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question to those who have a mechanical aortic valve

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Old 06-09-2005, 02:59 PM   #1
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starfish11040 HB User
Question question to those who have a mechanical aortic valve

It has been recommended that my valve be replaced with a mechanical one.
1) How difficult is it to keep your blood at the right level of coagulation? Are there bleeding problems with things like dental surgery, accidental cuts, etc.?
2) This valve has been around for 20+ years. Do you know what the risk is in numeric terms for stroke and infection over the years?
3) Are there restrictions on your activity?
4) What's the prognosis in terms of life span beyond the stroke and infection risk?
5) Any other comments would be appreciated. The more I know about this the better decision I can make.

Last edited by starfish11040; 06-09-2005 at 03:00 PM.

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Old 06-10-2005, 01:19 PM   #2
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Re: question to those who have a mechanical aortic valve

This information may help you understand your choices.

Key points to consider in making your decision between two types of valves: mechanical or tissue (also called biological). Mechanical valves are made of metal, carbon, or artificial materials, and sometimes a combination of these. Tissue, or biological, valves are tissue taken from the heart of a pig or a cow. Tissue valves may also be preserved human valves taken from a donor, similar to a donated organ.

Consider the following when making your decision:

The main trade-off between mechanical and tissue valves is durability versus risk of blood clots. A mechanical valve will last 20 to 30 years, while a tissue valve will last about 10 to 15 years. However, the risk of blood clotting is higher with a mechanical valve and as you know blood clots can cause a heart attack or stroke.

The choice also considers age: Under 60 a mechanical valve is likely to be your best choice because you are young enough that you probably would outlive a tissue valve. It also may work better because tissue valves can become hardened, or calcified, in younger people.
Anticoagulant issue: If you choose a mechanical valve, you will have to take anticoagulant medication every day for the rest of your life to lower your risk of blood clots. If you choose a tissue valve, you will need to take anticoagulants for only a few months after surgery. With a tissue value one will not have to take antibody medication before dental procedures.

Consideration with other heart issues: If you are already taking anticoagulants for other conditions, such as an irregular heartbeat (arrhythmia), one should strongly consider a mechanical valve. The only real advantage of a tissue valve is in not having to take anticoagulants, so someone who is already taking the medication would likely not get any added benefit from a tissue valve.

Because of the shorter durability of a tissue valve, there is an increased likelihood that you will need another replacement valve, and weigh that against the drawbacks of taking anticoagulant medication for the rest of your life or as long as you have a mechanical valve. These medications can increase the risk of bleeding.

Mechanical valves last at least 20 to 30 years in most cases. The greater durability of a mechanical valve makes it less likely that you will have to replace the valve in your lifetime. While mechanical valves can break down, this is very rare.

In spite of chemical treatments to improve durability, tissue valves typically last about 10 to 15 years. They usually fail because of the same calcification process that affected the original valve. Tissue valves may also tear or become infected. When tissue valves are used, a second valve replacement may be necessary.

In general, mechanical valves are the preferred choice for children, adolescents, and adults 60 and younger, all of whom will likely outlive a tissue valve and need another valve replacement.

Tissue valves are most appropriate for people who are less likely to outlive their valves, which includes people who:

Are older than 65.
Are younger than 60 with lung disease.
Have heart failure.
Have coronary artery disease.
Have kidney disease.
Have a life expectancy of less than 10 years.
Because anticoagulant medication is needed only for a short period after surgery, a tissue valve may also be the best choice:

When the risks of bleeding associated with anticoagulants are too great and this may be an individual's own general activities and health basis one would want to limit some activities because of the risks of bleeding associated with anticoagulants. To prevent blood clots, people who receive mechanical valves must take anticoagulants, such as warfarin (Coumadin), for the rest of their lives. This medication can increase the risk of severe bleeding from an injury and can cause a number of side effects are other considerations. Because one's system recognizes foreign substance there is a natural tendency to clot.

Tissue valves cause a much lower risk of blood clotting than mechanical valves. It is generally necessary to take blood-thinning medication only for several weeks after valve replacement, and then you would take only aspirin. While there is a risk of complications associated with tissue valve failure or infection, these complications are relatively rare.

The decision whether to get a mechanical or tissue valve takes into account your personal feelings and the medical facts are other considerations.

A mechanical valve lasts 20 to 30 years, and the durability of a mechanical valve makes it less likely that you will need another replacement valve in your lifetime. Depending on one's health and under 60 one likely to outlive a biological valve and require another replacement.

QUOTE:What's the prognosis in terms of life span beyond the stroke and infection risk? I have read an article from Mayo Clinic's cardiac surgeon who states one can expect to live a normal life span after valve surgery. This of course depends on an individual's general health, lifestyle, diet etc.

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