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.
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.
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.
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.