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Bicuspid Aortic Valve Replacement

  • 17-07-2021 9:54am
    Registered Users Posts: 3,231 ✭✭✭

    Looks like I'm heading for an aortic valve replacement and at my age, I'm stuck in a grey area with regards to mechanical or tissue (52M).

    I'm pretty active in that I cycle regularly, ride horses, farm work regularly enough etc. and I'm asymptomatic still.

    Bicuspid aortic valve is my issue. Had angio and stress test during the week and my heart is in great shape aside from the damn valve which has stiffened considerably over the last 2 years after being very stable for previous decades.

    I've a feeling they'll recommend mechanical but I'm really not sure that's what I want as the clicking and blood thinners for the rest of my life don't sound great to me.....I know the tissue will only last 10 to 15 years but TAVR would be an option when the day that it needs replacing comes.

    Just wondering if anybody else has any experience of aortic valve replacement and their experience. BTW, I know it's gonna be a tough recovery.....but recover I will. Thinking it'll happen in next few months based in surgeon.


  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Well, it's done now. Aortic valve replaced a couple of weeks ago.

  • Moderators, Science, Health & Environment Moderators, Social & Fun Moderators, Regional West Moderators Posts: 59,991 Mod ✭✭✭✭Gremlinertia

    How did it go?. Never heard of the procedure before.. Sounds intense for want of a better word..

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    It went well.... open heart......the first three days afterwards were rough as hell. I suspect very similar to a heart bypass procedure. You would be weak as a weak kitten for the first few days. Completely helpless.

    After around three days though, they start to remove the chest drains, pacing wires and catheter. You then start walking. A little....

    After that its about walking, walking & walking....

    I got home after a week and I walk, walk, walk, walk..... every day a bit stronger.

    It's not a rare procedure really. About 2% of the population have a bicuspid aortic valve and most of those people will require a valve replacement at some stage. They perform it on babies right up to people in their eighties.

    Tom Dunne (DJ), Ken McGrath Waterford hurler), Arnie (actor) also had this done.

    For older people, a new valve can be placed by TAVI (non open heart, through the groin) but its really only for people who are not well enough to be able for OHS at the moment. With modern advances though, it'll likely become the norm over the next few years. Valves will likely evolve that will be suitable for TAVI with younger patients.

    In short, although I'd been dreading it for years, the fear of the operation was worse than the reality and the recovery really picks up a lot after about a week or two.

    My poor left ventricle won't know itself pushing blood through a much larger orifice now! My valve area was down to around 1 cm^2 (normal = ca. 3-4 cm^2) and I had a gradient of 85 mm/Hg across my native valve which should be virtually zero now. 🙂

  • Moderators, Science, Health & Environment Moderators, Social & Fun Moderators, Regional West Moderators Posts: 59,991 Mod ✭✭✭✭Gremlinertia

    Glad to hear your recovery is going well and thanks for the information, as much s I might complain about the health system it is still able to perform.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Yep, have to say, I was very well looked after and have nothing but praise for my cardiologist, surgeon and the outstanding nursing care that I received.

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  • Registered Users Posts: 6,638 ✭✭✭SouthWesterly

    Had an aortic valve replaced 6 years ago. Did you get mechanical or tissue?

  • Registered Users Posts: 1,479 ✭✭✭PCeeeee

    I hope you don't mind me asking but tissue or mech in the end?

    I work for a med device company in R&D and my last 10 years have been spent on TAVI if that excuses my noseyness.

    I'm delighted it went well for you by the way.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Hi all, I chose the Carpentier Edwards Magna Ease Bovine valve. The valve size used is the 23mm. Both my cardiologist and surgeon agreed with my choice. It's the right valve for me, maybe not for someone else but for me.

    I'm 52M and pretty active in that I cycle, ride horses, bit of part time farming so I made the choice to go with bovine tissue. The operation went very well and I'm on warfarin for the period of 6 weeks or so and then I'll come off it.

    Its the right choice for me and my lifestyle. Due to my "young" age, mechanical would also be an equally good option but I'm happy with my choice.

    The most important thing for anybody facing into a valve replacement is that they are aware of the options available (and the drawbacks) so that they make a well educated and informed decision for themselves and their lifestyle.

    If someone is in the position of requiring an aortic valve replacement, both tissue and mechanical are the right choice, either one is a great choice.....the third option is death due to heart failure within a couple of years of onset of symptoms......I didn't have symptoms but the test data indicated that symptoms couldn't be far away so I opted to get it changed before symptoms started.

    I should add that there's a very good chance that I'll require another at some stage due to my age. However, the next one will likely be a TAVI.

    That's the benefit of mechanical - likely a once and done (with the trade off of Warfarin for life/ticking). In general, mechanical is recommended for people under 50, tissue for over 65 and either option for those in the 50-65 range. Tissue recommended for young women too (if they want children).

    It's funny, around 2% of the population have a bicuspid aortic valve but there are many more who require a valve change due to stenosis etc. so it must be a fairly common operation at this point.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

  • Registered Users Posts: 6,638 ✭✭✭SouthWesterly

    It's ticking away nicely. Still weird when the room is quiet and people ask what the ticking noise is 😁

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  • Registered Users Posts: 3,231 ✭✭✭Azatadine


    On-X I assume? Marvellous piece of engineering 🙂

  • Registered Users Posts: 6,638 ✭✭✭SouthWesterly

    I assume you got the same..

