A little evidence

[clay_from_nj]

These are REALLY old articles, the 2nd one is from 1985 and most likely wasnt about any of the valves being used today.

Precisely. Virchow's triad is basic medical science explaining what causes thrombosis. The article comparing hemodynamic properties of mechanical vs. tissue valves is notable in that even then there was that difference. Now, with advances since then, I would imagine the difference could even be greater. Today's carbon bileaflets probably flow a heck of a lot better than the old Star Edwards.

 

[Lynlw]

Precisely. Virchow's triad is basic medical science explaining what causes thrombosis. The article comparing hemodynamic properties of mechanical vs. tissue valves is notable in that even then there was that difference. Now, with advances since then, I would imagine the difference could even be greater. Today's carbon bileaflets probably flow a heck of a lot better than the old Star Edwards.

I'm not sure I would agree with your opinion, that the differences would be even greater, now, since I'm pretty sure they were using bileaflets mech valves, but without reading the whole study, MY guess would be they weren't using the perimount valves then since they were just doing trials in the early 80s. I guess it is interesting to read, but I wouldnt put much stock in almost 30 year old papers comparing valves in use then, about valves used 30-40 years before that. Since my guess would be almost all valves they are discussing arent used today and there have been so many improvements in the last 30 years.
also just for info, right now I believe the best hemodynamics is in percutaneous valves since there is no sewing ring.

 

[clay_from_nj]

I'm not sure I would agree with your opinion, that the differences would be even greater, now, since I'm pretty sure they were using bileaflets mech valves, but without reading the whole study, MY guess would be they weren't using the perimount valves then since they were just doing trials in the early 80s. I guess it is interesting to read, but I wouldnt put much stock in almost 30 year old papers comparing valves in use then, about valves used 30-40 years before that. Since my guess would be almost all valves they are discussing arent used today and there have been so many improvements in the last 30 years.
also just for info, right now I believe the best hemodynamics is in percutaneous valves since there is no sewing ring.

From an article published in 2012: "Despite similar valve-related event rates in both groups, the better hemodynamic performance of the mechanical valves and/or protective effect of oral anticoagulation seemed to improve the outcome."

TAVI valves still have some overhead in the way of the wire stent and fabric skirt, and they are mounted in the intra-annular position, restricting the size to what will fit in there, whereas many surgically-implanted valves are placed in the supra-annular position, allowing for a greater diameter. It is more difficult to avoid mismatch with a percutaneous valve because there is no direct measurement of the annulus during implantation. This is part of the reason why TAVI valves run a much greater risk of paravalvular regurgitation.("Paravalvular leak (PVL) is a frequent complication of transcatheter aortic valve replacement (TAVR) and is seen at a much higher rate after TAVR than after conventional surgical aortic valve replacement.") Simply the fact that there has been almost no experience with long-term (5-10+ years) implants, I would not be rushing out to get a TAVI valve yet.

Though, in my personal opinion, what is really important is that the performance of any replacement valve is far superior to the one being replaced and that the difference between them is negligible in comparison.

(Just to be clear, I'm not anti-TAVI, just anti-jumping-into-something-new-and-unproven. I sincerely hope to see the day when valve replacement is a relatively simple outpatient procedure - I just don't think we're quite there yet.)

 

[Duffey]

So are we agreed that the statement that TAVR valves are mechanical is not true? Let's cut to the chase here.

 

[Lynlw]

Or. . . could there be some heretofore unknown benefit derived from the anticoagulants themselves?

This is totally "outside the box" thinking, but it is one definite difference between the two groups. I wonder if there has been any research on this.

Pellicle - have you seen anything like this?

I think part of the reason there aren't very many details which makes it hard to learn much from this article, is the fact it is NOT a study, or even an abstract of a study, but simply an article about one of the studies presented at the 2011 STS conference, About a small group of valve patients at Swiss center. So of course you're not going to get many of the details, that people are assuming aren"t available. because articles about subject at conferences tend to be rather general . Also the fact it wasnt a randomized study, makes it harder to really determine why they results are different. I am NOT saying if we had the full study, they would have all the answers we are asking, or better breakdowns, but there is definetly more info available, in the study than just this article.

