Mechanical vs Tissue - need help deciding

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pellicle

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You also posted it more recently in another thread. I recall that someone came out of the woodwork and slammed you for it, apparently because it was a Russian review, which is really a silly criticism. It was peer reviewed and published in the AHA Journals.
my memory of that is clouded by the fact that I have some of those people on my "ignore list", but I was informed that person A slammed parts of it and person B slammed person A (a scientist IIRC) for being racist. Person A then backpedalled in a manner on that.

but this is all "heresay"; I do not know, I wasn't there.
 

Chuck C

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In a previous post I mentioned that in choosing valve type, it would be a good idea to be honest with yourself as to whether you are the type of person who is compliant with consistently taking your warfarin daily and paying attention to be sure that you are taking the correct dosage. I wondered out loud what a good litmus test would be.

Age still being the biggest factor for most people in deciding which valve is most reasonable, I thought of a litmus test that perhaps might suggest that a person should consider a tissue valve, even if they are younger than the guidelines recommend.

I think most people manage to get through their lives never accidently putting diesel fuel into their gas auto. Apparently, it does happen.

" However, this is not necessarily an easy mistake to make because diesel pumps are generally labeled in a vibrant green to differentiate themselves. Also, a vehicle's gasoline filler neck and the diesel fuel nozzle are purposely designed to be incompatible. Meaning, the diesel dispenser is too large to fit into a gasoline filler neck easily."

Still

"That being the case, people still somehow manage to pour diesel fuel into their gasoline tank."


If you have done this before, especially if you have done this several times before, even if you are young, you might want to consider a tissue valve.

You don't want to be this guy:

"Honey, I think you better take me to the ER. I was supposed to take 4 of the little pink pills (4mg) and I think I might have accidently took 4 of the dark blue pills (24mg)."
 

tom in MO

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Hi



ok, here are my more full thoughts
  1. your bio says you are 67 (change that to a year of birth if you want people to know it, because you may change over the years) at 67 and living in the USA my view is you should go SAVR and a tissue. This is because the system is geared that way (and all the horsehockey about choice is pretty much bs as you've discovered, its an illusion of choice)
  2. because you live in the USA the system is not supportive of modern patient methods of self management, if you want to have the best results with INR management it has to be self management. Now this is not to say that any given person will do well on self management, only most of them.
  3. the illusion of choice meets a hard wall in the USA when people want to do something a bit different, then they face the policies of their insurance companies who will dicatate things to them. If you doubt this just read enough threads here over time and you will see this again, and again ... and again. Here is just one such thread about the strife people have with clinics. This sort of stuff just doesn't happen in Australia because we don't have the same system as you
The stats show that for a male of your age you will enjoy at least 10 years before any signs of SVD occur in the valve (77) it will be a few years more (lets say 7) before the next intervention needs to occur (84) and you go with a valve and your situation is amenable to TAVR, this will give you a good 5 more years (probably trouble free) (89). After that its either a miracle or you're up for another SAVR

Only you can know your family history, but for me most of my family were pretty rough around the edges at 89 (well all their lives really). Myself I recognise I'll die and have made good friends with that (although most people seem to repeat it like a movie but when they suddenly get actual evidence for it freak out as if was a consensual fiction).

So given all of the above I believe you will be best served by SAVR and bioprosthetic.

Best Wishes
Your statements about the USA are completely false. I was given a clear choice as to valve type. I was encouraged to home test. When I requested I was allowed to home dose. I live in the US.

Your problem is you see the USA through Australian eyes and a with a negative bias. For example, you talk about the US "health system". Australia, Great Britain, etc. have systems. There is not a US unified health system. It varies by state, by city, by urban vs. rural, by insurance group and then there is Medicare and Medicaid, which vary by program and can vary by state.

You damn the US system but unlike those who live in national health system countries I got my valve replaced within 2 months of need and on the date of my first surgical appointment. I had a choice of 2 world class hospitals in my city. After I chose mechanical, my surgeon recommended the St. Jude because they have a good track record and were stocked but would have installed an Onyx, however he'd have to order them.
 

Mister_James

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You damn the US system but unlike those who live in national health system countries I got my valve replaced within 2 months of need and on the date of my first surgical appointment. I had a choice of 2 world class hospitals in my city. After I chose mechanical, my surgeon recommended the St. Jude because they have a good track record and were stocked but would have installed an Onyx, however he'd have to order them.
I don't know what system is better but I know this pandemic has shown Americans what is seen elsewhere...wait.
Americans lining up to be tested. Americans waiting for test results. Americans fighting for testing materials. Folks unattended in hospitals, overwhelmed doctors and nurses.

