One valve or two?

Hi all

I'm new on here & looking for any advice/suggestions/support that anyone can offer.

I had an aortic root & aortic (tissue) valve replacement 2 years ago. I now need a new mitral valve. At the time of this surgery it was expected that my mitral valve would need replacing at some point but should have been ok for the lifetime of the aortic replacement. The plan was that when the tissue aortic valve needed replacing I would have the mitral valve replaced too! However, less than 2 years after the aortic replacement my mitral valve has decided to pack in. The choice I have now is to just have my mitral valve replaced (with a mechanical valve) & then have the aortic valve replaced as & when that wears out. Or I could have 2 mechanical valves now.

I have met with the surgeon, who is the surgeon who did the previous surgery, who says that to just do the mitral valve would be a simpler, less invasive operation. They would go in just under my right breast rather than have to go through the sternum. The aortic valve could be done the same way when the time comes for that. If I opt to have both replaced at once it would have to be through the sternum. This would obviously be a more complex operation with greater risks & a longer recovery time.

I have gone over & over both scenarios but neither is standing out as the more obvious one. Has anyone been in a similar boat? Has anyone got 2 mechanical valves & how noisy are they? I realise that both options are major surgery & having gone through the aortic root & valve replacement I know just what to expect (aargh!) At the moment I am leaning towards the one big operation but about a month ago I was definately just having the one valve done!

Any suggestions/advice/tales of personal experience would be greatly appreciated.

Thankyou all for reading

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Permalink Reply by Graeme on August 17, 2010 at 11:44

Hi Jo.

I have read and reread your post here.. you certainly are no lightweight when it comes to heart surgery..an aortic root replacement and aortic valve - now a new mitral valve and the prospect of replacing the aortic valve later on...wow!

My thoughts on your question(s) are - and I DO STRESS - my thoughts only....were intially - like you to go with the one big op now. However on thinking that through - you already know just how painful and debilitating it is to have your chest cracked and how long it takes to recover from. Having it done again..that's a really tough decision.. However keyhole surgery now with the prospect of another keyhole surgery in 8-10 years time once the tissue valve wears out seems to be - to me - a quite palatable option instead of having your chest cracked again?

Further to this, the recent advancements in micro/keyhole surgery and stenting for valve replacements would - I would hope - lead me to believe that in a further 8-10 years time you hopefully will face even less invasive surgery than present keyhole surgery. Coupled with this, recent and ongoing research and advancements in tissue engineering and stem cell research MIGHT mean that you might not even need another mechanical valve?

So, bottom line is that I probably would go with the mitral valve now with keyhole surgery and let the future decide what happens when the time comes... These are my thoughts on your position....but I DO STRESS that the decision at the end of the day - MUST be yours and your surgeons ..

I also think having 2 mechanical valves 'thump-click-ticking' away at once would be a pretty interesting experience..as I know how long I took to get used to one of the little buggers!

I am also quite interested as to how you recieved a tissue valve so young - knowing that it would have to be replaced later in life.. the general rule of thumb seems to be that the younger you are the more likelihood you will recieve a mechanical valve - with the expectancy that it will last you a lifetime outweighing the warfarin regime required.. Interesting..

Take care - look after yourself - and don't hestiate to seek more opinion on what is quite a difficult decision that you face..

cheers

Graeme

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Permalink Reply by Joanne Stratton on August 18, 2010 at 12:14

Thanks for replying Graeme

I'm still in a massive dilemma but it is good to hear from others who have been in a similar position. I had a tissue valve last time to avoid the whole warfarin regime for the forseeable future. We always knew that my mitral valve would need replacing at some point, we just thought that it would have lasted for the life time of the aortic replacement (so far, so confusing?!) & then at that point I would have had 2 mechanical valves. I should mention that I had my mitral valve repaired when I was 3, along with as ASD repair. It seems that the movement in my heart after things settled after the 2008 surgery has exacerbated the leaky mitral valve.

At the moment I'm still waiting on seeing my surgeon to make the final preparations so I still have a bit of time to make my decision (or bury my head in the sand).

Thanks again for replying

Jo

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Permalink Reply by Graeme on August 20, 2010 at 18:33

Hey Jo

'head burying in sand or whatever' (!) is something i think we all do at different times with our 'thumper/clickers'...I know I do! Whatever you chose will be fine... listen to your heart (literally!) as well as your surgeon(s)..

take care and keep us posted!

cheers

Graeme

Joanne Stratton said:

Thanks for replying Graeme

I'm still in a massive dilemma but it is good to hear from others who have been in a similar position. I had a tissue valve last time to avoid the whole warfarin regime for the forseeable future. We always knew that my mitral valve would need replacing at some point, we just thought that it would have lasted for the life time of the aortic replacement (so far, so confusing?!) & then at that point I would have had 2 mechanical valves. I should mention that I had my mitral valve repaired when I was 3, along with as ASD repair. It seems that the movement in my heart after things settled after the 2008 surgery has exacerbated the leaky mitral valve.

At the moment I'm still waiting on seeing my surgeon to make the final preparations so I still have a bit of time to make my decision (or bury my head in the sand).

Thanks again for replying

Jo

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Permalink Reply by Graeme on September 3, 2010 at 14:47

Hey Jo,

any further news or progress on your big decision..?? If you want to talk it through further just let us know..

cheers

Graeme

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Permalink Reply by Joanne Stratton on September 20, 2010 at 19:14

Well, decision is made & the surgery is scheduled for 26th October. Just going for the one valve for now. I really was leaning towards having the two valves replaced now & getting it all over & done with, then we talked it over with my cardiologist who said to my husband "if it was my wife I would just do the one". That pretty much decided it for me, even though part of me was a bit disappointed in a weird kind of way. I have now come to terms with it. I know this is the sensible option, the (hopefully) easier option & I'll worry about my aortic valve as & when I have to!

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Permalink Reply by Graeme on September 26, 2010 at 11:31

Hey Joanne..

sorry to not get back sooner on this news...well...thats the decision made then! Well done! I think I tend to agree (for what it is worth!) with your surgeon..things are moving so fast now in the field of cardio-thoracic medicine that who knows what procuedures will be available in 10 years time..given the advances also in stenting and robotic surgery..take care..keep us all posted!

best

Graeme
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Joanne Stratton said:

Well, decision is made & the surgery is scheduled for 26th October. Just going for the one valve for now. I really was leaning towards having the two valves replaced now & getting it all over & done with, then we talked it over with my cardiologist who said to my husband "if it was my wife I would just do the one". That pretty much decided it for me, even though part of me was a bit disappointed in a weird kind of way. I have now come to terms with it. I know this is the sensible option, the (hopefully) easier option & I'll worry about my aortic valve as & when I have to!

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Permalink Reply by Holly Allen on February 22, 2011 at 1:16

Hey Joanne!! Just read all the posts and I am hoping you are well and are recovering nicely from your surgery...Please let us know how you are doing. What an ordeal!! Thinking and praying for you Holly

One valve or two?

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