Algorithm Algorithms

[Lily]

I was searching for something recently and stumbled across some other information about algorithms for valve selection.
I found it very interesting and thought some other members here might also. Here are the links, which I hope you will find helpful:

http://circ.ahajournals.org/cgi/content/full/117/2/253
Choice of Prosthetic Heart Valve in Today’s Practice - 2008 article

http://content.onlinejacc.org/cgi/content/full/41/6/893
STATE-OF-THE-ART PAPER
Choice of prosthetic heart valve in adult patients - 2003 article

http://content.onlinejacc.org/cgi/content/abstract/55/22/2413
(I couldn't access this newest 2010 Updated article without a subscription.)
STATE-OF-THE-ART PAPER
Choice of prosthetic heart valve in adults an update - 2010 article
Rahimtoola SH.
Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, Keck School of Medicine at University of Southern California, Los Angeles, California 90033, USA.

Abstract
In the last 7 years, more data have reconfirmed that patients' comorbid conditions are very important factors determining patient outcomes. Prosthetic heart valves (PHVs) that require aortic root replacement in the absence of aortic root disease are associated with poorer outcomes. For the vast majority of patients, the choice of PHV is between a mechanical valve and a stented bioprosthesis. The choice is largely dependent upon the age of the patient at the time of PHV implantation and on which complication the patient wants to avoid: specifically, anticoagulation therapy and its complications with the mechanical valve, and structural valve deterioration with a bioprosthesis. Data on the pros and cons of the choices and exceptions to the rules are discussed, and a new algorithm is developed.

 

[ALCapshaw2]

The authors of the first article obviously understand the trade-offs between Mechanical and Tissue Valves but as they appropriately noted in their paper, the Porcine Tissue and Bjork-Shiley Tilting Disk Valves are BOTH Obsolete and rarely or No Longer Recommended for use today.

Also, the Bleeding Risk Data compiled before 1990 was compromised by variation in Testing Reagents that has since been largely reduced by the International Normalized Ratio (INR) Testing methods used for the past 20 years.

It would be interesting to see a Study based on the Valve Choices available for the Last 10 years
and the (slowly) improving AntiCoagulation Testing and Management Techniques. If the Medical Community could just Educate the Out-of-Date Medical Practicioneers then there would be Far Fewer 'Bleeding Events' (and Ross would be a Happy Camper

'AL Capshaw'

 

[Luana]

I did see the algorithm chart before I had surgery in the first article that you posted. The deal breaker for me was another surgery. Had I chosen a tissue valve for the first one and next one, I'd probably even be facing a third surgery, and before I even had the first surgery, my feeling was that I probably would not want to have another surgery.

Maybe it was an uninformed choice to make having never had heart surgery before; however, I've been through a few medical things before including surgery, yet none of that prepared me for how difficult this was. I'm thrilled for the people who sail through it with little or no problems, but not everyone can expect that.

Certainly, if something happened to require another surgery, I would do it to prolong my life, but I'd rather not opt to have an OHS that guarantees another re-op.

 

[skeptic49]

Too bad a subscription is required to view the 2010 update. I'd like to know if the alogrithm has changed at all from the earlier 2008 article.

Jim

 

[Duffey]

Too bad a subscription is required to view the 2010 update. I'd like to know if the alogrithm has changed at all from the earlier 2008 article.

Jim

Maybe someone has seen the new update and will post.

 

[Luana]

I'm wondering what might change it? Seems like it would be about the same process.