Heart Valve Surgery - Tissue vs Mechanical - I need to make a decision?

[Bacstar]

I'm not sure if anyone read my post on my PADI OW certification, but during my final checkout dives, I had some breathing issues that had us abort the rest of my dives and revisit the doctor. After an echocardiogram, the cardiologist determined that I have severe mitral regurgitation due to mitral valve prolapse and referred me to a surgeon ,and I will now be getting open heart surgery for either a repair or replacement. Well....I have a choice in case the repair fails and the surgeon has to go with a replacement: 1. tissue 2. mechanical.

Tissue - I'll have a good chance of finishing up my diving certification. However, I'll probably need to have surgery again in 8 years. They do wear out a lot faster than mechanical valves.

Mechanical - I'll be on coumadin (blood thinners) for the rest of my life. I won't be able to dive and do pretty much any risky sport. I like to mtn bike too.

I'm leaning towards the tissue replacement, if necessary, because I'm still an active person with plans for the next few years with diving, mtn biking, sky diving, skiing, travelling, etc. being part of them. I'm 41 years old now. However, never going through this process before, will going through the recovery period be worth it just to redo again in 8 years. My cardiologist in Alaska said he would do the tissue valve and take the chance in 8 years that some new procedure or discovery will make it worth it, so I can live my life like I want.

Just looking for opinions, especially from folks who value quality of life over length or comfort. I promised myself long ago life isn't worth living if you can't do the things you want be it physical or mental or financial. I have until the 5th of January to decide, and it's stressing me out since this is one of the biggest decisions I've probably had to make so far in life.

 

[Dr. Doug Ebersole]

I got your PM and thought I'd respond here. As a cardiologist I have to counsel people on this issue a lot and there is no right answer -- as I'm sure you've figured out.

The good news is that a good surgeon is able to repair the vast majority of mitral valve prolapse cases, especially if it is due to posterior leaflet prolapse only. You may want to ask about your prolapse -- anterior leaflet (much harder to repair), posterior (much easier to repair), or both. I would think that with isolated posterior leaflet prolapse your likelihood of a repair without replacement should be around 90%.

If you have to have a replacement, you have addressed the issues quite well. A mechanical prosthesis will likely last longer but require lifelong coumadin (blood thinner) which could be problematic (though definitely not impossible) in an active lifestyle. My father used to go on windsurfing and snow skiing vacations with me all the time on coumadin. Also, at age 41, even a mechanical valve "probably" won't be the only surgery you require in your lifetime.

Tissue valves avoid the risk of coumadin (assuming you are not in atrial fibrillation or have some other reason to be on coumadin) but, in general, do not last as long as mechanical valves. That having been said, there are new designs of tissue valves which have much better durability than ones we had available even only a few years ago.

No one can make this decision for you. You need to decide what fits your lifestyle, wants, and desires the best and go that way. Thankfully, there is a very good chance that repair will be successful and the torment you are putting yourself through will be for naught -- which would be the best follow-up news you could give us.

Best of luck. Merry Christmas!

Doug

 

[h2odragon1]

I got your PM and thought I'd respond here. As a cardiologist I have to counsel people on this issue a lot and there is no right answer -- as I'm sure you've figured out.

The good news is that a good surgeon is able to repair the vast majority of mitral valve prolapse cases, especially if it is due to posterior leaflet prolapse only. You may want to ask about your prolapse -- anterior leaflet (much harder to repair), posterior (much easier to repair), or both. I would think that with isolated posterior leaflet prolapse your likelihood of a repair without replacement should be around 90%.

If you have to have a replacement, you have addressed the issues quite well. A mechanical prosthesis will likely last longer but require lifelong coumadin (blood thinner) which could be problematic (though definitely not impossible) in an active lifestyle. My father used to go on windsurfing and snow skiing vacations with me all the time on coumadin. Also, at age 41, even a mechanical valve "probably" won't be the only surgery you require in your lifetime.

Tissue valves avoid the risk of coumadin (assuming you are not in atrial fibrillation or have some other reason to be on coumadin) but, in general, do not last as long as mechanical valves. That having been said, there are new designs of tissue valves which have much better durability than ones we had available even only a few years ago.

No one can make this decision for you. You need to decide what fits your lifestyle, wants, and desires the best and go that way. Thankfully, there is a very good chance that repair will be successful and the torment you are putting yourself through will be for naught -- which would be the best follow-up news you could give us.

Best of luck. Merry Christmas!

