Valve replacement options

My wife ( age 56-good but sedentary health otherwise...main exercise being bridge and a little golf) is scheduled for a catherization next Weds.( 29th ) and an AV replacement on Thurs...she just found out about having moderate/severe stenosis (0.5-0.6cm sq aortic valve area with most other things looking OK)...We would like to know the various options as to replacement valves..don't like the idea of coumadin for life, but don't really know various side effects...Are there different types of the St. Jude( read something about a recent recall)...
Is minimumly invasive surgery available for AV replacements and, if so, for how long with what success rates..To sum up a rambling post, please let me know of the options generally considered best for her age and the things to be aware of with that particular option...Thank you for your help..my e-mail is ***@**** if any other poster have pertinent info...please pray for her..her name is Hennie

[Cleveland Clinic, MD]

Dear Jamie,
The big choice to make first is a mechanical vs. a tissue valve.  There are pros and cons of each.  The main advantage of a mechanical valve is its long life and the disadvantage is the coumadin.  The advantage of the tissue valve is not having to take coumadin but the disadvantage is having to undergo repeat surgery in a younger person.  It's really a presonal choice between her and her surgeon.  I tend to favor mechanical valves in these situations.  The St. Jude is the most commonly used valve.  There are several different sizes but they are all basically the same valve.  I hadn't heard about a St. Jude recall but if so those are usually for specific batches.  Generally min. invasive techniques are not used for aortic valve repair.

[Susan]

Due to severe aortic stenosis caused by a congenital birth defect (bicuspid aortic valve), at age 51 I had my valve replaced in February 99.  I chose the St. Judes mechanical (without the silizon ring) because I didn't want to risk having the surgery again later in life when perhaps there might be other medical factors to consider.  While the tissue valves (pig, cow or human) don't require coumadin therapy, their life expectancy is less than your wife's at age 56, so it would seem the likelihood of a repeat surgery would be rather high.  I have had no problem with the coumadin.  Once it was regulated (a few weeks), I go once a month to have my blood checked.  I am very active with a very demanding job requiring a lot of travel (plane, auto) and a child in college.  Walking post surgery is one of the best ways to a quicker recovery.  I was walking one mile at the end of the first week.  Also practicing breathing using the incentive spirometer she will get in the hospital is a great help.  If she is rather sedentary now, she will really need to get some pep in her step for a more speedy recovery.  Of course, the valve choice is purely person in conjunction with your surgeon, but I just wanted to comment that my experience with the mechanical valve and coumadin is not so bad and worth it to me to hopefully not have to consider repeat surgery.  Best of luck--she will do fine.

[Jamie]

Susan.. Thank you so much for your reply. Your situations appear very similar as hers is also congenital...She feels very comfortable about the artificial, and just wants to get on with it...Thanks for caring enough to take the time to reply...CCF..Thank you also for such a wonderful service..You are "the best".

[beverly]

Susan and Jamie, thank you for your information. I am only 50 and was just diagnosed with an aortic insufficiency and a tricuspid insufficiency, mild to moderate. I'll have further tests but in the meantime I'm trying to educate myself. Susan, would you plese describe your surgery?

[Jamie]

Beverly...I just brought my wife home today..she had a St.Jude mechanical valve put in and also had to have a dual permanent pacemaker ..She is doing great and  has been sitting up at home talking with friends for a couple of hours.. she looks great and this this whole experience has turned out to be a wonderful blessing, physically and spiritually...she never hurt much, and was only a little down when she was very weak...a pint a blood and a little time fixed that..I hope all goes well for you..We have an excellent heart facility locally (Raleigh, NC) and if you have the same, I sure recommend staying close to home for whatever you need