From my recent chat with Robert w Emery here are a few stats which are very encouraging (from one of his studies) and may determine which valve is best, especially for younger patients. People seem to think there are high risks with mechanical valves, especially with valve related strokes. However, there is almost no difference from mech or tissue valves- roughly 1% per patient year. This is very important to understand as many people make their decision based on this fact although for many it's also a lifestyle choice (don't want to be on warfarin due to active lifestyle etc). Therefore the main difference with mech valves is the bleeding issue which carries a 1% risk per patient year. Again, this is likely to be much lower if INR is monitored correctly and you are sensible with your life decisions (not to drink too much alcohol, sensible diet and avoiding contact sports).
In one of Robert Emery's articles he states that over a 25 year period there was only a 7.6% mortality rate associated with valve related events (37% overall mortality). What is even more interesting is that this is between 1977-2002, well before INR home testing and additional knowledge about food interactions etc. The other positive is that these figures are based on a mean age of 65. This study was based on 4480 patients.
Now, for all young patients worried about their long term future, here is another small, but positive bit of data- "a study in patients under 50 years of age followed 254 patients for up to 20 years and found an exceedingly low rate of valve related events, an exceptional long term overall survival of nearly 88% and event free survival or 92%" Again, this study is before INR home testing and proper management of INR and almost certainly doesn't take into account any other major problems associated with each patient. In simple terms you could argue that this means in a 40 year follow up you would have an event free survival of 74% although now we have the advantage of knowledge, better follow up and INR understanding.
Overall I think this highlights how safe and reliable mech valves are if compliance with INR is kept throughout a patients lifetime and hopefully this helps to discard the rubbish meta data analysis reports which are pretty useless.
Also, just got point out, the guys who did this study have no financial relationship with any mech valve companies (the study was based on the st Jude mech valve).
One last point, he says that many ball and cage valves are still working after 40 years. So Dick, I guess you are not alone!
In one of Robert Emery's articles he states that over a 25 year period there was only a 7.6% mortality rate associated with valve related events (37% overall mortality). What is even more interesting is that this is between 1977-2002, well before INR home testing and additional knowledge about food interactions etc. The other positive is that these figures are based on a mean age of 65. This study was based on 4480 patients.
Now, for all young patients worried about their long term future, here is another small, but positive bit of data- "a study in patients under 50 years of age followed 254 patients for up to 20 years and found an exceedingly low rate of valve related events, an exceptional long term overall survival of nearly 88% and event free survival or 92%" Again, this study is before INR home testing and proper management of INR and almost certainly doesn't take into account any other major problems associated with each patient. In simple terms you could argue that this means in a 40 year follow up you would have an event free survival of 74% although now we have the advantage of knowledge, better follow up and INR understanding.
Overall I think this highlights how safe and reliable mech valves are if compliance with INR is kept throughout a patients lifetime and hopefully this helps to discard the rubbish meta data analysis reports which are pretty useless.
Also, just got point out, the guys who did this study have no financial relationship with any mech valve companies (the study was based on the st Jude mech valve).
One last point, he says that many ball and cage valves are still working after 40 years. So Dick, I guess you are not alone!
