Society of Thoracic Surgeons Risk Calculator

Help Support ValveReplacement.org:

StretchL

Well-known member
Joined
Nov 15, 2005
Messages
627
Location
Miami, FL. I'm not really sure what country this
If someone knows a LOT about their condition, the following is a very interesting tool. It's a "risk calculator" on the web site of the Society of Thoracic Surgeons. It "allows a user to calculate a patient?s risk of mortality and other morbidities, such as long length of stay and renal failure. The Risk Calculator incorporates the STS risk models that are designed to serve as statistical tools to account for the impact of patient risk factors on operative mortality and morbidity."

Go to http://www.sts.org/sections/stsnationaldatabase/riskcalculator, put in your data, and await your fate. :eek:
 

bvdr

VR.org Donator
Joined
Mar 13, 2003
Messages
4,069
Location
Pinehurst, NC
Very Interesting. It is quite in depth but I'm not as bad a risk as I thought I might be:) .
 
S

SaraC

Guest
StretchL said:
If someone knows a LOT about their condition, the following is a very interesting tool. It's a "risk calculator" on the web site of the Society of Thoracic Surgeons. It "allows a user to calculate a patient?s risk of mortality and other morbidities, such as long length of stay and renal failure. The Risk Calculator incorporates the STS risk models that are designed to serve as statistical tools to account for the impact of patient risk factors on operative mortality and morbidity."

Go to http://www.sts.org/sections/stsnationaldatabase/riskcalculator, put in your data, and await your fate. :eek:
Thanks for the link Stretch. I haven't had surgery yet (anticipate around November-ish). I was wondering if there would be much of a risk difference post-Ross vs post- other valve. What do you think? SC
 

StretchL

Well-known member
Joined
Nov 15, 2005
Messages
627
Location
Miami, FL. I'm not really sure what country this
SaraC said:
Thanks for the link Stretch. I haven't had surgery yet (anticipate around November-ish). I was wondering if there would be much of a risk difference post-Ross vs post- other valve. What do you think? SC
Goodness gracious... that's way above my pay grade! :D

I will tell you that the learning curve for the Ross is VERY steep. I've read that one should not get a Ross from a surgeon who's done less than 100. I think I would raise that bar to 200, personally.

With 400+ under his scalpel, Paul Stelzer at Beth Israel has done more than anyone still cutting. (Ron Elkins has done the most in the US but he's retired.) Stelzer lost 3 patients perioperatively out of the first 30, then 3 out of the next 150, and none since then. He told me Saturday that a heart transplant is simple compared to the Ross. That was a real gut check for me. (Check his web site at http://ps4ross.com His son put it together, so it's very layman friendly.)

Stelzer's anecdotal statement is confirmed by the Society of Thoracic Surgeon's 2002-2004 Congenital Heart Surgery Data Summary. At the bottom, there's a table listing the degrees of complexity of various cardiac procedures. There are a couple of ways to read the table, but, basically, the valve replacements stack up this way, higher number being more complex:

Pumonary Valve Replacement 6.5
Aortic Valve Replacement, Bio 7.0
Mitral Valve Replacement 7.5
Aortic Root Replacement 8.0
Aortic Root Replacement, Mech 8.8
Aortic Aneurysm Repair 8.8
Ross Procedure 10.3

The Ross is also the only procedure given the highest "Basic Complexity Level" of 4.

It's not surprising that anything involving the left side of the heart is higher in complexity, given the high pressures on the left side.

I've uploaded this document to my web site. You can find it at http://stretchphotography.com/avr You can also get it and more at http://sts.org

Also on my site is a paper by Jaggers at Duke, where he states that Ross patients tend to stay in the hospital for a shorter time after the procedure, compared with mech valve patients. This is probably due to the fact that there's not so much of a concern with thrombosis as with a mech valve.

In my mind, and I'm still formulating my final opinion, the Ross is an attempt at a complete solution for a bad aortic valve. There's the possibility of a reoperation, but part of that risk is with the pulmonary valve, which is a much less complex procedure, and which is beginning to be done with "minimally invasive" techniques. Go to pub med:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?DB=pubmed and in the search window type: percutaneous pulmonary valve. You'll get plenty of references on this. (This link was given to me by VR.com member and Ross alum PapaHappyStar.)

