52 year old choosing between mechanical and bioprosthetic valve

[pellicle]

The two posts you quote don't appear to be from the same person.

Gosh you are right

I hate it when I make mistakes like that >.<


What a nong David W , this clarified why I thought you were saying the opposite.

My apology .

Thanks for ppointing out my error nohohamp (and Paleogirl I saw your post too, just acknowledging that too).

I'll go back into my corner now and put on my white cone hat.

 

[Paleowoman]

No worries Pellicle. I know you always do mean well, it was a simple mistake. I'll never forget the soothing mp3 sound in Australian countryside you sent me before I had surgery.

 

[ALLBETTERNOW!]

Great to hear about Dr. Flack, who'll be doing my surgery.

He and his staff and Baystate are really a well oiled machine on top of everything. Best of luck, it will all go well I'm sure!!!!!

 

[neil]

hi pellicle hows it going my old sparing partner , as many on here know. Me and pell have had a few cross words over the years lol, but I think in many cases we just mistook our own arguments the wrong way, now I look at pellicle as a good bloke who is a valued member of this great site although am sure we will cross swords again ha ha,

 

[pellicle]

Hey Neil

hi pellicle hows it going my old sparing partner

Not bad ... clearly lacking in the finer details at the moment.

although am sure we will cross swords again ha ha,

Well from my perspective only like this

Me: Harrr .. where is me buccaneer?

Chorus from the crew: Oh yer buckan-ed

 

[cldlhd]

I made one post. I feel that the mech. valve is the best decision for a 52 yo. I often wonder if Dr.'s are just trying to drum up future business by recommending tissue valves to 30-50 yo patients. JMO.ff
Yf

I'm as skeptical as the next but I doubt that's the underlying reason considering the theory is the future replacement for the failing tissue is expected by many to be TAVR and that's performed by an endovascular surgeon who is probably not the one who performed the OHS. As a matter of fact cardiac surgeons will take a big hit if TAVR ever takes off . The procedure is a lot quicker ( cheaper ) and is performed by different surgeons. The insurance companies and various government entities that pay for valve procedures will love it though.

 

[ALLBETTERNOW!]

I'm as skeptical as the next but I doubt that's the underlying reason considering the theory is the future replacement for the failing tissue is expected by many to be TAVR and that's performed by an endovascular surgeon who is probably not the one who performed the OHS. As a matter of fact cardiac surgeons will take a big hit if TAVR ever takes off . The procedure is a lot quicker ( cheaper ) and is performed by different surgeons. The insurance companies and various government entities that pay for valve procedures will love it though.

The insur co support is what will push it on and make it the standard of care, results being equal of course.... ;-)

 

[ALLBETTERNOW!]

My surgeon's guess was somewhere around a 70% chance of repair, though I think that was a somewhat off the cuff estimate. He's done about 100 repairs over the past 10 years, which my cardiologist says is a good number. As you say, my job is to decide which valve is plan B.

He likes tissue maybe because he hikes and likes to be dropped by helicopter on the top of a mountain

 

[cldlhd]

This decision is full of what ifs and hypotheticals. There are a lot out here that know more than me but I can share my thought process and who knows maybe it'll help even though you've probably thought of most of this yourself. When I was choosing my backup I bounced back and forth and eventually settled on mechanical. The positive for tissue was the thought that eventually an improved mech valve that doesn't require warfarin AND has better flow characteristics will be approved. The question is when? If I went tissue and got 10 to 15 yrs out of it hopefully that fancy new mechanical would be ready by then . Even so as I was getting wheeled in for my 2nd OHS to replace the failing tissue I'd probablybe thinking I should have just gotten that On-x back in 2015 and then 6 months later , assuming the surgery went well , once I was largely recovered I'd be happy that I made the right decision. But what if that new mechanical wasn't ready for primetime and I ended up getting the same valve I could have gotten the first time? I ended up with a repair and I know there are others out here who have had repair failures but as with pretty much all medical technology the techniques have improved and a lot is dependent on the condition of the valve and the experience of the surgeon . Maybe I'll post a video of a repair if anyone out here wants to see it.

 

[ALLBETTERNOW!]

