Bio vs Mechanical for a 31 yr old

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DJM 18

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MrFox...good luck to you with this decision and all I can offer is some data that will help you make a better decision, this is after all a very personal matter. The below is an important study which Stanford published late last year on this issue, I thought you might find this of interest.

Tissue could be a valid choice but I do not like the way your cardiologist is thinking. The questions with a tissue is if you are ultimately ok with a scenario where at age 40 or 45 you will need a second OHS. And if this is the case what would you choose then?

Lastly, through this forum I have personally changed in dramatic fashion my perception of life on Coumadin. And as for remote adventure, do not forget the woman who climbed Everest with a mechanical valve.

good luck to you...


http://med.stanford.edu/news/all-news/2017/11/mechanical-heart-valve-often-the-safest-choice.html
[h=3]A stark difference[/h]
Results showed a stark difference in health benefits depending on which valve was being replaced, Woo said. The long-term mortality benefit associated with a mechanical valve compared with a biological valve persisted until age 70 in patients undergoing mitral-valve replacement, the study found. For those undergoing aortic-valve replacement, this benefit persisted only until age 55.

“This study will definitely change the information that I give my patients,” said Jennifer Lawton, MD, professor of surgery and chief of the Johns Hopkins University Division of Cardiac Surgery, who was not involved with the study. Lawton, like Woo, faces the same daily discussion with her patients about which valve to choose. “The benefit of this study is that it looks at so many patients over a period of time,” she said. “Up until now, there have only been small studies on which the guidelines are based.”

The current national guidelines are based on data from studies that are not only small, but which examined the use of now-obsolete valves that were implanted more than 30 years ago, the new study said.

“Over the last 15 or 20 years around the world, there has been a dramatic shift in the increased use of bioprosthetic valves,” said Michael Argenziano, MD, professor of surgery and chief of adult cardiac surgery at Columbia University. “This is the first paper to provide solid evidence that maybe we have been moving too quickly away from the mechanical valve.” Argenziano was not involved in the study.

Sharing the results of this study with patients is particularly urgent right now because of this growing trend toward younger patients choosing biological valves, Woo said.
 

astle9

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DJM 18;n882392 said:
MrFox...good luck to you with this decision and all I can offer is some data that will help you make a better decision, this is after all a very personal matter. The below is an important study which Stanford published late last year on this issue, I thought you might find this of interest.

Tissue could be a valid choice but I do not like the way your cardiologist is thinking. The questions with a tissue is if you are ultimately ok with a scenario where at age 40 or 45 you will need a second OHS. And if this is the case what would you choose then?

Lastly, through this forum I have personally changed in dramatic fashion my perception of life on Coumadin. And as for remote adventure, do not forget the woman who climbed Everest with a mechanical valve.

good luck to you...


http://med.stanford.edu/news/all-news/2017/11/mechanical-heart-valve-often-the-safest-choice.html
[h=3]A stark difference[/h]
Results showed a stark difference in health benefits depending on which valve was being replaced, Woo said. The long-term mortality benefit associated with a mechanical valve compared with a biological valve persisted until age 70 in patients undergoing mitral-valve replacement, the study found. For those undergoing aortic-valve replacement, this benefit persisted only until age 55.

“This study will definitely change the information that I give my patients,” said Jennifer Lawton, MD, professor of surgery and chief of the Johns Hopkins University Division of Cardiac Surgery, who was not involved with the study. Lawton, like Woo, faces the same daily discussion with her patients about which valve to choose. “The benefit of this study is that it looks at so many patients over a period of time,” she said. “Up until now, there have only been small studies on which the guidelines are based.”

The current national guidelines are based on data from studies that are not only small, but which examined the use of now-obsolete valves that were implanted more than 30 years ago, the new study said.

“Over the last 15 or 20 years around the world, there has been a dramatic shift in the increased use of bioprosthetic valves,” said Michael Argenziano, MD, professor of surgery and chief of adult cardiac surgery at Columbia University. “This is the first paper to provide solid evidence that maybe we have been moving too quickly away from the mechanical valve.” Argenziano was not involved in the study.

