- Jun 4, 2022
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 ...
The homograft aortic valve: a 29-year, 99.3% follow up of 1,022 valve replacements - PubMedThis largest, longest and most complete follow up demonstrates the excellent advantages of the homograft aortic valve for the treatment of acute endocarditis and for use in the 20+ year-old patient. However, young patients (< or = 20 years) experienced only a 47% freedom from reoperation from str …pubmed.ncbi.nlm.nih.govFor 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.