HEART VALVE Choice, to click or not to click

[desmopedro]

Hello all!!!!

1st I want to say how disappointed I am in MYSELF on this issue.......

I am scheduled to have my heart valve replaced in just OVER A WEEK!!!! (9/20/2011) And I am very upset I didn't start this process sooner......

Just a quick bit of info about me. I am a 41 year old male. Married (not kids....) and I would say an "ACTIVE" guy! I am 6' 4" tall and currently weigh about 255 pounds.

About 15-17 years ago i was found to have a heart murmur, and upon further research later in life I was found to have two bi-cusped heart valves.

In the last year it has been decided that I need to have my heart valve replaced! (And stupid me......I can't remember which valve it is!!!! But I will get into that in a bit...) Not both.....just one....

This whole time I have gone through this, my General Physician recommended a Doctor here in Minnesota that is considered a CLASS LEADING Doctor and works with one of the leading heart clinics in the COUNTRY! The Doctors name is Dr. Robert Emery and he works at St Joseph's Hospital in the cardiovascular unit they JUST built a few years back!

I have done little research as I have been listening to the Doctor and taking his word as the "BEST" way to go, so there was little or no question......until recently.

Prior to surgery I had to get a heart cath to make sure everything was set for surgery about a month later. In all prior meetings I had with Dr. Emery, we discussed both options of a mechanical valve vs. a tissue valve, and each time he was clear in it was my choice and there were risks and rewards for each choice, but in the end it is still MY choice and he understood why I would want to go with either valve.

I left the meeting with the idea I was FINE with a tissue valve, with the idea that I would need a 2nd surgery in the next 10-15 years. I consider myself an active person and the thought of taking a blood thinner was very intimidating to me.

My "day" job is a desk job, but "at night" I do just about EVERYTHING! I cut wood with a chainsaw and split it with a huge splitter....I drive motorcycle.....I am remodeling my home and do all of my own work (or most of it), I lift heavy things like 50-80 pound speakers for a DJ side business I run, I am 6'3" tall and have a tendency to run into things....I work on my own vehicles...I like the idea I can water-ski, jump off a cliff, or punch a guy who might give my wife a hard time!!!! (I hope you get the idea....)

I am afraid if I do something wrong, or cut myself, or bump my head on the door frame I am installing, I will get some type of "non-stop" bleeding episode and I am screwed!

I know I would need a 2nd surgery but with medical advancement (in valve replacement and pharmaceutical advancements) in 10 years there WILL be a better option for me to have the LAST surgery I would have and have a mechanical valve put in, OR a drug would be introduced that would allow me to KEEP my tissue valve!!!!

Well.....after the heart cath.....Dr. Emery said he recommends a mechanical valve! He feels that there will be advancements in cardiac drugs I can take that will replace Coumadin the will be MUCH better for me and will have minimal bleeding risks that will be available in the next 3-5 years or SOONER! Again, he is FINE doing the tissue valve, but feels a 2nd surgery (with the risk....cost.....etc.) may not be the BEST option! He is retiring in the next 5 years, so he would not do the 2nd surgery, but I am SURE the hospital will have another heart Doctor that would be great....Still...he feels the valve may last a LITTLE as FIVE YEARS and is thinking 5-8 years for my age and activity level!!!!

I respect my Doctor!!! I hear GREAT things about him from MULTIPLE people and I KNOW other Doctors look up to him for advice! (He was even recently named editor-in-chief of the Journal of Heart Valve Disease!!!) But I am SO TORN!!!!

I want to LIVE MY LIFE!!!!! I want to run and jump and get another tattoo without worrying about bleeding to death!!!! I don't want to worry about consuming too much vitamin K (I guess a bad thing on Coumadin), I want to go to Mexico in Feb and play in the ocean without worrying about hitting my head on a rock and stroking out!!!!

BUT, I work for a LARGE company!!! My insurance is GREAT!!!! I get 26 WEEKS of 100% paid disability!!!! And do I WANT to have a 2nd surgery? In this economy I may be out of a job!! Or working for a different company with not as good of an insurance/disability policy.....

PLEASE!!!! HELP!!!! I need some advice!!!!

I have been told my "aortic regurgitation" is "severe", (If this helps decide what valve is being replaced) and there is enlargement of one side of my heart! This surgery is NOT an option!!!! I am tired...and my blood pressure is being affected by this....I KNOW I need it done.....

The question......WHICH VALVE should I go with!!!! I WIST there were a clear cut answer!

PLEASE.....if ANYONE can give me advice.....and I can get a tattoo in the future....maybe your name will be one of them!!!!! :-)

Thank you!!!

-Pete

[ed34]

Are you overlooking something important here? and perhaps your Doctor in his initial comments? You are 41 right? So, let's say you get 12 years out of your tissue valve, that makes you 53. BUT, what about when you reach 65? then 77?
You keep mentioning 2nd surgery, but what about 3 and 4?
How many valve replacements do you want to go through?
Is it just me, or have you not realised this?

I would just go for the mechanical.

[jimbeau]

I have had a mechanical valve for 31 years and taken warfarin since the replacement surgery. I really have never worried about bleeding to death. I think the risks from the warfarin are much lower than having a second open heart surgery. There has never been a limit on my activities. You will need to monitor your INR (warfarin level). They recommend having it checked monthly but I get mine checked about every 6 months if that tells you how worried I am about it, but you should get yours checked the first few years (decades?) as recommended. My surgery was done at age 20 so there was really no choice but the mechanical valve. I hope to never need open heart surgery again. The warfarin replacement is called Pradaxa. It is not yet approved for valves but may be within a few years.