Ross
Well-known member
We are always going to disagree. People not taking the drug seem to know far more about it then those that do. Meh, what else is new?
Newbie: Replacing with oversized bioprosthetic
- Thread starter mwkentner
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We are always going to disagree. People not taking the drug seem to know far more about it then those that do. Meh, what else is new?
WElcome, MW.
As others have said, I'm sure you and your surgeon will figure the best choice for you and your occupation. If you do discuss mechanical, ask about the ON-X valve. It has promising data on the possibility of lower coumadin dosages.
As others have said, I'm sure you and your surgeon will figure the best choice for you and your occupation. If you do discuss mechanical, ask about the ON-X valve. It has promising data on the possibility of lower coumadin dosages.
mwkentner
Active member
My wife, who is my biggest supporter and #1 advocate, wanted to remind me this so I thought I share..... sorry honey
I can't post since I am not a member, but you have to keep in mind that one of the BIG BIG BIG reasons for suggesting the oversized valve is that by the time you are a candidate for re-opperation, technology WILL have advanced to the extent that it will be possible to place a regular sized valve inside of the oversized valve by using a catheter.
I can't post since I am not a member, but you have to keep in mind that one of the BIG BIG BIG reasons for suggesting the oversized valve is that by the time you are a candidate for re-opperation, technology WILL have advanced to the extent that it will be possible to place a regular sized valve inside of the oversized valve by using a catheter.
mwkentner
Active member
Is your cardiologist suggesting that all people should get oversized biologic valves because they will last longer? Fascinating idea but I believe unfounded I don't believe this to be an option for everyone but I don't know. And again I have yet to talk to a surgeon. I'm sure he'll put his 2Cents worth in for consideration. Or is it a $100,000 worth of info. either way I am weighing both pros and cons.
Ross
Well-known member
Don't bet the farm on it. Yeah, it's being talked about, but whether or not it actually happens, remains to be seen.
Yes that is something to consider but not count on. BUt on the bright side in your case, since when this new valve needs replaced, it will be your 3rd valve replacement, even if at that time they are mainly using percutaneous valve replacement for REDOS or high risks surgeries, you would probably qualify. Wouldn't that be a relief, avoiding coumadin and avoiding another OHS.
ross before my ohs i hadnt even heard of coumedin,i dont know a lot about it now, i base my opionins on what my cardio, surgeon,and other experts in the field have told me,if there are wrong so be it, but again i will say most people on here get on well with it, but like all medication it can have detrimental effects on your health, thats all am trying to say,now give us a hug, a man hug by the way lol
Ross
Well-known member
Neil it's like any other drug, sure there are risks. There are risks taking asprin, decongestants, cold remedies and everything else, but people still take them and very few have any adverse events as a result. That's the only point I'm trying to drive home. Coumadin is not to be feared.
Now, fix us up a good hard liquor drink!
By the way, you ever going to send me your avatar?
Now, fix us up a good hard liquor drink!
By the way, you ever going to send me your avatar?
Welcome MK and Mrs. MK 
I'm surprised and disappointed by some of the comments on this thread.
What you are asking, about the oversized tissue valve, is very interesting. If my surgeon suggested it, I'd want to know: how long it has been tried, how successful the results have been, how many of this specific procedure my surgeon has actually performed, what all the results were, from whom he learned the technique, and a lot of other questions along that line.
And the possibility of a future percuataneous valve within an old oversized tissue valve is just fascinating. I'd be interested in knowing more about that. Because as tissue valves gradually decline, the openings get smaller, I think. Mine is anyway. I'm not sure how an oversized tissue valve could/would make a difference; but that's just my curiosity. I'm no doctor of course. Just an interested patient, as my tissue valve will evidently need replaced sooner than I had hoped also. And I would like to continue to take as few meds as possible .
Keep us posted? Best wishes .
I'm surprised and disappointed by some of the comments on this thread.