This decision is full of what ifs and hypotheticals. There are a lot out here that know more than me but I can share my thought process and who knows maybe it'll help even though you've probably thought of most of this yourself. When I was choosing my backup I bounced back and forth and eventually settled on mechanical. The positive for tissue was the thought that eventually an improved mech valve that doesn't require warfarin AND has better flow characteristics will be approved. The question is when? If I went tissue and got 10 to 15 yrs out of it hopefully that fancy new mechanical would be ready by then . Even so as I was getting wheeled in for my 2nd OHS to replace the failing tissue I'd probably thinking I should have just gotten that On-x back in 2015 and then 6 months later , assuming the surgery went well , once I was largely recovered I'd be happy that I made the right decision. But what if that new mechanical wasn't ready for primetime and I ended up getting the same valve I could have gotten the first time? I ended up with a repair and I know there are others out here who have had repair failures but as with pretty much all medical technology the techniques have improved and a lot is dependent on the condition of the valve and the experience of the surgeon . Maybe I'll post a video of a repair if anyone out here wants to see it.

What if they TAVR D in a new valve that could get you another 20 years? A pipe dream perhaps?

 

[pellicle]

Hi

I'm as skeptical as the next but I doubt that's the underlying reason considering the theory is the future replacement for the failing tissue is expected by many to be TAVR and that's performed by an endovascular surgeon who is probably not the one who performed the OHS.

I'm also skeptical, and until I see it in the mainstream am uncertain that TAVR will be mainstream. I believe there are more complications to overcome than those of us in the general public grasp. I often draw on the analogy that we went to the moon in 1960's and now we still aren't there. Noone has thought through the valve in the valve in the valve well (you know, your third revalve via TAVI), yes I've seen some designs that may address this, but many issues remain unsolved (diameter being one)...

As a matter of fact cardiac surgeons will take a big hit if TAVR ever takes off . The procedure is a lot quicker ( cheaper ) and is performed by different surgeons. The insurance companies and various government entities that pay for valve procedures will love it though.

of course if it doesn't "take off" then there will be more redo surgeries to do if surgeons keep the preference on tissue as they are. To quote Master Yoda: "Difficult to see the future is".

Don't get me wrong, I am coming to the conclusion that managing INR is beyond most people and so it seems to me that Mechanica Valves are for the enthusiast who manages his or her health. There are amateur athletes who do more measurement and documentation on their weekly training , to such a person INR management is trival. However there are many others who managing even their contact list in their phone is beyond them. If the questions I see on the AC forum here are anything to go by I wonder if self management suits many older people at all... The real irony is that its the younger and more competent who perceive themselves as better off with a tissue prosthesis (perhaps dreaming of a TAVI).

Lastly I'm always skeptical of anything someone who is NOT facing the actual choice says when they say "I'd choose X" ... somehow being there at the cross roads makes it different. Maybe they would, maybe they would agnoize a bit more than they make out.

 

[ALLBETTERNOW!]

Tav r has mortality and stroke rates near1.0% even in sicker patients. There is some hope there, no miracles, but hope

 

[Duffey]

I was facing a similar situation ten years ago, when I also had to chose my valve type at age 52. I went with tissue, and even now when the statistics say another replacement is likely in next five years or so, I have no regrets. I expect to have this one replaced with another tissue valve when the time arrives.

 

[cldlhd]

Hi



I'm also skeptical, and until I see it in the mainstream am uncertain that TAVR will be mainstream. I believe there are more complications to overcome than those of us in the general public grasp. I often draw on the analogy that we went to the moon in 1960's and now we still aren't there. Noone has thought through the valve in the valve in the valve well (you know, your third revalve via TAVI), yes I've seen some designs that may address this, but many issues remain unsolved (diameter being one)...



of course if it doesn't "take off" then there will be more redo surgeries to do if surgeons keep the preference on tissue as they are. To quote Master Yoda: "Difficult to see the future is".

Don't get me wrong, I am coming to the conclusion that managing INR is beyond most people and so it seems to me that Mechanica Valves are for the enthusiast who manages his or her health. There are amateur athletes who do more measurement and documentation on their weekly training , to such a person INR management is trival. However there are many others who managing even their contact list in their phone is beyond them. If the questions I see on the AC forum here are anything to go by I wonder if self management suits many older people at all... The real irony is that its the younger and more competent who perceive themselves as better off with a tissue prosthesis (perhaps dreaming of a TAVI).

