Re: tissue vs. mechanical and advancements

[temp69]

Re: tissue vs. mechanical and advancements

I so much wanted a tissue valve, but at 55, the doctors all told me that going with the On-x would be best. The reasoning was, and I lobbied for hoping for advancements, was that any technique that might be available when I needed the second tissue valve (min 10 years, I was told max 15, but hoping for 20, 20 looking good in some cases even) -- well, no magic technique on non-invasive exists quite yet for people like me, who needed OHS the fist time around, and even if there was something really cool, it wouldn't have been tested the required amount of time. Meaning, If I needed a new tissue valve in 20 years and they'd found some new way to replace that was easy, the technique would have only been around a few years, not long enough for my cardiologist. I hated her and his logic, but it made sense. Not to dis the tissue valve people out there, I know they rock and work great, but this is just one viewpoint.

People know and trust the St. Jude's because it's been around for 20 years or more, right? I went with the On-x, which has only been around for 10 years in this country, but seems to be doing well.

To all who are choosing, keep the "advancement trial period" in mind.

 

[CathyK.]

I am just wondering why they don't feel anything would be around long enough for them in 15-20 years when they want the On-X that has only been around 10 years. It seems like they are condradicting themselves.

 

[Lynlw]

I was wonderring that too, thanks

 

[temp69]

the thinking is/was that the on-x, having been proving itself for 10 years was "safe," whereas the unknown technique, unless there was a big breakthrough like, tomorrow, wouldn't have been tested enough.

It's all conjecture of course. I did lots of research like everyone and really wanted to go with a tissue, hoping that 10-20 years from now there would be a non-invasive technique. With only a faint "maybe" to go on, the cards thought that wasn't enough. I hope they're wrong, because any drastic new technique can benefit us all.

But I did see the logic in saying something "new" would be relatively new and not time-tested enough to count on.

 

[starfish11040]

temp,

Are you at the same level of anti-coagulation as people who have the St. Judes?


By the way, regarding the percutaneous procedure (the non-invasive technique), I was told by my cardio that it will only be for replacing a native valve not a sewn-in valve. That may be only the current perspective though.

 

[Karlynn]

I think it truly depends on what doctors' opinions you are getting. All carry their own biases that aren't 100% based on concrete evidence. And most have valid reasoning behind their biases.

At 55, there are many doctors that would have happily recommended a tissue valve for you. If you had gone to Cleveland Clinic, I'd be willing to bet my house that you would have ended up with a tissue valve. But I think the On-X also has good merits as does the St. Jude.

As we always say here "The only bad choice, is not having the surgery."

 

[tobagotwo]

Here are real numbers, from actual use: 90% of CEP bovine tissue valves are still implanted and working at 18 years, 80% at 20 years. What's not proven about that?

http://www.edwards.com/products/heartvalves/lifelonganticoagulationbrochurepdf.htm

Since then, Edwards has added anticalcification treatments and nondamaging tissue fixation methods to those valves. Medtronic is also doing well at the 10-year mark with their stentless and stented offerings. They also have added anticalcification treatments and nondamaging tissue fixation methods to their valves.

Be happy with your valve. It's a great valve. But there's nothing wrong with a tissue valve, either. At 55, your life expectancy with either valve choice would be the same, as the relative risks of the two valves are balanced, per studies done even before these new generation valves were the most common tissue valves in use. Your doctors have their point of view, but they didn't do their homework.

Best wishes,

 

[MikeHeim]

Just to pipe in briefly, I would find a Cardiologist/Surgeon that was comfortable with whatever procedure I was comfortable. If a new technique or new valve was devised and I had done my research and wanted to use it (regardless of whether it had been on the market for 2 years, 5 years, or 10 years), I would find a surgeon who was willing to do it on me. There are plenty of Cardiologists in the sea - there shouldn't be any reason as to why a person should have to argue or convince them as to what type of valve they wish to use.