For example http://www.ncbi.nlm.nih.gov/pubmed/22341653 I "believe" this is an abstract about this study and one of the things that jumped out to me was "The echocardiographic patient-prosthesis mismatch was greater at follow-up after biological aortic valve replacement (0.876 ± 0.2 cm(2)/m(2) vs 1.11 ± 0.4 cm(2)/m(2); P = .01). "
IMO since we KNOW that PPM makes a difference MY GUESS wuld be that played into the results too.

altho in another article discussing the study the autho admits they didn have autopsy resuls to see why these patients died.
http://www.internalmedicinenews.com...=98&tx_ttnews[tt_news]=52273&cHash=da03e20e36 they said
During a mean follow-up of 33 months, 13 patients in the BP group died (11.8%), compared with 3 in the MP group (2.7%), a significant difference. After adjusting for potential confounders in multivariate analysis, the researchers determined that patients in the BP group were five times more likely to die, compared with patients in the MP group.

Overall, "most patients died from cardiac-related causes based on medical records," Dr. Weber said. "There was no autopsy data, unfortunately, and one patient in the MP group committed suicide."

So the fact they didnt have autopsy data, makes it pretty hard to know why these people died or what kind of valve they had was related to their death at all.

Steve, to answer one of your other questions, "I wonder why a doc from CCF would speak so (apparently) strongly in favor of mech valves when CCF has been moving toward tissue valves for younger and younger patients over the past years."

From the article, "Commenting on the study at the STS meeting, Dr Tomislav Mihaljevic (Cleveland Clinic, OH) pointed out that some previous studies have shown that mechanical-valve patients have better survival odds than bioprosthetic recipients because the bioprosthetic valves required more reoperations. But those reoperations tended to be close to 10 years after the implant, while in this study, the survival curves appeared to diverge early and the freedom from operation was similar between the two groups. That suggests that the hemodynamic performance of the bioprosthesis was not the main reason for the difference in the survival, Mihaljevic suggested. "I wonder if there could be some patient-related factors that contributed to the early, but substantial, increased mortality in patients who received a bioprosthesis"

I wouldnt say he was speaking strongly about mech valves, He was not involved in this study and from the way the article was written, it looks like he either asked questions in the Q & A part of the session, or was asked his opinion about what they study showed, and he wonderred if it was some patient related factor the study didnt see.

 

[Lynlw]

From an article published

in 2012: "Despite similar valve-related event rates in both groups, the better hemodynamic performance of the mechanical valves and/or protective effect of oral anticoagulation seemed to improve the outcome.

"

Yes that is the abstract related to the article you posted to start this thread. I was pointing out that 30 year old articles really didn't have much to do with valves used today. I'm still not sure your points w/ the articles or how it relates to the thread,
since one is about http://www.ncbi.nlm.nih.gov/pubmed/9870192 "High prevalence of hypercoagulable states in patients with recurrent thrombosis of mechanical heart valves"
and the other
"Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations"

Prosthetic valve thrombosis (PVT) is a rare but serious complication of valve replacement, most often encountered with mechanical prostheses. The significant morbidity and mortality associated with this condition warrants rapid diagnostic evaluation. However, diagnosis can be challenging, mainly because of variable clinical presentations and the degree of valvular obstruction. Cinefluoroscopy (for mechanical valves) and transthoracic and transoesophageal echocardiography represent the main diagnostic procedures

and is about the differnt thrombosis diagosing and treatments

TAVI valves still have some overhead in the way of the wire stent and fabric skirt, and they are mounted in the intra-annular position, restricting the size to what will fit in there, whereas many surgically-implanted valves are placed in the supra-annular position, allowing for a greater diameter. It is more difficult to avoid mismatch with a percutaneous valve because there is no direct measurement of the annulus during implantation. This is part of the reason why TAVI valves run a much greater risk of paravalvular regurgitation.("Paravalvular leak (PVL) is a frequent complication of transcatheter aortic valve replacement (TAVR) and is seen at a much higher rate after TAVR than after conventional surgical aortic valve replacement.") Simply the fact that there has been almost no experience with long-term (5-10+ years) implants, I would not be rushing out to get a TAVI valve yet.

