NEWBIE: Needs advice
- Thread starter W84Me
- Start date
Help Support Valve Replacement Forums:
carolinemc
Well-known member
I
I was 36 when I got my St. Jude's Aortic leaflet valve in 2001. It is now 2023, still ticking and alive. And on warfarin and living alone. Very active. After one year, never heard the ticking, for you get so used to it, you won't hear it. So do not hesitate if you do not want another surgery 10 years later. Mechanical is a great way for a young person to go. Good luck with your decision.
user 15848
Liborio
- Joined
- Sep 20, 2015
- Messages
- 286
Well, i know one lady with a Ball Cage Mechanical Valve, that she got 45 years ago at 22;
has 3 children and that was a way back then Mechanical Valve, so today's St Jude and Onx should last at least 70....., But, some other collateral issues may show up, aortic related.
W84Me
Active member
- Joined
- Jun 24, 2023
- Messages
- 35
pellicle:
Your points are very well taken. A proven track record over the years is a powerful evidence of a product. And St. Jude thrives from that. One of the things I was made aware of was that On-X tends to be not prone to coagulation due to a specific coating. Hence they advertise lower INR requirement, at least in theory.
Will discuss both the valves with the surgeon and think about the benefits. I will definitely bounce the surgeon’s perspective here.
Meanwhile I came across this paper that relates to 20-year follow-up of On-X.
Your points are very well taken. A proven track record over the years is a powerful evidence of a product. And St. Jude thrives from that. One of the things I was made aware of was that On-X tends to be not prone to coagulation due to a specific coating. Hence they advertise lower INR requirement, at least in theory.
Will discuss both the valves with the surgeon and think about the benefits. I will definitely bounce the surgeon’s perspective here.
Meanwhile I came across this paper that relates to 20-year follow-up of On-X.
Last edited:
1. Good Choice
2. In my opinion, your reasons aren’t valid. People like to throw around On-X being a “next generation” valve. Compared to what?! Lol. If so, then the SJM is a “next generation” valve too. The On-X is not lenient on INR (IMHO). It’s just marketed that way to get people to use it.
3. As long as the keyhole surgeon agrees that he/she can do just as good of a job as SAVR. I know that we’ve seen mini-sternotomies be extremely successful here (Chuck C).
Two random thoughts from me:
- I have never really noticed the ticking with my 29mm St Jude (now in its 10th year). It is very quiet, and I have to actively listen for it to notice. I am not sure of the factors that affect the sound level: valve alignment? Valve size (with larger valves quieter)? Our build (I'm on the large side)? So all are things that are largely out of our control. Also, as we get older we hear some frequencies less of course.
- I was delighted to see that a new technique for appendix removal via the mouth is known as "cakehole surgery"
pellicle
Professional Dingbat, Guru and Merkintologist
first thing I noted
The mean clinical followup duration was 10.5±5.3 (median 10.9) years.
10 years, hardly anything really, even for a bioprosthesis
Sorry if that seems hard, but I always have a hard look at data.
pellicle
Professional Dingbat, Guru and Merkintologist
delighted to see that a new technique for appendix removal via the mouth is known as "cakehole surgery"
pellicle
Professional Dingbat, Guru and Merkintologist
@W84Me
its fascinating how much almost nothing has changed since 1979
I recommend a hard eyed read of this (with a highlighter pen) attachment.
Note, the mech valve being studied was the ball and cage, not the newer improved models of today like we all will get. Remember, Dick still has his from back then.
its fascinating how much almost nothing has changed since 1979
I recommend a hard eyed read of this (with a highlighter pen) attachment.
Note, the mech valve being studied was the ball and cage, not the newer improved models of today like we all will get. Remember, Dick still has his from back then.
pellicle
Professional Dingbat, Guru and Merkintologist
Hi
First I take their data and put it in a meaningful presentation order
This sort of slab isn't easy to read and process (for at least me)
So I pull out what's significant in a text editor so I can reformat it
The mean clinical follow up duration was 10.5±5.3 (median 10.9) years.
not terribly long for a mech (already mentioned this)
ok, is that good or bad?
https://pubmed.ncbi.nlm.nih.gov/34795909/A total of 11,190 index cardiac operations were performed during the study period and operative mortality occurred in 246 (2.2%) of patients.
so looks like their results are a little worse
(why did they linearize?)
to me its not suitable nor good for anything other than hiding data Its like a flash flood that kills everyone in the township vanishes in linearised 20 year data.
ok .. but why is NSVD even a thing in mech valves, I've literally never heard of it outside of bioprosthesis and why is it that high?
right ... now we see where the NSVD occurred ... even if we don't know why. I'm reminded of an old engineering quote
Theory is when we know why something should work, but it doesn’t.
Practice is when something works, but we don’t know why.
Here Practice and Theory meet: It doesn't work and we don’t know why."
I hope this shows you the sort of due dilligence which is required when reading a journal article. If you don't do that then you're just accepting what they say without question.
This car was one owner.