Bioprostheses will wear out in younger patients and definitely require re-op. These are last in my line of choices right now.

Mechanical valves make life long Coumadin an absolute necessity. Many people on this board take the stuff, but you'll notice that there are a LOT of posts on here, also, about how to manage it. It seems that everything from a change in the weather to a change in the diet can get one out of range, and people on here are very well educated and very attentive to their conditions. Home testing is said to keep people within their therapeutic range more often, and it's the only silver lining in that entire cloud, in my humble opinion. Nevertheless, given the option, I don't want to end up in a hospital for an otherwise uneventful procedure and force a doctor into a corner trying to decide whether to raise my risk of stroke or raise my risk of hemorrhage because he has to work his treatment strategy around the INR issue.

Also, if you look at some of the data on the mechanical valves like the "25 year" study from Minnesota on my site, you'll find that what's called a 25 year study has a mean post-op time of only 7.5 years! Before I saw that I was leaning a bit toward the St. Jude's valve, but now not so much...

In addition to the technical complexity of the Ross, cardiologists and some surgeons don't like it because they say it takes you from being a one valve patient to being a two valve patient. I suppose this is true, in a way. But I would counter that the risks of thrombosis of the mechanical valve and the resulting Coumadin treatments take you from being a one valve patient to a patient with a risks in two no less important areas- stroke and hemorrhage.

Finally, the Ross Procedure is right only for a very narrow subset of AVR patients; there are some absolute contraindications for the Ross. While it may be a good solution for the few, it's not a good solution for the many. The mechanical valves are a good solution for just about everyone; there are fewer contraindications for them.

Based on my research thus far, the Ross seems to me to be like a tailor made suit, whereas the mechanical valve is off the rack. (This is not meant as an insult to the mechvalvers out there...)

With the tailor made suit, if the tailor is damned good at what he does, and he accepts you as a client, you will walk out with a suit that fits you perfectly, is well put together, and should last you a long long time.

With the off the rack suit, you can probably find something that fits you pretty well, but, since it wasn't made just for you, you might have to have it altered in order to make it look just right. If the alteration (read: anti-coagulation) is done properly, it also should last a long long time.

WHEW! I hope that helps explain my thinking. There is a TON of information online about the Ross, and a lot of great people on this board who have had it or other AVRs. Honestly, I feel blessed that I have a choice in the matter of my valve procedure. Neither the Ross nor a mechanical valve will be a mistake for me, I don't believe. One may be more convenient in the short term, and the other in the long term. Don't ask me which is which. It really is nearly a toss up for me right now.

I do feel that some important things going into AVR surgery are often overlooked. I think it's very important to be in the best physical condition possible, to stop smoking if you do (I've never smoked, but I've even stopped going into smoky bars), to eat right and to keep your head in the right place.

You've found a great resource with this site. I'll be interested to hear how your decision making process flows.

ps- Where do you live in Colorado? My wife and I were in COSprings for 4 years between 97 and 02.
 
K

Karlynn

Guest
StretchL said:
Mechanical valves make life long Coumadin an absolute necessity. Many people on this board take the stuff, but you'll notice that there are a LOT of posts on here, also, about how to manage it. It seems that everything from a change in the weather to a change in the diet can get one out of range, and people on here are very well educated and very attentive to their conditions. Home testing is said to keep people within their therapeutic range more often, and it's the only silver lining in that entire cloud, in my humble opinion. Nevertheless, given the option, I don't want to end up in a hospital for an otherwise uneventful procedure and force a doctor into a corner trying to decide whether to raise my risk of stroke or raise my risk of hemorrhage because he has to work his treatment strategy around the INR issue.