Though, in my personal opinion, what is really important is that the performance of any replacement valve is far superior to the one being replaced and that the difference between them is negligible in comparison.

(Just to be clear, I'm not anti-TAVI, just anti-jumping-into-something-new-and-unproven. I sincerely hope to see the day when valve replacement is a relatively simple outpatient procedure - I just don't think we're quite there yet.)

I'm not sure what you are saying, yes paravalvular leaks is a problem but each generation of valves and sheaths are seeing improvements in that. I believe most people talking about TAVI are not to get one now, but the POSSIBILIY 10-20 years down the road, IF they choose a tissue valve now,
.. Are you saying that the hemodynamics of TAVI valves aren't better than surgical valves?

 

[clay_from_nj]

I'm not sure what you are saying, yes paravalvular leaks is a problem but each generation of valves and sheaths are seeing improvements in that. I believe most people talking about TAVI are not to get one now, but the POSSIBILIY 10-20 years down the road, IF they choose a tissue valve now,
.. Are you saying that the hemodynamics of TAVI valves aren't better than surgical valves?

I just don't think that a life-or-death decision should be based in any way on what the future might hold. Get a tissue valve because your are not good with taking regular medication or are a martial arts enthusiast or plan on a future pregnancy or might not be able to handle the clicking noise of a mechanical or any other reason based on known facts and information. But, don't choose a biological valve sure that you'll avoid future OHS with a TAVI valve. There are still too many unknowns and if you start out at a young enough age to need two or three future replacements, they surely won't all be TAVI. If one of your primary considerations is avoiding future surgeries, you probably want to consider a mechanical.

As far as hemodynamics, I think that just measuring up to surgically implanted valves is an accomplishment, to claim that TAVI is superior seems to be pushing it at this stage. In fact, the real superiority of TAVI is being able to implant it without surgery - I don't think it was ever conceived as a better valve per se, just an alternative way to get the valve into a patient who may need it and not be able to tolerate regular OHS. If they were more sure about the viability of valve-in-valve, maybe, but doesn't that surely necessarily reduce the effective opening? Still way too many questions to bet my life on it.

And of course, the most important thing in all of this (IMHO) is being able to match the therapy to the needs of the individual patient. The transcatheter approach gives us yet another tool and a greater chance of providing the best and most appropriate treatment to each.

http://www.ncbi.nlm.nih.gov/pubmed/21982276; http://shvd.org/abstracts/2011/C42_43.cgi; http://dare.uva.nl/document/457644; http://www.medscape.com/viewarticle/776724 (5 years +, good news so far); http://cardioegypt.com/cardioeg/CE2012-Presentations/27-2-2012/006007.pdf; http://www.valvexchange.com/physicians/ (just plain fascinating).

 

[pellicle]

clay, while I personally tend towards a mechanical prosthetic I feel this is a bit strongly worded to defend adequately.

I just don't think that a life-or-death decision should be based in any way on what the future might hold.

So while I complain about the presentation of data being inadequate to make a decision based on criteria such as "which will have less consequences", I think that the stats are put together by the medical fraternity specifically with death being the strongest weighted criteria. So the outcome of death of any valve replacement type is therefor moot.

The evidence as I see it suggests that up to 10 and perhaps up to 15 the death outcome from valve surgery is quite evenly balanced between tissue and mechanical. I personally tend towards feeling more inclined to mechanical prosthetic and my reading of the data supports my view to my personal satisfaction.

What it seems we don't have in the stats is if the choice of tissue (and attendant reoperation) leads to outcomes which are not death, but are undesirable[/U], in higher ratios. Such as (but no limited to):

• sternal infections leading to sternectomys (seems to be an emerging surgery group)
• atrial fib
• dammage to nerves requiring a pacemaker
• personal and familial stress, time off work
• financial costs ...