Doug

I'm a cardiac nurse, the above statement is correct on this issue. You will have to decide wich course of action to take; Tissue valve and no med, with a posibility of replacing it in 5-10 years, or the mechanical valve that should last a long, long time with the need for medication with coumadin, or other blood thinner, (lovenox; shots once or twice a day. or heparin; also shots once ar twice a day). The shots are rarely used, only if you cannot take coumadin.

 

[vtxkev]

I promised myself long ago life isn't worth living if you can't do the things you want be it physical or mental or financial.

Well here is an opinion from someone who does not work in the medical field or even have a clue what you are about to go through. Above is a quote from the OP and it seems to me like you have made up your mind a long time ago. Is this still the way you feel, well only you know the answer to that. I would say at 41 you are still very young and there are many many things left for you to do or continue to do. If it were me I would be going with tissue, but it isn't.....

Whatever the outcome I wish you luck.

 

[dschonbrun]

IMHO... Go with the Tissue if a replacement is required. In 8-10 years, the technology will have changed enough that the current procedure requiring open heart may be replaced by a method that is less invasive. I prefer people to try options that don't require lifelong meds.

 

[don Francisco]

FWIW, strictly as a layman, based only on the info given in your post, I'd go with the tissue replacement, if a repair wasn't possible.

Eight years is a very long time for a healthy 41 year old, so I'd opt for what gave me the best quality of life in the meantime, and hope that with progress, the next replacement might be the last.

Don't make the decision based on diving, since you're not even sure how important that'll be to you in the future. Make your decision based on the overall implications for your future.

Whatever you decide, once you make the decision close the door and decide that you won't look back later, thinking you should of...... This is one of those situations where you weigh your options and do what seems best at the time.

Best wishes for a successful outcome whatever you decide.

 

[Bacstar]

Thanks for everyone who replied. I can't decide. On one hand, knowing how bad I am at taking my meds on a regular basis, adding another medication to the mix is just asking for trouble. However, I'd hate to have to go through this surgery again in 8-10 years. I did get a reply that getting a mechanical valve will not prevent me from diving, but then finding a doctor to give me clearance may be difficult.

Nothing about this whole thing is going to be easy. I guess it all depends on the repair being a success. Only if they could just know beforehand...and if only I led a boring sendentary lifestyle, knowing the pro's and con's, I'd probably definitely go with the mechanical valve. I'll probably leave it in the hands of fate and flip a coin on the morning of the 5th to finally make a decision. Anyone know any good psychics?

 

[Bacstar]

And just to let everyone know....My surgeon is Dr. Anees Razzouk at Loma Linda Medical/Heart Institute. He's come highly recommended by a few cardiologists my sister works with as well a cardiologist at the Anchorage Heart Institute.

It's been quite a trial getting scuba certified...from meeting the woman that got me started, losing 44 pounds, working out, passing my swimming test, doing my checkout dives in alaska in the middle of winter, and now to having this surgery which is now entirely out of my hands. I guess I'm a man on a mission, and I'll find a way. There has to be a way...this is how much diving means to mean right now. I guess you can say this is my midlife crisis and diving is my sports car Hmmmm maybe this train of thought just made up my mind ....

 

[Bacstar]

Just wanted to finally update the status of this topic...

Well, I'm back in Anchorage, AK. I actually returned on March 1st and was finally cleared to work on March 9th, light duty. Then after another month for recovery, I was allowed to start a normal life with no restrictions. I get to finish my scuba certification and continue everything else. All i have to show for my surgery is a few scars....oh, and a few leftover medical bills.

I went through the surgery on January 5th and was in the hospital for 4 days. The surgery was a big success. Thankfully, the surgeon was able to repair my mitral valve. As the surgeon documented in his report, I had a cleft Posterior leaflet with little to no prolapsed tissue and a torn chordae...pretty interesting read. All he had to do was repair it with some stitches and implant some kind of ring. Unfortunately, the recovery part was the most painful and drawn out part of the whole experience. All in all, it's something I definitely do not want to ever do again, but considering how i feel now, it was worth a little bit of suffering.

So far, as of my last appointment with the cardiologist, my heart murmur is gone I will be completing my checkout dives in June with my original instructor out of Seward, AK. He's also going to give me some refresher dives in the pool at the end of May. Woohoo...just in time for summer

 

[Dr. Doug Ebersole]

Congratulations! It's great to hear everything turned out so well for you. Thanks for the update.