Anyone wish they had chose the other option?

[Forrest]

Heart of the Sunrise,

It’s good you’re doing lots of research in advance, as I imagine in some cases a mixture of doctor recommendations, forum member experiences and your own personal preferences between the pros and cons will help guide you to what is right for you. It was a difficult decision for me, but I’m glad I was able to make a choice. Unfortunately some folks had an emergency and didn’t get the opportunity to research their decisions as much as they’d prefer, so it’s nice to be able to choose based on both medical advice and what’s important to you.

I agree that both valve types are good choices today, and both types are seeing improvements with growing technologies on the horizon. I’m no expert, probably none of us are but some are very well read or have gone through quite a bit of heart operations, and we all provide personal experiences that are hard to find elsewhere. I’m not sure but it seems likely that mechanicals are somewhat more recommended on average, especially if you’re younger than a certain age, but then again we’re all different. I was about 50 when I chose tissue, and I don’t regret it, am doing quite well, as are those with mechanicals. I know I assumed a certain amount of particular risks (and it could have backfired on me), but I was willing to do so. But don’t let my choice (a sample of one) influence you at all. If you make the choice that makes you feel the safest (which can be either valve) and what fits with you personally, while taking in the information you find most important to you, then you’ve done well. Best wishes, regardless of what you and your doctors find appropriate for you.

 

[neil]

mark there not my facts just something i read in a british paper, the same one which states that a study in the canadian medical association journal shows the chance of internal bleeding whilst taking blood thinners could be at least double current estimates, now before you jump down my throat all i am trying to do is present the wider picture and the problems anti coags can bring,let me state that i still think mech valves offer a very good choice as do tissue, it just seems to me that some people smooth over the facts and say absol no problem its just taking a pill, which thankfully in most cases is right,i cert would not try to tell people what valve choice to make , all i am trying to do is be honest and present the full facts, all of us here would rather we didnt have to make the choice, whichever you pick is the right choice for you,

 

[MarkU]

mark there not my facts just something i read in a british paper, the same one which states that a study in the canadian medical association journal shows the chance of internal bleeding whilst taking blood thinners could be at least double current estimates, now before you jump down my throat all i am trying to do is present the wider picture and the problems anti coags can bring,let me state that i still think mech valves offer a very good choice as do tissue, it just seems to me that some people smooth over the facts and say absol no problem its just taking a pill, which thankfully in most cases is right,i cert would not try to tell people what valve choice to make , all i am trying to do is be honest and present the full facts, all of us here would rather we didnt have to make the choice, whichever you pick is the right choice for you,

Not jumping down your throat or making any judgments, just asking for the source of the information the paper was quoting since it's somewhat inconsistent with what I've seen over the years. I'd be interested in reading the actual study if I could find it.
I've done a lot of research on Coumadin over the past twelve years, since I have a vested interest in doing so. Most of the stuff that I've read concerning internal bleeding goes back to the patient either being out of theraputic range or other complicating factors, not some spontaneous bleeding event triggered by the Coumadin alone. If there is documented evidence of other types of events, then it's something I'd like to know about.
Mark

Mark

 

[Fundy]

Mark, I'm always open to the possibility I'm mistaken. So do you agree with newmitral's algorithm result that the probaility in that instance is 64% over 25 years? Its been a long while since I studied the matter so maybe the algorithm is correct for that use.

The reason it seems wrong is that if I calculate the probability of each person in the simple lottery example, the statistical wins per person don't add up to the correct number. Maybe I am mistaken though. Do you have a link for some credible tutorial or explanation? I would in fact be interested.Googling so far just keeps giving me links to sample google books.

 

[newmitral]

just something i read in a british paper, the same one which states that a study in the canadian medical association journal shows the chance of internal bleeding whilst taking blood thinners could be at least double current estimates

Hi Neal,

I would also welcome a link to either the British paper article or the Canadian Medical Association Journal article ,or pub. date, author, etc. so I could possibly find it myself. This does seem to contradict the many articles I have found which indicate that staying within the target INR range results in an overall risk of bleed/stroke for mechanical valves approximately EQUAL to those of bio-prosthetic valves. If the article/study is indicating a higher risk as a result of people on ACT _NOT_ staying within range, then that's another matter. This is why I would like to read the original source.


Hi Fundy,

Do you have a link for some credible tutorial or explanation?

I don't want to hijack this thread with a tutorial on statistics, but if you want to start a new thread on the subject in the "small talk" forum section, I'll be happy to take a bit more time to explain why my math is correct, and where I think you are going astray. I just don't think it is appropriate to divert this thread that far from its original topic with more statistics math.