These just don't appear in the studies as they seem to focus on 'mortality' or 'reoperation due to failure'.

On that topic of reoperation due to failure, Tissue prosthetic is given advantage with the exception clause limitation of 15 years(with tissue prosthetics where (except in the elderly) reoperation due to failure was a given).

So therefore they use the 15 year event horizon for 'freedom from reoperation'. If they just did 'freedom from reoperation' period then I'm sure you'd see the 15 year mark as a marker and that at 30 years it would look quite different. Of course such a long timeline would be difficult to follow up. And we can already note the short 'median' follow up times in many studies and the (cute statistical fudge of) 'study patient years'.

To me the stats and thinking behind developing the stats has its historical legacy in valve surgery for the elderly and while valve surgery for the young is not yet as high I'm confident that its growing.

That said I'm 100% behind this one.

But, don't choose a biological valve sure that you'll avoid future OHS with a TAVI valve.

for there may be some years yet. I have a friend who work in valve sales and he constantly reminds me when we discuss advances how long these things take to come to market. Because the surgical community takes death so seriously (although non-death leading to more treatments is actually good for business ... it was just a complication ... it happens some times).

 

[clay_from_nj]

clay, while I personally tend towards a mechanical prosthetic I feel this is a bit strongly worded to defend adequately.
("I just don't think that a life-or-death decision should be based in any way on what the future might hold." -clay)

I should have worded that better, such as: I do not believe that such an important decision as which valve to choose should be based on unproven possible future advances, specifically TAVI becoming common, safe, and durable, both for younger patients and when used valve-in-valve. (Pellicle, with this kind of topic and material at least, you are a far better writer than I am.)

I do agree with your assessment of mortality vs morbidity. In my own case, the choice to go with a mechanical valve was not based on any sort of death criteria, but mainly wanting to avoid the potential negative health effects of a failing biologic valve. I've dealt with CHF, so bad that I couldn't walk more than a few yards without stopping to gasp for breath (LVEF as low as 15%) and I never want to deal with even a little of that again. Another surgery wouldn't be bad (IMO), but there is no way I want to go through the symptoms and dysfunction leading up to it. I think that in these medical studies, quality of life should be counted right up there with length of life.

 

[dick0236]

I think that in these medical studies, quality of life should be counted right up there with length of life.

Amen to this. To me, the "quality of life" is much more important than the "quantity of life".

 

[Lynlw]

I just don't think that a life-or-death decision should be based in any way on what the future might hold. Get a tissue valve because your are not good with taking regular medication or are a martial arts enthusiast or plan on a future pregnancy or might not be able to handle the clicking noise of a mechanical or any other reason based on known facts and information. But, don't choose a biological valve sure that you'll avoid future OHS with a TAVI valve. There are still too many unknowns and if you start out at a young enough age to need two or three future replacements, they surely won't all be TAVI. If one of your primary considerations is avoiding future surgeries, you probably want to consider a mechanical

.

I don't believe anyone at least here, who chooses a tissue valve is "sure that you'll avoid future OHS with a TAVI valve" They do so planning on having at least 1 more OHS, if they are younger than 50, and plan on out living a tissue valve they would get now. BUT based on the info available today,not in the future, they also know that when THIS valve needs replaced in 15-20 or even 10-20+ years from now, there IS a very real possibility that TAVI valve in valve MIGHT be an option for them.

I DO believe that anyone choosing a tissue valve right now, should discuss with their surgeons which tissue valves in use today, look like they will be the best bet of being able to have a percutaneous valve implanted in it when the time comes, to increase their chances of being able to take advantage of that. I think it is pretty important, but rarely see it discussed. OF course TAVI will NEVER or at least in the next decade or so replace ALL surgical valve replacements, some people will always need open heart surgery for first or second valve replacements, but some valves are already known to be easier to implant valves in and some are much harder, IF they are even able to have another valve placed inside them safely.w/ the available valves and deployment systems.

