Update on Valve Information

[Kate]

Did posts disappear from this thread? I tried to read the most recent listed in "new posts" and it wouldn't come up. Then, upon reviewing the thread, I found I was unable to locate Bob's post in which he raised some mild concerns about the information originally presented.

As I feel this thread better reflected our commitment to accurate, balanced information when it included Bob's post, I hope it will be restored. If not, I encourage anyone seeking an unbiased review of the pros and cons of various valve choices to be sure to read the Famous Tobagotwo Writings On Valve Selection at the top of the Valve Selection Forum.

 

[Mary]

It's all there, Kate.
I've been following the thread, and I don't think any replies are missing.
Of course, just as sure as I state this, someone will come along and prove me wrong.
But I don't think so!

 

[Kate]

Thanks Mary, but I still can't seem to access them. I sometimes get confused with all the various reply chains though so it's possible I'm just missing them somehow. Kate

 

[Karlynn]

Kate, Bob's first post is #11. He did not reply to this thread before that.

 

[Wise]

Dr. Emery sounds like a very knowlegable surgeon.
I hope Ross will make this a sticky thread in valve selection.

I second this sticky request. Al's post is definitely one I would revisit regarding valve selection, if that time comes for me. Just my two cents.

 

[Guest]

I don't think that the risk of stroke lowers over time. The risk of atrial fibrillation increases with age. Atrial fibrillation is a major risk factor for stroke.

Aspirin may be sufficient for an aortic mechanical valve if the person has a normal ejection fraction, normal heart cavity size and is in normal sinus rhythm. These are conditions that would be met in only a very small minority of people.

Whether or not the ON-X group included a significantly higher proportion of young people should be easy to find if someone has the time to look it up. However, you would have to decide which St. Jude group you would compare it too.

I have no doubt that there are people who are very skilled at implanting On-X valves.

I only threw this things out for people who are considering which valve to get. For people who already have valves you can only say that you made the best decision that you could with the information that you had at the time. You can't revisit a past decision with information that you did not have at the time. You have to say that you made the best decision possible with what was known at the time.

Remember, too that "expert opinion" is the lowest grade of evidence on which to base a decision.

 

[Ross]

Did posts disappear from this thread? I tried to read the most recent listed in "new posts" and it wouldn't come up. Then, upon reviewing the thread, I found I was unable to locate Bob's post in which he raised some mild concerns about the information originally presented.

As I feel this thread better reflected our commitment to accurate, balanced information when it included Bob's post, I hope it will be restored. If not, I encourage anyone seeking an unbiased review of the pros and cons of various valve choices to be sure to read the Famous Tobagotwo Writings On Valve Selection at the top of the Valve Selection Forum.

Kate nothing has been deleted by myself nor any participants. They are all here. Now somethings got moved to Pilot Talk in the Lifestyles forum, but that was because I thread jacked this thread when replying to Jim and we went off on Piloting discussions. All of those are still intact, but had nothing to do with this thread.

 

[Kate]

This is SO strange. I'm sure you all are correct, but I still can't find Bob's post in the thread. Is is possible that I somehow eraced it on my computer? Anyway, it doesn't really matter as long as everyone else can see the whole thing. I'll stop fussing about it and move along! Kate

 

[Karlynn]

Kate, here's his 1st post on this thread, copied and pasted here. Maybe you are mixing it up with another thread and another reply by Bob.

Please remember when reading this that the information in the lecture regarding tissue valve lifespans and percentage requiring warfarin were not taken from the 34,675 patient-year St. Jude study. We don't know the sources for those statements.

While I'm not indicating at all that Dr. Emory is attempting to mislead, he clearly has a bent. He was, I take it, involved in the study? I note (only from the post) the point made about the clotting risk of mechanical vs. tissue evening out over time, but not about the bleeding risk expanding on the mechanical side over time. As far as "50% of all tissue valves have failed in 12 ? 15 years," taking the lifespan of all tissue valves from the beginning of record keeping (although I doubt such a definitive compilation exists) does not produce any valid data. If all brands and types of mechanical valves were lumped together from their inception, the figure would not be 98% at 25 years either.

This isn't intended as a rebuttal to the post, as much as a little leveling of the field.

Best wishes,

 

[tobagotwo]

There were only two posts I made to this thread: a general post and a reply to Al Capshaw. To my knowledge, neither has gone missing at any time.

Maybe the confusion was related to a different thread. I occasionally obsess over something I think I wrote or someone else wrote that I can't find, especially when there are two very similar threads going simultaneously. I usually eventually locate it in some thread I didn't expect it to be in, and sadly, it generally isn't as well-written or definitive as I remember it.

Best wishes,

 

[Guest]

I just found an abstract (not the whole article) about a study done in Australia and New Zealand. People with valves were surveyed and less than 1% wish that they had made a different choice on the type of valve. I know nothing else like how long they had them etc.

