Possibly non-vegetarian heart.
April 1, 2010 9:57 AM   Subscribe

My father will likely have to have an aortic valve replacement. He's 63. His choices are a pig valve (with an expected replacement time of 15 years) or a mechanical valve (and a lifetime of coumadin). Any personal experiences? What do you recommend? You are not a doctor.

My father is a moderately active, generally happy guy, 63. Mildly overweight. He inconsistently goes to the gym and uses the rowing machine for 30 minutes fairly vigorously. And he jogs occasionally. But he also really likes to eat as much bread as possible and consistently drinks >=2 beers per day. He loves green leafy vegetables. He also works with his hands currently (works in a boatyard, although he doesn't have to, he's retired) and likes tinkering around the shop. He's not maybe the worlds most safety conscious tinkerer, and has cut himself on occasion (once with a chainsaw).

He's acknowledged that he'd have to clean up his act pretty seriously if he went on Coumadin. I think he could. However, many of the things he likes (working with his hands, drinking beer, eating brocolli) would be affected by being on Coumadin.

My grandfather had the same operation in his 70s and had a pig valve put in. He had a very vigorous, healthy life up until he died in his mid 80s and was not on medication.

My dad's choice now is the pig valve and the probability that he would have to have another operation in his late 70s where he might have less good prognosis for recovery, or a lifetime of coumadin and all the management of that.

I know this is not a tragedy in any way and that my dad is lucky that this is his primary problem. I love my dad very much and would like him to be around as long as possible.

Do you have personal experience with this decision or your coumadin/pig valve experiences? Obviously you are not a doctor and this is not medical advice.

posted by sully75 to Health & Fitness (24 answers total) 2 users marked this as a favorite
Response by poster: To sum it up a little clearer: my dad really loves drinking beer. I think he has an overall "heatlhy" relationship with beer, but it's something he really enjoys. He also likes to eat, and is fond of the kind of potassium rich stuff that can mess with your coumadin dosage.

So those two issues, combined with the increased bleeding risk while working around machines and old houses and stuff are the main concerns for him re: coumadin.
posted by sully75 at 10:06 AM on April 1, 2010

Boring anecdata: My dad's been on Coumadin for a number of years for atrial fibrillation, but he is older than your dad. It forced him to acknowledge that he wasn't going to be able to ski again, and he had to quit riding his bike. So there was certainly a lifestyle change, or a mindset change. I know he did cut himself, kitchen cuts and whatnot, and that was not much of a problem.
posted by chesty_a_arthur at 10:12 AM on April 1, 2010

A friend of mine had valve repair surgery instead of replacement. His surgeon is Dr. David Adams, who is pretty well-known for doing this. I have no idea if your dad is a candidate for repair surgery vs. replacement, but might as well look into it. Dr. Adams is in NYC.

Another friend who is on Coumadin for another condition has had to change her lifestyle pretty dramatically - no drinking, no power tools, has to be extremely careful even with just minor cuts, etc. She only has to do this temporarily, while your dad would have to do it permanently, and though giving up beer is not necessarily a tragedy, if he has to give up a bunch of things he enjoys it might make his quality of life go down a bit.
posted by bedhead at 10:15 AM on April 1, 2010

My guess is in 15 years aortic valve replacement through a catheter will be a proven technology. If it is, valve replacement will be much less traumatic and risky. I'd go for the pig technology. See "Percutaneous aortic valve replacement".
posted by cosmac at 10:18 AM on April 1, 2010

My mom had an aortic valve replacement at 51 last fall. My mom decided on the tissue valve because of her young age, active lifestyle and confidence that another surgery could be accomplished with better surgical techniques. Honestly, for my mom talking to her surgeon and reading about the developing, cutting edge techniques let her make her decision.

And as far as recovery and all that goes, if you want to know more or have questions, memail me and I can talk a little about what my mom went through.
posted by Phoenix42 at 10:25 AM on April 1, 2010

I chose a pig valve (I snort when I laugh) because I didn't want to have the constant medication and associated medical things that go with the mechanical valve. I was 37 when I had the surgery and it's been six years, and it's really been great. A friend who had the same surgery a little earlier than me suggested the pig valve -- she chose mechanical, as she's about fifteen years older than me, and thought I would feel "old" having the restrictions it entails.

Every situation is different (I also thought I might have more children, which helped swing for the pig), and I've found the people on this forum generous with information and support.

Best of luck to your dad.
posted by bwonder2 at 10:26 AM on April 1, 2010

My grandfather just (a few weeks ago) had an aortic valve replacement and double bypass. They went with the pig valve for him because of his age (85). He is doing really really well - in physio, back to walking, soon back to swimming, and starting to drive again.