Also IF you are young enough that you will need to need two or three future replacements, you are either very young, 30s or younger- or very unlucky - and still choose a tissue valve, today, when this valve needs replaced, you will make the best choice of available options when the time comes and aren't locking yourself in to numerous ( 3 or more) surgeries.

I DO agree If one of your primary considerations is avoiding future surgeries, you probably want to consider a mechanical. BUT for MANY 1st and 2nd OHS patients they rather the risks of at least 1 more OHS, than getting a Mechanical valve and requiring Anticoagulants and everything that goes along with that, possible ticking, bloodwork, (even home testing) increase chances of (Clotting OR bleeding stroke, bleeds possible issues effecting Vit K from doing all its jobs etc, the rest of their lives.
Luckily in this day and age both choices are very good and gives you the chance of a long and happy life, and Millions of dollars are being spent to make improvements in valves, tissue or mechanical, how the valve is replaced, surgery or cath and Meds like all the new anticoagulants that HOPEFULLY make all choices and lives better.

As far as hemodynamics, I think that just measuring up to surgically implanted valves is an accomplishment, to claim that TAVI is superior seems to be pushing it at this stage. In fact, the real superiority of TAVI is being able to implant it without surgery - I don't think it was ever conceived as a better valve per se, just an alternative way to get the valve into a patient who may need it and not be able to tolerate regular OHS. If they were more sure about the viability of valve-in-valve, maybe, but doesn't that surely necessarily reduce the effective opening? Still way too many questions to bet my life on it

.

Again I agree that just measuring up to surgically placed valves as far as hemodynamics IS an accomplishment, but many studies show that the hemodynamics ARE better for TAVI valves compared to surgically placed, most likely because they dont have the large sewing ring taking up space, the leaflets are sewn right onto the very thin wire stents. OF course nothing is 100%, but even in the 1 article you linked to
http://shvd.org/abstracts/2011/C42_43.cgi from the un of Pa (Justin's doctors "Hemodynamic Comparison of Aggressive Supra-annular Surgical Aortic Valve Replacement Versus Transcatheter Aortic Valve Implantation"
the opening sentence was "Transcatheter aortic valve implantation(TAVI) has been purported in many large cohort series to provide improved hemodynamics versus traditional aortic valve replacement(AVR) likely due to the absence of an obstructive sewing ring"
and concluded with
"CONCLUSIONS: TAVI and open AVR can show similar hemodynamics with the application of aggressive oversizing of the open AVR prosthesis. Both techniques show hemodynamic improvement at one year and further long-term follow-up is warranted"
So pretty much to get the surgical valve to be equal to the hemodynamics of the TAVI valve, involved aggressive oversizing of the open AVR prosthesis (my bold)
Now these were valves implanted from 2007-2009 and alot of improvements have been made to percutaneous valves and placement in the following 5 ish years.

YES when they do valve in valve, since the old leaflets are basically smushed open, that could make a very small difference (the thickness of the leaflets) in the valve opening area, but when you watch videos of TAVI placement, its amazing how little difference it makes. still less than a sewing ring.

I'm also not sure I agree with your statement that "I don't think it was ever conceived as a better valve per se, just an alternative way to get the valve into a patient who may need it and not be able to tolerate regular OHS."
I agree they probably weren't making the percutaneous valves Better, but are hoping they are equal or at least, "Noninferior" to valves surgically placed, BUt disagree they mainly planned on them being used in "not be able to tolerate regular OHS" people, since already they are using them (in Trials" in the US and approved in other countries) in lower and lower risk patients needing Aortic valve replaced You figure since they already have done 60,000 TAVIs, world wide they couldnt all be highest risk or inoperable patients. I "Think" right now the patients in trials only have a 15% chance of mortality in surgery, Yes that is higher than most 1st-or 2nd valve OHS, but would be considerred great stats for many of the more complex heart surgery patients. and obviously they have some other comorbidities, that raises their risk of surgery