Sharing the results of this study with patients is particularly urgent right now because of this growing trend toward younger patients choosing biological valves, Woo said.
But and it is a but the future is not going to be geared towards OHS or so those involved in the research and development state, the days of invasive and costly surgeries that keep patients in expensive beds and away from their employment are numbered, it may take a few years but the future will be all about valves being replaced without cracking open your sternum. I chose this pathway simply because i strongly believe i will never need another OHS but my valve can be replaced TAVR in the future and with minimum time taken from me. We get back to this single issue for me anyway and that is nobody could guarantee to me that a mechanical valve is guaranteed for life so i chose not to have the balancing of the INR and the ticking of the valve (i do appreciate a lot say the sounds fades with time) and instead took a chance that may or not pay off.
The choice the OP makes must be his own but i think it is important that both valves are given the pros and cons.
I doubt that the study being a year or so old would have factored in these new generation of valves and the claimed longevity of them, the science of heart surgery is surging ahead and who knows where it will go.
 

Superman

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astle9;n882394 said:
We get back to this single issue for me anyway and that is nobody could guarantee to me that a mechanical valve is guaranteed for life so i chose not to have the balancing of the INR and the ticking of the valve (i do appreciate a lot say the sounds fades with time) and instead took a chance that may or not pay off..
My valve has a lifetime guarantee. As soon as it fails, the guarantee is up.*



*My apologies. I love that joke.
 

tom in MO

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astle9, per your single issue "We get back to this single issue for me anyway and that is nobody could guarantee to me that a mechanical valve is guaranteed for life". The data on mechanical valves indicates that it is "guaranteed" for the life of the patient at a level of >99.9%. My valve, a St. Jude Model 23AGFN-756 had only one recorded failure when I checked FDA records upon implantation in 2/2012. For some reason the leaflet pivot came loose resulting in death to the patient. Both my surgeon and cardio told me that my particular valve is proven, robust and can handle low INR w/o problem. I've had a surgery on warfarin w/o the need to bridge, just had to lower my INR for the procedure.

Mr. Fox,

With a tissue valve at a young age (30yo), you are "guaranteed" it will fail at least 2, possible 4 times before you reach 75. If you happen to be prone to calcification (no way to tell this ahead of time) it could fail in <7years. You will never leave the "waiting room" with a tissue valve.

With a tissue valve, you have to have good insurance for the rest of your life to pay for the reoperations. If you live in the USA, this is not guaranteed either. Warfarin is a cheap prescription (<$5). You also have to work a job that lets you take off for 8 weeks every time you need an operation.

With a mechanical valve you cannot take certain drugs, particularly in my case NSIDS for arthritis. To me this is the biggest single detraction of a mechanical valve.

Per contact sports, an INR of 2-2.5 (my range for a proven mechanical valve) means that you will take 2-2.5 times longer to clot when injured. If I cut myself shaving this is annoying. If I slam into a wall, this means a bigger bruise. When I had surgery it took about 2x as long for the blood to stop leaking. No big problems. However, in a severe head injury this could mean death or additional disability. Since OHS has a risk of death of 1%, I think the risk of severe head injury is less, but I have no facts to support this risk assessment.

I find it surprising you got told which valve "was best." At age 55 in MO, I was told it was my choice by both my cardio and surgeon. They refused to give a recommendation. After I chose, they both told me my choice of mechanical was a good one and what they would have chosen themselves. They probably tell that to every one :) Personally, I'd be careful with your cardio's advice since he recommended TAVI which has yet to be proven for routine use and if I recall correctly must use successively smaller valves for implantation. Both my surgeon and cardio, 5 years ago, told me to not base my choice on future new technology, there is no guarantee...
 

Superman

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The spouse of a friend of mine chose tissue about 10 years ago on the basis of TAVI likely being "routine" in 10 years. He was in his 30's at that time.