Your dad is going to need to think really seriously about his quality-of-life - and I don't think he should feel badly if he decides that he would just need to give up too many things being on blood-thinners-for-life starting now.
posted by purlgurly at 10:31 AM on April 1, 2010

I vote pig. In 15 years, he's gonna be 78 - that's not too old for another replacement surgery. Plus, what if they make progress through the next 15 years and the surgery will be even easier? Coumadin has been associated with all sorts of problems - why take that risk plus the hit to his lifestyle, when he doesn't have to? Further, with the artificial one, he's stuck - if they make a better one down the road, what's he gonna do... keep the old inferior one? Because if he then elects to have it replaced with a better model, he's just removed the big advantage over the pig one of not having to go through another operation. Finally, and not to be grim, but you don't know the future - how long will he live? What if he's only destined to last anther 10 years? If so, isn't it better to have good quality coumadin-free 10 years? Ultimately of course, there may be some very specific reasons in his individual case to go for one vs the other, but just with what you've presented, it seems the pig is the way to go.
posted by VikingSword at 10:39 AM on April 1, 2010

For reasons cited by cosmac above I would also go for the pig valve. They work well and new technology is long overdue in this space.
posted by london302 at 10:40 AM on April 1, 2010

My good friend and roommate has a pig valve. He is in his 30s, and leads a completely "normal" lifestyle that you'd expect of an active 30-something. He drinks beer (and other beverages), does karate, works out regularly, and generally lives it up to the fullest. You would never know he had the valve if he didn't tell you, or if you didn't see the scar.

I don't have any experience with the mechanical valve. I just offer this as anecdotal data about quality of life that you and your dad might consider. Best of luck to you both.
posted by jeffmshaw at 10:43 AM on April 1, 2010

Only person I know with a replacement valve has a mechanical one, is in their 20s and it doesn't seem to cramp their style beyond minor annoyance of having to get blood levels of warfarin checked.
posted by Coobeastie at 10:52 AM on April 1, 2010

Anecdote: My grandfather had a heart valve (but not the aortic one, I think) replaced with a cow valve many years ago, even though it only had a ten year "guarantee", and they picked it so that he would not have to take the lifelong coumadin associated with a mechanical valve. But then he had some heart issues (atrial fibrillation, I think) and he ended up needing to take coumadin anyway, to prevent a possible stroke, which was kind of a bummer. Still, the valve worked fine for over eight years until he died of unrelated issues following a fall and broken hip.

So even if you do choose the pig/cow valve, you can get stuck with daily coumadin anyway. Something to think about.
posted by Asparagirl at 10:59 AM on April 1, 2010

No information on the valve part, but my mother said her life quality went up tremendously when she finally could get off her coumadin (she had a blood clot hit her lung, doctor put her on it to deal with all the other possible issues that could have caused it). Again, anecdotal, but.
posted by mephron at 11:03 AM on April 1, 2010

The way you describe it it's not even close. Seems very clear to go with the pig.
posted by Perplexity at 11:39 AM on April 1, 2010

A friend of mine had an aortic valve replacement due to a failing bicuspid valve last year, at age 42. He is extremely active, and chose a bovine valve to avoid blood thinners and because of the higher performance characteristics it offers. He blogged about the decision. Rather than link to his blog, which he might not appreciate as it's often quite personal, here's a cut-n-paste:
Valves: Unfortunately, or fortunately, there are decisions to be made when getting this type of surgery. The biggest is choosing the type of valve you want to get installed. And, according to Dr. Stanton, it's not what's good about them that you need to think about, it's what sucks about them. Here are the choices:

  • mechanical -- these are made out of plastic, titanium and other high tech materials. They will last for 40+ years, and you'll never need to get this valve replaced. Unfortunately, with a mechanical valve, you need to be on cumiden, a blood thinner. Otherwise, clots will form on the valve, and you can/will stroke out. Living on a blood thinner isn't for me. For reasons that I won't go into now, I just don't think that this is a good option.
  • tissue (pig) -- no blood thinner needed. But, this valve will wear out, and you will need to get another surgery down the road. The lifespan varies, but you can expect a 50% failure rate after 10 years. Some last as long as 18 years, and some fail after 5 years.
  • human -- First of all, no, I don't need to wait for someone to drop dead. But it does take a week or so to get one of these delivered. The upside with the human is that it lasts much longer, and has a better flow (good for athletes). This valve can last as long as 25 years (in fact, they don't even have data for that lengh of time yet). But, the downside is this...when it does fail, and it will, the next surgery is (as Dr. Geuber put it) "a ball buster." AND, since the second surgery is so difficult, they will only install a mechanical valve. So, blood thinners. The failure rate is 10% after 10 years -- but they have failed in as few as 7 years.
(He never wrote about why he ended up with a cow valve rather than a pig valve, by the way.)
posted by richyoung at 12:22 PM on April 1, 2010 [1 favorite]

My father is a cardiologist and talks about pig valves all the time. They're apparently far preferable to artificial valves in almost all applications at this point.