HTH
so I thought I'd walk you through how I read that sort of thing
First I take their data and put it in a meaningful presentation order
This sort of slab isn't easy to read and process (for at least me)
Between 1999 and 2015, 861 patients (mean age=51.6±10.9 years) who underwent prosthetic valve replacement using the On-X valve in the aortic or mitral position were enrolled (aortic=344, mitral=325, double=192). The mean clinical followup duration was 10.5±5.3 (median 10.9) years. Operative mortality occurred in 26 patients (3.0%), and linearized late cardiac mortality was 0.9%/patient-year without an intergroup difference. Linearized thromboembolism, bleeding, prosthetic valve endocarditis, non-structural valve deterioration (NSVD), and reoperation rates were 0.8%/patient-year, 0.6%/patient-year, 0.2%/patient-year, 0.5%/patient-year, and 0.5%/patient-year, respectively. Prosthetic valve endocarditis was more frequent after double valve replacement than after aortic or mitral valve replacement (P=0.008 and 0.005, respectively). NSVD and reoperation rates were significantly lower aortic valve replacement than after mitral or double valve replacement (P=0.001 and 0.002, P=0.001 and <0.001, respectively). Valve replacement in the mitral position was the only risk factor for NSVD (hazard ratio [95% confidence interval]=5.247 [1.608–17.116], P=0.006).
So I pull out what's significant in a text editor so I can reformat it
The mean clinical follow up duration was 10.5±5.3 (median 10.9) years.
not terribly long for a mech (already mentioned this)
Operative mortality occurred in 26 patients (3.0%), and linearized late cardiac mortality was 0.9%/patient-year without an intergroup difference.
ok, is that good or bad?
https://pubmed.ncbi.nlm.nih.gov/34795909/A total of 11,190 index cardiac operations were performed during the study period and operative mortality occurred in 246 (2.2%) of patients.
so looks like their results are a little worse
Linearized
(why did they linearize?)
to me its not suitable nor good for anything other than hiding data Its like a flash flood that kills everyone in the township vanishes in linearised 20 year data.
thromboembolism: 0.8%/patient-year,
bleeding; 0.6%/patient-year,
prosthetic valve endocarditis: 0.2%/patient-year,
non-structural valve deterioration (NSVD): 0.5%/patient-year, and
reoperation rates: 0.5%/patient- year,
ok .. but why is NSVD even a thing in mech valves, I've literally never heard of it outside of bioprosthesis and why is it that high?
Valve replacement in the mitral position was the only risk factor for NSVD (hazard ratio [95% confidence interval]= 5.247 [1.608–17.116], P=0.006).
right ... now we see where the NSVD occurred ... even if we don't know why. I'm reminded of an old engineering quote
Theory is when we know why something should work, but it doesn’t.
Practice is when something works, but we don’t know why.
Here Practice and Theory meet: It doesn't work and we don’t know why."
I hope this shows you the sort of due dilligence which is required when reading a journal article. If you don't do that then you're just accepting what they say without question.
This car was one owner.
HTH
nobog
Well-known member
I can tell you that is absolutely not true. "On paper" the valve will, in practice it does not. Marketing hype. Hint: that tells you something about the flow through the valve.
I disagree that they are a good read. The document is more than 30 years old, and much has changed since then. Not least the introduction of POC devices like the CoaguChek meter to monitor INR and enabling the patient to manage it effectively, and valve design.
The author of the first report, Donald Ross, considers a mechanical valve to be a "sword of Damocles" hanging over the patient, with the threat of "embolism, thrombosis and anticoagulant haemorrhages" and the need to attend regularly at haematology departments. As the "owner" of a mechanical valve I feel exactly the opposite, with the sword of Damocles being if I had a tissue valve wondering how long it would be before my quality of life started to decline and another operation become necessary.
He then goes on to state that a biological valve does not require anticoagulation, which may be true for the risks he has already set out for mechanical, but ignores the increased risk of atrial fibrillation all valve replacement patients face.
At least the authors of the second report, Dieter Horstkotte et al, acknowledge the benefits of home prothrombin estimation, describing it as a "major advantage, not only in the reduction of morbidity and mortality after valve replacement surgery, but also in the improvement of the quality of life".
They also make some interesting remarks about the issue of valve noise, stating that those with "high tone sound sensitivity ... (exceeding 8kHz) may find the high tone clicks of a mechanical valve especially unpleasant ...". As we get older we naturally find our high tone hearing reduces, so I wonder if it is worth a prospective patient undergoing a hearing test to see how good their high tone hearing is, and therefore whether that might be an issue for them. In my case the clicking has never been an issue, and mine was done when I was 48 years old, so I am not sure how much the sound level varies due to other factors.
I am only half way through the 33 pages, so may add to this once I return and read on.
Edited to add: I do not wish to dismiss tissue valves as an option; we each have our own set of issues that are important to us, placing different values on different factors, and whatever valve we choose will be a better outcome than ignoring the problem, or putting off a decision until our heart is in a worse shape. There is no doubt that being a "highly compliant" patient, taking medication regularly and not missing doses, is important for mechanical valvers, but earlier in this thread you have already said that you are good in this regard..
Last edited:
carolinemc
Well-known member
That is why I go by expert information, not marketing.
W84Me
Active member
- Joined
- Jun 24, 2023
- Messages
- 35
So I did the STS risk score calculation based on what I so far know including blood levels etc. (including first cardio surgery) and left the items blank that I did not know. Attached is the result. The thing that comes out me at is the morbidity and mortality at almost 15%. Should I be worried? Of course, it is only one parameter in the whole scheme of things.
Attachments
pellicle
Professional Dingbat, Guru and Merkintologist
no you should be vigilant.
The accident rate is not what happens to everyone, its what happens to the group who behave like a group
Do you eat like this?
or like this?
that isn't taken into account when dealing with the average who eat like the above one
What you do makes a difference to those scores.
Just Saying
Did you do the test on the basis of NOT having the valve replaced? That score is 100%
Superman
Well-known member
I eat like the first picture. Did a 20 mile bike ride today though. I’m all about balance.
