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

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newarrior

I have mild moderate Aortic Stenosis live Bangkok
Joined
Jun 28, 2019
Messages
550
Location
Bangkok Thailand
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
 
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tommyboy14

Active member
Joined
Mar 17, 2014
Messages
35
Location
London, United Kingdom
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.


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

I have mild moderate Aortic Stenosis live Bangkok
Joined
Jun 28, 2019
Messages
550
Location
Bangkok Thailand
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
 
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