But just to keep things in perspective, your father is talking about major heart surgery--anything that isn't done via catheterization is a big deal almost by definition--because his heart is unhealthy. As recently as fifty years ago, this would have meant that he was going to die soo. Modern technological advances have given him two choices, either of which may well give him years of enjoyable, functional life, but 1) recovery is not going to be immediate, 2) neither will be as good as his original, healthy heart, and 3) neither will last forever. He's going to need regular followups with a cardiologist and quite possibly more surgery a few years down the road regardless.

As you choose between these two options, remember that this is a stopgap, a patch, not a cure. I'd definitely recommend getting more information from your cardiologist and CT surgeon before making a final decision.
posted by valkyryn at 12:39 PM on April 1, 2010

not to put too fine a point on it, but 15 years on a pig valve puts the replacement date beyond the average male life expectancy. In all sincerity here's hoping he lives long and healthy, but, there is a good chance getting the pig valve will last him the rest of his life... which will be not spent on coumadin.
posted by edgeways at 1:08 PM on April 1, 2010

Just amused by the synchronicity: Robin Williams talked about why he went with a cow replacement heart valve on the Daily Show recently. His opinion was the biological replacement was better than the mechanical one, so depending on how much weight you place on the medical research done by Robin Williams, it may be of use to you.
posted by AzraelBrown at 1:11 PM on April 1, 2010

I went with the pig valve at age 67. I take various medications and did not one more (coumadin) added to my regimen. I had "minimally invasive valve replacement surgery" which is anything but minimally invasive. If this is offered to your dad, ask him to discuss it long and hard with the surgeon. It has both pros and cons. I expect, by the time I need a new one, there will be another advancement in surgical technique and it may well be possible to do it by catheter.

I eat bacon and have no guilty feelings. I asked the surgeon if, when they put the valve in, could I take the rest of the pig home. He was half way through his explanation of why this was impossible when he realized it was a joke.
posted by Old Geezer at 1:25 PM on April 1, 2010 [1 favorite]

In my last year of pharmacy school I did a rotation in a coumadin clinic at Kaiser. The pharmacists were responsible for adjusting patients coumadin dosages to stay within the therapeutic range.

Beer and broccoli are OK on coumadin! The key is consistency. One beer per night is fine. 7 beers on one night of the week will mess you up.

Coumadin is an awesome, wonderful drug. It's cheap, and it extends people's lives for years. Can your dad handle the consistency? It would mean eating about the same amount of veggies each night, not binge drinking, and following basic safety precautions while woodworking. It wouldn't mean giving any of those things up. Also, going in for monthly (or sometimes weekly) blood draws is a pain, but there are machines becoming available that let you self-monitor at home.

Personally, I'd go with the mechanical valve because I would hate the idea of having to undergo heart surgery again in my 70's.

People are living longer and longer, and if your dad works out 30 minutes a day and doesn't smoke... well, I personally would anticipate living a lot longer than my 70's.
posted by selfmedicating at 1:28 PM on April 1, 2010 [1 favorite]

My mother had a stroke during that operation, caused by a piece of dislodged gunk. If you can afford it, I'd have someone on hand to treat that immediately if it happens. I might take the medicines given to stroke victims in advance as a precaution.
posted by StickyCarpet at 2:15 PM on April 1, 2010

My grandmother had a pig valve for the last decade of her life, went for daily runs, and drank a bit of wine at Passover. Despite the fact that the pig valve wasn't kosher, she was very happy with her choice.
posted by PhoBWanKenobi at 3:39 PM on April 1, 2010 [1 favorite]

My grandmother had a mechanical valve emplaced in 1987. She's still going strong. She is on daily coumadin. She never did drink (nice South Indian ladies don't touch alcohol) so that was never an issue.
posted by pointless_incessant_barking at 9:19 AM on April 2, 2010

Response by poster: To finish this up: My dad ended up going with a pig valve. He's doing well and starting his recovery. The surgeon said he was really close to dropping dead, which wasn't what we thought going in. Very glad he's still alive and kicking.
posted by sully75 at 5:56 AM on June 14, 2010 [1 favorite]

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