Mechanical vs Tissue - need help deciding

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Mister_James

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Heart surgery is $200‐300k having it twice in your lifetime because of clicking and some dirt cheap rat poison?
I have seen folks drive convertibles top down with AC on blast. I think it's crazy they say why not.
 

pellicle

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Heart surgery is $200‐300k having it twice in your lifetime because of clicking and some dirt cheap rat poison?
interesting perspective, and in societies where medical systems are publically funded I believe that there is less "informed patient choice" and more mechanical valve + Anti Coagulation Therapy.

To get answers, I often say "follow the money"
From 2012: EDWARDS LIFESCIENCES REPORTS THIRD QUARTER RESULTS
• Global THV Sales Grew 50 Percent, or 66 Percent Excluding FX​
• EPS Up 35 Percent, or 53 Percent Excluding Special Items​
• Fourth Quarter Sales and Earnings Guidance Trimmed​

“Given our updated projections, we now expect full year sales at the bottom of our previous $1.90 billion to $1.97 billion range, which represents an underlying growth rate of more than 15 percent. For the fourth quarter 2012, we project total sales of $490 million to $520 million. “We expect diluted earnings per share to be between $0.76 and $0.80 for the fourth quarter, and between $2.54 and $2.58 for the full year 2012. Full year net income growth is expected to be between 25 and 27 percent,” Mussallem added. The company’s guidance for diluted earnings per share and net income growth excludes special items and assumes renewal of the R&D tax credit.​

Then from: 2013;95:S1–S66 AORTIC VALVE/ASCENDING AORTA MANAGEMENT & QUALITY MEASURES

1656558953370.png


The potential population needing AVR for severe AS is estimated at 350,000 and increasing. The exact number of aortic valve procedures, including repairs and replacements, is unknown. A number of 48,000 has been reported [23]; however, a number of 95,000 Medicare patients was reported in a recent publication [24] (Tables 2 and 3). Table 2 shows the number of valves sold to hospitals for one year (92,514).

I think there is some small errors in that table, I calculate this:


mech (all makers)​
16780​
tissue​
ats​
216​
carbomedics​
5290​
edwards​
39367​
Medtronic​
18688​
St Jude​
11666​
75227​
total all valves​
92007​
cost per valve tissue valve​
$5,792.03​

So while I know (because its in the guidelines and the subject of many studies) that in specific a age groups picking a tissue prosthesis is a reasonable choice, it does not mean that for a younger cohort its statistically a good idea. Further its well established that something like 60% of patients on a tissue prosthesis require ACT by the time they are 15 years into having that valve.


why sell a durable product to people who will mismanage their INR (contributed to by a background setting of not promoting self management) when you can make more money out of reselling valves.

I wonder when the music will stop on the funding merry-go-round of the US health care "industry".
:unsure:
myself "... dunno", but I wouldn't be comfortable with relying on the status quo as the economics go forward.

Best Wishes
 
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PeterII

Liborio
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So while I know (because its in the guidelines and the subject of many studies) that in specific a age groups picking a tissue prosthesis is a reasonable choice, it does not mean that for a younger cohort its statistically a good idea. Further its well established that something like 60% of patients on a tissue prosthesis require ACT by the time they are 15 years into having that valve.

Yeap...
And then, at the end 6 out ot 10 with a Tissue valve will have to take ACT plus !, antother tour to the Hospital were to begin with is the world of viruses of all kind no matter how clean the place is, but , if i were 70+ at the time of first OHS, sure i take the tissue as most likely, life will expire before the valve does
 

tom in MO

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...I wonder when the music will stop on the funding merry-go-round of the US health care "industry".
:unsure:
myself "... dunno", but I wouldn't be comfortable with relying on the status quo as the economics go forward...

Since you are Australian, why not tell us about your country instead of criticizing the US; a place you know little about outside of movies, TV and biased media. For example, are patients in Australia denied tissue valves if under your personal metric of 55yo?
 

Daniel758

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Since you are Australian, why not tell us about your country instead of criticizing the US; a place you know little about outside of movies, TV and biased media. For example, are patients in Australia denied tissue valves if under your personal metric of 55yo?

It seems some people have a need to put others down to feel good about themselves. My best guess is they are probably low self worth individuals and were bullied as children.

