Tissue or Mechanical?

Have you ever been asked that question?

Well, looking back on all the segments of my life, there have been many questions that have been asked of me.  Questions like how do you like your steak?  Would like paper or plastic?  Is this cash or charge?  Would this be credit or debit?  Would you like cheese on that?  Would you like that super-sized (my answer to that was always of course)?  Are you married or single?  Do you have any children?  Are you a  Republican or Democrat?  Are you conservative or liberal?  These questions get asked of most everyone very frequently, but not mechanical or tissue?

Well, now I have to really start thinking about how to answer what quite possibly might be the single most important question for my future.

Would you like tissue or mechanical, Captain Blowdri?

Aortic Valve Replacement Picture Using Bioprosthesis Valve Device

This mechanical aorta valve will last forever.  However the the patient must take coumadin for the rest of his/her life.  There are some really serious possible side effects from prolonged use of this drug:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); back, side, muscle, joint, or stomach pain; black, tarry, or bloody stools; blood in the urine (pink or brown urine); bloody or coffee ground-like vomit; chest pain; decreased urination; dizziness; fainting; fever; numbness or tingling; pain, unusual color, or temperature change in any area of the body; pale skin; purple, dark, or painful toes; shortness of breath; skin sores or ulcers; stroke symptoms (eg, confusion, slurred speech, vision problems, one-sided weakness); sudden severe pain in your legs, feet, or toes; trouble swallowing; unexplained swelling; unusual bruising or bleeding (eg, nosebleed, unusual bleeding from gums, increased bleeding from cuts, increased menstrual or vaginal bleeding, coughing up blood, bleeding at the injection site); unusual headache or weakness; unusual pain, swelling, or discomfort; wounds or sores that do not heal properly; yellowing of the skin or eyes.

Additionally the following may occur:

  • Fatal or nonfatal hemorrhage from any tissue or organ. This is a consequence of the anticoagulant effect. The signs, symptoms, and severity will vary according to the location and degree or extent of the bleeding. Hemorrhagic complications may present as paralysis; paresthesia; headache, chest, abdomen, joint, muscle or other pain; dizziness; shortness of breath, difficult breathing or swallowing; unexplained swelling; weakness; hypotension; or unexplained shock. Therefore, the possibility of hemorrhage should be considered in evaluating the condition of any anticoagulated patient with complaints which do not indicate an obvious diagnosis. Bleeding during anticoagulant therapy does not always correlate with PT/INR.
  • Bleeding which occurs when the PT/INR is within the therapeutic range warrants diagnostic investigation since it may unmask a previously unsuspected lesion, eg, tumor, ulcer, etc.
  • Necrosis of skin and other tissues.
  • Adverse reactions reported infrequently include: hypersensitivity/allergic reactions, including anaphylactic reactions, systemic cholesterol microembolization, purple toes syndrome, hepatitis, cholestatic hepatic injury, jaundice, elevated liver enzymes, hypotension, vasculitis, edema, anemia, pallor, fever, rash, dermatitis, including bullous eruptions, urticaria, angina syndrome, chest pain, abdominal pain including cramping, flatulence/bloating, fatigue, lethargy, malaise, asthenia, nausea, vomiting, diarrhea, pain, headache, dizziness, loss of consciousness, syncope, coma, taste perversion, pruritus, alopecia, cold intolerance, and paresthesia including feeling cold and chills.

Rare events of tracheal or tracheobronchial calcification have been reported in association with long-term warfarin therapy. The clinical significance of this event is unknown.

Priapism has been associated with anticoagulant administration; however, a causal relationship has not been established.

Let me just add that if I were to “suffer” from priapism I could start a whole new professional acting career and make a ton of money down in the San Fernando Valley!!  (I understand that the adult film industry, just like the United States Marine Corps, is always looking for a few good men!!!)

Now my other choice for aortic valve replacement is a tissue valve.  The tissue replacement may come from the patient, from a pig, or from a cow.  Life expectancy of the tissue replacement valve is approximately 10 years.  Therefore, at my present age, 59, there is a possibility that I might have to endure two of these surgeries, when the decision to replace my aorta arrives !

Now having researched these two options still doesn’t make the decision very easy.

Let me review these choices:

If, when the time comes, I select a tissue replacement from either a pig or a cow there are some serious humanitarian concerns.  What are the ramifications to society for consuming either a very finely grilled prime rib, rib eye, T-bone, porterhouse, an In-N-Out burger, or some really great pork chops?  Would that be a tabu thing to do in our society?  Would I be considered a cannibal?  These are questions that I want the surgeon to clear up before I ever have to make this particular decision!

Similarly, if the decision is made to have the mechanical valve relacement, and I was confronted with the dreaded side effect of priapism, would I be considered an outcast if I decided to capitalize on that “misfortune” and move to the San Fernando Valley to start my film career?

What is your view?  I need your help!  Is it mechanical or tissue?

I’ll get by with a little help from my friends!!