In my last posting, I speculated that repairs of tissue valves 20 years from now could be done as a minimally invasive repair. It's good to hear from Lyn that there are now tissue valves with 20+ year track records. It should be safer for us old people to not have to worry about INRs and anticoagulation when we hit our 70s or higher age ranges.
I'll back off my cynical view that some doctors put in valves with shorter anticipated useful lives than those for mechanical valves, and hope that the future proves this less cynical view to be well placed.
(And returning to the original subject of this thread - there are medications being developed that seem to do a better job than warfarin -- lets just hope that these are developed soon, by a company whose only motivation isn't pure profit, and the cost could approach that of warfarin)
You can be as cynical as you want, doesn't bother me ..I just wanted to make sure others know, things you HOPE happen or specualte MIGHT happen, or possiby happen in 20 or more years already either exist and have for years, like the tissue valves they started using in the early 80s and have already proven record of over 20 years in the majority of patients over 65, or how they will need replaced and have been talked about/with links quite often here, for longer than I was a member.
Min invasive repairs/replacements that involve much smaller incisions or robotics, have been in use for probably close to a decade- but even better percutaneous valve replacement, that beside only needing a small incision for the cath, also do NOT need the heart/lung machine Already have been APPROVED and done daily in the US, for pulmonary valves (for the most part in children or young adults who are very active). I'm sure anyone who has been a member here for even a few months also is aware that the trials for Percutaneous Aortic valves already have been going on, with great results for edwards sapien valve and most likely WILL be aproved in the US the beginning of 2012 if not earlir. Medtronics corevalve trials have also started in the US and according to one of the latest european conferences almost HALF of the Aortic tissue valv e implanted in Europe this year have been done by Cath. (links somewhere here ill look for them later)So chances are pretty good the " 80 year old whose tissue valve lasted for 20 years and is facing repair or replacement, the prospect of another open heart surgery could be pretty daunting". most likley ill be able to have it replaced in the cathlab and be home in a day or so, like people with stents are, without the long recovery OHS involves. Actually chances are pretty good a person who is 60 now and chooses a tissue valve, not only can have this valve replaced by cath in 10-20 years, but already they are replacing cath valves with new cath valves, so he'd probably be pretty safe. They are working on percutaneous valves for the other valves too, but pulmonary and aortic are much further along
There are very good reasons MANY of the leading surgeons are reccomending tissue valves in patients 60 and up NOW with the hope they will live a long and happy life and when THIS valve needs replaced in 10-20 years they will most like have a cath, day surgery. Of course some people won't be able to avoid OHS, depending why they need another surgery.
Thats without even taking into considerations coumadin and ANY anticoagulants DO have risks, and the risks go up even more in the "elderly" especially if they have other comorbidities that being on anticoagulents can, not will complicate, or fall etc (when most studies show elderly people who are on coumadin IN RANGE do the worst, even in something as small as a fall from standing.) not to mention other things like bone density that involve Vit K, that Coumadin can (of course not always) make worse. The fact is the % of valve patients getting tissue valves is increasing quite a bit in the last 5-10 years
YES some tissue valves can and Do last much shorter than hoped for or the average, especially in younger (less than 40) either because of the valve being calcified or poor stitching, panus, BE etc . but like you remember the short lasting tissue valves, I remeber quite a few of the older members whohad their mech valve over 20 years, were on their 2nd mech valve or needed another surgery to repair of clean up their origonal one..just like Justin's dacron conduit that SHOULD have lasted "forever" needed replaced in less than 2 yars..thing happen. Even if the valve didn't malfunction, from our experience id doesn't matter why you need the extra surgery, just the fact you do.
but yes it is great they are working on so many new things, better meds that dont need testing and aren't related to vit K, so food doesn't matter as well as better surgeical techniques and valves. MY big hope for the future is tissu egineered valves, that they will be able to make from the person's own cells, so SHOULD not only last long, but even better grow with children if they get them so they dont need extra surgery because they outgrew their valve.