Why I Chose Mechanical Over Tissue

It was recently suggested to me that I provide an explanation of why I decided to receive a mechanical valve, rather than a tissue valve to replace my diseased aortic valve. This post will  be dedicated to why I made this (very personal) choice.

ross procedure

ross procedure

There are generally two options for someone in my situation; Replace the Bicuspid Aortic Valve with either a mechanical valve, or a tissue valve. Tissue valves are usually from a cow or a pig. They can also be homograft, which comes from a human cadaver (check off organ donor on your driver’s license y’all!). There is also a crazy option called the Ross Procedure where the surgeon takes the patient’s pulmonary valve, puts it in the aortic position, and takes a pulmonary valve from a cadaver, and puts that in the pulmonary position. I mean, wow.

Mechanical Valve Pros & Cons

  • Mechanical valves typically last for life. Patients who expect to live for more than 15 more years are often encouraged to get mechanical valves. This means that one should expect only one open heart surgery.
  • The main drawback of mechanical valves has been their requirement for warfarin anticoagulation therapy, with its accompanying risk of bleeding. Bleeding events are rare but are potentially fatal. With properly managed anticoagulation therapy, rates are low for both bleeding and clotting. Without anticoagulation therapy, a blood clot may form on the new valve, inevitably causing a fatal stroke.

best-heart-valve-replacement-1

Tissue Valve Pros & Cons

  • The lifetime of a tissue valve is typically 10 to 15 years, (possibly) less in younger patients. Tissue valves may also last longer.
  • Additional valve replacements places additional chances of risk that inherently goes along with open heart surgery.
  • The primary advantage of tissue valves is their lower requirement for anticoagulation therapy, which reduces the incidence of bleeding. However, other heart issues may require patients with tissue valves to go on anticoagulation therapy.

My Choice: The On-X Mechanical Valve.

Perhaps it is the cyclist and rock climber in my that thought that ‘carbon fiber with titanium housing’ sounded cool. My surgeon did not specify whether or not he thought this brand was better than others.  The St. Jude’s Valve is the most commonly used. I chose mechanical for several reasons:

  • If I can help it, I only want one heart surgery in my lifetime. Getting tissue valves would mean getting 2 or 3 replacement surgeries in my lifetime, especially since I am young.
  • Though doctors recommend against competitive or extreme sports, the reason for this is for the potential of injury, thus causing major bleeding events due to the anticoagulation therapy. I feel that I can do my sports of choice, with an understanding of the risks, and taking necessary precautions.
  • After recovery, the mechanical valve will probably perform better than the current diseased valve.
  • An exciting study involving On-X Valves and lower anticoagulation drug doses may result in future recommendations of lower doses of the anticoagulant drug Coumadin or Warfarin. Lower doses would lower the excessive bleeding episode risks.
  • Because mechanical valves typically last for life, I can get the replacement surgery now, rather than waiting for the last possible moment, which is often done with tissue valves (to reduce the total number of heart surgeries in one’s lifetime). This is a benefit since I also need an ascending aortic aneurysm fixed. The aneurysm dissecting or rupturing actually poses my greatest current risk.
On-X Mechanical Valves

On-X Mechanical Valves

This choice is a personal one. Some athletes choose tissue valves because they do not want to worry about anticoagulant drugs affecting their sports of choice. It is is important to remember however, that sometimes tissue valves still require these drugs, depending on the circumstances. To some athletes, multiple surgeries are an acceptable consequence to avoiding drugs for 6-15 years. For me, I have learned from my doctors and other mechanical valve ownersWomen who plan on having children will also choose a tissue valve, because anticoagulation drugs cause damage to the fetus.

The best thing to do is to weigh the pros and cons, think about what you want out of your own life, make a decision, and then make a game plan that will lead you towards a healthy, active, productive life.

I’m kind of annoyed that I cannot embed this here. Welp, here is the link.

6 thoughts on “Why I Chose Mechanical Over Tissue

  1. Brian

    I had my AVR back in 2009. My choice without hesitation was a tissue valve as I am active in contact sports (hockey). At 26 years old I did not want my life interrupted with visits to a Coumadin clinic and the fear of the excessive bleeding. I appreciate your decision as it is personal but for me, one thing I am banking on is the increase use of TAVR. That procedure greatly reduces the risk/recovery time of a patient. The golden ticket would be TAVR along with a life lasting valve that does not require any sort of anti-coagulation treatment. In any regards, appreciate reading others views as well and monitoring the web for news about AVR advances.

    Reply
  2. Andy Blake

    Had a replacement titanium Coates carbon fibre aortic valve replacement two years ago. 2013. Incredible. I had five years of worrying about open heart surgery, but I shouldn’t have as I have had dental surgery more painful! 2 years ‘on’ and all the “ticking” sounds and saphire blue lights in my (closed) eyes, as well as ear ‘rushing\beating’ noises have COMPLETELY subsided. Go for it, don’t worry and look forward to another 50 years! andyb@countonabacus.com

    Reply
  3. Paul Snaith

    I have just had my aortic valve replaced ,with a section of aorta
    ,I’ve had the ,On X ,valve fitted ,which apparently is the low dose warfrin valve,
    I’m 57 and still very active ,I’m hoping the valve will outlast me!
    Good luck to everyone who has to go through with heart surgery.
    (Paul UK)

    Reply
  4. Roger

    I’m about to go through the same in 3 weeks (bicuspid valve, and ascending aortic anurism).
    I am not finding very detailed info about diet and blood thinners. Stuff like … does it matter to miss regular meals? or is steady vitamin K the ABSOLUTE only concern??
    Wish there was more detail online, since this is for life! Do these married cardiologist choose life partners in a week or three weeks time? Why wait till last minute to offer such PERMANENT life changing requirements to clients??

    I am anxious to begin the healing, though. And put the surgery behind.
    I’m in very athletic health at 54, but I did get genes for mediocre valve, and weak walls for ascending aorta.

    Reply

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