Dr. Schaff - Mayo Clinic Presentation on Artificial Heart Valves

[big_L]

My dear wife found this today. We watched it together. We found it to be very well done and quite informative. I'm even more pleased with my recent decision to go to the Mayo Clinic. If this is the quality of work that they're generating, I'm excited. (Or as excited as you can be when you're facing major surgery).

I was leaning to the mechanical, then waivered a bit after one cardio told me - you could do the bio and surely we'd then have approval to do percutaneous by then if it failed.

I'm an analytical chemist and my wife is a med tech. No concerns here about handling self testing.

It's 35 minutes long, but it was time well spent for us.


Apologies if this has been posted previously.

 

[Duffey]

Thanks for posting. It's good that you're satisfied with your choices. That's the way it should be.:smile2:

 

[texasmike]

Thanks for the post. I had my second AVR done by Dr. Schaff three years ago. He is excellent, as is the entire staff at Mayo.
There is no question that many surgeons are very biased regarding mechanical vs. bio, and this 35 minute discourse should be listened to by everyone facing AVR.
I wish I had listened to this presentation by Dr. Schaff before my first surgery.

 

[canon4me]

I spoke to Dr. Schaff on the phone when I was shopping for a surgeon. I eventually settled on Dr. Gillinov at Cleveland Clinic. Mayo and Dr. Schaff was my second choice. I had no problem with Mayo at all. They performed my partial nephrectomy for renal cell carcinoma in 2003. I still go back there every year for rechecks. Ultimately, decided on Cleveland because their mortality rates were lower than Mayo and I thought I would actually have more say over what valve I received. They also seemed to be on the forefront with new procedures, etc. Mayo is top notch though. I staked my life on them in 2003 and it was a good decision. Dr. Michael Blute, urologist/surgeon in my estimation is THE best in the world.

 

[T in YVR]

Just saw this video - really great information...thanks for posting. I was already leaning very heavily towards a mechanical valve (On-X), and this just pushed me over the edge. Long live mechanical valves (and as it turns out, the patients too) - quite literally!
Tony

 

[neo]

Please keep in mind the dates of the studies Dr. Schaff is referring to. Many of his studies are 30-40 years old, studies from Italy, not statistically significant, or specific only to the Mayo Clinic. This doesn't mean that he is necessarily over-selling mechanical valves, just that it would be better to consider tissue valves based on newer data and technologies, your specific co-morbiditys, TAVR (valve in valve) replacement possibilities, etc.

Just saw this video - really great information...thanks for posting. I was already leaning very heavily towards a mechanical valve (On-X), and this just pushed me over the edge. Long live mechanical valves (and as it turns out, the patients too) - quite literally!
Tony

 

[ElectLive]

Please keep in mind the dates of the studies Dr. Schaff is referring to. Many of his studies are 30-40 years old, studies from Italy, not statistically significant, or specific only to the Mayo Clinic. This doesn't mean that he is necessarily over-selling mechanical valves, just that it would be better to consider tissue valves based on newer data and technologies, your specific co-morbiditys, TAVR (valve in valve) replacement possibilities, etc.

Not only that, but he closes with an almost ridiculous statement for someone in his position: "I doubt there's going to be any patients on Coumadin [by 2015]."

The miracle drug he mentions, dabigatran (more commonly known as Pradaxa), will certainly not be replacing Warfarin in the next two years, nor likely ever. The initial dosing study of dabigatran for those with mechanical valves did not even begin until 2 years after this Mayo presentation, by the way, and was quickly halted after significantly more (double or higher) stroke and bleeding events than those on warfarin.

Even had that dosing study gone in the other direction, it would have then required a full blown randomized trial before even thinking about submitting for FDA approvals, again pending actual good results. Probably would have taken about an 8 year process, since the same drug went through the same process for A-Fib. Plus, at the time of this presentation, dabigatran wasn't yet approved for A-Fib either. And when it later was, it was very clearly not indicated as clinically better than warfarin, but non-inferior (also with big bold warnings - Not for those with Valve Problems!)...as was generally expected based on the trial data that was available at the time of this presentation.

Anyway, I digress. Just goes to show...bias and salesmanship are everywhere, Mayo and Cleveland alike, just in different forms. No matter how good our surgeons are (which they are) and how great they sound...it's always good to be cautious, to question, and to self-inform.

 

[T in YVR]

I agree - there is likely some degree of valve type bias that can exist with many surgeons. My comment was made slightly 'tongue in cheek'. I think there have been advances in both tissue and mechanical since some of these studies were commissioned helping increase life expectancy for everyone faced with this type of issue. For me personally, I'm gaining a greater comfort level with going mechanical as my surgery timing nears, and this type of information (even if there is a slight bias or a couple debatable claims/predictions) just helps reaffirm this.
Tony