Choices, choices

It's an dilemma that many have faced - what type of valve should I have. Once you know you need a valve replacement you will be offered the following choices: tissue valve or mechanical valve. Simple right? No.

Tissue valves can come in the from an animal, a human donor or even yourself (i.e. the Ross procedure, where a person's pulmonary valve is used to replace their aortic valve). With a tissue valve you won't have to take any medication and can leave a relatively normal life assuming things go correctly. However they have the drawback of only lasting a certain amount of years, usually around 10. After that another operation would be needed. Mechanical valves on the other hand are intended to last life long meaning one operation. The drawback? Taking the drug Warfarin for the rest of your life to keep your blood thin and prevent strokes. But also continually monitoring your level of medication to make sure you don't have a hemorrhage. The other problem is increased bleeding from cuts, more bruising, and avoiding contact sports.

So, that's that (and if you're a patient I'm sure you've heard this all before many times). Now when I was first told about this my initial reaction was to go for a human valve. At 22, being on Warfarin for the rest of my life really does not seem appealing. It would mean around 60 years, touch wood, of fretting about knocks to the head, blood tests etc... But thinking about it more and more... I've read about so many people having problems with tissue valves - leaking etc. There's also the fact that tissue valves degrade quicker in young people. If a valve only lasted 8 years that could in a (excuse the pun) heart beat. I would always have it in the back of my head, counting down...

More recently I've heard about a certain type of mechanical valve - the ON-X - which is being used in America at the moment. They're running clinical trials to test how well the valve works without Warfarin, or with patients taking aspirin. The research is in its early stages and I should be very sceptical as there are no concrete results out just yet...but I can hope right? However, although the ON-X is becoming fairly common in America, the U.K. has not caught on just yet.

Americans seem to be heavily involved in choosing the type of mechanical valve they have. Which isn't surprising given that they have to pay for the surgery! But in the U.K. the process is very different. Patients don't seem to have any say at all in the choice of mechanical valve. I got in contact with my surgeon and he seems very reluctant to use the ON-X valve. We're going to have a discussion next week about it but I don't hold out much hope of convincing him.

On a lighter note I googled a picture of my surgeon and I think he looks like Mr Spock. He seems to leer at the camera in a predatory way...I wish I could post a picture but that would reveal who I am! And you never know, he may just stumble upon this blog and decide to do a botch job of my valve as revenge!