Has tissue valve replacement become the new "preferred" for 40-50-60year olds?

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Ok, beat the mech vs. bio valve choice to death yesterday in debating with LynW (she won, or at least got in the last post) :biggrin2:

so today my preference is for milk chocolate, tomorrow it may be dark chocolate, or milk chocolate...heck I like them both..must be andropause settling in:thumbup:
 
Here is a copy of Bradley White's post (I'm only 24! thread, reply #35, in the Valve Selection Forum) from February 2007 debuking the MYTH that Coumadin Risk is Cumulative:

I cannot stress that when risk for ACT complications is given on a "per annum" basis it is not to be taken as cumulative. This is true of any statistic which is laid out as "the risk per patient year is X%". This is a quite basic principle in all biological sciences, especially medicine. I find it astounding that any surgeon would try to say the risk is cumulative!!!! It just makes no sense.
Scary how little medical professionels understand about basic statistics.

If risk were cumulative then that would imply at a risk rate of 3% at 35 years of anti-coagulation the risk would be greater than 100%. This simply isn't true or possible, it is not how statistics works. These risk events are always observed in patient years, one could not reasonable extract that data and attempt to add it up and say that after 35 years everyone would have had an event. That's simply not how statistics works. Anything whose risk is finite in a per year basis will never be 100% over any course of time. It will approach 100% but never reach it.

The cumulative nature of anti-coagulation risk is that every year there is a 3% risk. That means that every year there is a 97% chance of not having an event. As time goes on the chances that you won't have experienced an event decrease due to the recurring risk of 3% per year. You can calculate this risk by taking .97 and using the amount of years you are interested in as the exponent and then subtracting that number from 1 to figure out your chances of HAVING an event in X years:

I have made the following calculations based on a 1%, 2%, and 3% risk at 10 thrugh 50 years. The number represents the chances that you WOULD experience an event by this year if you were on ACT for mechanical valve.

AT THE 1% RISK LEVEL

10 YEARS = 9.6%

20 YEARS = 18.2%

30 YEARS = 26%

40 YEARS = 33.1%

50 YEARS = 39.5%

AT THE 2% RISK LEVEL

10 YEARS = 18.3%

20 YEARS = 33.2%

30 YEARS = 45.5%

40 YEARS = 55.4%

50 YEARS = 63.6%

AT THE 3% RISK LEVEL

10 YEARS = 26.2%

20 YEARS = 45.6%

30 YEARS = 59.9%

40 YEARS = 70.4%

50 YEARS = 78.2%

If anyone doesn't understand how I calculated those risks I can send them the excel file. The thing that stands out the most is the huge long term risk change when one goes from a 1% per annum event rate to a 3% per annum event rate. At 30 years, less than half of those at 3% per annum event rate will have not experienced an event, while at the 1% per annum event rate 74% of individuals should not have experience an event. This a significant reduction in the long term risk of anti-coagulation and represents the major medical reason why self-testing is such a huge advance since it has been shown to decrease the event rate from the 2-3% per annum category to around 1% per annum.

Trust me surgeons and doctors are not infallible, especially when it comes to math. I teach pre-med students a 300-level Fundamentals of Genetics course (decent working knowledge of statistics) at Nortre Dame and it scares me to death to think that some of them could one day be my doctor based on their complete incomprehension of statistics (among other things) at this point in their eduction.

Brad (screen name Bradley White)

Ross Procedure, Dr. Quintessenza, All Children's Hospital, St. Petersburg, FL -- 9/12/2000

Aortic Root and Valve Replacement with 23 mm Homograft, Dr. Joseph Dearani, Mayo Clinic, Rochester, MN -- 12/7/2006

==================

Topless - Out of Curiosity, which surgeon told you that the risk of Coumadin was cumulative?
 
Valves & Chocolate

Valves & Chocolate

Anyone else out there seen the latest on the medical research which indicates dark chocolate is definately the best choice? Milk would definately taste better if it came in a dark chocolate flavor.

The reference in the original post referencing the "pill taker" thing is definately a concern. My surgeon actually asked me if I could and would be able to do daily meds rather religiously. In all honesty, since I had never done daily meds, I really didn't know. I essentially confrmed that I would do what it takes and it has required developing a routine.

Regarding the increasing risk issue with coumadin, both my surgeon and cardiologist told me it was nonsense. People are entitled to believe who they choose... I'll believe the guys who took care of me.

My new artifcial valve really is better than my old one.

-Philip
 
1% or 10% risk; who cares about numbers. This risk factor is strongly influenced by user error, not something we don't have control over. Since about 20% of the population is complete idiots, I am surprised the number would not be higher.

If you manage your INR you can reduce your risk to an extremely low amount, so whatever statistic out there can be avoided. After all, the rat poison reduces your risk for stroke as you age. I wanted a tissue valve until moments before surgery, but for a variety of reason I ended up with a mech; for this reason I will never take side one way or the other. The one reason the tissue valve was my first choice was the allure to put all this behind me; I wanted no reminder of this problem (pills, INR, etc). Because I was pushed in the direction of a mech valve, I am now glad that is the way it turned out. Once you get used to the pill INR thing it will simply be a new normal, no big deal. As for forgetting all this, I now know that I need to have heart health in the front of my mind, not something I need to forget.
 