I haven't checked back to see how he's doing at this point. I don't work with this person anymore. I am curious though.
 

pellicle

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Paleowoman;n882390 said:
Hi Pellicle - this Inspiris Resilia valve is a new generation of bioprosthetic valve - it is not like the previous bioprosthetic valves.
Time will tell. I am always more conservative, others may choose to pick the prediction made by the marketing teams. It is entirely the choice of the individual.

If people are of the inclination to believe that then that is entirely their choice
 

pellicle

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astle9;n882391 said:
these have nothing to do with the new generation of valves.
Of course it doesn't, the new valves are nothing at all like the older ones (which promised more or less the same).
I don't doubt they will be improved a little.

But I'm glad you have that Crystal Ball...
 

cldlhd

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hx77;n882373 said:
I was faced with the same question before. But i am 24 years older than you so the decision will be less harder for me.

Tissue values get calcified faster in younger patients than older patients. So you want to make sure your are not prone to calcification. If your native valve is deposited with lot of calcium, i would say you are not a good candidate.
I actually think your decision is harder. In my opinion being 31 I would definitely go mechanical, unless I was a female contemplating pregnancy . At 45 tissue would be a little more reasonable to my mind but I'd still choose mechanical. I had my valve repaired at 45 and mechanical was my backup. Just my opinion fwiw
 

Agian

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astle9;n882385 said:
i was told no more alcohol of any description as it will destroy the calcification coating, happy with that, eat clean and avoid too much calcium in my diet, happy with that, exercise daily and maintain a health weight (once on cardiac rehab) i am happy with that. Very happy with my choice and if it fails it was my choice so we will do it again.
Does the no alcohol rule include methylated spirits?
 

jwinter

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This decision needs to be made with patient and specialist. I had porcine valve the first time. It only lasted a little over 4 years for me(calcified). Felt pretty smart when I decided to get a mechanical the second time. Now I have stomach lesions. The warfarin I am on causes them to bleed to the point of several transfusions before they got them fixed (I hope) Kind of a crap shoot but life is like that.

Best of luck with either decision and let those heart doctors be your guide. Go with it, be happy with your decision, and live your life to the fullest!
 

cldlhd

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DJM 18;n882392 said:
MrFox...good luck to you with this decision and all I can offer is some data that will help you make a better decision, this is after all a very personal matter. The below is an important study which Stanford published late last year on this issue, I thought you might find this of interest.

Tissue could be a valid choice but I do not like the way your cardiologist is thinking. The questions with a tissue is if you are ultimately ok with a scenario where at age 40 or 45 you will need a second OHS. And if this is the case what would you choose then?

Lastly, through this forum I have personally changed in dramatic fashion my perception of life on Coumadin. And as for remote adventure, do not forget the woman who climbed Everest with a mechanical valve.

good luck to you...


http://med.stanford.edu/news/all-news/2017/11/mechanical-heart-valve-often-the-safest-choice.html
[h=3]A stark difference[/h]
Results showed a stark difference in health benefits depending on which valve was being replaced, Woo said. The long-term mortality benefit associated with a mechanical valve compared with a biological valve persisted until age 70 in patients undergoing mitral-valve replacement, the study found. For those undergoing aortic-valve replacement, this benefit persisted only until age 55.

“This study will definitely change the information that I give my patients,” said Jennifer Lawton, MD, professor of surgery and chief of the Johns Hopkins University Division of Cardiac Surgery, who was not involved with the study. Lawton, like Woo, faces the same daily discussion with her patients about which valve to choose. “The benefit of this study is that it looks at so many patients over a period of time,” she said. “Up until now, there have only been small studies on which the guidelines are based.”

The current national guidelines are based on data from studies that are not only small, but which examined the use of now-obsolete valves that were implanted more than 30 years ago, the new study said.

“Over the last 15 or 20 years around the world, there has been a dramatic shift in the increased use of bioprosthetic valves,” said Michael Argenziano, MD, professor of surgery and chief of adult cardiac surgery at Columbia University. “This is the first paper to provide solid evidence that maybe we have been moving too quickly away from the mechanical valve.” Argenziano was not involved in the study.