 

[pellicle]

Hi

statistically mean you should experience 1 stroke by the time you reach 81.

should is the correct word. But not will, as it remains a statistical likelyhood not a certainty.

 

[pellicle]

but if you want to start a new thread on the subject in the "small talk" forum section, I'll be happy to take a bit more time to explain why my math is correct,

done

 

[Julian]

On a fun note you have about as much chance of dying from a major coumadin bleed or re operation to replace a bad valve as you do from a car accident... According to some studies.

 

[pellicle]

On a fun note you have about as much chance of dying from a major coumadin bleed or re operation to replace a bad valve as you do from a car accident..

we seem to have different ideas of fun ;-)

but I agree with your sentiment. Deaths in car accidents are also quite similar to those from brain tumors. I notice the press agitates more about the road deaths than for better research into cancer.

While we can control many things in our lives it is wise to accept that quite a much more is wholly outside our control, seemingly outside even the influence of the prayers of loved ones.

I would draw attention to the (approximate) words of St Francis of Asisi

have the strength to change what you can and the serenity to accept what you can not and the wisdom to know the difference

 

[neil]

mark it was in a daily british paper the daily express, with a medical pullout,i was only stating what they said, there is plenty of websites for you to browse and am sure you will find it, the point i am trying to make is simple,i am not knocking peoples choices or ever will, i am simply pointing out the pros and cons all round,when i first found out i need my ohs my cardio told me the choices, straight away i said mech as another op down the line compared to just taking a pill was a no brainer, but then he explained the possible side affects of anti coags,for me that tipped the scales to tissue,for many others they choose the pills,as my cardio joked that when even top surgeons and cardio people cant agree on the best valve for people what the hell chance do we have lol, summed it up for me, its a tough choice one we all wish we didnt have to make, but all i ever have said is there is pros and cons on both sides, and the main thing is its gonna save your life

 

[OldManEmu]

Neil
It isn't just layman like you and I that can't agree, with my redo the surgeon was suggesting a mechanical valve and the cardio a tissue valve. I always put more store in the cardio opinion than the surgeon as they have to deal with many patients and their issues associated with VR long term, not just those that require further surgical intervention.

 

[Mike59]

Fully concur with Neil's comments:

We are very lucky to have two very successful options, which both extend and improve quality of life!

 

[normofthenorth]

+1 to ElectLive's post from me, too.

And before we leave the statistics debate, I think the truth is much simpler than has emerged so far, with some truth on both sides. Here goes:

If there's a 4% annual chance of something happening, all else equal, the statistical EXPECTATION is that a person will experience one of them in 25 years. With 100 people, there will be 4 per year (on average), and 100 after 25 years, which is one per AVERAGE person. That's where the whole is equal to the sum of the parts, and the sums balance. BUT that expecation includes a bunch of people who ESCAPE, with NO events, while others have more than one each. So the PROBABILITY of one of those people experiencing one (or more) of those events is NOT 100%, because that means that nobody escapes, which is false. THAT probability has to be calculated as outlined above, from the probability of escaping (96%/yr) multiplied times itself 25 times.

So stop fighting, you're both right, sort of. And both numbers are right, if the 4%/year number is right. . .

 

[blackdodgepu]

Maybe since I have a tissue valve I don't quite understand this. I thought that once you got a mechanical valve, you would take warfarin for as long as you had that valve regardless of valve size. Am I incorrect:?

Apparently it all depends on the size of the valve they put in and your body's reaction to it. It has been 18 months since my surgery and I am still on the warfarin but according to my surgeon and cardiologist after three years or so I may be able to slowly back off the warfarin. They will monitor everything and if my body reacts favorably I could be off for good.

 

[Julian]

Apparently it all depends on the size of the valve they put in and your body's reaction to it. It has been 18 months since my surgery and I am still on the warfarin but according to my surgeon and cardiologist after three years or so I may be able to slowly back off the warfarin. They will monitor everything and if my body reacts favorably I could be off for good.

I've never heard such a thing. How do you know if your body acts favorably to it? Even worse what if it doesn't?!? With a stroke quality of life can be changed forever. Now if you have an On X valve you may be able to have the option to be on a very low dose of warfarin but as far as no anticoagulants I don't think that currently is ever recommended regardless of valve size. Has anyone else heard of this?

 

[Mom2izzy]

The biggest issue I find with the stats is the three little words near the beginning of normofthenorth's post: "all else equal". There are so many variables at play...INR management, diet, participation in more "dangerous" activities, age, etc. For my father in law...everything was completely fine until he sustained a head injury in a car accident...I don't see how the statistics can take that into account.

