Mechanical Valve & Coumadin

What is A Mechanical Heart Valve?

A mechanical heart valve is made from materials that do not include any form of biological tissue (pig, cow, horse). Instead, very strong materials -- such as titanium and carbon -- are used in a mechanical heart valve that make them incredibly strong and durable. Some reports suggest that the mechanical valves available today are able to last indefinitely. Recently, an accelerated wear tester suggested that one mechanical heart valve could last over 50,000 years.

However, a key consideration for patients is that mechanical valves require continuous use of blood thinners, also known as anticoagulants, such as Coumadin. Patients on Coumadin therapy need to be monitored regularly with a PT (Prothrombin) blood test. These blood tests help ensure that the patient’s INR (International normalised ratio) is acceptable. For example if the INR level is 5, this indicates an elevated chance of bleeding, whereas an INR level of .5 indicates the possibility of a blood clot. *I personally have to keep my INR between 2.0-3.5*
The three major kinds of mechanical heart valve replacements are the tilting-disc mechanical valve, the bileaflet mechanical valve, and the original caged-ball mechanical valve.

The ‘Bileaflet’ Mechanical Valve

A bileaflet mechanical valve consists of two leaflets that are semicircular and rotate around struts that are attached to the housing of the valve. In 1979, the bileaflet valve design was introduced. Some reports suggest that bileaflet mechanical valves povide more natural bloodflow compared to the aforementioned mechanical heart valves.

Advantages Of Mechanical Heart Valves

The main advantage of mechanical heart valve replacements is durability.

• Mechanical heart valves are made from very durable materials including titanium, carbon compounds and teflon. While the average tissue valve (porcine, bovine, equine) is estimated to last between 10-15 years, reports suggest that mechanical valves can last 30 years or more after implant. That said, for some younger patients, a mechanical heart valve can be a suitable replacement for the diseased valve.

Disadvantages of Mechanical Heart Valves

There are a few disadvantages, or considerations, that should be noted about mechanical heart valves.

• First, to reduce the risk of clotting, patients are required to use blood thinners (e.g. Coumadin, Warfarin) for the balance of their lives.
• Second, due to the mechanical nature of the valve, some patients can hear their valves "click" while opening-and-closing in their hearts.
• Third, with the ongoing interest and use of transcatheter valve replacements, it is not possible to replace a mechanical valve should complications occur years after implant.

Selecting a heart valve replacement is a very important decision for the patient, their family and friends.

mySurgical Experience

So the day has come and gone, and thank God I made it through my surgery but not without a change in the program. I arrived in San Francisco on August 24th with my daughter and  her dad. We dropped her off for the first time ever to spend the night away from us. We went across the Bay Bridge and stayed the night in a hotel with my mother, where I didn't get much sleep, because I was a nervous wreck. The morning of August 25th I ran around like crazy, we got up at 4:30am and began to prepare for the long day ahead. We drove to the hospital which was only 7-10mins away from where we stayed. We got there and I broke down in nervousness, because I just didn't want to go through it at all. Knowing I had no choice my family held me and supported me getting through it. We went across the street to the hospital and went into the Pre-Surgery waiting room where there were other patients/families waiting to go up to have surgery as well. After a half an hour of waiting, they came to get us all and took us up to the surgery floor. We all had numbers for our beds and things with our names on them to put our stuff in. I put on my robe and sat on the bed, took one last test to make sure I wasnt pregnant, came back and laid down on the bed while they attached IV's to me in my arms to prepare me for the surgery. My family and I talked, laughed and prayed....

I was rolled out of the room on my bed, and taken to the surgery room. Thinking I was going to have my surgery, we we're stopped in the hall because they had ran out of a medication that was needed for the surgery. They rolled me into the area I would go after my surgery before ICU, until they could get the medicine needed since they had already even me the medicine to "calm me down." After a few minutes my Anesthesiologist came back in and said they were able to get enough medicine for my surgery and that it was time. They pushed me back into the surgery room and began preparing me.
To lighten up the mood a nurse yelled out "we're doing a toe amputee?", which I replied "no, your doing breast implants, and a butt lift." Everyone burst into laughter.... next thing I know my eyes were closing and I was falling asleep.


After hours of surgery, I finally came to. I woke up strapped to the bed and with what felt like a million tubes, wires, needles, and etc going in and out of my body. I had a tube down my throat which they warned me about, three tubes inside my chest, pacerwires in my stomach up to my heart, IV's in both arms, and in my neck, plus other things in and outside of my body. I was extremely out of it, and didn't know who was there or what was going on. All I know is people were talking to me, telling me to relax, its okay etc etc.... I was in the worse pain and i needed to be able to talk and couldn't. They gave me paper and a pen but the pain prevented me from being able to fully write correctly. Eventually they took the breathing tube out a couple hours then they had planned since I was stable and I was able to talk but was in extreme pain throughout my whole body, I finally received pain medicine and was out like a light. Not remembering what family, or friends were there or much of anything the rest of the night seemed to go pretty fast, and is a little blurry of the details.

They gave me a "Shumsky Therapeutic Heart Pillow" for me to use when getting up, laying down, moving, sitting etc. It helps protect my chest from many things and I was so happy to recieve such a beautiful pillow for life.

I began healing pretty fast in the ICU, by the next day I was eating regular food sitting up, talking normally, as long as I wasn't in pain I felt pretty good, considering I had just had open heart surgery. But what kind of OHS did I just have was still lingering in my head. As I stated before I was set to have a Mitral Valve Repair, and it hit me that I never asked what happened when they opened me up. I asked my family, what happened and received the worse news which was that they had to REPLACE my valve. As I said before a replacement meant I would be on blood thinners forever, in hopes to keep me from clotting or thinning to much, "Coumadin" (Warfarin) is now my bestfriend, my life partner. I continued to break down everytime someone would say those words to me. I asked why they replaced it after all the test, that said a repair was completely possible?? Unfortunately when they opened my heart and got to my valve they realized how bad it really was and my Dr. explained to my family that it was a lot worse then they thought, and that if they would have replaired it, I would have had to have another surgery within 2-3 years. =( Sadly this wass my new reality! I had no choice in the matter. I am now to live the rest of my life with a mechanical valve, and coumadin to help me survive.

I had some great nurses and staff members taking care of me and my room, everyone went above and beyond (except for one) to take care of me and make sure I was comfortable and healing. As the days went by I was recovering nicely, I got to walk by the third day, I was moving a lot better day by day. But fear also played with me when they said I could go home on the 29th, I was extremely nervous about going home. They ensured me all would be fine and that they would supply me with enough information to make sure I would be fine at home. I decided to stay one more night and go home on the 30th. They were more then happy to keep me there as long as I needed. On the 30th I had got the full go ahead to go home, I filled out a lot of discharge papers got a lot of information from different staff members. I felt better about leaving but still was nervous and unsure if I would be okay at home.

 

 

They came to get me with a wheelchair and we headed downstairs, my family and I left the hospital and left to my mothers home. The ride was a little difficult emotionally and physically I cried a little bit and attempted to accept what my life was about to endure. I've gone REDagain!