Why they choose to bully others and believe rudeness is somehow "cool" after what they have been through in life is beyond me.
 

Daniel758

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Really ?, ooooppppsss , so cnn is not true then hmmm, no wonder evereything else is .... true or not true ?

My mom used to tell us this when we were kids, it may help clear up your confusion:

"First get rid of the log in your own eye; then you will see well enough to deal with the speck in your friend's eye."
 

Daniel758

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Further its well established that something like 60% of patients on a tissue prosthesis require ACT by the time they are 15 years into having that valve.

Two things:

#1 You have claimed in the past that getting 15 years from a tissue valve makes one a statistical outlier.

If this is the case, is 60% of an outlier a relevant argument?


#2 Do you have any statistics on how many mechanical valvers:

A. Will still have the cognitive ability they have today to self manage anticoagulants (using your spreadsheets, etc.) 15 years into having their valve? How about after 20? Or 30?

B. Will still have the ability to get themselves to an anti-coagulant clinic on a regular basis in 15 years or more if self management fails? What happens when they can no longer self manage or regularly get to a clinic?

C. Will NOT develop another condition (arthritis, cancer, strokes, ulcers, etc, etc, etc.) whose treatment will be negatively affected by or impossible to implement due to anticoagulants used for their mechanical valve in 15 years? 20? 30?
 

Daniel758

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Let's hope the new polymeric valves will end this agonizing choice younger people have to make.

Agreed!

Progress is a good thing.

And when it does come out, I hope people don't try to talk/scare other people out of it (and thereby lower their quality of life) because it doesn't/won't have years of in patient data backing it.
 

pellicle

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Let's hope the new polymeric valves will end this agonizing choice younger people have to make.
I'm no fan of hope, it gets in the way of planning.

Personally I doubt the polymers will have no downsides (and may even thrombose in later operations). People go on about the "ticking" as if its a detached phenomenon like a clock in the room. I've always been aware of my heart beat (as indeed it seems are the writers of many songs) but what I find the hardest to work with is tinnitus (probably caused by years of construction sites, motorcycles and bands).

Yet even with that symphony of cicadas I still find that I can hear small things in the bush before my friends (and usually around the same time as the dogs).

People who haven't experienced it just can't imagine it ... (at least that's what it seems to be).

Best Wishes with your personal choices ... oh and welcome aboard
 

Lucker

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I'm no fan of hope, it gets in the way of planning.

Personally I doubt the polymers will have no downsides (and may even thrombose in later operations). People go on about the "ticking" as if its a detached phenomenon like a clock in the room. I've always been aware of my heart beat (as indeed it seems are the writers of many songs) but what I find the hardest to work with is tinnitus (probably caused by years of construction sites, motorcycles and bands).

Yet even with that symphony of cicadas I still find that I can hear small things in the bush before my friends (and usually around the same time as the dogs).

People who haven't experienced it just can't imagine it ... (at least that's what it seems to be).

Best Wishes with your personal choices ... oh and welcome aboard
Thanks for welcome and good wishes.
Not to derail the thread, but apparently the oldest implanted Foldax valve is already at 3 years mark, which is great. I wonder, how long will the Indian trials last before the valve is cleared for use. At the moment I loathe the mechanical perspective so much, that I'd rather go to India and pay for surgery when the time comes, despite having available free surgery with a mechanical at home.
Can't see why the thrombosis of the whole valve couldn't be avoided, if the valve doesn't throw small clots to the bloodstream. There's even a case describing a man having a St. Jude with no ACT for more then a decade and still being fine. I worry about structural integrity more.
Ticking of the mechanical valve seems to me like nothing, compared to the potenial troubles Daniel758 mentioned, apart from the overall ACT hassle.
Glad to be here with you all, fine and resilient people.
 
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pellicle

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Good morning

Not to derail the thread, but apparently the oldest implanted Foldax valve is already at 3 years mark,
Which is great. Its trials that make clear if a conjecture into the unknown will actually work and identify the unforseen in the great testing lab that is real life.