Well if I might just pipe in: Had porcine valve 5 years ago-just popped a leaflet 2 weeks ago and will now get me one of those nice shiny mechanical valves,my own home testing unit and hopefully a PR in a Triathlon next year. My tissue valve chances of failing was 4%,but like my cariologist said "4% is 100% when it happens to you" I respect anyone's valve choice--you cannot judge it--sorta like which chocolate(dark),spouses (not too good on that one either) or running shoe(I got that one perfected!)
Laura
Hoping to get engine work done and sewn up in time for the Harrisburg Relay Marathon with the Valve-o-lines and Cardiac Athletes in November!!
 
The reference in the original post referencing the "pill taker" thing is definately a concern. My surgeon actually asked me if I could and would be able to do daily meds rather religiously. In all honesty, since I had never done daily meds, I really didn't know. I essentially confrmed that I would do what it takes and it has required developing a routine.

To me, that would be a cop out excuse. If you know that your life depends on it, your not going to forget to take your pill. The experience of having surgery is going to remind you daily anyway.
 
dam it,i have just eaten 1 bar of dark and 1 milk, and ive forgotten which i liked the best, oh crumbs am gonna have to try again shucks,
 
Here is some food for thought. If tissue valves were truly the chosen, why would mechanicals even be offered anymore?

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It's about half and half for valve choice. I think it's a good thing having BOTH types. Like I said, maybe someday in the near future we will see a breakthrough in improvements for both types. Surgical advancements also.
 
Oh yeah?!?!?! Boy, I can sure tell you're still a young whippersnapper..:biggrin2:

This beach scene reminds me of the time in 1976 when I was a young whippersnapper. I am reminded of an old saying...."We get too soon old, and too late smart". Forgetting warfarin, for an unreasonable time, can cost you dearly. Been there, done that.....thats why I "harp" on the notion that if you cannot follow a SIMPLE reginen....don't go on warfarin.
 
By the time you have read all the threads on Mechanical v Tissue you will be 156 which makes your decision irrelevant. If you are under 60 then it is mechanical in the U.K. and over 60 you can choose. I choose mechanical as I do not want to have the operation again. Nor do I want a stroke which is a risk for mechanical but careful monitoring "should" prevent this.
Try and be confident in your decision whatever it is and have a confident and carefree outlook.
 
I'm five years out, with a bovine valve, and I rarely give my avr a thought.
IMHO neither tissue or mechanical valves will ever completely give way to the other. In everything there's an exception to the rule, so in some instances, one or the other (or the Ross) will be the preferred selection for implantation.
 
ross if mech was the choosen one why have tissue? seriously i think the gift of being able to have the op is the choosen one, i havnt heard that one before about having mech if you 60 or under in the uk? i know a lot of people in the uk under 60 with tissue, and a lot with mech,right guys on to a more serious matter, what about getting 1 bar of milk and 1 bar of dark and melting them together,
 
ross if mech was the choosen one why have tissue? seriously i think the gift of being able to have the op is the choosen one, i havnt heard that one before about having mech if you 60 or under in the uk? i know a lot of people in the uk under 60 with tissue, and a lot with mech,right guys on to a more serious matter, what about getting 1 bar of milk and 1 bar of dark and melting them together,

Thanks for this message, Neil. I have been mulling that around in my head all day that under 60 you have no choice but to get mechanical. I'm happy that doesn't seem to always be the case. I found that very disturbing.
 
ross if mech was the choosen one why have tissue? seriously i think the gift of being able to have the op is the choosen one, i havnt heard that one before about having mech if you 60 or under in the uk? i know a lot of people in the uk under 60 with tissue, and a lot with mech,right guys on to a more serious matter, what about getting 1 bar of milk and 1 bar of dark and melting them together,

But that's not the title of thread or the question posed. Anyhow, I prefer beer. Chocolate doesn't get it for me.
 
I am 28 and have 2 babies. When I found out about my heart condition my cardiologist asked if I was done having children. I said well I always wanted more children, but yes I guess 2 is enough! He said okay you are going to get a mechanical valve. I knew nothing at this point about any heart things or problems or valves. I asked him if that meant I would never need another surgery and he said yes. I went home 100% for the mechanical valve. I was only scared about hearing the "ticking" noise. For 2 months I stuck with my decision for the mechanical valve. I went to see the surgeon downtown and received a booklet on the whole heart valve replacement procedure. I read through it and it had a section about tissue valves and mechanical valves. The tissue valve section was 1 large paragraph. The mechanical valve was a page and a half of information. After reading it, then doing research online, I suddenly changed my mind and decided to go tissue valve. After having my surgery, I am 100% happy with my decision and am very confident about living my life with a tissue valve now. It is a very personal decision and go with your gut or you won't be happy!
 
Drivetopless,

I had AVR on almost 3 months ago. Before surgery, I was told "a guideline recommendation" was: mech for under 40; tissue for over 60; 40-60 was a "gray" area. Based on my age (39) and the fact I prefer not to have the surgery again, I chose mechanical.

I'm now the proud owner of a 27mm St. Jude Regent. I've come to the conclusion that I could have benefited from the surgery a year or two ago. When I cut grass the other day, I wasn't huffing and puffing the way I was before surgery.

Just started my cardio rehab this week. I'm looking forward to getting into some sort of shape other than a gelatinous mass.

Scott
 
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