ll get the aneurysm fixed and you’ll have a new valve! I know the operation will be a big hurdle to clear but just be positive, trust in God or whatever and you’ll be fine.

    Do you know yet who will be doing the operation?

    Which hospital will the operation be performed at?

    Good luck with the operation and advance congratulations on joining the chest zip club ... I'm thinking of having mine tattooed with a zip!

    Onward and upward!

    Regards,

    Phil

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    • Posted

      Phil,

      Thanks very much for your post, it was particularly interesting and helpful. I like the thought of being a member of 'the chest zip club', although less keen on the tattoo idea. Ha Ha!

      I will be having my Surgery at Royal Stoke Hospital. The Cardio Thoracic Surgeon is Mr. Balacumaraswami, who has a pretty good track record and bags of experience.

      I have been able to hear/feel my heart beating in my ears at night for as long as I can remember - I just thought that was normal, so I am not really that concerned about 'noises'.

      I guess I am still favouring the Mechanical Valve because of its effective lifespan over the Tissue valve, given my age.

      I have no symptoms at all, so finding this out came as a bit of a shock, although I am grateful that is has been found and both issues are being addressed at the same time.

      I have a 54 year old brother with the same sort of aneurism found 8 years ago, albeit that his was 4.6 cm when last checked 4 years ago - he is due for another check in Nov 2019.

      I hope you get your surgery soon and everything goes well, 5.4 cm sounds bad enough to me, so take good care of yourself.

      Maybe we can swap good news stories in a few months.

      Kind Regards.

      Ted.

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    • Posted

      Hi Ted,

      I'll certainly post here as time goes by and let folks know what is happening. All too often one never gets to know what happened in the end. The trouble is that with AAAs and TAAs silence (no posts) can imply a rather dire outcome.

      If things do go west this time I have asked my partner to let you all know. I'm not being morbid though, just practical.

      Cheers for now.

      Phil.

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