Old topic new spin: Valve selection--I am getting close to my AVR date--thanks for the feedback)

[newarrior]

My Pros Cons Short I know apologies

Mechanical

Pros
Long life-not always

Cons
Warfarin and all related things
Ticking

Tissue

Pros
No ticking
No warfarin

Cons
Shorter life lifespan
Lifespan even shorter still if you have high lipoprotein

 

[tommyboy14]

There are also differences in statistical survival depending on your age.

The article below is a synthesis (I.e. summary) of studies that compared the survival consequences of a mechanical vs a tissue valve.

It basically says that if you look across the literature, if you are less than 50, there is no survival advantage. In the 50-70 group, mechanical valves offer a survival benefit over tissue valves, and the in the 70 plus group, tissue valves offer a survival benefit over mechanical ones.

https://academic.oup.com/ejcts/adva...8/6571808?redirectedFrom=fulltext&login=false
There are a few things to keep in mind when looking at these statistical studies, which refer to populations. Younger people tend to be have less concurrent disease on average than an older people. So perhaps the less than 50 years result is just reflective of underlying baseline health. in other words, survival after surgery really depends on your individual circumstances.

Finally, I would say that many of these statistical results are likely not as applicable today. To get 20 years results in Humans, you need to rely on technology from 20 years ago. But the underlying technology changes over time, including for mechanical valves. I.e. For mechanical valves, sef-testing and self-management are now much more common in many countries and across age groups (20 years ago it was just Germany that was really using this technology on a large scale). This apparently reduces anti-coagulant related side effects by 40% or even more. For tissue valves, the inspiris resilia and foldax valves could turn out to be much more long-lasting than the tissue valves we have today, but there is no way of knowing.

The only thing that is still certain is that you will likely not need a re-op with a mechanical valve. With a tissue valve its not so clear anymore (I.e. if you are 60 and get 10-15 out of a tissue valve, then you are probably TAVI candidate, so no more OHS required. However TAVI is not a risk-free option/procedure. The data show a higher pacemaker rate with TAVI.

Good luck with your decision.

 

[newarrior]

inspiris resilia and foldax

Thanks--taking notes from your valuable insights to my doctor--Expected lifespan of each type of valve--thank you never thought of this..I will dig into this more...I am leaning towards tissue - but my high Lpa will lower the life of this valve--maybe--and also depends on what tissue valve is available here in Thailand.. The hope would be get TAVI when tissues wears out--great questions for my surgeon..thank you sir

 

[newarrior]

There are also differences in statistical survival depending on your age.

The article below is a synthesis (I.e. summary) of studies that compared the survival consequences of a mechanical vs a tissue valve.

It basically says that if you look across the literature, if you are less than 50, there is no survival advantage. In the 50-70 group, mechanical valves offer a survival benefit over tissue valves, and the in the 70 plus group, tissue valves offer a survival benefit over mechanical ones.

https://academic.oup.com/ejcts/adva...8/6571808?redirectedFrom=fulltext&login=false
There are a few things to keep in mind when looking at these statistical studies, which refer to populations. Younger people tend to be have less concurrent disease on average than an older people. So perhaps the less than 50 years result is just reflective of underlying baseline health. in other words, survival after surgery really depends on your individual circumstances.

Finally, I would say that many of these statistical results are likely not as applicable today. To get 20 years results in Humans, you need to rely on technology from 20 years ago. But the underlying technology changes over time, including for mechanical valves. I.e. For mechanical valves, sef-testing and self-management are now much more common in many countries and across age groups (20 years ago it was just Germany that was really using this technology on a large scale). This apparently reduces anti-coagulant related side effects by 40% or even more. For tissue valves, the inspiris resilia and foldax valves could turn out to be much more long-lasting than the tissue valves we have today, but there is no way of knowing.

The only thing that is still certain is that you will likely not need a re-op with a mechanical valve. With a tissue valve its not so clear anymore (I.e. if you are 60 and get 10-15 out of a tissue valve, then you are probably TAVI candidate, so no more OHS required. However TAVI is not a risk-free option/procedure. The data show a higher pacemaker rate with TAVI.

Good luck with your decision.

Thanks re reading your reply and the link. I am about to turn 61 and am 1-3 months out from surgery. I agree with all the other points you made. Yes calcification tends to break off in an uncontrolled manner when the new TAVI valve is inserted so you higher degree of stroke, afib and pacemaker risks.

 

[newarrior]

There are also differences in statistical survival depending on your age.

The article below is a synthesis (I.e. summary) of studies that compared the survival consequences of a mechanical vs a tissue valve.

It basically says that if you look across the literature, if you are less than 50, there is no survival advantage. In the 50-70 group, mechanical valves offer a survival benefit over tissue valves, and the in the 70 plus group, tissue valves offer a survival benefit over mechanical ones.

https://academic.oup.com/ejcts/adva...8/6571808?redirectedFrom=fulltext&login=false
There are a few things to keep in mind when looking at these statistical studies, which refer to populations. Younger people tend to be have less concurrent disease on average than an older people. So perhaps the less than 50 years result is just reflective of underlying baseline health. in other words, survival after surgery really depends on your individual circumstances.

Finally, I would say that many of these statistical results are likely not as applicable today. To get 20 years results in Humans, you need to rely on technology from 20 years ago. But the underlying technology changes over time, including for mechanical valves. I.e. For mechanical valves, sef-testing and self-management are now much more common in many countries and across age groups (20 years ago it was just Germany that was really using this technology on a large scale). This apparently reduces anti-coagulant related side effects by 40% or even more. For tissue valves, the inspiris resilia and foldax valves could turn out to be much more long-lasting than the tissue valves we have today, but there is no way of knowing.

The only thing that is still certain is that you will likely not need a re-op with a mechanical valve. With a tissue valve its not so clear anymore (I.e. if you are 60 and get 10-15 out of a tissue valve, then you are probably TAVI candidate, so no more OHS required. However TAVI is not a risk-free option/procedure. The data show a higher pacemaker rate with TAVI.

Good luck with your decision.

Thank you again

 

[newarrior]

Hello everybody thanks for your responses. I'm going to see my surgeon again on the 10th I'm doing it for surgery on the 20th that's going to be the coronary angiogram then surgery on The 21st. Today is the third. My doctors pushing resilia but I don't know what the strategy is once the resilia fails. Got a lot of questions to ask him on the 10th. Regardless it looks like I'm definitely in the severe category may have been for a long time maybe for over a year which is insane and it looks like I'm starting to have pretty bad damage to my heart which could be irreversible. I've got Category 2 diastolic dysfunction which is bad. I'm getting more and more left ventricle hypertrophy bizarrely though I can still exercise at a pretty high level but that may be my diet my fitness anyways hope everybody's doing good I'll post some updates after the 10th and yes I totally agree that if you're under 71 mechanical is the way to go I'm just paranoid about the ticking and the managing my INR I'm not worried about taking the drug everyday self testing doesn't seem to be a big deal either I think I'm just worried about the ticking and modifying my diet also I tend to be an accident prone and fall and hit my head a lot