I'm not going in for DIY heart surgery, although I did know a chap who operated on his own knee. However, it seems my aortic valve is not working properly and needs to be replaced. I have two choices:
1) an artificial valve that will outlast me, but requires me to take rat poison for the rest of my life
2) a tissue valve that will only need me to take aspirin, but that will wear out in 10-20 years, by which time current advances may, or may not, have made valve replacements much simpler operations.
So, my question is, does anyone have experiences with either type they would care to share?
Some artifical valves have had problems with clots forming (I think I'm remembering right), but technology has moved on and that might not be problem anymore.
What does your consultant recommend? Have you asked him/her what they'd do in your position?
I don't see the problem with taking rat poison I certainly have no side effects. As far as I am concerned I will be taking it for the rest of my life. My problem is, though I have a healthy heart and arteries, my heart periodically has a little dance. May of happened for years but a few months ago it caused a clot to form which blocked an artery to my heart, hence a heart attack. Could happen again, in fact the dancing bit does, but rat poison should stop another clot from forming.
If the dancing bit becomes more than just intermittent, a pacemaker may help (after electro-cautery of the AV node). The rat poison will still be necessary, though.
I've heard of that as well, are modern ones a bit more sophisticated than a seat, a ball and a cage? The clacking ball is what damages the blood cells, hence requiring to be on rat poision to stop clost forming. Question for your consultant, does this make you more prone to bleeding from cuts or internal injuries?
Aspirin has some problems in long term use but probably not at the dose you might be on, 1/2 or 1 tab/day.
I can't think what advances in 10 or 20 years are going to make a valve change less traumatic. It's not the sort thing you can thread up the femoral artery like a stint. I guess you could have something like a "ship in a bottle" but if that went wrong during deployment in the working heart you'd be in deep doo doos... and how do you get the old valve (tissue or mechanical out? Naw I think you're stuck with opening the chest and presumably plumbing you into an artificial heart while they stop and work on yours.
What may happen in 10 or 20 years is being able to grow a new valve in the lab from your own stem cells(*), thus is "you" and won't be rejected. I don't think the tissue valves are 100% "you", so along with the aspirin you might be on immunosupresants of some sort.
(*) Some new research is looking promising using cells that are not quite stem cells but still cells that can be presuaded to grow into different tissues. There was one, maybe two, BBC World Service radio documentaries about this recently, not sure if it was in the "Discovery" series or the Documentary Archive. Have look to see if they are still available from the BBC Podcasts pages.
He favours the artificial valve, because I can expect to live long enough to need a tissue valve replaced and will be a lot older, and possibly less suited to surgery, when that happens. However, he also tells me that he has one patient who dislikes Warfarin so much that she has opted to have a tissue valve only two years after getting an artificial one. As she is 52, she can expect to need more than one replacement. OTOH, there is already work going on to do replacements via keyhole surgery, entering through the femoral artery. It is a complex issue and, ultimately, the choice lies with me.
What about INR control, is that intrusive? The consultant was talking about checks being needed when travelling. The drug also seems to have a lot of interactions. How careful do you need to be about diet? I don't drink alcohol, so that is not an issue. Anything you can tell me about how taking the drug affects how you live your life would be appreciated. I don't like illness being intrusive and Warfarin seems to need a lot of management.
Thank you. Apparently, it is a defect I have had since birth, but fortunately it managed to wait until the correction is almost routine before giving any signs. I also seem to be in excellent overall health, which greatly improves my chances of a fast recovery.
I have been warned of that. It wouldn't be likely to worry me. I have slept through a heavy hailstorm in a hut with a corrugated iron roof. However, I'm not sure my partner would get enough sleep without her earplugs in.
"nightjar.me.uk>" What about INR control, is that intrusive? The consultant was talking
You need to have INR checks every couple of weeks so they can adjust the rat killer to suit your body/lifestyle. They take a blood sample and tell you what does to take for the next couple of weeks.
Life expectancy, rather than just age is the guide. Given my medical history and current health level, I could expect to need at least one replacement; more if they go every 10 years or if I live as long as I plan to. At present, I am an excellent candidate for surgery. In 20 years' time, I might not be.
My dad had this done a couple of weeks ago - as he's in his eighties, he was given a tissue one presumably for this reason, and which should see him out.
You might want to have a look on Youtube for more info if you aren't too squeamish! I did so myself, and found quite a lot of US teaching/patient information material about it, including one where a surgeon was running through case histories which included describing the rationale behind what type of valve is used in different instances.
OTOH, there is already
Transcatheter Aortic Valve Implantation (TAVI) is already available actually, though not in many UK centres yet. It's currently reserved for patients who are basically too frail to withstand the full open-chest procedure. For an otherwise 'healthy' patient I think TAVI's considered more risky than the open-chest op; but for patients who would not be considered for that, the potential benefits of TAVI outweigh doing nothing at all.
The current one is a flap mechanism that mimics the natural valve better, but it still damages the cells.
Yes, unless the level is very carefully balanced, which is one of my concerns.
I am already on 75mg a day, but it has an enteric coating, to avoid problems in the stomach.
Apparently, that is exactly what they are working on. The other option being investigated is entering from the side, rather than opening up the entire chest..
....
The consultant said I would only need to take aspirin and none of the literature, of which I have been given a lot, makes any mention of immunosuppressents. I think rejection is only a problem if the tissue is living and, as I don't think they bring a pig into theatre as a donor, I suspect it is not.
I read something about this work too. I'm not sure it would be ready in only a decade or two though.
The consultant clearly told me that I would only need to take either Warfarin for the artifical valve or aspirin for the tissue valve and none of the literature mentions anti-rejection drugs.
Is there any way you can take warfarin as a trial to see how it affects you before choosing which valve to have? Is it any worse than, say, insulin, in terms of management?
Personally, the thought of knowing I'd have to go through major surgery again in maybe 20 years time, when I might be a lot less well, would be a considerable factor against the tissue type. And I'm only just over 39. Also when the tissue type wears out does it 'degrade gracefully' or is it a twos-and-blues job and hope there's a compatible spare in the body bits cupboard?
I had a feeling it would be something like that, which I would find unduly intrusive. It is bad enough having to go to my GP every six months for check-ups on my blood pressure
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