If healthcare was available to all, just the diabetics going for care regularly would gum up the works.

There is no wait in America because a lot cannot afford to seek treatment.

There is wait in America too. We just don't count those who choose to pay rent than seek care. Those who choose to buy food that buy prescriptions. Those do not exist.
 

Unicusp

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Your statements about the USA are completely false. I was given a clear choice as to valve type. I was encouraged to home test. When I requested I was allowed to home dose. I live in the US.

Your problem is you see the USA through Australian eyes and a with a negative bias. For example, you talk about the US "health system". Australia, Great Britain, etc. have systems. There is not a US unified health system. It varies by state, by city, by urban vs. rural, by insurance group and then there is Medicare and Medicaid, which vary by program and can vary by state.

You damn the US system but unlike those who live in national health system countries I got my valve replaced within 2 months of need and on the date of my first surgical appointment. I had a choice of 2 world class hospitals in my city. After I chose mechanical, my surgeon recommended the St. Jude because they have a good track record and were stocked but would have installed an Onyx, however he'd have to order them.
Hello – I am a US citizen and agree more with Pellicle’s view on our system. I’m guessing that you most likely have a good job with good insurance, and probably have had such, your entire working life. Before that, your parents took care of your needs. When you have top tier insurance especially when working for large Corporations, the patient can usually get whatever they want.

As an aside, this situation causes some people to stay in jobs they hate because of the great insurance. That causes other issues impacting our economy.

But when you become unemployed (after ridiculously expensive COBRA coverage runs out) the resulting options are very poor. The premiums are based upon your most recent tax year, not your current zero income, so if you were making good income previously, the premiums with even very high deductibles, are insane like $25k / year with $10k annual deductibles.

The affordable care act was a good idea, but it really only works well for the poor who are paying next to nothing, and as you said it varies widely by State. The middleclass gets screwed.

Then when you hit 65 and retire and go on Medicare, your choices will be limited by what is covered. You will not have the luxury of choosing whatever you want and get it for free.

The recent handling of Covid in the US is a good example of how medicine works in other countries. You need a test, go in, get it done, free. You need a vaccine, go in, get it, and it’s free. You need monoclonal antibodies, (first try to get them as they are allocated) but say you are fortunate enough to get, they are free to you. This is how the system should work. We are all paying for it thru different means either way, but our friends in Washington will never change it as they personally benefit from the current system.

Home testing in my (limited) experience, is not well known nor encouraged. My PCP who is close to 60 years old and has been practicing medicine for at least 30 years with a very successful practice, has zero patients home testing. I had to educate his office on how it’s done. Again, our system encourages patients to use more expensive methods such a Coumadin Clinics, Quest diagnostics etc. to bill more and keep that system humming along. They do not believe in efficiencies.

Look at drug pricing. I worked in the pharmaceutical industry for over 20 years. See what manufacturers charge for the exact same drugs across different countries. We are getting screwed and helping subsidize the other countries lower prices, and all of the nice direct to consumer drug advertising you see on TV every night.

There is so much room for improvement! I’m just scratching the surface.

Sorry, but that’s my opinion.

This reminds me of that great Jeff Daniels clip. No, we are not the greatest. But could be…….

 

jlcsn2015

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I choose Mech over Tissue based on the recommendations of the 10 doctors in my close family, Plus, the fact that i did not want to "Plan" for another visit to a Hospital, since "lots" of things are always going on there CCP Virus or otherwise, not best place to be health wise; So, i wish i was born with a normal heart not a defective one with BV, too bad, but those were the cards i got; my other wish is to keep out of hospitals as much as i can, in 70 years have been only ONCE into a hospital as a patient; and As long as tissue valves are made out of "tissue" the human body "Will" attack it, 100% sure; and claims of things lasting 100 years on paper , mean nothing in reality. But,at the end is a choice, do you want to "Plan" for more weeks at hospitals at any given time after 10 years, or not, "my view", there is no wrong or right, just mine :)
 

AZATADINE

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I choose Mech over Tissue based on the recommendations of the 10 doctors in my close family, Plus, the fact that i did not want to "Plan" for another visit to a Hospital, since "lots" of things are always going on there CCP Virus or otherwise, not best place to be health wise; So, i wish i was born with a normal heart not a defective one with BV, too bad, but those were the cards i got; my other wish is to keep out of hospitals as much as i can, in 70 years have been only ONCE into a hospital as a patient; and As long as tissue valves are made out of "tissue" the human body "Will" attack it, 100% sure; and claims of things lasting 100 years on paper , mean nothing in reality. But,at the end is a choice, do you want to "Plan" for more weeks at hospitals at any given time after 10 years, or not, "my view", there is no wrong or right, just mine :)
That's what suits you. That's fine. It doesn't suit everyone. I had tissue implanted at age 52 and given everything I know and have experienced since, I'd make the exact same choice again if I was to roll back the clock. Like you, I made my choice and was well aware of the facts beforehand.