Also, if you look at some of the data on the mechanical valves like the "25 year" study from Minnesota on my site, you'll find that what's called a 25 year study has a mean post-op time of only 7.5 years! Before I saw that I was leaning a bit toward the St. Jude's valve, but now not so much...
Now Stretch.....:rolleyes: :).... There are a few things you are leaving out of your theory. We have the oldest living mechanical valve recipient in our membership. RCB has had mechanical valves for 45 years. True, he has had a few replacements. But considering that it was brand new technology at the time of his first surgery (and most did not survive the procedure) and valves have continued to be improved upon ever since. My 15 year-old valve and Linda's 25 year-old valve are still working fine. With me, having mine implanted when I did, if it had been tissue, I'd be on my 2nd one by now. And those receiving mechanicals now are getting better technology than Linda and I have.

We do have an Anticoagulation forum here where people come on and post problems or questions. But I think if you were to stop and compare the number of members who've posted with problems, to the number of members we have on ACT, you'll find there isn't a huge percentage. I think the biggest problem for people on ACT is management by those who are not up-to-date on what it is they think they know how to manage. And maybe that's a valid reason for not going with a mechanical. But your statement somewhat reads like ACT management is a huge pain in the @$$, and it isn't for most.

You'll notice that the "calculator" also gives choices for 1st surgery, 1st re-operation, 2nd and so forth. This would lead one to believe that, as we've always said here, the risk goes up for repeat surgeries.

We've had people with failed mechanicals, failed tissues, tissues that didn't last as long as the doctor "promised", and failed Ross Procedures. And let's face it, a lot of people find their way here because they're having problems, but does it reflect the over-all population? I don't know, but I would tend to doubt it because many of these procedures wouldn't be done if they didn't have good track records.

All this being said Stretch - If my problem was Aortic and I was told I was a great candidate for a Ross Procedure - that would be my first choice. But I would also want the doctor to make the final decision after getting in there and seeing the plumbing. I'd ask him to only do it if he was very sure it would work (because you're messing with 2 valves to fix one bad one), and if not, drop in the mechanical instead.
 

Dennis S

VR.org Supporter
Joined
Jun 28, 2005
Messages
1,595
Location
Northern New Mexico
"I do feel that some important things going into AVR surgery are often overlooked. I think it's very important to be in the best physical condition possible, to stop smoking if you do (I've never smoked, but I've even stopped going into smoky bars), to eat right and to keep your head in the right place."

This is intended as just a quick addition, (not intended to get this thread off track)... To the good suggestions you make above, I would add being sure your dental work is up to date, and-if called for by your individual circumstances-the beloved colonoscopy.
 

StretchL

Well-known member
Joined
Nov 15, 2005
Messages
627
Location
Miami, FL. I'm not really sure what country this
Karlynn said:
You'll notice that the "calculator" also gives choices for 1st surgery, 1st re-operation, 2nd and so forth. This would lead one to believe that, as we've always said here, the risk goes up for repeat surgeries.

All this being said Stretch - If my problem was Aortic and I was told I was a great candidate for a Ross Procedure - that would be my first choice. But I would also want the doctor to make the final decision after getting in there and seeing the plumbing. I'd ask him to only do it if he was very sure it would work (because you're messing with 2 valves to fix one bad one), and if not, drop in the mechanical instead.
Thanks for your thoughtful reply, Karlynn. Clearly, valve choice is a very personal decision.. I'm just posting my thoughts, which may or may not have any relevance to anyone else's situation.

Yes, the risk goes up with re-dos, but it is still minimal. This was mentioned to me in an e-mail I received this morning from a surgeon in Germany. I've copied and pasted it below, including my original e-mail to him. The paper he mentions is at http://www.stretchphotography.com/avr/SieversOnRoss.pdf