What you are asking, about the oversized tissue valve, is very interesting. If my surgeon suggested it, I'd want to know: how long it has been tried, how successful the results have been, how many of this specific procedure my surgeon has actually performed, what all the results were, from whom he learned the technique, and a lot of other questions along that line.
And the possibility of a future percuataneous valve within an old oversized tissue valve is just fascinating. I'd be interested in knowing more about that. Because as tissue valves gradually decline, the openings get smaller, I think. Mine is anyway. I'm not sure how an oversized tissue valve could/would make a difference; but that's just my curiosity. I'm no doctor of course. Just an interested patient, as my tissue valve will evidently need replaced sooner than I had hoped also. And I would like to continue to take as few meds as possible
.Keep us posted? Best wishes
.mwkentner
Active member
I must agree, remarks seem to slip off topic quickly, I'm just interested in finding out if anyone has or knows anything about such a procedure.
It seems hypothetical, but you could make an argument for using larger tissue valves from this article:
http://www.ncbi.nlm.nih.gov/pubmed/19852139
http://www.ncbi.nlm.nih.gov/pubmed/19852139
sorry if i have been one of those who went of subject, hands up dont shoot, ross i hope the drinks are on you ? you come across as a secret millionare? so its sunny here and am just off for a swim,anybody want to join me?
Ross
Well-known member
Despite some people not liking to hear anything about Coumadin, any time I see someone posting something what we know to be untrue about the drug, because we are on it and speak from experience, doesn't mean that it shouldn't be addressed.
I am addressing this part of the first post, so it is in no way, off topic!
I am addressing this part of the first post, so it is in no way, off topic!
What was said that was not true about coumadin? It IS more risky than the other meds you mentioned and it does have FDA black box warnings for a reason. YES there ARE myths about coumadin and they need to be corrected, like diet, shaving running with sizzors. It isn't just myths, there are numerous studies about the effects on coumadin and how the mortality rate is signifigently higher from EVEN falls from standing, let alone other major or minor head traumas.. There are numerous studies also showing how the morbity and mortality of internal bleeding is worse on people who take coumadin, wether from traumas, or just medical issues like ulcers ect. IF we all are free to discuss the dangers of surgery why can't we be as honest about coumadin? Now I know the coumadin doesn't cause the bleed, but it can make things worse, which IMO is what matters when making valve choices and trying to decide which you would prefer.
The only actual side effect I know of from just taking coumadin seems to be turnning out from most , but not all of the studies is there most likely is an effect on bone density in both children and adults taking coumadin, which makes sense since they found out the role of Vit K in bone density. but hopefully since they are now aware of that, doctors can keep an eye on things before it is a problem
BUt it does make many more medical problems more difficult and most studies show the elderly(65 and up) do have more problems related to the fact they take coumadin. Especially as you get even more older 75 an up when many not all of course, poeple do becomes, frailer, have balance problems and fall ,have thinner skin and more fragil veins and arteries and many issues that are more common as you get older can be complicated by coumadin like bad backs, hip problems ect. There are also medical illness, cancers, blood disorders, Gi problems that being on coumadin can cause problems with the treatments or meds or you have to bridge, which has its own risks. Studies also show the people who do worse in traumas are people who are in range, not just have very high INRs. and it isn't because the older people have dementionia ect, many people in their 60-70s and early 80 still are going strong and their thought process is fine. Young people ALSO can end up in the ER bleeding because of coumadin that is in range. http://www.ncbi.nlm.nih.gov/pubmed/18073596 "Degree of anticoagulation, but not warfarin use itself, predicts adverse outcomes after traumatic brain injury in elderly trauma patients" CONCLUSIONS: Therapeutic anticoagulation with warfarin, rather than warfarin use itself, is associated with adverse outcomes after traumatic brain injury in elderly patients.