So long as someone is aware that they will require further intervention at some stage (depending on age of course), there is absolutely nothing wrong with making the decision to go with tissue.

Believe it or not, its not just down to whether or not you'll need a further intervention. There are other things to be considered. If it was just down to whether or not the it could be a once off and done, everyone would get a mechanical valve. If mechanical was for everyone and if mechanical didn't have drawbacks also, there wouldn't be a market for tissue at all. That's not the case though.There are choices for a reason 🙂

Sometimes, a person could pick up the impression that anyone choosing a tissue valve is not making an educated decision. I'm sure sometimes it happens to be fair, but not always. Like people who choose mechanical for a reason, people who choose tissue do so for reasons also.
 

Superman

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That's what suits you. That's fine. It doesn't suit everyone. I had tissue implanted at age 52 and given everything I know and have experienced since, I'd make the exact same choice again if I was to roll back the clock. Like you, I made my choice and was well aware of the facts beforehand.

So long as someone is aware that they will require further intervention at some stage (depending on age of course), there is absolutely nothing wrong with making the decision to go with tissue.

Believe it or not, its not just down to whether or not you'll need a further intervention. There are other things to be considered. If it was just down to whether or not the it could be a once off and done, everyone would get a mechanical valve. If mechanical was for everyone and if mechanical didn't have drawbacks also, there wouldn't be a market for tissue at all. That's not the case though.There are choices for a reason 🙂

Sometimes, a person could pick up the impression that anyone choosing a tissue valve is not making an educated decision. I'm sure sometimes it happens to be fair, but not always. Like people who choose mechanical for a reason, people who choose tissue do so for reasons also.
I don’t think anyone disagrees with that sentiment. Everyone who comes in here and explains their decision is not making an indictment on the choice they didn’t make.

I think park of the decline in this forum of late is the defensive posture of our society as a whole. People generally know the pros and cons. The choices we make tend to be that the cons of one choice outweigh the cons of the other choices, for us. For you, the cons of living with mechanical and medication, ticking and testing outweighed the cons of riding this roller coaster again in the future. For others it’s the opposite. For both, the cons of doing nothing are the same.

Judgment free zone or whatever. Heck, if I knew for a fact in 1990 that 19 years after my first replacement I’d have to do it all again due to an aneurysm in 2009, and there was a tissue with a 20 year guarantee- I might have gone that route too. I’m sure I made some questionable choices for someone on warfarin in my teens and 20’s. But those options didn’t exist then. Still don’t I guess. The guarantee part anyway.


Thing is. 2009 likely would have been my 3rd or 4th OHS based on what was available back then. Glad it was only my second. I know I don’t want to do it again. It didn’t get easier with practice for me anyway.
 
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AZATADINE

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Ah yeah, I know. You're right to be fair. I guess I'm kinda new to this particular forum and I sometimes pick up the impression from here that tissue valve recipients made a bad choice getting tissue, particularly if on the "younger" side of the spectrum (which I suppose I am, at 52). Maybe it's just how I'm picking it up and I could well be wrong.

If I was a bit younger, I would have chosen the On-X (which was an option for me). I did consider both and choosing tissue was not something that I took lightly (fully aware that I'll need another intervention of some sort). It was a tough decision. Because it was so tough, I know that I made the right decision for me so it irks me sometimes when I pick up (likely wrongly.....) the impression that tissue valves are somehow not really a great option for anyone under a certain age. I suppose I just don't think it works in a simplistic way like that. Sometimes there are other factors outside of age to consider.

I'll try to not be so sensitive 🙂.
 

Superman

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No worries. The thing I lose perspective on in here is just how much of an outlier I am. I’m not even 50 yet and I’ve been ticking and taking warfarin for over 30 years now. I’ve only seen a couple folks in their teens or twenties come here with questions.

At just over 50, you’re still on the young side of first timers that come here and yet, you have a couple years on me in age.


