Biological vs Mechanical -- what does the ACC think?

[Guest]

Read this article from the American College of Cardiology that seems to lean toward favoring bioprosthetic valves:

http://www.acc.org/latest-in-cardio...c-valves-are-better-even-in-the-young-patient

 

[dick0236]

I'm certainly glad I got a mechanical valve when I was a young patient of 31.

 

[Agian]

I'm just pleased there seems to be progress in this area and that people are thinking about it.
I'm sure it's only a matter of time before what we've been through will be a thing of the past.

 

[Mellyouttaphase]

This article is somewhat frustrating. Reoperation rates are low with biological valves? Not if the patient's life expectancy is longer than the life expectancy of the currently available product. The figures are irrelevant if they are trying to market to younger recipients.

 

[pellicle]

... Reoperation rates are low with biological valves?

sure ... if your cohort dies

 

[pellicle]

...I'm sure it's only a matter of time before what we've been through will be a thing of the past.

well if Donald gets elected, the world will enter a new "dark ages" and there will be no more surgeries .... people with heart defects / disease will just die again

no operations performed...

;-)

Of course if Hillary gets in, those Hawks will start WW3 and then we'll also have "no operations"

 

[Nocturne]

sure ... if your cohort dies

Yeah, that article presents some pretty depressing information WRT longevity after AVR. What they're saying is that people of any age typically do not live past the degradation of a bioprosthetic valve after AVR surgery.

The relevant paragraph:

"The major argument against use of biologic valves in young and middle aged patients is the inevitability of reintervention for structural valve failure. In contrast, mechanical valves are often presented as a life-long solution. Are these views supported by evidence? A critical review of the literature will show that most patients receiving biologic valves will not have reoperations. Aortic stenosis, its cardiac sequalae, and its treatment all result in reduced life expectancy, regardless of therapy. The life expectancy after valve replacement varies with age, but life-table analyses of large datasets suggest the average life-expectancy of a 60 year old after aortic valve replacement is about 12 years10. Because death and structural valve degeneration are competing outcomes, and most biological valves have a median valve survival (time to structural degeneration) in the 10 to 15 year range, many patients will die before the valve degenerates. For those patients, there would be no incremental benefit of a mechanical valve in terms of freedom from reoperation. Indeed only 45% of patients aged 50, and 25% of patients aged 60, who receive biological valves are likely to have a reoperation in their life-time10. This is validated by prospective studies which report that less than 20% of patients aged below 70 years have reoperations within 15 years of initial biological valve implantation."

 

[Nocturne]

I'm certainly glad I got a mechanical valve when I was a young patient of 31.

In your case, it was clearly the right choice. The question is, how much of a lucky lottery winner are you?

 

[pellicle]

...Are these views supported by evidence? A critical review of the literature will show that most patients receiving biologic valves will not have reoperations. ...but life-table analyses of large datasets suggest the average life-expectancy of a 60 year old after aortic valve replacement is about 12 years10. Because death and structural valve degeneration are competing outcomes, ... in the 10 to 15 year range,

So ... clearly talking about the 30 to 50 yearolds here aren't they ...

and in my view Dick won the most important lottery ... long and healthy life.

Its not an accident ... its called lifestyle ... a healthy one

 

[Mellyouttaphase]

sure ... if your cohort dies

Exactly. Difficult to take seriously!

 

[cldlhd]

well if Donald gets elected, the world will enter a new "dark ages" and there will be no more surgeries .... people with heart defects / disease will just die again

no operations performed...

;-)

Of course if Hillary gets in, those Hawks will start WW3 and then we'll also have "no operations"

There are plenty of people in this world who are eager for ww3 but as I don't share their certainty in the afterlife or my place in it I'll pass. Theres not a lot of desire for another war as far as I can tell but then again they sold the last one the same way they sell laundry detergent.
If someone somewhere tweets something negative about Donalds " hair" he'll launch the nukes....

 

[cldlhd]

Yeah, that article presents some pretty depressing information WRT longevity after AVR. What they're saying is that people of any age typically do not live past the degradation of a bioprosthetic valve after AVR surgery.

The relevant paragraph:

"The major argument against use of biologic valves in young and middle aged patients is the inevitability of reintervention for structural valve failure. In contrast, mechanical valves are often presented as a life-long solution. Are these views supported by evidence? A critical review of the literature will show that most patients receiving biologic valves will not have reoperations. Aortic stenosis, its cardiac sequalae, and its treatment all result in reduced life expectancy, regardless of therapy. The life expectancy after valve replacement varies with age, but life-table analyses of large datasets suggest the average life-expectancy of a 60 year old after aortic valve replacement is about 12 years10. Because death and structural valve degeneration are competing outcomes, and most biological valves have a median valve survival (time to structural degeneration) in the 10 to 15 year range, many patients will die before the valve degenerates. For those patients, there would be no incremental benefit of a mechanical valve in terms of freedom from reoperation. Indeed only 45% of patients aged 50, and 25% of patients aged 60, who receive biological valves are likely to have a reoperation in their life-time10. This is validated by prospective studies which report that less than 20% of patients aged below 70 years have reoperations within 15 years of initial biological valve implantation."

Well I thought the average life span for can American male was around 72 anyway?

 

[Agian]

well if Donald gets elected, the world will enter a new "dark ages" and there will be no more surgeries .... people with heart defects / disease will just die again

no operations performed...

;-)

Of course if Hillary gets in, those Hawks will start WW3 and then we'll also have "no operations"

Donald has and always had ZERO chance of being elected. They chose a buffoon to make his opposition seem reasonable.
But what would I know, I'm not American. There's money to be made and politicians come and go.
One of your Presidents left a parting warning.... You know, the General.