I'm not arguing that any of the stats or the inferences from those stats is wrong. I just think it may be too complex to apply a number to everyone across the board.

 

[Bina]

My only choice was between Open Heart Surgery -or- jumping off a bridge.....Since I have family, I chose the surgery.

 

[ElectLive]

The biggest issue I find with the stats is the three little words near the beginning of normofthenorth's post: "all else equal". There are so many variables at play...INR management, diet, participation in more "dangerous" activities, age, etc. For my father in law...everything was completely fine until he sustained a head injury in a car accident...I don't see how the statistics can take that into account.

I'm not arguing that any of the stats or the inferences from those stats is wrong. I just think it may be too complex to apply a number to everyone across the board.

This is a very very important point for any and all of us to never lose sight of. Everyone (surgeons, cardiologists, valve manufacturers, patients, etc) wants to pin down what valve is really best, extrapolating for whom and at what age, but we should always keep in mind that these valves are not doing their jobs in a controlled laboratory environment. They are installed with varying techniques inside living breathing patients each with their own individual risk profile and lifestyle, all of which is constantly changing over time. As much as we discuss constant risk, one decision could change everything. Start smoking. Stop exercising. Heck, there's plenty of unavoidables too, just get older or be born with bad genes. Because sadly, all bets are off for constant risk (stroke or hemorrhage) anyway once someone of any valve type hits the age of 60 or so.

Not many may know what it actually takes to get a heart valve approved by the FDA here in the US. Probably a randomized clinical trial as is done with any new medication? Nope. Maybe study results of thousands of patients over a significant chunk of life? Nope. So then, what does it take? 800 total patients years. So, take 266 or so patients, of varying characteristics, put a new heart valve in them, and follow them in a clinical study for around 3 years. That's it. Then, evaluate the results and compare to historical data on previously approved valves to ensure the results are "significantly less than twice as bad". I'm not kidding about that quoted part...it's in there as the measure of equivalency for approval.

Now, I make this point not to make us worry about long term results of new valves. This objective performance criteria method of approval the FDA uses has been analyzed and proven to be a very effective, and almost inarguably the best method for valve approvals. In fact, it would have prevented the Silzone recall problem many many years ago if it had been required at the time, which it was not since Silzone was a modification to a prior approval.

But I do make this point to emphasize even further that these magic annual risk numbers everyone wants to nail down are so very limited. A very small but diverse patient group is followed for a very short period of time and results are published and decisions made. So while everyone brings up very small numbers such as 1% or even 4% annual risk...well, how about using stats to establish those forecasts from only 4% of an actual lifespan (3 years, in other words)! I don't know about anyone else, but I wasn't worried so much about the first 3 years when making my decision, it was the next 25 to 50 that I was more worried about. Yes, of course, there are much longer time period studies out there, encompassing many thousands of patients, but inevitably these trend toward valves no longer used, and at the end of the day, the fact remains, we don't want so much to know what a precursor of our valve did in other patients, we want to know what our own valve will do in us, right?

As has been said, results of both valves are excellent over time, and the unique risks of each generally do merge together over time at their respective age groups. Thus the reason for the great debate. So while tissue and mechanical valves are very different, when put in enough appropriate patients, the overall results (complications) trend pretty similar. Yes, a mechanical valve does present additional stroke risk in and of itself, but in a properly anticoagulated patient, the risk over time will be very similar to a tissue valve because those are put in typically older patients with higher inherent stroke risk and as those valves degenerate stroke risk also rises. As for hemorrhage, yes, warfarin does obviously raise the risk, but compared again to the typically older tissue valve patient group where hemorrhage risk is inherently higher, the results again begin to merge. Low risks, and pros and cons, as has been said time and time again here, all very true. No one would ever volunteer for unnecessary heart surgery or warfarin use, but when required, both are predominantly manageable with excellent results.

Now, one more things, back to those risk numbers I've basically said we all should just ignore... :rolleyes2: As I said, the FDA uses a historical model called the Objective Performance Criteria to approve new valves, based on previously approved valves, and the criteria are different for each valve type. For tissue valves, the risk values for thromboembolism, all hemorrhage, and major hemorrhage are respectively: 2.5%, 1.4%, and 0.9%. For mechanical valves, the same category values are: 3.0%, 3.5%, and 1.5%. So, yes, there is a difference, but again, these are historical values, so outdated to some extent. In my opinion, there really may not be much more universal truth in these numbers than any other given study, but for anyone overwhelmed about which numbers to believe and why, these are at least about as "official" as the statistics will ever get since the represent the safety control and approval mechanism here in the US. So, just wanted to put that out there for the sake of crossing our t's and dotting our i's...