"And of course, the most important thing in all of this (IMHO) is being able to match the therapy to the needs of the individual patient. The transcatheter approach gives us yet another tool and a greater chance of providing the best and most appropriate treatment to each.

http://www.ncbi.nlm.nih.gov/pubmed/21982276; http://shvd.org/abstracts/2011/C42_43.cgi; http://dare.uva.nl/document/457644; http://www.medscape.com/viewarticle/776724 (5 years +, good news so far); http://cardioegypt.com/cardioeg/CE2012-Presentations/27-2-2012/006007.pdf; http://www.valvexchange.com/physicians/ (just plain fascinating).[/QUOTE]

I agree its all good news and anything that makes more people live improved lives, new better valves, percutaneous valves, and different accesses for them, new drugs is only a good thing.

BTW Clay, I want to make sure you don't think I am picking on you or attacking anyone on this thread, I personally try NOT to highjack scared Newbies threads where they are trying to make the best decision for them with long back and forth discussions like this, especially since alot of things here are just our thoughts or opinions and we arent doctors. so this looked like a good thread to discuss this
Since either choice really IS a good choice, I don't want to scare new patients or drive them off at a time they are looking for and need support from people who have been there.

 

[Lynlw]

What it seems we don't have in the stats is if the choice of tissue (and attendant reoperation) leads to outcomes which are not death, but are undesirable[/U], in higher ratios. Such as (but no limited to):

• sternal infections leading to sternectomys (seems to be an emerging surgery group)
• atrial fib
• dammage to nerves requiring a pacemaker
• personal and familial stress, time off work
• financial costs ...

These just don't appear in the studies as they seem to focus on 'mortality' or 'reoperation due to failure'.

I believe MANY of the studies on various, Valves, surgery, longevity, ect DO take into account things like sternal infections leading to sternectomys (seems to be an emerging surgery group)
atrial fib, damage to nerves requiring a pacemaker and any other problem that can happen since most studies discuss not only mortality but also morbidity usually during the first month or hospital stay, readmissions, up to the first year. whether it is a first OHS or in some cases 5th and 6th, Studies on valves in the long term also track and report not only how the valve is structurally, if it needed replaced, but also things like BE, bleeds, strokes etc. Even the various ranking for hospitals take into consideration infection rates as well as other issues http://health.usnews.com/best-hospi...diatric-rankings/cardiology-and-heart-surgery In the US at least there are stats on everything.



Luckily the chances of a complete and successful recovery are very high, and the chances of complications are very low, not zero of course but, i think about 1-3% chance of some problem, which seems to be about what the experience of members here having complications is. I wouldnt personally consider them higher ratio they are relatively rare.
Even tho it is always terrible to have some bad complication, like a deep sternal infections, in MOST cases, after treatment life is good and there isnt any effect to your day to day living. even in the case of pacemakers, altho no one WANTs to need one, for the most part it is not something that causes issues for the most part people tend to forget about them unless it is time for the phone checks.

YES REDO surgeries have personal and familial stress, time off work, financial costs BUT Many people are willing, prefer all these risk and choose a tissue valve, knowing they will most likely need another OHS and the risk of another surgery when that happens, instead of the risks that go along with choosing a mechanical valve and the need for Anticoagulation (right now Coumadin)for the rest of their lives, and there ARE risks, even in the best valves and home testing INRs there are still risks each year I believe it is something like 1-3% chance of having a major bleed each year and another 1-3% chance of having a clot and stroke each years, and all the cost that go along with that. As everyone knows the risks of Mechanical valve and anticoagulants go up in the elderly and most people who choose a mechanical valve do so hoping to become elderly. Many people prefer the chance of dieing less than the fears of surviving a major stroke, even smaller strokes can effect your life, certainly the quality of it

Luckily in this day and age, the chances of having a successful surgery w/ low to no morbidity and the chances of not having major problems w/ mechanical valves and Coumadin are very good That is why almost every study says for the most part the patients choice should play a role in what kind of valve they want. IF one choice was clearly better than the other there wouldnt be choices.

