Tissue Valve and on Warfarin

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I don't accept those numbers for use in the way they're being presented here, as there's too little qualification as to what their frame of reference is. Statistics without qualification are utterly valueless, excepting for their use in rhetoric or propaganda. Thus Disraeli's "Lies, damned lies, and statistics."

On page seven, Dr. Emery states that "20 to 30%" of aortic tissue valve recipients are on Coumadin for other reasons, and "up to two-thirds or more" of mitral valve patients are on Coumadin.

Those do not come across to me as numbers, but rather as very loose estimates, and would be difficult to quantify, much less verify. Nor does he invoke an age group, study group, or any other qualifications.

Here's another quote from Dr. Emery. "When we look at quality of life as compared to the normal population, do you think that returning to the quality of life of a normal person after valve surgery is a fair requirement?"

Apparently, patients seeking a return to normalcy is not fair. Dr. Emery appears to excuse his specialty from the goal of the rest of medical science, in feeling that close enough should be seen as acceptable, perhaps admirable.

Does Dr. Emery really feel that way? Probably not. I hope not.

However, if I'm to believe the vague and "guesstimated" numbers in the first quote, should I not also take at unquestioned face value the uncaring pompousness of the second? Again, probably not. The point is that this is a surgeon, not an apostle. Not everything he says is valid out of context.

This is a group of gifted surgeons talking at a convention sponsored by the world's largest producer of mechanical valves. One brought a graph with him. As pointed out by another poster above, there are graphs available from reliable "scientists" (Dr. Emery's favorite validating word) that show "accurate" data all over the map for that question, and many others.

Remember, ten years ago these gifted individuals would have sworn to you that butter is the destroyer of your arteries, and you must stick to margarine. Now they will tell you that a little butter is okay, but you must stay away from the trans fatty acids and hydrogenated oils in margarines. The point? Certainly not to invalidate them. Just to point out that they succumb to marketing within their industry, too. They absolutely do want to advise the right things to their patients, but they're human, and they get fooled sometimes, too. By "scientists," no less.

I suspect a view of the data with the 75+ age group out would not bear out Dr. Emery's percentages. Conversely, in ages over 80, I'm going to guess 60% might be light. At those ages, I suspect the Coumadin numbers are nearly as high for those without AVRs at all.

Interestingly, these surgeons all seem to feel the tissue valves are superior for patients over 65, even though they expect that they most likely will wind up on Coumadin. And yet not necessarily for younger patients who very likely will not wind up on Coumadin at all before their resurgery. There's a mixed message for us.

Further, they discuss resurgery as being mostly an issue for institutions where resurgeries are seldom seen. Note to self: find competent surgeon and facility at resurgery time.

I don't care which valve type wins out, myself. If I can use the next On-X with just aspirin therapy, I'm fine with it. Delighted, in fact. That is being investigated, by the way.

However, I absolutely believe that "returning to the quality of life of a normal person after valve surgery" is not only a fair, but an achievable and absolute requirement for AVRs, MVRs, PVRs, and TVRs all.
 
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coumadin and VR what I know

coumadin and VR what I know

I have a more simple way to look at this from what I know, and granted I dont know half of what many have said here.......wish I did but we rely on our collective knowledge. Anyhoo... I have had a fib and a flutter for probably 8 years, diagnosed by hapistance (seeing the right doc actually) and of course am on coumadin. I have CHD, pulmonary atresia, repaired at birth. Anyone who has had a valve repaired or replaced is at risk, I was quoted 30% for A-Fib in their life. That may be where some of the stats come in, dont know, I am just glad mine was found before I had a stroke. I was in A-Fib 80% of the day for a while. Dont know if this helps
Leighanne
 
You're quite right that you don't have to have a replaced valve to be on warfarin. And there are different levels of use, as well. Not everyone using Coumadin is at the INR level required to maintain a clear valve.

Of course, you're now going for MAZE surgery, I believe, which will hopefully take that atrial fibrillation issue out of your life. Depending on what happens with your other surgery, you might possibly go off of Coumadin sometime in the future.

Best wishes,
 
I have 2 male friends who live in my gated community..One in his 80's and 1 in his 60's..both on coumadin..Neither have had a valve replacement and neither tests their INR..but every few months. :eek: :eek: :eek: When I had my surgery and started taking coumadin..both of their wives ( my friends) said I was too obsessed with my INR. :mad: :mad: Well, one passed out from taking Vit. E..severe nosebleed..and the other just came home from wintering in Mesa, Az..Saw him outside and he looked great (the one in his 80's)Oh, well, after 2 years on coumadin and NO problems..I don't even think about my INR that much anymore. :) Bonnie
 
stats

stats

Bob

I am fully with you: most of the numbers presented in these studies are based on fairly thin sample size (what is 1200 avr over eight years in the USA? That's probably less than one percent!!!). I always wonder why the meds get away with all that anyway ;-)))

But who cares, let them do a good job during surgery, I reckon that;s most important, because that's the part we all canNOT influence!

well2u
ar bee
 
There is nothing about a tissue valve that will require a person to be on warfarin other than a short time after surgery. HOWEVER, people with tissue valves develop atrial fibrillation, blood clots in their legs and lungs, have strokes, get lupus, discover that they have clotting abnormalities, develop cancer, need a permanent IV catheter etc just the same as the rest of the population. Having a mechanical valve is actually way down the list of reasons for people taking warfarin. Having a tissue valve does not protect you from needing warfarin. I see a lot of people with tissue valves who take warfarin. Not because they have tissue valves but for many of the other reasons listed above.

If getting a tissue or mechanical valve was only a matter of having to take warfarin or not the decision would be much easier than it actually is.

There may be a replacement for warfarin somewhere in the future but as of right now we do not know of anything in development.
 

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