----------------------------------

Dear Charles ?Stretch" Ledford

Thank you for your e-mail. Ross or not is a question of attitude of the
surgeon and the patient. For the surgeon Ross is difficult, putting a lot of
responsibility on him. But the surgeon will very rarely get a follow-up call
telling that his patient is on the neurosurgical unit with brain bleeding due
to warfarin as an anticoagulant that is necessary with mechanical valves. But he will sometimes get back a patient for a redo especially on the homograft in the Ross. Long term results are scarce, we have 12 years experience (the paper is attached: Sievers HH. A Critical Reappraisal of the Ross Operation. Circulation. 2006; 114[suppl I]:I-504 ˆ I-511.) on 430 cases with 15 redoes now all of these went home after 10 days. To make it short, if you don't care taking warfarin and if you can keep the anticoagulation level constant, and if you are not disturbed by the click noise of the mechanical valve and if you are not afraid of getting a major bleeding or thromboembolism (risk of 1-2% per patient year) than take a mechanical valve. If you like near physiological hemodynamics but don't
care getting a redo (risk around 1% per patient year for Ross, about 0.3 for
mechanical valve) try to get a Ross.
However, a Ross is not always possible in every patient (in 5% anatomy of
aortic root or pulmonary autograft prevents a Ross). There is only one paper
with longer-term Ross patients (see Chambers JC. Pulmonary Autograft
procedure for aortic valve disease. Long-term results of the pioneer series.
Circulation. 1997; 96: 2206-2214 ). What is outstanding with Ross is no
medication, normal life expectancy, normal hemodynamics, almost zero risk of
bleeding and thromboembolism, no noise but the increased risk of redo.
I am working (or in your words burning) since 25 years developing mechanical
valve without the necessity of taking warfarin which would be a real progress
in valve surgery. We are now on a good way in the project, but not ready for
clinical implant. If you are interested and probably have an idea to support
this work please contact me.
If you like more information on the Ross please specify.

Sincerely

Hans H. Sievers


>Betreff : Ross Procedure
>Gesendet: 30.08.06 06:46:30
>An : "sievers@xxxxxx"
>Von: "Charles \"Stretch\" Ledford <Stretch@StretchPhotography.com>"

>----- Original Message -----
>Hello, Dr. Sievers. I found your e-mail address on CTS Net. Dr.
>Oury in Montana mentioned your name and your work to me during a
>telephone conversation this afternoon.

>I am a 43 year old male with congenital aortic stenosis. I have a
>bicuspid aortic valve. I am otherwise healthy- non-smoker, moderate
>drinker, very active, 6'4" tall and weigh 189. (Up from 155 about 3
>years ago!)

>My heart disease has been followed yearly since I was an infant. I
>have been asymptomatic until recently, when I gradually began to
>experience shortness of breath.

>A cardiac catheterization a few weeks ago indicated that it is time
>for me to have my valve replaced.

>My cardiologist, Dr. George Vetrovec, has recommended that my native
>aortic valve be replaced with a mechanical- probably a St. Jude. The
>surgeon here in Richmond, Virginia, Dr. V. Kasirajan, concurs.

>I am very interested in the Ross Procedure, and have spent way too
>many hours online researching it. Neither Drs. Vetrovec or Kasirajan
>are very enthusiastic about the Ross.

>Although the short and mid-term results of the procedure seem to be
>promising, I've not found much data (I don't know if it exists) on
>the long term prospects of the Ross.

>If you have any thoughts on the Ross, and especially any data on long
>term outcomes of your surgeries, I'd be very grateful if you'd share
>them.

>Thank you for your time.
 

StretchL

Well-known member
Joined
Nov 15, 2005
Messages
627
Location
Miami, FL. I'm not really sure what country this
Good Point

Good Point

Dennis S said:
I would add being sure your dental work is up to date, and-if called for by your individual circumstances-the beloved colonoscopy.
I agree completely. A few years ago I took notice of something I saw in the Readers Digest (the only magazine in America one can trust) :p that said one predictor of cardiac health among seniors is their level of dental health. That's when I started flossing. :)

Interestingly, I had a colonoscopy yesterday! It wasn't that bad... I actually enjoyed watching the monitor, much as I did watching the cath monitor a few weeks ago.
 
K

Karlynn

Guest
StretchL said:
To make it short, if you don't care taking warfarin and if you can keep the anticoagulation level constant, and if you are not disturbed by the click noise of the mechanical valve and if you are not afraid of getting a major bleeding or thromboembolism (risk of 1-2% per patient year) than take a mechanical valve. If you like near physiological hemodynamics but don't
care getting a redo (risk around 1% per patient year for Ross, about 0.3 for
mechanical valve) try to get a Ross.