As I wrote before make your choice and be happy with it. Seems to work.

 

[Susan BAV]

The St. Jude Medical Cardiac Valve Prosthesis: A 25-Year Experience With Single Valve Replacement
Robert W. Emery, MD*, Christopher C. Krogh, Kit V. Arom, MD, PhD, Ann M. Emery, RN, Kathy Benyo-Albrecht, RN, Lyle D. Joyce, MD, PhD, Demetre M. Nicoloff, MD, PhD
Cardiac Surgical Associates, PA, St. Paul, Minnesota

Accepted for publication August 23, 2004.

Address reprint requests to Dr Emery, Cardiac Surgical Associates, PA, 2356 University Avenue West, Suite 258, St. Paul, MN 55114... [email deleted]


"BACKGROUND: From October 1977 to October 2002, 4,480 patients (age range, 17 to 94 years; average, 64 ± 13 years) underwent single valve replacement with the St. Jude Medical heart valve. Of 2,982 aortic (AVR) and 1,498 mitral valve replacements (MVR), concomitant coronary artery bypass grafting was performed on 42% and 33%, respectively.

METHODS: Cardiac Surgical Associates has maintained an independent database of patients having valve replacement with the St. Jude Medical prosthesis since the world's first implant. Patients were contacted by questionnaire or phone from November 2002 through June 2003. Hospital course and valve-related events were verified by patient chart review or physician contact.

RESULTS: Follow-up was 95% complete. Operative mortality was 4% with AVR and 9% with MVR. Total follow-up was 32,190 patient-years (range, 1 month to 24.8 years; average, 7 ± 5 years). During the study period, patient freedom from late mortality was 61% (AVR, 61%; MVR, 63%), and from valve-related mortality 92% (AVR, 93%; MVR, 91%). Freedom from thromboembolic events was 85% (86% AVR, 81% MVR), from bleeding events, 81% (81% AVR, 81% MVR), from reoperation, 98% (99% AVR, 97% MVR), from endocarditis, 98% (99% AVR, 98% MVR), and from valve thrombosis, 99% (99% AVR, 98% MVR). There was one MVR structural failure (0.06%).

CONCLUSIONS: The St. Jude Medical valve has proven to be an effective and durable valve prosthesis with a low event rate during the long term."

------------

This was also interesting and is from a few years ago but I'm not clear exactly how it fits with the more current information presented here, however, the St. Jude valve certainly appears to be a very good option.

 

[Susan BAV]

Healthcare Sales and Marketing Network News

Healthcare Sales and Marketing Network News

There was quite a bit on the web about the Dr. Emery and the 25 years. Another interesting article was
from the Healthcare Sales and Marketing Network News (for Medical Sales and Marketing Professionals):

News Release: March 22, 2005

"Twenty-Five Year Retrospective Study with St. Jude Medical Mechanical Heart Valve Published in Annals of Thoracic Surgery

ST. PAUL, Minn.--(HSMN NewsFeed)--March 22, 2005--The St. Jude Medical® mechanical heart valve has proven to be an effective and durable valve with low complication rates, according to a 25-year retrospective study published in the March issue of the Annals of Thoracic Surgery. The study, conducted by Minnesota-based Cardiac Surgical Associates, is one of the longest, largest and most comprehensive studies on a bileaflet prosthetic heart valve.

The study analyzed 4,480 patients from October 1977--when the world's first St. Jude Medical® valve was implanted at the University of Minnesota by Dr. Demetre M. Nicoloff--to October 2002, marking the 25th anniversary of that milestone. The study's primary objectives were to document patient survival and valve-related events or complications during the 25-year period.

An independent database was created to study patients who had received a St. Jude Medical® aortic or mitral valve during this timeframe. To ensure accuracy, clinical study documents from prior studies were crosschecked with the new data. These efforts resulted in 95% complete follow-up covering 32,190 patient years.

The paper's conclusion states: "In summary, this extensive experience demonstrates excellent function of the SJM valve in the mitral or aortic position. Valve-related events were low, most commonly caused by patient-related factors as opposed to the presence of a prosthetic valve. Valve-related mortality was low, and there have been no reoperations as a result of valve wear. The SJM valve can be recommended to patients as a prosthesis that will last their lifetime."

"This exhaustive, in-depth study represents the most complete retrospective evaluation of a bileaflet prosthetic valve ever conducted," said Robert W. Emery, M.D., the study's lead author at Cardiac Surgical Associates. "The process involved multiple steps and crosschecks to ensure the completeness and accuracy of all data. These results validate the long-term effectiveness and safety of the St. Jude Medical® mechanical heart valve, which is designed to last over a patient's lifetime."