    My only complication was a fast heart beat and a beta blocker to slow things down.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    If I was going mechanical, yes, but I got bovine (Edwards Magna Ease) so no ticking. I'll admit that the ticking was something that I did take into consideration though. I think I'd go mad but I'm guessing you get used to it quickly enough.

  • Registered Users Posts: 1,479 ✭✭✭PCeeeee

    It is great to hear about your excellent result. Thank you for telling us. TAVI has been the centre of my working life for a decade now and if it gives you any comfort for the future I can tell you it is advancing rapidly. By the time you get there it will be fantastic.

    All the best.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Thank you. Yeah, It was a part of my reasoning with going tissue....hopeful that I could get TAVI when/if the time for replacement comes. OHS is a tough operation and I wouldn't relish another one if I can get away with it. So be it if I need to of course 🤷‍♂️

  • Registered Users Posts: 6,638 ✭✭✭SouthWesterly

    Thats why I wouldn't want to go through it again even with TAVI being an option

    The more they go in the higher the risk.

    You get used to the ticking. The kids love the idea of me having a clock inside me.

    Just a piece of advice for you. Don't do anything silly and avoid lifting heavy objects.

  • Registered Users Posts: 1,479 ✭✭✭PCeeeee

    If you don't mind me asking what level of contribution do you have to the decision on your treatment? How does that work?

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Yup. I'm only 2 weeks after the op yet so early stages still.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Well, in my case, the cardiologist and surgeon proposed the options to me. I've known I would be getting the op at some stage for years and years so I had some level of familiarity with the options ahead of time. I have a scientific background so I had a good understanding of the valves. They discussed the pros and cons with me and made sure that I was educated on the options.

    I was interested in the Inspiris Resilia but my surgeon felt that there's not enough long term data yet. He does feel that it will likely be a good option in future but he wasn't a fan of using it on me as I'm so "young".

    I also expressed an interest in the Ross procedure but I wasn't really a suitable candidate.

    I really feel that they were comfortable with my choice because I'd thought it all out and understood the benefits and drawbacks of both options.

    I also think that they would have tried to edge me towards mechanical if I was much younger or had a different lifestyle.

  • Registered Users Posts: 1,479 ✭✭✭PCeeeee

    Thank you, that's very interesting. Most of our feedback comes from clinicians. Certainly in the US patients have more influence but here I didn't realise it was such a factor.

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  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    That was my own personal experience anyway. I certainly had a lot of input into it anyway.

  • Registered Users Posts: 6,638 ✭✭✭SouthWesterly

    My surgeon gave me the options but my preference was mechanical which had less long term risks which

    Someone I know had aortic surgery 3 times having torn the artery twice. The third time he didn't come out of surgery alive due to a bleed. He was silly doing heavy work at home which put a strain on the system.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Very sorry to hear that. That's terrible.

  • Registered Users Posts: 6,638 ✭✭✭SouthWesterly

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Just for extra info, I thought I'd share some info on the valve I've received.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Just a quick update in case anyone ever does a search for this operation.

    I'm 5 months post op now. Recovery has gone very well.

    I'd say I started to feel pretty normal around 3 months post op. No pain, resting pulse mid 60's, BP 120/80 pretty much.

    After meeting my cardiologist (4 months post op), she took me off warfarin and also Bisoprolol (beta blocker) so my only medication is one baby aspirin per day (75 mg).

    I can walk around 15 km per day (not so much the last couple of months admittedly as I'm back in work full time but I always try to do at least 8 km. Also back on the bike 😀.

    One final comment I'd have though is that I was not prepared for the mental side of recovery. I went through prolonged periods of insomnia and struggled a bit to avoid going down rat holes if I felt something was a bit off such as maybe a skipped beat now and again - I'd start to measure heart rate etc obsessively to the point where I'd be completely convinced I was going into Afib (which I wasn't).

    So, overall, it wasn't so bad 🙂. Not something I'd like to be doing too many times but probably not as bad as I feared either. Just be prepared and take the psychological recovery into account too. I was well prepared physically but nobody mentioned the mental side beforehand.

  • Registered Users Posts: 1 BJHOG

    How are you doing since your last post?

    I'm facing something very similar soon and came across your posts on a Google search! I'm 52 so will have a decision on valve type etc. I haven't spoken to my surgeon yet, only my cardiologist.

  • Registered Users Posts: 3,231 ✭✭✭Azatadine

    Doing great thanks. Back doing everything I did before the operation after about 6 to 8 months. Horse riding, cycling and general activities all going great.

    As I mentioned in an earlier post, while it's not a walk in the park, it wasn't as bad as I'd feared at all and it's amazing how quickly you start to recover.

    I guess the difficulty for you will be the personal decision in relation to valve choice. The most important thing is to be certain that whichever one you go for, you are happy to commit to. It would be horrible to wake up and realise that you made the wrong choice. Your cardiologist and surgeon can help guide you on that.

    Because I chose tissue, I can do whatever I want in terms of activities without having to worry about bleeds and no ticking BUT I'll need another intervention at some stage as the trade off. As an FYI. I was on warfarin for three months post op and it was actually fine when it was dialled in. I'm not sure how I'd have handled the ticking though. Apparently you get used to it.