Aortic Valve Replacement Surgery

[Re_Re]

I am a 42 year old female.  I am having aortic valve replacement surgery in the next couple of weeks.  I am interested in any information that you can give me about prosthesis valves.  I am verrrrry concerned about being on Coumadin for the rest of my life. I was born with a bicuspid valve and had Rheumatic Fever has a child.

[Cleveland Clinic]

Depending on the center, sometimes the valve can be salvaged and repaired instead of replaced. The ability to repair the valve is generally only available to the best of cardiothoraccic surgeons, such as those at very large tertiary referral centers. In most local hospitals the option to repair is not even available and the surgeons simply replace the valve. Then, once the decision is made to replace the valve the next decision has to be what kind of valve to use. Bioprothetic valves do not require anticoagulation with coumadin, but in your age group have much less longevity than mechanical valves probably because of a very active immune system. The average expectancy for such a valve in a young patient is probably 9 years. Mechanical valves last longer but do require anticoagulation. The decision on which valve to use depends on the particular patient and discussions with the surgeon, understanding the benefits and drawbacks of both valves. It is of particular interest the reproductive status ( that is are you planning on having children or not) because pregnancy with a mechanical valve is difficult to manage because of the need for continued anticoagulation.

[Fionajnz]

No help at all on the surgical aspect, but I do have input on the concerns you have about coumadin therapy.  

I have done total of about 3 yrs on blood thinners.  Heparin during and after pregnancies (3 live births) and after our third was born I developed post partum cardiomyopathy and then a PE.  I was on coumadin for about 6 mths after delivery.

So, the low down on coumadin - by the way, we are the same age.  The most important issue that affected me was getting the INR level correct, it took a bit of time and you need to know and understand the range they want you in.  Often cardiologists offices have a coumadin clinic, that helps with that.  Dietary wise, if you eat a balanced diet, it really is fine, diet becomes an issue only if you make huge changes in say Salad intake, but if you normally eat it, keep on doing it.  Your body basically adjusts to the vitamin intake based on *your* norm.  Next - the potential for bleeding based on what are normally minimal things.  Say, nicking yourself when shaving your legs.....best to use a wax method.  It can really take a while to stop that type of stuff.  I had a sml amt of wax in my ear canal, it was removed and doing so scraped the inside of my ear, it bled for nearly 24 hrs, needing urgent care intervention.  I would personally advise wearing a medic alert too, its a small thing you can do to help others understand what is going on and its urgency if you are hurt.  Its not hard to adjust truthfully, its just taking the time to do so.  

Right now they are advising once again that I do coumadin for the long term, so I am reflecting on the whole experience again.

Meantime, best wishes for a great outcome with your surgery, I am sure it will go well and so will the therapeutic meds afterwards.

HTH.

Fiona

[Re_Re]

Fiona,
Thanks for the insight.  

Re_Re