porcine vs. bovine? any thoughts helpful

[pellicle]

Strips can be $10 each, a lab draw is $17 where I'm at. $1,100 up front cost for a machine would take 157 tests to make up the costs. 3 years if testing weekly, 13 years if monthly.

Online prices can be down to US$6 per strip if buying in 48 strips.

Some places don't have convenient labs. I often wait 45min at the lab. That is annoying. Home testing allows you to be in control rather than be a passive recipient. A patient. Clearly home testing is not for everyone but as I mentioned stuff can be sourced at much much lower prices than $1100 (a figure I only started with to compare with the possibility that simply warfarin alone would be $2000 a month (as open stated)

A used coaguchek can make it cheaper.

An alternate cost benefit analysis could be:
* Used coaguchek (sold by someone who didn't like home testing for instance) ~= $500
* 48 strips ~= $260
Yeilds $15.80 each for those 48 tests
However you get to keep the meter so subsequent tests are $5.41 each test.

Compared to lab tests you are ahead before you complete the first 48

This doesn't factor in blown strips in training nor the costs of transport to and from the lab. Thus this is not exhaustive.

However my point is that other economic choices can offer more advantages.

Lastly but not insignificantly
http://www.lancet.com/journals/lancet/article/PIIS0140-6736(00)02470-3/abstract

The proportion of patients who spent most time in the therapeutic target range was larger during self-management than during anticoagulation clinic-guided management.
The odds ratio for a better control of anticoagulation (defined as the period of time in the therapeutic target range) during self-management compared with anticoagulation clinic-guided management was 4·6 (95% Cl 2·1—10·2).
A patient-satisfaction assessment showed superiority of self-management over conventional care.

Most certainly self monitoring is not a panacea and some may feel uncomfortable with it. Further good reading here

http://web.clas.ufl.edu/users/msscha/mtmcc/meta_analysis_coumarin_selfmgt.pdf

Information is power

 

[jhusker2]

Kate,

I was facing the same dilemma about my mitral valve as well a little over 2 years ago. I was so hopeful that they would repair my calcified mitral valve ( surgeon gave me 80% probability he could save it) that I never gave the thought of a replacement valve a real chance. That said, I still did my homework and opted to receive the Edwards Magna Mitral ease bovine valve in case the repair was unsuccessful. The fact that it is a 3rd generation bovine valve with anti-calcification thermaflex technology seemed appealing to me. Nonetheless, when I woke up from surgery, the first words out of my mouth were, "did they repair my valve?" Unfortunately, they couldn't and didn't, so I ended up with the MAGNA bovine replacement. My surgeon insisted that the 3rd generation valves should last a heck of a lot longer than previous generation tissue valves, but there isn't enough factual data to really support the claim. That said, it is completely a waiting game to know for sure.... There isn't a day that goes by that I wonder just how much longer do I have before round 2 though. At the same token, I'm grateful to be able to enjoy life without worrying about daily medication and INR levels ( In retrospect,... to enjoy life period). I used to take a daily aspirin, but now I'm fortunate to not take anything.

I would stay on this forum and continue to research your best options. That said, this forum was and continues to be an invaluable resource that was my saving grace going through the entire process. There are so many wonderful contributors on here everyday that I can't imagine anyone going through heart surgery without hearing their stories and advice....

Good luck and please keep us posted on your progress!

Jason

 

[neil]

both are good valves and am very happy with my porky pig,didnt want to be on anti coags and all the problems that it might bring, saying that most do well on it, good luck with your choice,

 

[Ola Thoresen]

Re: porcine vs. bovine? any thoughts helpful

Just to get back to the catheter-discussion for a second. I asked my surgeon a lot about it, and was wondering if I could volunteer for one of those. Being a chicken I was really frightened about the thought of all the pain of an open surgery.

However none of the doctors would even consider it. There are several issues that are not resolved, and neither of them believed they would be in the foreseeable future.

* They can't remove the old valve that way, so all they do is insert the new valve inside the old one. That means there is a higher chance of leaks, and all the calcium and other residue is left there.
* Even if they could cut out the old valve, there would be a huge risk of debris or other impurities being released into the blood, while removing it, causing clotting, heart attack or other severe problems.

Of course they might find a solution to this, but the last issue is what they are really afraid of, so unless they find a way to get rid of ALL of the old valve and be sure nothing is lost into the blood stream, they probably stick to the safe, old way.

That said, I had a lot less pain and problems than I first expected. It is now less than 2 months since surgery, and I am already beating my old records on the treadmill. I have not had any real pain since week two or three. And even then, a couple of paracetamol would be enough.

I will live the same life I used to. I'll travel, do sports, go skiing, and not really be any different from before surgery (except that now I might have a hope of beating my girlfriend in squash).
I take a few pills every day, but that is just routine. I self check inr values at home. Currently they do it at the lab as well, but already they say I don't have to do it more than once every second week. Later, when they know I'm stable, it might be once a month or even every second month. And I'm not talking about a long, long into the future. They say that might be from April.
When travelling, all I have to remember is to bring the medication, and my coagucheck if I'm away for more than a couple of days.

So I don't think the cost will be overwhelming, and you can probably keep on doing all the stuff you like.

Good luck, no matter what your choice of valve ends up with.