Lastly I'm always skeptical of anything someone who is NOT facing the actual choice says when they say "I'd choose X" ... somehow being there at the cross roads makes it different. Maybe they would, maybe they would agnoize a bit more than they make out.

I don't have a lot of faith that tavr will be the standard anytime soon if ever. Actually I was reading about a conference where a tavr enthusiast , an endovascular surgeon, was accusing a cardiac thoracic surgeon ( my surgeon as a matter of fact ) of representing the "chest cutters " of the world resisting tavr as it would hurt their bottom line.
I do believe a better mechanical valve is inevitable so I could understand if a younger person decided to roll the dice and get a tissue hoping it would buy time until that valve was available. That's a personal call. I don't think warfarin management would be difficult for me , I guess the only concerns would be does it help progress calcification and the possibility of future medical conditions that contraindict the use of warfarin. Of course you weigh those possibilities against the almost certainty of a reop-depending on your age.
The moon? I know people so skeptical they think we landed in Arizona....

 

[pellicle]

Hi

... Actually I was reading about a conference where a tavr enthusiast , an endovascular surgeon, was accusing a cardiac thoracic surgeon ( my surgeon as a matter of fact ) of representing the "chest cutters " of the world resisting tavr as it would hurt their bottom line.

yeah ... I think its a passionate area of debate that's for sure.

The moon? I know people so skeptical they think we landed in Arizona....

I know some of them here too ... to me that drifts beyond skeptical into the "so uneducated / stupid" that you are unable to understand the evidence ;-)

 

[Fundy]

A 1 hour video of a valve surgery I watched before my surgery, was fairly informative to me. It kind of touched on various variables one would consider. It seems to have disappeared( I can no longer find it), but a transcript is here:
http://www.or-live.com/transcripts/med_1326_186.pdf

Dr. Cooley mentions that at a then recent surgeon conference(2005), the surgeons were asked which valve (tissue or mechancial) they would choose themselves at 55-60 yrs. He mentioned it was about 50/50.

Also, interesting is the discussion where he states he has had a few mechanical valvers refuse to use warfarin and have no issues even after 30 yrs. Not in that transcript but elsewhere, I noticed he has had several patients with 1st generation pericardial valves lasting over 30 yrs.

 

[nohohamp]

He likes tissue maybe because he hikes and likes to be dropped by helicopter on the top of a mountain

Precisely. Very different from my lifestyle. How do you know Dr. Flack?

 

[jumpy]

There happens to be a TAVR convention this weekend....

http://www.medpagetoday.com/MeetingCoverage/TCT/54045

 

[MethodAir]

If you get the chance have a listen to this YouTube webinar. It kind of settled it for me as my mind was leaning this way prior to hearing it.

https://www.youtube.com/watch?featur...bIzBIM0#t=2929

TAVR https://www.youtube.com/watch?v=2vf9TwktzTk

"The major risks of the procedure are related to delivery of the valve to the aorta and then the actual deployment of valve"

Sometimes convenience comes at a cost. As barbaric as a sternotomy might be, it may have advantages in terms of open access to the heart.

If someone has an issue with a bicuspid valve and/or ascending/root aorta, the most logical solution for me (bar women wanting to get pregnant) is to replace the section with a mechanical valved conduit. No lifestyle changes to speak of. 5 minute INR test once a week. A target INR that is not much higher than what my body produces naturally. And peace of mind.

​

 

[McCbon]

"
Registered User
Join Date: Dec 2009
Posts: 298
#56
3 hours ago
A 1 hour video of a valve surgery I watched before my surgery, was fairly informative to me. It kind of touched on various variables one would consider. It seems to have disappeared( I can no longer find it), but a transcript is here:
http://www.or-live.com/transcripts/med_1326_186.pdf

Dr. Cooley mentions that at a then recent surgeon conference(2005), the surgeons were asked which valve (tissue or mechancial) they would choose themselves at 55-60 yrs. He mentioned it was about 50/50"

Fundy, I find the 50/50 figure interesting because it is not reflective of the general population in which the percentage is (from what I've read) %80 tissue to %20 mechanical. Meaning more docs in that age range would choose mechanical. Just thought that was interesting. Bonbet