 

[Agian]

Well I thought the average life span for can American male was around 72 anyway?

That's so 1970s. Much higher today.

 

[Agian]

Yeah, that article presents some pretty depressing information WRT longevity after AVR. What they're saying is that people of any age typically do not live past the degradation of a bioprosthetic valve after AVR surgery.

The relevant paragraph:

"The major argument against use of biologic valves in young and middle aged patients is the inevitability of reintervention for structural valve failure. In contrast, mechanical valves are often presented as a life-long solution. Are these views supported by evidence? A critical review of the literature will show that most patients receiving biologic valves will not have reoperations. Aortic stenosis, its cardiac sequalae, and its treatment all result in reduced life expectancy, regardless of therapy. The life expectancy after valve replacement varies with age, but life-table analyses of large datasets suggest the average life-expectancy of a 60 year old after aortic valve replacement is about 12 years10. Because death and structural valve degeneration are competing outcomes, and most biological valves have a median valve survival (time to structural degeneration) in the 10 to 15 year range, many patients will die before the valve degenerates. For those patients, there would be no incremental benefit of a mechanical valve in terms of freedom from reoperation. Indeed only 45% of patients aged 50, and 25% of patients aged 60, who receive biological valves are likely to have a reoperation in their life-time10. This is validated by prospective studies which report that less than 20% of patients aged below 70 years have reoperations within 15 years of initial biological valve implantation."

My baloney-metre just went off. What is it they're actually trying to say? Most people who receive 'biological' valves are elderly people with stenosis. The reason they get stenosis, requiring valve replacement, as opposed to their peers, may go some way into explaining why they don't live as long. Then there's the Warfarin-factor and the multitude of misinformed elderly, whose doctors are happy to play Russian roulette with their INR.

 

[Agian]

In your case, it was clearly the right choice. The question is, how much of a lucky lottery winner are you?

That's just rude.

 

[epstns]

I call this another case of "figures never lie, but liars often figure." Sure, they can show data indicating that a large percentage of middle-aged or older tissue valve patients never have a re-op, but when they calculate their survival stats, do they eliminate all deaths from non-valve-related causes? (e.g. Do they present a "relative survival rate?") If not, this is not a valid conclusion. If they do, then they may have a case. But then, how many of those seniors who have failing tissue valves have other conditions that preclude another surgery, or they are simply inclined to let things go their course? All of this could distort the statistical relationships the authors are trying to promote.

Also, for those patients having failing tissue valves and who are not candidates for another OHS, there does remain the potential for TAVI, even now. It may not be perfect, and it may not offer the "full" life span of a conventional tissue valve, but it could avoid death at that time and afford some additional lifetime to the patient.

Each successive "generation" of tissue valves is "expected" to last longer than the predecessor generations, but they are not old enough yet for us to have any large-scale statistics regarding their durability. As I've said before, I don't remember seeing anywhere that a tissue valve manufacturer showed the range of life span that their valves have experienced, only the median lifespan. And, they all speak of "freedom from explant" but not mortality. So. . . thinking for my own case, if I need a re-op for my tissue valve at age 75, and if I remain in good/strong health, I have decent odds of surviving another valve surgery. Not that I look forward to it, but I certainly wouldn't be the oldest patient to do so.

 

[cldlhd]

That's so 1970s. Much higher today.

It depends where you're at. I just looked it up and for an American male it's now 78 on average. Places like the northeast are around 80. West Virginia, Alabama, Mississippi its more like 72.
Ya I'm aware of the Generals warning but without wanting to get too political that guy would have been called a communist by the loudest wing of his party today.A highly progressive tax policy, against the 'military industrial complex', might as well come out agaisnt fellatio with that one.

 

[epstns]

Ya I'm aware of the Generals warning but without want in to get too political that guy would have been called a communist by the loudest wing of his party. A highly progressive tax policy, against the 'military industrial complex', might as well come out agaisnt fellatio with that one.

Now THAT comment almost cost me another keyboard. I was drinking my morning coffee when I read it. . .

 

[cldlhd]

I call this another case of "figures never lie, but liars often figure." Sure, they can show data indicating that a large percentage of middle-aged or older tissue valve patients never have a re-op, but when they calculate their survival stats, do they eliminate all deaths from non-valve-related causes? (e.g. Do they present a "relative survival rate?") If not, this is not a valid conclusion. If they do, then they may have a case. But then, how many of those seniors who have failing tissue valves have other conditions that preclude another surgery, or they are simply inclined to let things go their course? All of this could distort the statistical relationships the authors are trying to promote.

Also, for those patients having failing tissue valves and who are not candidates for another OHS, there does remain the potential for TAVI, even now. It may not be perfect, and it may not offer the "full" life span of a conventional tissue valve, but it could avoid death at that time and afford some additional lifetime to the patient.

Each successive "generation" of tissue valves is "expected" to last longer than the predecessor generations, but they are not old enough yet for us to have any large-scale statistics regarding their durability. As I've said before, I don't remember seeing anywhere that a tissue valve manufacturer showed the range of life span that their valves have experienced, only the median lifespan. And, they all speak of "freedom from explant" but not mortality. So. . . thinking for my own case, if I need a re-op for my tissue valve at age 75, and if I remain in good/strong health, I have decent odds of surviving another valve surgery. Not that I look forward to it, but I certainly wouldn't be the oldest patient to do so.

Exactly, my grandmother's husband had a valve replacement ( tissue) at I believe the age of 72 and he never had a reop as he died of cancer at 88.