St. Jude Medical has been a world leader in mechanical heart valve technology since the Company's founding in 1976. In November 2004, the Company announced its 1.5 millionth mechanical valve implant in Iwate, Japan--the only heart valve company to achieve this milestone. The Company's most advanced mechanical valve, the SJM Regent® valve, offers outstanding hemodynamics while maintaining many of the traditional design features that have established the St. Jude Medical® valve as the "gold standard" for almost three decades, a rare achievement in the implantable medical device industry.

"We would like to thank Dr. Emery and his colleagues for undertaking this thorough analysis of the St. Jude Medical® mechanical heart valve," said George J. Fazio, President of St. Jude Medical's Cardiac Surgery Division. "More than 1.5 million patients around the world have benefited from the quality and durability of the St. Jude Medical® mechanical heart valve. We are committed to continued advancements in our mechanical heart valve franchise, while we also broaden our portfolio of therapies and technologies to enhance surgeons' clinical practice and their patients' care."

St. Jude Medical, Inc. [website deleted] is dedicated to the design, manufacture and distribution of innovative medical devices of the highest quality, offering physicians, patients and payers outstanding clinical performance and demonstrated economic value.

Source: St. Jude Medical

Issuer of this News Release is solely responsible for its content.
Please address inquiries directly to the issuing company."

 

[Andyrdj]

atrial fibrillation stats

atrial fibrillation stats

If you get a tissue valve in the aortic position you have a 15 to 30% chance that you will need warfarin because of atrial fibrillation, increased left ventricular size, decreased ejection fraction or some condition that puts you at high risk of clotting.. If it is in the mitral position there is a 25 to 50% chance that you will need warfarin.

I question these stats - everywhere else I've read suggests far higher odds of A/F in the mitral position than in the aortic. Surely the St Jude is claiming that it is different there?

 

[RCB]

I question these stats - everywhere else I've read suggests far higher odds of A/F in the mitral position than in the aortic. Surely the St Jude is claiming that it is different there?

Andy,
The stats. are correct relative to each valve position:
"aortic position you have a 15 to 30%"
"mitral position there is a 25 to 50%"

However to be fair, the population they are most relevant to has an average age of 65. If you are younger, like yourself, the numbers are much lower. Does this make sense?

 

[Ross]

I've had in interesting pfd on a valve selection Roundtable discussion that Dr. Emery took part it. IT IS outdated since it was from a valve selction symposium in 2001 so alot of the info is old, but I still found it interesting and learned from it there are 3 sections discussng different things that go into selcting the "right' valve for each person the 1st is about
the first of how life expectency plays a role
http://www.onevalveforlife.com/documents/1of3.pdf
the second is about anticoag

http://www.onevalveforlife.com/documents/2of3.pdf

the last is the importance of hemodynamic function
http://www.onevalveforlife.com/documents/3of3.pdf

and again this is 6 year old info, so they numbers have changed, but IMO the over all discusion and hearing each surgeons thoughts were pretty interesting, if they didn't answer all my questions, they at least helped me think of questions to ask.

Now my feelings are hurt. All of these links are in the "Must Have References" Section of the References forum. Does anyone even look in there? Should I just get rid of it. It would be one less sticky.

 

[Wise]

Now my feelings are hurt. All of these links are in the "Must Have References" Section of the References forum. Does anyone even look in there? Should I just get rid of it. It would be one less sticky.

I've read it on several occasions, for what it's worth. IMO, it is still a valuable tool. It's one of those things that I have a mental note to refer back to whenever I progress to surgical candidacy.

 

[tantenay]

valve choice

valve choice

I was 49 when I had my aortic valve replaced in 2000. I really struggled with even going through the surgery, much less choosing a valve.I decided to go with a bovine valve. I really felt that the mechanical valve would be more likely to cause clots, and that the couomadin would be a hassle . I didn't want to have to think about the valve all the time, which I knew I would with the mechanical - not only with the monitoring, but the clicking. I am so sensitive to outward stimuli, and was sure the clicking would make me nuts!

I have had no problems so far, at 7 years out. They do expect this valve to last longer than previous bio valves, as the cow pericardium is stronger than the pig (so they say). As far as another surgery goes, well, I'll deal with it as it comes. I don't plan on doing it unless they can do it minimally and without a heart-lung machine!!! Until that day, I'll just take the natural approach.

Anyway, guess it's too soon to know, but hopefully I'll get another good 10 years, and I'll be happy!

 

[Susan BAV]

I question these stats - everywhere else I've read suggests far higher odds of A/F in the mitral position than in the aortic. Surely the St Jude is claiming that it is different there?

I must have missed this question about the anti-coagulation stats earlier...

I was put on coumadin post-op with Afib and/or Aflutter, but only for three months post-op. I wonder if the quoted stats include temporary coumadin use?