Foldax Continues

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Aqua_Grim7

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Jun 4, 2022
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here's the thing I don't understand: why is there a focus on the new and unproven (called bleeding edge for a reason) when there are already good alternatives around with sufficient time in the market to have more than 20 years of accumulated evidence on how they last.

People seem to get excited that their valve lasted a year ... what the hell was your expectation then? If I knew I'd only get a year out of a valve I'd be despondent. Each time I've had OHS I've assumed that I'd get 20 (although when I was a ten year old I didn't think like that, but by the time I was a teenager going to yearly follow ups I sure did and was always wondering how long will it last. At OHS #2 I certainly wanted to get durability.

What makes this viewpoint even harder for me to grasp is the highly emotional posts about "how long will I live" or "has my absolute lifespan expectation been dropped by 2 years" (with expectations of 80 years being reasonable).

I just can't fit concept A (yippee ... I got a year) and concept B (I want an untested unproven technology because it looks cool) together.

I mean if you were build a house and were told by the builder it might fall down at 12 or 15 years but would be guaranteed to 10 you'd walk away from that deal immediately.

Yet the losses of that are not "everything" ... because if you die you lose not just your house, not just your job, you lose everything.



If the focus of a person is longevity then avoiding reoperation would be significant factor.
If avoiding ACT (<organHorrorChord>blood thinners</organHorrorChord>) is the significant factor then Homograft is an option which will buy someone under 50 a statistically likely 15 years ...
For all cryopreserved valves, at 15 years, the freedom was
* 47% (0-20-year-old patients at operation),
* 85% (21-40 years),
* 81% (41-60 years) and
* 94% (>60 years).
Root replacement versus subcoronary implantation reduced the technical causes for reoperation and re-replacement (p = 0.0098).

But to bet on an unknown dark horse ... are you feeling lucky?

I was just curious is all.

I think a lot of people (myself included) would prefer to have a valve without the need for lifelong blood thinners.

Whilst they do indeed offer lifelong durability, they certainly carry some drawbacks too, which is why I imagine a lot of people who know they’ll need to have a second valve replacement will be keeping an eye on Foldax’s progress in the coming years.
 

Dunwanted

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Oct 3, 2022
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Hello, in case anyone is interested in the link below this person claims to be in the foldax trial and they did a 595 days update after their AVR with a tria Foldax valve.

 

nobog

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Jun 14, 2019
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Wisconsin, USA
^^^^ I had a 27 mm valve installed, but as it happens it needed to be a tiny bit smaller. The end result is that I’ll likely be on Warfarin indefinitely.

That makes no sense whatsoever.
 
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Aqua_Grim7

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Jun 4, 2022
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^^^^ I had a 27 mm valve installed, but as it happens it needed to be a tiny bit smaller. The end result is that I’ll likely be on Warfarin indefinitely.

That makes no sense whatsoever.
This ^ I thought the whole point of foldax was that warfarin wasn’t needed?
 

Paleowoman

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^^^^ I had a 27 mm valve installed, but as it happens it needed to be a tiny bit smaller. The end result is that I’ll likely be on Warfarin indefinitely.

That makes no sense whatsoever.
I took this to mean that it was because the 27mm valve is a bit too big that the end result is that the person thinks they'll likely need to be on Warfarin indefinitely.

I know from having a valve that is too small for my body size that when a valve is inserted the annulus is measured during surgery and the replacement valve has to be the exact size for the annulus - you can't have a valve inserted which is too small nor too big for the annulus. In my case the size of my valve is right for my annulus but that means it's too small for my body size. With the recipient of that Foldax valve he/she suggests they got a valve which was too big for his/her annulus which, I suppose, must cause a problem necessitating warfarin ? We can't ask them though can we.
 

nobog

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I took this to mean that it was because the 27mm valve is a bit too big that the end result is that the person thinks they'll likely need to be on Warfarin indefinitely.

I know from having a valve that is too small for my body size that when a valve is inserted the annulus is measured during surgery and the replacement valve has to be the exact size for the annulus - you can't have a valve inserted which is too small nor too big for the annulus. In my case the size of my valve is right for my annulus but that means it's too small for my body size. With the recipient of that Foldax valve he/she suggests they got a valve which was too big for his/her annulus which, I suppose, must cause a problem necessitating warfarin ? We can't ask them though can we.
So lets say he should have got a 25mm (instead of a 27mm) - there is nothing involving fluid dynamics that the net result would be the difference between warfarin or no warfarin. Something doesn't add up.
 

Paleowoman

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So lets say he should have got a 25mm (instead of a 27mm) - there is nothing involving fluid dynamics that the net result would be the difference between warfarin or no warfarin. Something doesn't add up.
I would have thought maybe he meant a tiny bit smaller than 27mm, say his annulus measured 26mm - there isn't a 26mm valve is there. If, for the sake of argument his annulus was 26mm then having a 27mm valve would mean there was an element of obstruction...though I don't know...I mean how do they insert a valve that is a bit too big ? Distort it ? Would that necessitate Warfarin ? I don't know but it's just his inference....pity we can't ask.
 

Lucker

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It was me who asked him for an update :)
Yeah, this issue with the valve sizing is strange. AFAIK, the surgeons always try to install the largest possible valve.
But most importantly, his valve keeps going strong.
 

Paleowoman

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Yeah, this issue with the valve sizing is strange. AFAIK, the surgeons always try to install the largest possible valve.
A cardiac surgeon who I was referred to (not the one who did my surgery) explained to me that they can only put in the size valve of the size of the annulus, and that there is no 'give' in the annulus as it is "very fibrous". I believe the way they can give a patient a bigger valve is by placing the valve in the supra-annular position.
 

Lucker

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A cardiac surgeon who I was referred to (not the one who did my surgery) explained to me that they can only put in the size valve of the size of the annulus, and that there is no 'give' in the annulus as it is "very fibrous". I believe the way they can give a patient a bigger valve is by placing the valve in the supra-annular position.
And still there are techniques in the annulus enlargment and reduction.
 
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