Yes it is RARE people die because of coumadin because of bleeding or clots, (which technically wouldn't be caused because of coumadin, but be caused by having a mechanical valve and coumadin cuts down on that) Just like it is RARE people Die because of surgery. but my point is not all the things people fear about coumadin is myth, most of it is based on decades of studies and are facts. It is not just people who don't respect or understand the drug that have problems or die. many people whose 1st problem with abrain or other internal bleed is fatal, even people who are properly managed. The articles have been posted so i'm not going to make this longer, but anyone that is interested can search pub med. for coumadin /falls, coumadin bones, coumadin elderly ect. Coumadin does always end up on the list of 1 of the top drugs that people ende up in the ER because of complications that the med plays a part in.
IF there was no real problems with mechanical valves/and coumadin. There would not be a choice and it certainy woudn't be a difficult choice, but as many people who die from surgery die because of problems that are related to the fact they have a mechanical valve and take coumadin. IF it was safer to just get a mechanical valve and take coumadin, many of the leading centers would NOT be giving tissue to younger and younger people and valve companies wouldn't be spending milliuons of dollars to improve tissue valves/percutaneous replacements to avoid coumadin and people wouldn't be thrilled about the trials where the ON-X valve MIGHT let people get a mech valve but not have to take coumadin. If anyone is interested this article discusses This is a pretty good study if anyone is interested http://www.circ.ahajournals.org/cgi/content/full/116/11_suppl/I-294 Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age
Conclusion, In this cohort of adult patients <60 years of age followed for >20 years after AVR or MVR, the use of a tissue versus a mechanical prosthesis at initial implant was not associated with a significant difference in long-term survival, despite higher reoperation rates with bioprostheses. Our experience therefore suggests that a mechanical prosthesis may not necessarily be warranted in the younger adult patient population in need of first time, single left-heart valve replacement.
Sorry to go OT, again, but we really should be able to dicuss the risks of both surgeries and coumadin/mechanical valves. People come here to learn and we shoud be honest and admit there are problems with either choice, What you prefer to live with is pretty much a personal choice and you should have a long health life, whichever valve you decide on.
Back to your origonal questions. I was thinking about this yesterday and this doesn't really answer your situations, since it is a different valve. But I know for quite a while they have been discussion if there was a benifit to putting over sized valves and/or conduit in the pulmonary postion. Now the pulm position is unique because that is the one valve they can remove and not replace and people do well for years and some times life times and the pressure is usually much less than the right side, so what works on that side might not work the same on the left /aortic side. But they do seem to try alot of different theories with the pulm replacement, since the pressure is lower mechanical valves are usually not recomended, so the kids/adults will have quite a few replacemnts thruout life and they are always looking for ways to cut that number down.
Part of it was to cut down on the work the right ventricle has to do get the blood to the lungs too. Because many people with pulmonary stenosis who need numerous surgeries also have enlged over worked right ventricles.I'm not sure IF they ever agreed on wether it helped in the long run or not, But I'll look around and see if i can find anything.
Ross
Well-known member
We can go on, but the points to be made, have been. I never said there were no risks. What I said was those risks could be minimized and would be practically nil. Figures I'm getting are
<.09% to <2.9% a year. That's pretty dang close to nil. While some may consider this an arguement, you can't say they aren't learning.
Hey, whatever floats your boat. I'm done.
<.09% to <2.9% a year. That's pretty dang close to nil. While some may consider this an arguement, you can't say they aren't learning.
Hey, whatever floats your boat. I'm done.
FWIW, the ATS Open Pivot AP360 I have also has 10 year duration data of lowered INR levels being allowable. I believe their data says an INR of 1.5 - 2.0 is sufficient. My target range at the moment is 2.0 - 2.5, not sure why, but I certainly appreciate all of the information shared on this topic.
Nancy
Well-known member
Joe was on Coumadin for over 30 years. He had two mechanicals. He had fewer problems and side effects from Coumadin than he had from any of his other medications. I see arguments about taking Coumadin and getting older and having co-mobidities. And Joe did get older (passed away at 75), and did have multiple and very serious co-morbidities.