On that topic of reoperation due to failure, Tissue prosthetic is given advantage with the exception clause limitation of 15 years(with tissue prosthetics where (except in the elderly) reoperation due to failure was a given).

To me the stats and thinking behind developing the stats has its historical legacy in valve surgery for the elderly and while valve surgery for the young is not yet as high I'm confident that its growing.

Yes for the most part the people who do get valves, Aortic valves at least tend to be the elderly

for there may be some years yet. I have a friend who work in valve sales and he constantly reminds me when we discuss advances how long these things take to come to market. Because the surgical community takes death so seriously (although non-death leading to more treatments is actually good for business ... it was just a complication ... it happens some times)

You know I have actually been surprised how fast percutaneous valves have been approved, Starting with Pulmonary melody valves, I was so used to things taking decades to be approved so the fact that about 5 years after the first one was used, children and young adults could get percutaneous melody valves FDA cleared amazed me. Even in the highest risk Aortic patients I thought it was great that when the corevalve was starting its US trials, because the highest risk patients did so much better w/ the Sapien valve in the PARTNER trial- compared to the medical treatment, that the FDA allowed he highest risk people to just get the TAVI since it wouldnt be ethical to sign 1/2 the people up to a treatment they knew they wouldnt do as well with.

 

[Duffey]

Just my personal opinion, but I think members that go tissue tend to stay more current with the latest developments since we are more likely to face another replacement than those with mechanical valves.

 

[pellicle]

Hi

I believe MANY of the studies on various, Valves, surgery, longevity, ect DO take into account things like sternal infections leading to sternectomys (seems to be an emerging surgery group)

that's excellent ... can you perhaps send me some references which quantify those outcomes? I've been unsuccessful in locating any. So far they just seem to discuss mortality not "alive but without a sternum anymore" or "alive but now needs a pacemaker" for the redo surgeries and how this varies with respect to the initials.

Thankyou

 

[pellicle]

.., but I think members that go tissue tend to stay more current with the latest developments since we are more likely to face another replacement than those with mechanical valves.

I think that's an excellent point.

 

[clay_from_nj]

BTW Clay, I want to make sure you don't think I am picking on you or attacking anyone on this thread, I personally try NOT to highjack scared Newbies threads where they are trying to make the best decision for them with long back and forth discussions like this, especially since alot of things here are just our thoughts or opinions and we arent doctors. so this looked like a good thread to discuss this
Since either choice really IS a good choice, I don't want to scare new patients or drive them off at a time they are looking for and need support from people who have been there.

Absolutely why I started this thread. Thank you for participating like you have - I thought it was time for a thread where we could just "let loose", discuss things out, and get a good productive dialogue going. (And to be perfectly honest, it was just a little bit "bait" to lure folks out.)

BTW Lyn, I was looking briefly at your website and noticed you are from my old stomping grounds. I grew up in South Jersey (mostly Burlington County, not Freehold or Trenton, they only think they are South, we know better) and my daughter had her PDA repaired at CHOP. We last lived in Pennsville before trading the Garden State for the Rocky Mountains. Have you had any experiences with Deborah H&L? I wonder if they are the center of excellence that they were many years ago...

 

[pellicle]

all screwed up by browsers - http - and a rubbish 3G data connection, see below

 

[pellicle]

Thank you for participating like you have - I thought it was time for a thread where we could just "let loose", discuss things out, and get a good productive dialogue going.

And also from my perspective to effectively pool resources and share what research we've uncovered with each other, we are after all - all in this together.

I personally have learned much from reading counter points and following up references given here (by both sides of the coin)

 

[ottagal]

And also from my perspective to effectively pool resources and share what research we've uncovered with each other, we are after all - all in this together.

I personally have learned much from reading counter points and following up references given here (by both sides of the coin)

That's a big ditto for me, too! :thumbup:

 

[Duffey]

All of this is fine, as long as the information presented is accurate. Lyn had to point out that the valves being used for TAVR's are not mechanical and would therefore not require long-term ACT management as previously stated. This is an important point in valve making decisions.