Hmmmm - I'm sensing this guy isn't a fan of mechanical valves.:D Basically, he's telling you that only an idiot would choose a mechanical valve today. :rolleyes: Because what person in their right mind says they wouldn't mind a major bleed or a stroke. Plus, by putting it this way, he's making it sound like it is a large likelyhood, even though he gives the low percentage. (That's a seasoned debater's tactic.) What he doesn't say is what he would recommend if you aren't a Ross candidate. I was surprised at the 5% who don't qualify for a Ross. We've had several members here who were told they weren't Ross candidates, and that leads me to believe that the percentage may be higher - unless he's talking about a particular subset of those with Aortic Valve Disease.

While this doctor may know his "stuff" when it comes to the Ross (and judging from his Googled articles, he does), he sounds a bit like a BMW dealer who isn't about to talk up any other car other than a BMW. Doctors that specialize to that degree tend to be that way. BMW's are great cars, but so are Volvos and Audis. And a BMW dealer will be able to rattle off chapter and verse of things that are wrong with Volvos and Audis.

As I said, if I was a Ross candidate - that's what I'd go with. But I also wouldn't want to be so turned away from any other option that I would be worried, disappointed, or frightened if I awoke to find I was now having to live with it. So make sure you are really okay with your 2nd choice, what ever that is, if the Ross ends up not being an option.
 

Ross

Observer
Joined
Dec 16, 2001
Messages
25,981
Location
On The Hot Seat
Yes it does sound like a sales pitch.

Stretch let me say this, if you nearly lost your life during a first surgery do you honestly think that you'd believe statistical numbers when it came time to have another? I had no problem taking Mechanical, since I did not want to ever have to go through this again if it can be helped. To people like me, the stats on redo's are meaningless. The terror of experience makes the decisions.
 

RCB

Well-known member
Joined
Jul 21, 2003
Messages
1,101
Location
NW Ohio
Seems pretty thorough....but

Seems pretty thorough....but

StretchL said:
Thanks for your thoughtful reply, Karlynn. Clearly, valve choice is a very personal decision.. I'm just posting my thoughts, which may or may not have any relevance to anyone else's situation.

Yes, the risk goes up with re-dos, but it is still minimal. This was mentioned to me in an e-mail I received this morning from a surgeon in Germany. I've copied and pasted it below, including my original e-mail to him. The paper he mentions is at https://www.stretchphotography.com/avr/SieversOnRoss.pdf

----------------------------------

Dear Charles ?Stretch" Ledford

Thank you for your e-mail. Ross or not is a question of attitude of the
surgeon and the patient. For the surgeon Ross is difficult, putting a lot of
responsibility on him. But the surgeon will very rarely get a follow-up call
telling that his patient is on the neurosurgical unit with brain bleeding due
to warfarin as an anticoagulant that is necessary with mechanical valves. But he will sometimes get back a patient for a redo especially on the homograft in the Ross. Long term results are scarce, we have 12 years experience (the paper is attached: Sievers HH. A Critical Reappraisal of the Ross Operation. Circulation. 2006; 114[suppl I]:I-504 ˆ I-511.) on 430 cases with 15 redoes now all of these went home after 10 days. To make it short, if you don't care taking warfarin and if you can keep the anticoagulation level constant, and if you are not disturbed by the click noise of the mechanical valve and if you are not afraid of getting a major bleeding or thromboembolism (risk of 1-2% per patient year) than take a mechanical valve. If you like near physiological hemodynamics but don't
care getting a redo (risk around 1% per patient year for Ross, about 0.3 for
mechanical valve) try to get a Ross.
However, a Ross is not always possible in every patient (in 5% anatomy of
aortic root or pulmonary autograft prevents a Ross). There is only one paper
with longer-term Ross patients (see Chambers JC. Pulmonary Autograft
procedure for aortic valve disease. Long-term results of the pioneer series.
Circulation. 1997; 96: 2206-2214 ). What is outstanding with Ross is no
medication, normal life expectancy, normal hemodynamics, almost zero risk of
bleeding and thromboembolism, no noise but the increased risk of redo.
I am working (or in your words burning) since 25 years developing mechanical
valve without the necessity of taking warfarin which would be a real progress
in valve surgery. We are now on a good way in the project, but not ready for
clinical implant. If you are interested and probably have an idea to support
this work please contact me.
If you like more information on the Ross please specify.