 

[Jkm7]

Kate,

I was facing the same dilemma about my mitral valve as well a little over 2 years ago. I was so hopeful that they would repair my calcified mitral valve ( surgeon gave me 80% probability he could save it) that I never gave the thought of a replacement valve a real chance. That said, I still did my homework and opted to receive the Edwards Magna Mitral ease bovine valve in case the repair was unsuccessful. The fact that it is a 3rd generation bovine valve with anti-calcification thermaflex technology seemed appealing to me. Nonetheless, when I woke up from surgery, the first words out of my mouth were, "did they repair my valve?" Unfortunately, they couldn't and didn't, so I ended up with the MAGNA bovine replacement. My surgeon insisted that the 3rd generation valves should last a heck of a lot longer than previous generation tissue valves, but there isn't enough factual data to really support the claim. That said, it is completely a waiting game to know for sure.... There isn't a day that goes by that I wonder just how much longer do I have before round 2 though. At the same token, I'm grateful to be able to enjoy life without worrying about daily medication and INR levels ( In retrospect,... to enjoy life period). I used to take a daily aspirin, but now I'm fortunate to not take anything.

I would stay on this forum and continue to research your best options. That said, this forum was and continues to be an invaluable resource that was my saving grace going through the entire process. There are so many wonderful contributors on here everyday that I can't imagine anyone going through heart surgery without hearing their stories and advice....

Good luck and please keep us posted on your progress!

Jason

I was in similiar situation and my surgeon really wanted to attempt a repair though he thought the chances small. My fear was a failed repair but seeing this was my second OHS with this surgeon at Mass General (now rated the number one heart center in U.S.), I agreed for him to try. Deep down, I really wanted a tissue replacement...... and I got what I wanted.

My surgeon said similar to me about third general bovine. They can only base their estimates on longevity of viability for these valves by factoring how long the older model lasted and what improvements have been made. In those patients approaching the range of 60 years old, they really expect they will last twenty plus years and are not ruling out more. All of these fine surgeons are not 'misleading' us with this information. If it was only one or two, perhaps they were 'wishful thinkers' but the majority are in agreement.

 

[tprice54]

Kate, if I may, the porcine valve is the actual pig valve fom their heart. The bovine valve, made by Edwards, is made from the pericardial sac from the cow, and hand sewn into a valve. That is the difference. How well they work, or last....well, that is the great debate!!

 

[epstns]

Thanks for the clarification, Tom. I had forgotten that the pig valve was a natural valve, while I did remember that the Edwards bovine valve is an "engineered" valve.

MOO!

 

[kate22]

thanks everyone for your responses and support, am so glad I found this support network My first instinct had been to go with a tissue valve as that was my surgeon's recommendation and his hopes that a trans-cath would be available in the future ---but after much research -- I'm 57 (yesterday, happy b-day to me) --and would be looking at at least 2 tissue valves, maybe 3 figuring in a younger active person they last 8-10 yrs. And I think also that from my reading the mitral trans-cath is behind the aortic and also will be only for no other option candidates for quite a while. And that is also my understanding from research, that the trans-cath does not replace your existing valve but just puts in place a new one. So, now am re-thinking and may decide on the mechanical despite the coumadin thing. What was confusing is that my surgeon had recommended the tissue, but in talking to my cardiologist, he was for the mechanical. That made me feel very much alone until I started reading this network and all your posts, so truly, thanks. I have a wonderful, super supportive husband, but it's hard to work your way through all the different options, pros and cons to come to a decision. So, yes, I get now that the choice is totally my own, and I am the one who will have to live with it. P.S. This is actually my second heart surgery --- I had open heart surgery to correct an atrial septal defect when I was 8 - so will be my 50th anniversary next year, yeahhh!!! The mitral thing is unrelated, just luck of the draw. Because of the scar tissue from that operation they are unable to consider the minimally invasive robotic procedure. My scar from that operation is in the shape of an upper case "T",and still very visible - my surgeon says he'll make one straight line thru' it and go up higher, so now I'll have a lower case"t" - but when I was a kid, my dad used to say the doctor signed his initial on me (his name started with T) - and again, my surgeon's name starts with T, too funny!! K

 

[Jkm7]

One thing you may want to research a bit more while making your decision......

At 57, you are in the range of it being totally realistic a tissue valve could last upwards of 20 years. Your statement of 8-10 years would apply to a much younger person in most cases. None of us have guarantee, of course, but you are really 'low balling' saying you only expect 8-10 years from it.

 

[epstns]

I'll agree with Jkm7. Do the research - you may have more options than you think. (I know - makes the decision tougher. But then, at least you would know that you considered all the options.)

I had my aortic valve replaced with bovine tissue at age 63. I may not have to do it again. If I do, I'll deal with that set of options at that time. Until then, it simplifies things without anticoagulation to manage. (Plus, I can still sneak up on people without them hearing a mech valve. . . )

 

[SimonB100]

For us, the choice of tissue valve-type was more important than the bovine/porcine issue. Having looked at the durability data for different tissue valves (replacement life being the main determinant of valve choice), we went with the bovine CE Perimount, since trials have been conducted over an extended period and the data was there for us to see. Best wishes

 

[missaviator]

At 19yr old I had Double Valve Replacement. I have a Bovine on my Aortic valve and Porcine on my Mitral valve. A little over 9 years and the valves look okay still. Will definitely need them replaced again soon, I will make the same choice as I would like to have a couple babies.

 

[CarolM]

As others have said, seems to matter the most to our surgeons. I went with bovine since my surgeon has had great success with their longevity.
He is the expert, so here's hoping he is right!

Best of luck!

 

[Pat J]

And I went with mechanical valve same diagnosis as Carol in Feb at Johns Hopkins as I'd like to never have OHS again!

 

[CarolM]

And I went with mechanical valve same diagnosis as Carol in Feb at Johns Hopkins as I'd like to never have OHS again!

Amen to no more OHS. It's the biggest factor, in my opinion. I am hopeful my future replacement procedure will be trans-catheter. My surgeon thinks this is extremely likely. No guarantee of course; just wishful thinking. Another spin of life's roulette wheel!