Sharing the results of this study with patients is particularly urgent right now because of this growing trend toward younger patients choosing biological valves, Woo said.
Admittedly I didn't read the whole study but what jumped out to me was the part about judging 'comorbitities' . So basically they might decide to choose a valve that might not last as long as you might like because they figure you probably won't outlive it because of other issues?
 

FredW

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astle9 , can you give me the reference your statement: “ i was told no more alcohol of any description as it will destroy the calcification coating”?

BTW, I like the thread and the fact most contributors are being respectful of other’s view. I idea to present information as opposed to pushing an agenda is good.
 

LondonAndy

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Hi Mr Fox, and good luck with your decision. Whatever you decide do not spend time regretting it, but get on with living your life. None of us have a crystal ball about our futures, and the best we can do is take a decision based on rational consideration and guidance from the professionals.

I had a replacement aortic valve 3.5 years ago, at age 48. I went the mechanical route, based heavily on advice from my surgeon at the London Heart Hospital (I had had a 'cardiac event' and was already in hospital when decisions were being taken about what valve). My background is an electrical engineering family and so emotionally I am fine with technology and gadgets - just as well, as I ended up with a pacemaker as well, through surgical complications!

We know that surgery is a major trauma in our lives and always comes with risks, and those risks increase with repeat surgeries. The prospect of my mechanical lasting the rest of my life was more attractive than the prospect of re-surgery as I get older and weaker, accepting Agian's point that there are no guarantees. (As someone once said: the only certainties in life are death and taxes!).

I agree with the comment about not to put too much faith in future developments. Yes, it is great that TAVI and new generation valves are happening, and the prospect of avoiding OHS altogether is clearly attractive. The best way that such technologies can develop is if people choose them, and their own attitudes to life will determine if they think the potential benefits outweigh the reduced track record that is unavoidable with new technologies. Life comes with risks. But I have been an insulin dependent for well over 20 years, and for almost all that time I have seen articles about an end to injections. But here I am, still injecting 5 times a day.

With warfarin, I self test weekly at home and have been 100% in range for over a year, which drastically reduces risks of stroke and thrombosis. I carry a small, lightweight first aid pack in my manbag so that if I do have a bleed I can bandage it quickly - probably overkill but generally I like to be prepared as best I can. My mother has a tissue valve and is also on warfarin, but I don't know what these new generation tissue valves might require.

Choose wisely, and then get on with life..
 

pellicle

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jwinter;n882418 said:
Now I have stomach lesions. The warfarin I am on causes them to bleed to the point of several transfusions before they got them fixed (I hope)
I'm sorry to read this, that must be difficult for you.

Best Wishes
 

dick0236

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LondonAndy;n882421 said:
Hi Mr Fox, and good luck with your decision. Whatever you decide do not spend time regretting it, but get on with living your life..........

.........Choose wisely, and then get on with life..
Any choice has a crapshoot element attached to it. My surgeon told me that the valve he would put in me was "designed to last 50 years".......but he was amazed, a few years ago, when he and I talked via phone that that old "first generation valve" was actually still working. Even Edwards Lifescience, who manufactured my old valve, as well as the new Inspirus valve, was reluctant to give me a wallet ID card a few years ago......I guess they where also amazed that a valve that they touted would last 50 years.......actually did.

"choose wisely and then get on with life" is very good advice.
 

astle9

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FredW;n882420 said:
astle9 , can you give me the reference your statement: “ i was told no more alcohol of any description as it will destroy the calcification coating”?

BTW, I like the thread and the fact most contributors are being respectful of other’s view. I idea to present information as opposed to pushing an agenda is good.
the only reference is my surgeon and this was told to me in the high dependency unit after the op, i am seeing him on thursday and i will ask him to confirm that.
 

neil

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hello mr fox, as you can see theres differing views on choices, imo both are good as its gonna save your life, both have risks imo , I have a tissue and its still honking away after 10 years, everybody is different and sees things in a different light, do whats best for you, theres no bad choice, but as my mate said, Don't measure what you need using someone elses ruler,
 

mrfox

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Thanks again for the replies everyone. Definitely helpful as I make my decision. Thanks!
 
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