That said, I do think medical professionals tend to oversell the cons of living with warfarin and undersell the cons of repeat intervention. I tend to think that’s part of why so much if this forum tilts toward living on warfarin and what it’s really like. And, we’re higher maintenance post op, so we tend to stick around here longer and help each other out. Whereas tissue valvers do as advertised. They’re here when it’s intervention time or close to it. They’re gone in the intervening years. How often would you hang around the dealership and talk cars if your car never needed an oil change?
 
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pellicle

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How often would you hang around the dealership and talk cars if your car never needed an oil change?
Or if there was no manual and dealers couldn't manage to change the gearbox oil or agree on tyre pressures.

It's like hanging around a hot rodder forum for guys with 302 motors
 
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carolinemc

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I don't know what system is better but I know this pandemic has shown Americans what is seen elsewhere...wait.
Americans lining up to be tested. Americans waiting for test results. Americans fighting for testing materials. Folks unattended in hospitals, overwhelmed doctors and nurses.

If healthcare was available to all, just the diabetics going for care regularly would gum up the works.

There is no wait in America because a lot cannot afford to seek treatment.

There is wait in America too. We just don't count those who choose to pay rent than seek care. Those who choose to buy food that buy prescriptions. Those do not exist.
I am a heart person, birth defect of the aortic valve with murmur, replaced in 2001 with a St. Judes' valve. I am also a type 2 diabetic, gene pool from family and surgery triggered and not clogging up my hospital visits over it. You know nothing about the true Americans , except for what you read and listen to in the news media. I did not have to wait for surgery. I was able to get it due to how bad the valve was and the strain on my heart and lungs.
If you want to point fingers about health care for heart patients, look no further than at many countries make a heart patient wait months before they can get surgery, even with health insurance or not.
I am proud of my country. No need to be nasty to us. Have a nice day and be kinder to people here.
 

Superman

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Carolinemc, what in the world are you so angry about? You’re angry facing everything. People must have to walk on eggshells around you in real life. Honestly see nothing in any of the posts you’re 😡 that warrant that reaction. It’s rude. Feel free to disagree and have a conversation, but the face isn’t needed.


That said, looking forward to my angry face! Don’t let me down! 👍
 

Dano64

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No worries. The thing I lose perspective on in here is just how much of an outlier I am. I’m not even 50 yet and I’ve been ticking and taking warfarin for over 30 years now. I’ve only seen a couple folks in their teens or twenties come here with questions.

At just over 50, you’re still on the young side of first timers that come here and yet, you have a couple years on me in age.


That said, I do think medicinal professionals tend to oversell the cons of living with warfarin and undersell the cons of repeat intervention. I tend to think that’s part of why so much if this forum tilts toward living on warfarin and what it’s really like. And, we’re higher maintenance post op, so we tend to stick around here longer and help each other out. Whereas tissue valvers do as advertised. They’re here when it’s intervention time or close to it. They’re gone in the intervening years. How often would you hang around the dealership and talk cars if your car never needed an oil change?
Superman, you speak the truth. At 37, I chose a homograft because I viewed that choice as providing me with the most normalcy at my young age. I hung around this site for a while after and offered assistance where I could. Then, I changed jobs and had a new baby daughter and I vanished until recently, gone for almost 20 years. I recently found a post here at my 40th birthday with people wondering how I was doing with concern. Maybe some people and some surgeons do lean tissue. I guess I am one of those people. Nobody told me about the connection between BAV and aneurysms until 3.5 years ago when I was at 4.9 and my cardiologist scared the **** out of me. I should have stayed connected to this site. There is a lot of anger in our world these days, but it is good to talk about this stuff. I appreciate your perspective for sure. Thank you.
 

Croooser

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IMG_0458.JPG

Normally I try not to wear things on my sleeve. Don't want to be "that guy". But when you mentioned 302s, I just had to...

This has a 302 but it has been seriously worked over - approx. 400hp at the crank and in a 2400lb car. Took me 5 years part time. It's no joke in the performance department.

One would think I would have leaned toward a mechanical valve:LOL:
 

pellicle

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View attachment 888360
Normally I try not to wear things on my sleeve. Don't want to be "that guy". But when you mentioned 302s, I just had to...

This has a 302 but it has been seriously worked over - approx. 400hp at the crank and in a 2400lb car. Took me 5 years part time. It's no joke in the performance department.

One would think I would have leaned toward a mechanical valve:LOL:
because you didn't quote me I nearly missed this.

My mate has this one
cobra.jpg


That's not my style, I had one of these

1642115134413.png


that I decided to restore ... which broke down me over time

1642115031938.png


but I'm sure you get it
 
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