Risk of Repeat Surgeries
Risk of Repeat Surgeries
Actually, Al Lodwick posted this study about eight months ago. It's just a handy citing: please note I am not trying to embroil Al in this.
http://www.valvereplacement.com/forums/showthread.php?t=7339
Risk of reoperation with tissue valve vs. warfarin
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This was just published in the journal Heart Surgery Forum
Background: Many patients are advised to have mechanical aortic valve replacement (AVR) because their expected longevity exceeds that of tissue prostheses. This strategy may avoid the risks of reoperation but exposes patients to the risks of long-term anticoagulation therapy. Which risk is greater? Methods: We reviewed the records of 1213 consecutive, unselected AVR patients, 60% of whom had concomitant procedures, who were treated from 1994 through 2002. Of these patients, 887 were first-time AVR patients, and 326 underwent reoperation. Of the reoperation patients, 134 had previously undergone AVR (redo). We constructed a risk model from these 1213 cases to assess the factors that predicted mortality and to examine the extent to which reoperation affected outcome. Results: Multiple logistic regression analysis indicated that factors of reoperation and redo operation did not predict mortality. In fact, the mortality rate was 4.1% for all first AVR operations and 3.1% for all reoperation AVR ( P =.891). Significant predicting factors (with odds ratios) were reoperative dialysis (6.03), preoperative shock (3.68), New York Heart Association class IV (2.20), female sex (1.76), age (1.61), and cardiopulmonary bypass time (1.26). Conclusions: In this series, the risk of reoperation AVR is comparable with the published risks of long-term warfarin sodium (Coumadin) administration after mechanical AVR. Any adult who requires AVR may be well advised to consider tissue prostheses.
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Al Lodwick, R.Ph.
Certified Anticoagulation Care Provider
Go to my website for warfarin information
This is a highly singificant study of over 1,200 AVRs who were not preselected to brace up a premeditated conclusion.
When deciding on a valve, it is important to distinguish between surgeries for those who have connective tissue disorders or complementary health issues (such as lung or kidney problems) and people who are fortunate enough to be able to respond to surgery in a more normally recuperative way. It's certainly not fair. But it is real.
People who are not handicapped by these things, and have otherwise reasonable health, should make the decision based on the
full pallette of options available to them. For them, the mortality odds do
not favor
either type of valve over time. (Unfortunately, Ross Procedure patients do not figure in this study.)
The use of tissue valves, with their required repeated operations over time, is neither callous nor frivolous: it is accepted medicine. Nor is tissue considered a "second best" option vs. a mechanical valve. It is simply a
different option, with a
different set of benefits and risks. Ask my surgeon. And many, many others.
There are many thought factors that need to go into a valve decision. When concurrent health problems are a part of your picture, your choice may be short-circuited one way or the other. If those are not in your cards, you can look at your age, your preference for risk-taking, your likely ability to function as a warfarin patient, your probable life events (hopeful pregnancy? work on a ship or away from advanced healthcare?), downstream expectations for your heart (will you need another OHS for something else?), even your personality, including your ability to cope with daily requirements.
Reoperations aren't for everyone. Neither is the stroke/bleeding risk faced by mechanical/ACT patients. That is why it is a debate. That is why each new member who strives to make a choice must learn as much about himself as about these valves in that process.
Best wishes,