In his case, Coumadin was not the big issue you might imagine.
You really want to know what the biggest problem was? It was the co-morbidities which developed as he aged, and the fact that he probably needed a 4th heart valve replacement in the Tricuspid position. His cardiologist was very blunt and told him that that would not be happening. His cardiothoracic surgeon told him that he would never operate on him again, that he would die on the table.
Multiple surgeries are the biggest problem as you age with heart valve issues and other medical problems that crop up.. The first and second of Joe's surgeries were fine, even the third one, he did OK with. But the 4th one would never happen for him.
It is prudent to try to think about the future. No one can predict what other problems you might develop over time, and if the time comes when you need a valve replacement, and you are too ill to get one--where does thet leave you?
My own feeling is that if you have a tissue valve for the first surgery, fine, even the second. But after that, you might want to consider a mechanical valve, if only to avoid having to have another replacement as you age and have other issues. Or you could get a mechanical first off, and be done with it.
By the way, Joe died with his mechanical aortic and mitral valves fully functional. Mechanical valve failure was not what took him out, it was the co-morbidities and multiple organ failure.
The fewer surgeries one can have, the better.
A heart is a very small organ. How many times can such a small organ be cut into and still function correctly? Every surgery creates scar tissue which does not act the same way regular tissue reacts. And repeat surgeries can cause restrictive or constrictive heart problems.
In his case, Coumadin was not the big issue you might imagine.
You really want to know what the biggest problem was? It was the co-morbidities which developed as he aged, and the fact that he probably needed a 4th heart valve replacement in the Tricuspid position. His cardiologist was very blunt and told him that that would not be happening. His cardiothoracic surgeon told him that he would never operate on him again, that he would die on the table.
Multiple surgeries are the biggest problem as you age with heart valve issues and other medical problems that crop up.. The first and second of Joe's surgeries were fine, even the third one, he did OK with. But the 4th one would never happen for him.
It is prudent to try to think about the future. No one can predict what other problems you might develop over time, and if the time comes when you need a valve replacement, and you are too ill to get one--where does thet leave you?
My own feeling is that if you have a tissue valve for the first surgery, fine, even the second. But after that, you might want to consider a mechanical valve, if only to avoid having to have another replacement as you age and have other issues. Or you could get a mechanical first off, and be done with it.
By the way, Joe died with his mechanical aortic and mitral valves fully functional. Mechanical valve failure was not what took him out, it was the co-morbidities and multiple organ failure.
The fewer surgeries one can have, the better.
A heart is a very small organ. How many times can such a small organ be cut into and still function correctly? Every surgery creates scar tissue which does not act the same way regular tissue reacts. And repeat surgeries can cause restrictive or constrictive heart problems.
Nancy
Well-known member
Forgot to also add that open heart surgery can cause electrical conduction problems leading the arrhythmias. Maybe not everyone will have the problem, but there are more than enough on this site who have had this happen. Multiple surgeries just add to that problem.
Right now, there is not a viable alternative to Coumadin. But if that were to happen, would you go with a mechanical or a tissue valve?
Right now, there is not a viable alternative to Coumadin. But if that were to happen, would you go with a mechanical or a tissue valve?
mwkentner
Active member
They are doing this now but results are few and preliminary. Bil B provided the link to this article, but did not mention the title. To be clear, there are preliminary results available for:
Transcatheter "valve-in-valve" implants for failed bioprosthetic valves. Here is a summary: http://www.cardiologytoday.com/view.aspx?rid=62917 Link
The hope of a transcatheter valve when I need a reop was not why I selected a tissue valve, but maybe it will be an option when I wear out this one. Nancy was correct, my biggest problems during AVR and my biggest reop fears are the co-morbidities of the surgery especially those related to rhythm issues.
Best,
John
