Question Title: AOR

I am a 29-year woman who has an artificial aortic heart valve. This is the second artificial aortic valve that I have had - the first was a tissue valve, which was damaged by endocarditis, and I now have a mechanical valve for which I have to take warfarin. I am trying to find out information about whether there are alternative valves available that would enable me to come off warfarin as I am increasingly worried about the long term effects of warfarin - I have particular fears about haemorrhage or stroke. I understand that there is research into tissue engineering that might eventually enable surgeons to build new valves from patient's own cells, but am finding it very hard to find out any information about this procedure. Is it likely that this will be available in the future? I would also really like to know if my fears about long term warfarin use are justified. I would be very grateful for any help you can give me on this subject, as it has become a subject of great concern for me.
I posted this on 12/12/98, but it has since disappeared from your list of questions.

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Dear Stacey,
Firstly I apologize for the lost first posting.
Secondly, you shouldn't be so fearful as you are cautious. Yes, the warfarin does increase your likelihood to bleed/hemorrhage, but only alittle-so little in comparison to the risk (stroke, heart failure and death) without the mechanical valves. Even had your first tissue valve not become infected, it would not have lasted you more than 10 or so years, and for such a young person that means multiple reoperations in a lifetime-each with ever increasing risk of stoke and death.
As for the stroke issue in regards to being on warfarin, yes warfarin increases slightly your risk of a hemorrhagic stroke but not of an ischemic stroke (the most prevalent type, occurring in older patients.) As a matter of fact many older patients with increased ischemic stroke risk are on warfarin to REDUCE their risk of ishemic stroke. So as you may see, your fears are in a way unfounded.

There is alot of research involving the search for the perfect valve replacement, including longer lasting tissue valves, however their availability is years away. The exact timing of course is unpredictable, however I would guess it will be a good decade before any seriously new valve replacement is available.

I hope this information is useful. Information provided in the heart forum is for
general purposes only. Only your physician can provided specific diagnoses and therapies.
Feel free to write back with further questions. Good luck!

If you would like to make an appointment at the Cleveland Clinic Heart Center, please
call 1-800-CCF-CARE or inquire online by using the Heart Center website at
www.ccf.org/heartcenter. The Heart Center website contains a directory of the
cardiology staff that can be used to select the physician best suited to address your
cardiac problem.

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