Sincerely

Hans H. Sievers


>Betreff : Ross Procedure
>Gesendet: 30.08.06 06:46:30
>An : "sievers@xxxxxx"
>Von: "Charles \"Stretch\" Ledford <Stretch@StretchPhotography.com>"

>----- Original Message -----
>Hello, Dr. Sievers. I found your e-mail address on CTS Net. Dr.
>Oury in Montana mentioned your name and your work to me during a
>telephone conversation this afternoon.

>I am a 43 year old male with congenital aortic stenosis. I have a
>bicuspid aortic valve. I am otherwise healthy- non-smoker, moderate
>drinker, very active, 6'4" tall and weigh 189. (Up from 155 about 3
>years ago!)

>My heart disease has been followed yearly since I was an infant. I
>have been asymptomatic until recently, when I gradually began to
>experience shortness of breath.

>A cardiac catheterization a few weeks ago indicated that it is time
>for me to have my valve replaced.

>My cardiologist, Dr. George Vetrovec, has recommended that my native
>aortic valve be replaced with a mechanical- probably a St. Jude. The
>surgeon here in Richmond, Virginia, Dr. V. Kasirajan, concurs.

>I am very interested in the Ross Procedure, and have spent way too
>many hours online researching it. Neither Drs. Vetrovec or Kasirajan
>are very enthusiastic about the Ross.

>Although the short and mid-term results of the procedure seem to be
>promising, I've not found much data (I don't know if it exists) on
>the long term prospects of the Ross.

>If you have any thoughts on the Ross, and especially any data on long
>term outcomes of your surgeries, I'd be very grateful if you'd share
>them.

>Thank you for your time.
Did this unbias doctor, just happen to quote you the chances of AF if you are over 40 and no surgery. Furthermore, did he happen to mention that heart surgery increases your chances of AF. AF = warfarin. Funny how things just slip by here.:D

"But the surgeon will very rarely get a follow-up call
telling that his patient is on the neurosurgical unit with brain bleeding due
to warfarin as an anticoagulant that is necessary with mechanical valves. "
Yeah, probably true, but the same is true of patients who die on the table of redos. Surgeons rarely call the original surgeon!

"Yes, the risk goes up with re-dos, but it is still minimal."
Some would consider this misleading. If you have a surgery at 35,
then one at 50( and you haven't developed any other risk factors that come with age and the surgeon is experienced with redos ) the risk isn't bad, but if you have a third at 70, with all the associated aging problems- "minimal" doesn't seem to to be a word I would chose. Others may use the word of their choice.
 

mtkayak

Well-known member
Joined
May 1, 2006
Messages
281
Location
Smynra, GA
StretchL said:
Mechanical valves make life long Coumadin an absolute necessity. Many people on this board take the stuff, but you'll notice that there are a LOT of posts on here, also, about how to manage it. It seems that everything from a change in the weather to a change in the diet can get one out of range, and people on here are very well educated and very attentive to their conditions. Home testing is said to keep people within their therapeutic range more often, and it's the only silver lining in that entire cloud, in my humble opinion. Nevertheless, given the option, I don't want to end up in a hospital for an otherwise uneventful procedure and force a doctor into a corner trying to decide whether to raise my risk of stroke or raise my risk of hemorrhage because he has to work his treatment strategy around the INR issue.

Also, if you look at some of the data on the mechanical valves like the "25 year" study from Minnesota on my site, you'll find that what's called a 25 year study has a mean post-op time of only 7.5 years! Before I saw that I was leaning a bit toward the St. Jude's valve, but now not so much...
Warfarin managment is not as time consuming as it sounds. It only seems overwhelming right now is because you are reading a lot about it. There is a bit of a learning curve in the beginning where you need to watch your levels closely till they stabilize. This can take up to 3 months, even tissue valves require 3 months of Warafrin. Once, you levels are stable you start to see how your diet and activities may affect it. You will eventually learn to self dose. I have to admit in the beginning it is a pain in the ass to regulate but you will grow into quickly. Once, you get your own home kit, it gets even easier. Basically, you spend 5 minutes a week testing, that's it.
Mutiple 5 minutes a week x 52 times and that equals 4.333 hours a year to manage your Warafin. If you go to the Doctor once a month you might want to add an hour to that.

