Precautions

[Agian]

There was a paper you uploaded some time ago, about bleeding that concluded the rates were the same between self-managers and the general population. I meant to read it, but didn't get around to it. I looked up your old posts, but the forum didn't allow me to go back far enough.

So, this is it then?

The paper challenges the findings of older studies: "Survival after aortic valve replacement is reported to be significantly lower compared with the general age-matched population, especially in younger adult patients." (References 1-3; 2000, 1989, 2005); and concludes: "In contrast to older reports, relative survival in these selected young adult patients closely resembles that of the general population, possibly a result of highly specialized self-management anticoagulation treatment, better timing of surgery, and improved patient selection in more recent years."

But back to the issue of bleeding. I would have thought this would be rarer in the general population, as compared to those on Warfarin, even if control was tight.

 

[pellicle]

Hi

There was a paper you uploaded some time ago, about bleeding ... So, this is it then?

I suspect that it is ... I can only say that its possible that I got confused because I 1) read another paper making that assertion, which led me to 2) download and read this paper. I subsequently did not keep the original paper (or at least link it to this paper in my pathways) so for the moment that's lost.

The paper challenges the findings of older studies:

indeed ... there were many interesting findings in that ... for instance, on the subject of selection they say:

Ross patients, for example, were on average 7 years younger,
more often had aortic valve stenosis, and were in better physical
condition than patients who received a mechanical prosthesis.
Patients who received a mechanical prosthesis more often had
diabetes, hypertension, and, besides aortic valve disease, other
cardiac conditions requiring concomitant cardiac surgery.

so the Ross patients were younger and healthier on average than the mechanical valve recipients ... yet:

During follow-up, 5 Ross patients and 1
patient with a mechanical valve experienced a thromboembolic
event.

and

Of note, in the mechanical prosthesis group, none of the late
deaths were valve related, whereas 4 (2 valve related with acute
myocardial infarction and stroke, 2 unknown but attributed to
valve related according to the guidelines) of the 7 late deaths in
the Ross group were.

and again:

Surprisingly, we found not only that there was no survival
advantage for the Ross procedure over the use of mechanical
prosthesis with optimal anticoagulation self-management but also
that there was even a tendency toward a survival advantage in
patients who received a mechanical prosthesis.

its interesting that this theme of mechanicals having slightly greater survival over all other techniques continues to emerge. I have cited it in many other places ...

On anticoagulation they reported:

In the unmatched subset of ESCAT II patients
from Bad Oeynhausen, mortality is lower than mortality in the
entire ESCAT II cohort (linearized occurrence rate, 2.90 per
year).14 This suggests that the innovative postoperative management
of patients in Bad Oeynhausen is extraordinarily effective
in terms of complication and survival rates

This observation suggests that the optimized
anticoagulation self-management treatment that mechanical
prosthesis patients receive in Bad Oeynhausen has resulted
in a minimization of thromboembolic and bleeding events and
decreased valve-related mortality compared with older reports

which nicely matches the observations of anyone who has fought to have self management of AC and their INR. IE: we're fed up with the hit and miss approach of someone how doesn't care as much about our health as we do and we want to take the reins.

Seems we (self managers) have better outcomes ...

Finally, the present study shows that late survival after both
the Ross procedure and mechanical prosthesis implantation is
excellent and comparable to that of the general population

The advantage of a mechanical prosthesis
is the excellent durability and low reoperative hazard. The choice
for a Ross procedure, on the other hand, would mean a limited
durability of the aortic valve autograft and pulmonary valve allograft
and implies a certain risk of reoperation during the patient’s life

which also matches the few Ross procedure patients who have posted here..

 

[kevinsworth]

So, I did meet with my cardiologist. I brought a written list of activities for him to okay...or not. He suggested limiting lifting to 30-50 lbs. and avoid lifting heavy, wet snow. Any lifting that makes me "grunt" can spike my heart rate, and stress the valve. Other than that, I can do EVERYTHING else. I have a bovine tissue valve. I only take two 81mg aspirin per day, and I have no other serious health issues. I'll be 63 in a couple weeks. Old enough to know better than to over-do it.

 

[cldlhd]

My work is assisting that I come back to work on full duty and that there is no light duty available. They are sending me a list of physical demands of the job so that my surgeon can review them. Seeing that he said there will be no restrictions I guess the list is a moot point