Ivan Hernandez - How I Chose a Replacement Valve
I won’t slow down. Science should speed up. @ivebeenivan
After four different medical opinions from four different surgeons, I found myself sitting at home still undecided on a replacement mitral valve. Cow, pig, artificial? Horse and human valves were other rarer options. There was also a new-ish lap band type procedure where my leaky valve could be clipped to close a bit better and possibly delay the need for replacement surgery.
My first surgery was an attempted repair on a severely regurgitating mitral valve. Less than four years later, the repair failed and this was to be my second surgery to replace it. As a very active and healthy 37-year-old, I felt confused, frustrated and deceived. The repair was supposed to last 10 or more years and many patients had even gone on to 20! But here I was staring at three little rings gambling on the fate of my next decade.
I embarked on a valve opinion tour. My original surgeon recommended a bovine pericardial (cow) valve. A local surgeon, confidently and without knowing my lifestyle, stated an artificial valve was best. Another suggested a porcine (pig) valve, but was also aligned with my original surgeon’s take. The last one left it entirely up to me.
More undecided than ever, I went home and loaded all of their comments into a spreadsheet. Then, I Googled the durability and success rates of heart valves. Here is what I found… Horse and human valves are not easily accessible. Cow valves are constructed from cow tissue that is shaped into valves and is very tough. Pig valves are actual heart valves and behave most like human valves. Artificial valves are made of carbon or titanium materials. Cow and pig valves don’t require you to take blood thinners, but don’t last forever. Artificial valves last forever, but require you to take blood thinners for life As for the lap band, it’s only recommended for patients who are too frail to undergo surgery.
After some soul searching, the answer came easy. Even though the “general rule” of valve replacements was that younger patients should get artificial valves to avoid additional surgeries, I would have to be less active due to the risks that come with blood thinners. I gambled on the evolution of medicine - a very large pig’s valve that would give me the option to, hopefully after 10+ years, have a catheter valve-in-valve procedure that will be even less invasive than minimally invasive valve surgery is today.