there are actually instances here for anecdotal support to what is established in the literature
I'd look at my points here and note the reference to the other discussion (what I'm talking about there) for context (and how it relates to On-X and lowering INR marketing (to the ignorant hysterical):
Hi Team, I came across this great website to make evidence appraisal easy for clinicians: NERDCAT They also have an interesting analysis of the ON-X valve PROACT trial: https://nerdcat.org/studysummaries/proact They say (the bold is from their analysis, ie not me): Based on the 95% CI, the...
Next I'd cite this study (which IIRC includes On-X valves) of some thousands of participants (so yes, from a clinic) and in particular note the graph I've copied (and annotated) below from that study
View attachment 889245
URL for study
Background Oral anticoagulant therapy is effective for the prevention of arterial thromboembolism in various patient groups. The increased risk of hemorrhage remains the major drawback to this therapy and is associated with the intensity of anticoagulation. Finding the optimal intensity at...
Also of importance is time in therapeutic range (TTR) the longer you are TTR the better and the more that you will have the age related issues of stroke or bleed (meaning what happens to every human who isn't on a mechanical valve or warfarin). An discussion of what those statistics mean is found here:
Morning all...Newcomer here who is based in the UK. I was recently diagnosed with a bicupsid aortic valve causing severe aortic stenosis. I have surgery booked for December to have it replaced and to have a section of the ascending aorta also replaced but to dilation. Surgeon has recommended a...
Its important to note that if you didn't yet watch (linked in my above blog post) the presentation by Dr Schaff I'll suggest you do it now
It is well worth paying attention to, and any dismissals of it being 2009 I would rebuff with:
- what subsequent studies have been done to counter or dismiss his points
- what has changed about human anatomy and biochemistry since then (hint; nothing)
The question is often asked "what makes a goo valve?" ... personally I think @nobog
's advice of "one that lasts 20 years is the best answer.
I began my surgical career (as meat) when I was 10 (with a repair). I had that repair replaced with a homograft at 28, then had that 2nd hand valve replaced at 48 with a mechanical. I'd thus class the homograft as a good valve.
you consider that another surgery will be in your future (because, say
) then a homograft may be a way to stretch that future surgery further down the path. I say may because "it depends
". There are always factors to consider.
Lastly I'll say that (as Dr Schaff observes) many people on a tissue valve statistically will find that warfarin is needed eventually as they age. Indeed this is true of the general population (as I'm just now helping a person who's been introduced to warfarin because of a stroke history). Wouldn't it be pernicious to the mind to specifically chose a valve that will fail over a valve that will never fail to avoid what you find yourself on anyway? The wait for that failure will probably be more stressful.
IFF you go mechanical then soon after you make that choice and soon into recovery (when your INR is more or less well established) then reach out and I can give you a hand with managing INR. Or just keep an eye on my signature as my book on that subject is nearly finished at the proof reader (wow, very interesting) and I'll be publishing within a month or two I expect