I wonder, how long will the Indian trials last before the valve is cleared for use.

well that's something we just don't know. We don't know about the outcomes yet. Probably another 4 or 5 years if no problems emerge before we can even have short term outcomes. I mean how would YOU personally feel to get a valve which you hope to last 15 or 20 years (not sure of your age) and find that it was inferior in some way to the existing products?

cheated?

At the moment I loathe the mechanical perspective so much

whoa ... loathe? Wow ... what causes that?


Can't see why the thrombosis of the whole valve couldn't be avoided, if the valve doesn't throw small clots to the bloodstream.

well there is more to thrombosis than thrombogenesis triggered by platelet activation or other activations. There is surface adhesion type thrombosis which becomes obstructive and or breaks off in clumps and acts as the "snow ball"

Current bioprosthetic valves do this. This is known and not uncomon and directly correlated to the time the valve is in place.

There's even a case describing a man having a St. Jude with no ACT for more then a decade and still being fine.

there is (indeed I've even posted that here) but this is not to say its the ordinary, it is indeed more indicative of the outliers. Statistics means that there are likelihoods not certainties. Its rather like playing russian roulette with 1 bullet vs 5 in the cylinder ...


I worry about structural integrity more.

me too, which is exactly why on my 3rd OHS I went with the most structurally sound option so far, which is the mechanical and I accept the need for ACT

Perhaps you are unaware of the decades of research into the problems with the durability of structural design of bioprosthetics


makes for very good reading. In summary it says you should get 10 years on average if you are younger. Just yesterday a person posted (yet another) example of younger people getting less than 10 years before a biorpsothetic underwent structural failure.

There are reasons to pick either valve type, you should know them well and correctly understand the parameters and trade offs

compared to the potenial troubles Daniel758 mentioned, apart from the overall ACT hassle.

I don't know exactly what particular troubles Daniel has had but as he doesn't have such a valve and has no actual experience in either the valve or managing INR.

I on the other hand have both and quite an amount of work done with many people and really am at a loss to understand what you mean troubles when I'd call them trivialities of management.

Best Wishes
 
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Superman

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There are reasons to pick either valve type, you should know them well and correctly understand the parameters and trade offs

Bingo. I think some read this forum and get defensive or even hostile when the trade offs are pointed out. As though it’s an attack on one choice or the other. The reality is that no choice is better than being born with a good, normally functioning valve. Not fixing a bed valve has negatives. Fixing with a tissue has negatives. Fixing with a mechanical has negatives. The challenge for anyone is to pick the most tolerable negatives (for them) coupled with the most acceptable risk (for them).

Making sure all aspects are known when making a decision is a service this forum procvides very well. Even if some aspects aren’t pleasant.

I’m adjusting for a 5.2 INR this morning due to steroids needed for my back. Done with that course of meds, now getting my INR back in line. In the meantime, I won’t be skateboarding on the half-pipe until I’m in range again.
 

pellicle

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I’m adjusting for a 5.2 INR this morning due to steroids needed for my back. Done with that course of meds, now getting my INR back in line. In the meantime, I won’t be skateboarding on the half-pipe until I’m in range again.
hang brutha ...

ps
I think some read this forum and get defensive or even hostile when the trade offs are pointed out. As though it’s an attack on one choice or the other.

that's called "tribalism" and sadly its common
 

pellicle

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Also @Admin I'm also aware of a group of posters who prefer to personally attack me rather than engage in fruitful and logical discussion (this). That you permit this is poor form. It leads to an antagonistic atmosphere not an inclusive and supportive one.

I have most of these people on my ignore list (as you must know) but people still mention it to me and I know that this tribalism sets a poor tone for the forum.

I support discussion and debate of the facts, and one recent for instance attack on me calls things "my standards" but has himself failed to ever substantiate his own claims with more than "my doctor told me". May as well get a letter from his mum, right?.

Its up to you what sort of place you want to curate here, but its pretty sad when Reddit has a better and more managed heart valve subreddit.

I shall however continue to provide the same actual support of perople here, as well as be a source of veracity based content. I will continue to encourage people to get the facts as indicated by the following sorts of sources:
  • Peer Reviewed Journals
  • The Annals of Cardiothoracic Surgery
for making their "informed choice".

Your response (even its lack of) will clarify to any readers what sort of place this is. I hope its not just a click-revenue page of traffic.

Best Wishes
 
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