Today is 11/25/99
WHO AM I?
I am a 66 1/2-year young male,recently diagnosed with aortic stenosis by echo-cardiography
and verified with a cardiac catheterization (55 mmHg drop across the heart valve, coronary arteries
but with partial blockage in only one coronary). My heart muscle is strong (ejection fraction ~63%)
and diastolic end pressure in the heart is ~10 mmHg. The only symptom I have is that I at about
4:00 pm in every work(or play)day I usually feel fatigued. When significant weather fronts pass
over, I frequently feel overly sleepy, and just sit in my chair and watch TV. I am currently employed
and work between 8:00 and 5:00 pm.
WHAT DOES MY SURGEON SAY?
My surgeon suggests that I am a candidate for a Carpentier-Edwards pericardial bioprosthetic heart
valve (his bias?). He indicates that the recently improved valves of this type will last about 14 years with a
probability of no problems with likelihood of around 95-98% for a person my age. I have been able to
partially confirm his statment from my limited perusal of several articles in medical journals
(Dr Cosgrove, Cleveland Clinic, wrote one of these). Because I am somewhat active (biking, hiking, swimming,
light weight-lifting), and on-foot overseas travel, I am attracted to this valve. Because of these activities,
my wife is afraid that if I am on coumadin, I will hit my head and cause brain bleeding so she also favors
the pericardial valve approach ( I am aware that some persons do take coumadin even though they have a
tissue valve implanted).
MY QUESTION:
Since your surgical team has extensive experience in valve operations, I hope they also have good statistics
that would verify my surgeon's claim of a likely 14-year life time for me if I select the "new" C-E pericardial valve?
Note that his estimate excludes any consideration of the C-E porcine-type valves). Further impetus for my selection is
an article posted on your site, Unique Identifier 98309271, that indcates a respectible incidence of morbidity and
mortality for a re-opeartion.
PROBLEM:
On the other hand, my cardiologist recommends a St.Jude's mechanical valve. He suggests that I have an operation
to replace my aortic valve (bicuspid, congenital condition) within one to two months (February or March 1999).
I realize the decision is mine, but perhaps your extensive knowledge will make us feel more comfortable about
the choice of a pericardial tissue valve over a mechanical valve.
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Dear Robert,
Thank you for your question. Your question is a classic debate and one that we hear often in this forum. "Which is better - a tissue valve or a mechanical valve?" There are pros and cons of each which I outline below. Ultimately the decision is between you and your doctors. Good Luck.
Tissue Valve.
Types: CE Valve, Homograft
Pros: Do not require anticoagulation. (unless there is another indication such as atrial fibrillation)
Cons: Have a limited life span.
Mechanical Valves
Types: St. Judes, Medtronic-Hall
Pros: Long life span
Cons: Require anticoagulation to prevent blood clot complications
I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions.
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.