Some comments that my Surgeon of 35 years made regarding statistics:


Bell curve on tissue valves 8 to 10 years. Of course, after 10 years valve will slowy start to deteriorate, maybe lasting 15 years.

Mechanical valves: less than 1% for pannus encroachment

Bleeding events: annually is 2%. Not accumlative.

Thromboembolism: annaully is only 2% with proper Warfarin Management.

Reops: 5% mortality per occurance after 1st surgery. This is accumaltive. This is highly speculative as age, fitness and heart condition, procedure affects this number greatly.

St. Jude valve is the mechanical valve that has the longest successful track record with 25 years thus far.
 
P

Phyllis

Guest
Not to sabotage this thread, Stretch, but I checked out your commercial sites and you are truly a gifted photographer (as your nomination for a Pulitzer attests)- both the "art" and the "wedding photography". Found it interesting that you enjoyed watching the colonoscopy- must be the artist in your soul!:D You certainly have done your research and I know that you and your surgeon will make the best decision for "you".
 

RCB

Well-known member
Joined
Jul 21, 2003
Messages
1,101
Location
NW Ohio
Something to think about

Something to think about

A side on these discussions:
I am always amazed how member here discuss the latest development on heart surgery and yet never assume that ACT will be more accurately and easily managed in the future. I predict a growing market in this field as a result of the Boomers growing old. It doesn't take a Nesbitt to predict what the rate of AF is going to be among "healthy" Americans. The rates of complications for ACT, which are always a lagging statistics, will improve greatly as current mech. valves affect the statistic distribution and ACT management improves outcomes.

I can personally attest to the fact that heart surgery has come along way in my lifetime, but ACT has too! I realize that some don’t have that perspective, but sometimes having an old curmudgeon around, can give that.
 

RCB

Well-known member
Joined
Jul 21, 2003
Messages
1,101
Location
NW Ohio
Truly impressive!

Truly impressive!

Phyllis said:
Not to sabotage this thread, Stretch, but I checked out your commercial sites and you are truly a gifted photographer (as your nomination for a Pulitzer attests)- both the "art" and the "wedding photography". Found it interesting that you enjoyed watching the colonoscopy- must be the artist in your soul!:D You certainly have done your research and I know that you and your surgeon will make the best decision for "you".
Thanks Phyllis for calling attention to this. Stretch is certainly a man of
amazing talent! Sometime we forget, that people here have a life outside
this forum. Some, like Stretch, are leaders in their field!

I have often wondered how many really famous people check this website, but don't bother th register for obvious reasons.
 

StretchL

Well-known member
Joined
Nov 15, 2005
Messages
627
Location
Miami, FL. I'm not really sure what country this
<<Blushing>>

<<Blushing>>

Phyllis and RCB- Ya'll are very kind. Thanks for taking time to visit those sites. I've said it before and I'll say it again, I'm grateful beyond words for having found this wonderful group of people. :)

Just today I received a couple of e-mails from surgeons about surgical options... I'll post those as soon as I have a chance.
 

twinmaker

Well-known member
Joined
Jun 8, 2005
Messages
1,136
Location
I live in Denver NC
Stretch, I just visited your wedding photography site (I had visited your other one a few weeks ago) and they're both wonderful. I especially enjoyed the wedding site as our second son is getting married in October (his twin brother was married this past May). Your photography is just beautiful. Our daughter was married six years ago, and now with the twins, it seems like I've been looking at wedding portraits a lot lately. Again, yours were wonderful!!!

I have also been reading some of the other sites on heart surgery that you posted. You certainly are doing your homework. I am one of the early St. Jude pioneers. I got mine 25 years ago last month. The St. Jude hadn't been approved by the FDA when I got mine. But here I am ticking away! And I've been on Coumadin all that time also. If you're reading my other posts the last few days, I'm dealing with some up and down issues with my INR because of being sick with a sore throat and infection. But, this happens so rarely and is really not that big of a deal. I probably make it a bigger deal just because I've had so few problems with Coumadin all these many years. I've had one bad bleeding experience (serious), but it was many years ago. Back in 1983. Things have come such a long way with the development of the INR and home testing. It's amazing.

