Ah yes, "the chance of mechanical valve re-op".
It would he helpful if someone could find some Numbers comparing Re-op Rates for Tissue vs. Mechanical Valves.
I expect the numbers are no-where near being close.
In all the years I've been reading the VR Forums, I DO NOT recall reading of a Mechanical Valve Failure.
Yes, I have read about mechanical valve replacements for Pannus Tissue Growth and Endocarditis,
but those causes for re-ops have little to do with Valve Type and can happen to BOTH types of valves.
'AL Capshaw'
Of course the rates of re-ops for tissue are higher than mechanical valves
It would be more interesting/ important to ME to see the rates of BAD outcomes from the REDOs in tissue valves compared to the Bad outcomes of Mechanical valves and coumadin. Since pretty much that is what the choice boils down to, which you feel more comfortable living with.
FWIW most studies or articles show about 10% of mech valves need REDOs in the first 5-10 years Others show about 10% have reoperation in 20 years or less depending on the article.
I remember from an earlier thread, many of the people here, who've had a mechanical valve for a very long time (20 plus years) where on their 2nd mechanical valve or they had their valve repaired, anything from sewing a popped stich or cleaning up the valve. One of the concerns w/ REDOs that make them riskier is if they are ER surgeries and not planned "elective" surgeries, I believe a larger percentage of mechanical valve REDOs are emergencies (mainly clots would be ERs) compared to the percentage of Tissue valve REDOs. I am NOT in any way saying or implying theire are MORE mechanical valves needing REDOs than tissue valves..what I am saying is out of all the REDOs needed for either type, the % of those surgeries being an emergency are higher for mechanical valves.
As for why a person with a mechanical valve needs a REDOs, wether it is because of BE, Pannus, clots, popped stitch or need a repair I don't think it matters to them as much as the fact they need to go thru a surgery and recovery (at least in my family's personal experience) on a part that should have lasted a "lifetime".
Of course Tissue valves will also need REDOs and pretty much if you live long enough you will probably need a REDO. Since it is surgery there ARE risks, less in the centers that have alot of experience with REDOS. Hospitals that do several REDOs a week will have better stats than ones that do a couple a month. For the most part the hospitals /surgeons with the most experience in REDOs are the ones that take care of Congenital Heart defect patients, children and adults.
Which since there are about 50,000 REDOs of all types of heart surgery each year (in the US), quite a few hospitals are becoming pretty experienced in them.
I don't know how to quote 2 post so I'm copying part of duffs
"Even if pradaxa ends up being a good replacement treatment for A-fib or VTE - which really the jury is still out on - if you're lifelong anticoagulated on pradaxa, it stands to reason that, if doses are properly managed, it's similar in bleeding risk to being anticoagulated with coumadin except you don't have the 50 years of knowledge of the drug to provide insight in to how it works. What i mean to say is, we can't possibly know as much about Pradaxa as we do about Coumadin right now... at least not in my opinion. The lack of familiarity in the medical community about Pradaxa seems a risk in itself. The lack of reversal agent (that I'm aware of) is also concerning. From my perspective and to my personal situation, the only clear benefit to Pradaxa is convenience."
I don't know if this would interest you, but if you have a spare 1/2 hour, There is a pretty interesting (IMO) webcast panel discussion on the different clinical trials going on for the new anticoagulants
http://www.theheart.org/article/115...edium=email&utm_source=20110128_TopStories_EN
hopefully this goes to a page describing the discussion and you can click on "view conference" if it doesn't work , let me know and i'll try a different way.
It is too early to see if there are any problems from longtern pradaxa and it, BUT the RELY trials for Pradaxa w/ AFib (18 thousand patients) showed over a 30% DECREASE in stroke and systemic embolism and a signifigant decrease in hemoragic stroke /cerebral bleed. There was lightly less bleeding in the 150 2 times a day group and a signficant reduction in "life threatning" bleeds compared to Coumadin.
I haven't read or heard anything about this, BUT I was thinking since there seems to be a relation between BAV and brain annuerysms that might be even more helpful for those patients, but maybe it wouldn't matter, it might be something interesting to ask about.
Another benefit could be Since Pradaxa doesn't have anything to do with Vitamin K, there wouldn't be the same worry about reduced bone density as it looks like there is with Coumadin.
The not having a reversal agent would be a concern, but since Pradaxa half life is very short 12-17 hours, compared to Coumadin 20-60 hours and you have to take it every 12 hours. For the most part you would only worry about reversal if you you have a trauma or major bleed, Depending how close it was to your last dose, they would probably use charcoal to absorb any left in your stomach and then -like they do for plavix and aspirin that also do not have reversal agents- most likely they would treat the bleed with blood, Fresh frozen Plasma, Cryo, platlets or different clotting factors depending on your bloodwork.
