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Quote Originally Posted by neil brewer View Post
if this carries on we are going to drive so many good people away from this forum ,which is such a shame
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It already has and it is a shame
FWIW the study mentioned in an earlier post about how many tissue valves needed redos, was interesting in that several times thru out the study they say
background— Several centers favor replacing a diseased native heart valve with a tissue rather than a mechanical prosthesis, even in younger adult patients. However, long-term data supporting this approach are lacking. We examined the survival implications of selecting a tissue versus a mechanical prosthesis at initial left-heart valve replacement in a cohort of adults <60 years of age who were followed for over 20 years.
comorbid and procedural data were available from 6554 patients who underwent valve replacement at our institution over the last 35 years. Of these, 1512 patients contributed follow-up data beyond 20 years, of whom 567 were adults <60 years of age at first left-heart valve operation (mean survivor follow-up, 24.0±3.1 years). Late outcomes were examined with Cox regression. Valve reoperation, often for prostheses that are no longer commercially available, occurred in 89% and 84% of patients by 20 years after tissue aortic and mitral valve replacement, respectively, and was associated with a mortality of 4.3%. There was no survival difference between patients implanted with a tissue versus a mechanical prosthesis at initial aortic valve replacement (hazard ratio 0.95; 95% CI: 0.7, 1.3; P=0.7). For mitral valve replacement patients, long-term survival was poorer than after aortic valve replacement (hazard ratio 1.4; 95% CI: 1.1, 1.8; P=0.003), but again no detrimental effect was associated with use of a tissue versus a mechanical prosthesis (hazard ratio 0.9; 95% CI 0.5, 1.4; P=0.5).
Conclusions—
In our experience, selecting a tissue prosthesis at initial operation in younger adults does not negatively impact survival into the third decade of follow-up, despite the risk of reoperation.
furthur down under death they mention
ithin AVR patients, the 20-year actuarial freedom from valve reoperation was 11.4±3.5% in those initially implanted with a tissue prosthesis, versus 73.0±4.9% in those who received a mechanical aortic valve (HR: 3.9, tissue versus mechanical; 95% CI: 2.6, 6.3; P<0.001). The median time to reoperation was 10.2 years in tissue AVR patients, and beyond this cohort’s maximum follow-up (ie, >35.0 years) in mechanical AVR patients.
Similar observations were noted in MVR patients, where the 20-year actuarial freedom from reoperation was 15.8% ± 4.6% with tissue prostheses, versus 65.0% ± 9.6 with mechanical prostheses. In MVR patients, the median time to reoperation was 11.8 years with tissue prostheses, and 24.4 years with mechanical prostheses.
The perioperative mortality associated with initial valve reoperation in this cohort was 10 of 235 (4.3%), and no mortality occurred at subsequent reoperation. These rates were not significantly different between implant sites. The impact of reoperation as an overall cause of death in this cohort was not significantly different between tissue and mechanical patients, both within AVR patients as well as within MVR patients (HR: 1.9, 95% CI: 0.2, 4.7; P=0.5)."
and Stroke
Stroke
Thirty-five patients in the cohort died from stroke. The 20-year freedom from death attributable to ischemic or hemorrhagic stroke was 97.9±1.2% in tissue AVR patients, 83.9±4.9% in mechanical AVR patients, 96.1±1.9% in tissue MVR patients, and 85.6±5.3% in mechanical MVR patients. After adjusting for coronary artery disease and atrial fibrillation, the use of a mechanical valve was a significant risk factor for dying from stroke in either implant position (for AVR, HR: 7.0; for MVR, HR: 4.5; both P<0.02)."[/B]
That of course is just people who died from stroke, it would be interesting to know how many people had strokes but survived and how well they were doing or had permanet damage..
So pretty much as most people say BOTH valve types are very good and have problems, Tissue valves WILL need replaced at some time, in higher rates for people less than 60.. BUT as this study showed, the vast majority of being getting a Valve REDO do great.
Mechanical valves last longer, and most likely will not need it replaced, it has happened to members here.. but because they are more prone to clot, they require aniticoagulent, which increases the bleeds, most major bleeds do fine but risk increase for internal bleeding like GI or Brain., even WITH the newer valves, INR and Home testing the risks are still about 1-3 % chance of major bleed and about equal chance of clots and major srokes.
True information IS important, it is also important to get facts for both valve types.
In the years I've been a member there have always been members who feel strongly for one valve type or another, but the difference was it didnt get personal..if it did it was stopped. Maybe it would help if people can share info with out insulting either members who chose different, or insulting the members here as a whole, or a Country you dont like, and try to accept that there ARE risk for both choices. Things are improving yearly, but even w/ the best surgeons w/ most experience working on REDO, things happen , luckily for the most part they do well with a full recovery. On the other hand even tho the newest mech valves are better than earlier models and improvements have been made, INRs were first being used, home testing ALL helps keep INR more stable, but there still are many people who have major life threatning bleeds or clots each year.
So some people prefer the chance of the risk for REDOs , while others pref to take the risk of the yearly chances of having a bleed or stroke.
