Another Reason to Not Base Your Choice on Warfarin

[Guest]

The new ATS valve has solved much of the problem of clotting with mechanical valves. I have not understood why they were so much more likely to form a clot than pig, cow or human valves. It turns out that the place where the blood stagnates is in the area of the hinge. Think of it being a door and the side between the door frame and where the door opens back. The blood gets trapped and doesn't flow out. This allows clots to form. So you need warfarin to maintain high INRs.

Now ATS medical has developed a mechanical valve that has no dead space around the hinge. In Belgium, they have been using this valve in the aortic position with low doses of warfarin to keep the INR between 1.5 and 2.5 over a period of several years.

I am convinced that the younger people requiring mechanical valves will live to see the time when they will take only minimal, if any, amounts of warfarin.

 

[Karlynn]

I am convinced that the younger people requiring mechanical valves will live to see the time when they will take only minimal, if any, amounts of warfarin.

This has been one of my points for a while. We see a lot mentioned here about the possibilities of improved tissue valve surgery and longevity "in the future". Why wouldn't we think that mechanical valves will also make positive advancements in the future?

 

[Ross]

Just so people aren't basing todays decisions on the possible improvements of tomorrow.

 

[Karlynn]

Just so people aren't basing todays decisions on the possible improvements of tomorrow.

I almost added that... but knew you'd be along shortly to do it.

 

[Gemma]

Jim's valve is apparently designed in such a way that the aerofoil housing profile minimises blood stasis, and it has "effluent channels in the hinge area" to allow for "passive blood washing". Sounds kind of icky but I guess that's the same kind of thing as the ATS valve.

 

[PapaHappyStar]

Al - Do you have journal citations? Thanks, Burair

 

[Guest]

Van Nooten GJ, Taeymans Y, Van Belleghem Y, Francois K, Van Overbeke H, Poelaert J, Caes F, De Pauw M.
Lower anticoagulation for mechanical heart valves: Experience with the ATS bileaflet valve.
Heart Lung Circ. 2003;12(3):164-71.
PMID: 16352127 [PubMed - in process]

 

[tobagotwo]

The main reason that people don't think in terms af future improvements to mechanical valves is that, once you have one, there is not a great likelihood that you'll get to try another. The first one will probably last.

When you get a tissue valve, your chances of eventually trying a newer variety are very high.

However, a future non-ACT or low-level-ACT mechanical valve might be a good swapover for a tissue valver at replacement time...

Best wishes,

 

[terryj]

My husbands surgeon said he only used the ATS valve if we went mechanical and mechanical was his choice for my husband because of his age,etc. We keep his INR between 2.0-3.0. But, we don't panic if it falls a little under or over. We have learned to adjust the dosage and he eats a little less or more greens as needed. He has had his aortic valve for 4 years and showed only minimal leakage(about normal for a 55 year old) at his last echo. I also think they will keep improving valves until clotting factors will not be so critical. I hope if he ever needs another mechanical that will be the case.

 

[Guest]

It is extremely unlikely that a person who was over 50 when the valve was put in will ever need another. They should last well in excess of 20 years.

 

[terryj]

Thats good news to hear. We were slightly concerned about the coumadin but the surgeon said we were intelligent people and he did not think we should have any problem in dealing with any coumadin issues. I wasn't quite sure what he meant by this at the time but I think we understand now.

 

[Guest]

People fear bleeding to death but I cannot find any ER doc or nurse who can recall a patient bleeding to death from a cut to the arm or leg in the past 15 years. It seems to be a leftover urban legend from prior to 1990 when there was a big change in how warfarin wwas managed.

 

[RCB]

Yeah but.......

Yeah but.......

People fear bleeding to death but I cannot find any ER doc or nurse who can recall a patient bleeding to death from a cut to the arm or leg in the past 15 years. It seems to be a leftover urban legend from prior to 1990 when there was a big change in how warfarin wwas managed.

......I bet you would have no problem finding people who had a stroke from A-fib that weren't on warfarin.