Mital and Aortic Valve Replacement

[Vanessa Naicker]

My partner is scheduled to have a double valve replacement on the 15th of March 2000.  Alex was diagnosed with having mitral stenosis and aortic incompetence in 1992 (8 years ago). He has been managing his health condition with medication for the past three years.  However, a recent visit to his cardiologist (Prof. P. Manga)confirmed that his heart had enlargened significantly, necessitating valve replacement asap.  We've met with the surgeon, Dr Martin Sussman (Milpark Clinic, Johannesburg, South
Africa), and he has recommended a mechanical valve for the mitral valve and a bioprosthetic (pig)valve in the aortic position.  We are concerned about his valve choices as Alex is only 30 years old, and we understand that the prosthetic valve will require replacement in about 5-10 years time, which we would like to avoid if possible.  We do understand that Alex will have to be on Waffarin for the rest of his life, but he has been taking this for the past 3 years with no associated problems. Furthermore, this medication will be necessary as he is to have a mechanical valve in the mitral position.  
Please answer/comment on the following:
1. The use of two mechanical valves instead of the proposed machanical + bioprosthetic valves.

2. The use of St Judes bileaflet valves for both valve replacements.  

3.We are very encouraged by the work done by the Cleveland doctors on minimal invasive surgery and would prefer this method to the standard surgery.  But is it advisable in the case of double valve replacement? NB! repair of the mitral seems remote.

4. If he opts for two mechanical valves would the dosages of Waffarin be significantly increased?


Thank you. Looking forward to your response.
Vanessa

[Teresa]

I would like to know if you know how many children have had  mitral valve replacements.  My daughter was 14 months old when she had her 1st. mitral valve put in. She was 5 years old when she had her 2nd mitral valve put in. She will be 8 years old this year and she is doing very well.

[Harvey]

To Sean,
I had a wonderful Doctor that told me that he wouldnt do the ross procegure on anyone older than a teen ager. He said it just doesnt work as well on older people. I beleived him. I have a Homograft and I dont take any medicine other than a baby asprin a day. If you want to take rat poisan every day for the rest of your life to thin your blood, I guess the mech. is for you. It seems that even the mech. vales dont always last a lifetime like they say they do. Remember that a blood thinner will restrict you if your lifestyle is at all active, and most 36 year olds are. And also remember the noise factor. There is no guarantee no matter what valve you get but you have to decide and then come to piece with yourself about your decision .

[Harvey]

To Kerry,
I know that things have been rough for you but you WILL make it .
Dont pick the mech. valve just for monetary reasons. Look around on this site and you will see that it doesnt always last a lifetime. Your life is at stake. Money should not be what you are thinking about now. Homograft is also an option, not just a pig valve. Also, as I have said before  there is the noise factor with  the Mech. Valve. Im sure you will make the right desision, I too am 46. 8 Weeks Post Op.

[kerry wright]

i am 46 yrs old .i have had quad bypass surgery at 29 yrs old and again at 35 years old. i now haveaorta valve that is .07 according to cc,i need new valve and 2 more bypass. dr tells me mechanical is the way to go,cant afford to go back again and replace pig valve. how much is a mechanical valve going to change my life  hoping of course i can live thru the operation ,,this being no.3 time

[james]

Dear Sean.  I have had a mechanical valve put in to replace my leaking bicuspid aortic valve.  First Warfarin is the same as Coumadin and you do have to limit your consumption of alcohol.  Lucky for me I didn't drink anyway so it didn't affect me.  But I know of others who can only have a couple of beers before it starts getting to them.  When before they just drank all they wanted.  To answer your question about the valve and how noisy it is.  Let me tell you it can be noisy.  When I'm alone in a room I can hear it quite loud and others can as well if they are near me.  It sounds a lot like the ticking of a clock as the valve opens and closes.  But it's also something you get use to quickly.  Sometimes I won't notice it at all and will have to think about it and listen hard just to hear it myself.  It does grow on you.  But overall you have to be the one to decide whether or not you want a homograft or a mechanical valve.  Both have their pros and cons and it's up to you to decide.  I hope I've helped you a little.  Later.

[Sean Smith, London, England]

I am a 36 year old male about to have aortic valve replacement surgery at the Royal Brompton Hospital in London. My surgeon advises me that a mechanical valve is probably the best, though he admits that others might advise a 'Ross Procedure' - he thinks that this is somewhat risky and that the advantages are only potential ones, or 'conceptual' as he puts it.
I haven't got much time to make my decision but I'm really unsure.
What are the disadvantages of warfarin? (is this the same as Coumadin?) Do you have to moderate alchohol intake with it? And, in particular, is a mechanical valve noisy? - How noisy, I'm a very light sleeper!! This might sound trivial but it's really troubling me.
Some of your correspondents say; don't worry about re-operation and choose a homograft, and that they might last 20 years. Is this sensible advice, can someone evaluate it?