Believe me, I'm not trying to sell you on one way or another concerning the choice you have to make. You've come to the right site to get a multitude of opinions. Ultimately, you and your surgeon will have to decide what's right for you. I'm extremely happy with the choice I made 25 years ago. Back in 1981, I was 29 years old and already had 1 OHS under my belt and was getting ready for my second. I really didn't want a third one, so decided to sign those papers which allowed me to get that unapproved but promising, new mechanical mitral valve. I don't know what the future holds, but I'm glad I made the decision I did back then.

Keep us posted on all the research you're doing and what you are finding out. We're interested and we care. LINDA
 
K

Karlynn

Guest
twinmaker said:
Back in 1981, I was 29 years old and already had 1 OHS under my belt and was getting ready for my second. I really didn't want a third one, so decided to sign those papers which allowed me to get that unapproved but promising, new mechanical mitral valve. I don't know what the future holds, but I'm glad I made the decision I did back then.
Linda, a lot of us are grateful you made the decision 25 years ago. Thank you!:D
 

StretchL

Well-known member
Joined
Nov 15, 2005
Messages
627
Location
Miami, FL. I'm not really sure what country this
twinmaker said:
Stretch, I just visited your wedding photography site (I had visited your other one a few weeks ago) and they're both wonderful... Our daughter was married six years ago, and now with the twins, it seems like I've been looking at wedding portraits a lot lately. Again, yours were wonderful!!!
Thanks for your kind words, Linda... I have a wedding this weekend, two in October, and one on November 4. I'm waiting until after that one to have my surgery.

That's an amazing story about getting the St. Jude valve before it was even approved! Congratulations on making a wise decision in the face of uncertain long term outcomes. :) That's kind of how I'm feeling about the Ross these days...

Your warfarin experience is interesting. From what I've read, the mitral mechanical valves have a greater chance of thrombosis than those in the aortic position.

Thank you for your encouraging words, and for taking time to look at my work.
 

Dennis S

VR.org Supporter
Joined
Jun 28, 2005
Messages
1,595
Location
Northern New Mexico
Hello Stretch:

Hello Stretch:

I have enjoyed reading your research concerning the best valve choice, even though this is no longer an issue for me. I am wondering if you have the answer to a question that I have posed before. We keep seeing percentages listing stroke & bleeding risks. No one ever seems to know what your risk is for stroke or bleeding if you don't have a mechanical heart valve. On a hunch, I just looked up a listing on Web MD of the most commonly prescribed drugs in America. Warfarin is just within the top 40, at about 17,100,000 prescriptions per year if I read the chart correctly. I believe those of us with mechanical valves form a small part of the population taking Warfarin.

So it seems to me that casually tossing around statistics (as many Drs. seem prone to do) is very misleading. I pose the question-what is your risk of a bleeding or stroke event if you don't have a mechanical valve? We know it is greater than 0 and probably less than 3%, but what is it? The mechanical valve increases the stroke risk & the warfarin prescribed increases the bleeding risk, but how much is the increase? For example, is the risk for the general population age 55 & up .5%, 1.5% or even 3% ? Untill you know this, how can you know the increased risk of a mechanical heart valve?

Furthermore, is it possible that the warfarin prescribed for the mechanical valve actually offer protection from strokes that might otherwise occur from some non-valve related risks? it seems to me this would occur, at least on occaision.

And if it is correct that there are 17 million annual prescriptions for warfarin, shouldn't the statistics take into account that a number of people will incurr whatever risks may exist in warfarin, whether or not they choose a mechanical valve?

I think these are all substantial questions, that would lead me to believe that it is nowhere near accurate to imply that you increase stroke exposure by 3% per year if you have a mechanical valve. Does anyone see anything I am missing? I don't want to "win" an argument-I am, however, very curious as to whether there is something I am missing.
 
2

Latest posts

Top