I'm somewhat curious - obviously you were operated on by Dr. Laks just as I was. He didn't seem to have any problem with me having a tissue valve as a backup plan (at age 28). Was that the same for you? Was it only your Cardiologist who refused to let you get a tissue valve?

 

[temp69]

As for the coumadin, no, I'm on a regular dose (4mg). Was told that might not need it at all. Small chance of that, I think.

Both Laks and Cardiologist at UCLA Michelle Hamilton were pretty adamant about going with the On-X. Maybe they get a kickback. I specifically spoke with Laks about going with a Tissue, hoping that when I needed another, there would be some advancements which would make it simpler. He said the non-invasive technique wouldn't work because of embolism danger -- at least that'w what I recall. The gamble, if you will, is to try and make it "well into your 90's" as Laks put it, with the On-x valve and not have to go in for a reop.

Bottom line is, can't really tell the difference because I haven't had a tissue. I know an elderly lady who said she was fine, she was on her 2nd tissue valve and going strong.

So the only bad decision is not to have the surgery. Just wanted to mention the thinking by the doctors, since it affected my choice. I can tell there's a chasm between the two types of valvers, as would be expected. I truly wish the cards had told me a tissue valve would last 20 to 30 years, then it would have been a no-brainer, I think. But as I get stronger, the coumadin thing is not such a big deal, I don't bruise, am active...so...my choice is a winner so far. Biggest advantage seems to be no sound for tissue valves, and no coumadin for most patients.

 

[temp69]

http://www.hsforum.com/stories/storyReader$1472

I think I must have read this same version of analysis of the debate a dozen or more times prior to my surgery.

Not saying they're right, but I kept running into this over and over, and for someone who's under 60...well it does make a certain sense. Now Arnold Schwarzenegger, he's a porcine valve guy...and he's built like a tank.

so go tissue, go mechanical, it's probably a lot less diff. than any of us think.

 

[mtkayak]

As for the coumadin, no, I'm on a regular dose (4mg). Was told that might not need it at all. Small chance of that, I think.

What is your target INR range with the ON-X valve? Just curious.

 

[Lynlw]

http://www.hsforum.com/stories/storyReader$1472

I think I must have read this same version of analysis of the debate a dozen or more times prior to my surgery.

Not saying they're right, but I kept running into this over and over, and for someone who's under 60...well it does make a certain sense. Now Arnold Schwarzenegger, he's a porcine valve guy...and he's built like a tank.

so go tissue, go mechanical, it's probably a lot less diff. than any of us think.




The problem with alot of information on the web is alot of it is outdated. you have to be really careful to check dates. This is a really interesting article, but was written in 96

1. Ross, D. Personal communication. Controversies in Homograft and Autograft Surgery. The Ross Procedure Symposium. May 8-11, 1996. Indianapolis, Indiana.

2. Joyce F, Tingleff J, Pettersson G. Expanding Indications for the Ross Operation. The Journal of Heart Valve Disease 4(4):352-363, July 1995.

 

[temp69]

Yes, that was an old article. but if you google the question, you come up with basically the same stuff as in that article. sorry for using that one, but I urge you to look online -- almost all the articles say the same thing for tissue valves, when you're younger, they wear out faster. and you're up for a reop. ok some some, but not for moi.

 

[Keithf]

Can't get rid of risk

Can't get rid of risk

To me it doesn't make sense not to use an On-X valve because it doesn't have as long of a track record as some others and there is some risk of some problem showing up eventually.

First of all, having a valve is just risky. You can choose re-operation risk with a tissue valve, or choose ambient anticoagulant/stroke risk. It's just a matter of picking your (rat) poison. With the On-X valve, you're exchanging some "not tested" risk for some anticoagulant/stroke risk. Is it worth it? Who knows?

Secondly, if your product has just two moving parts, on a 50-year old technology, you can bet that it is well-understood. The engineers know all about what's going on with that valve.