Biological vs Mechanical -- what does the ACC think?

[cldlhd]

Well the way I see it the aneurysm was going to kill me probably sooner rather than later so I needed that taken care of so all I can do now is try to live a pretty healthy lifestyle going forward. As for my repair I know everyone has their favorites but I got a surgeon who's definitely on the count on one hand best of list of best regarding repair, at least in the states I'm not sure about the entire planet. I told him I only wanted a repair if it was a durable one with a CHANCE of lasting a lifetime. As I had no stenosis at the time of surgery and minimal leakage it worked out and he put it in his top 5 and presented my case at the 1st North American valve repair symposium in 2015. My backup was mechanical and I know I could end up there one day anyway. My one year scan showed zero leakage but some calcification on the annulus. My theory I presented to the nurse practitioner is the the surgery causes the endothelial damage that allowed the calcification, she said that's possible but it's also likely that it's scar tissue being interpreted as calcification. I think with theses scans there's a lot of cover your ass mentality, better to make it seem a bit more dire than it is than to miss something.

 

[Agian]

It was pretty clear to me what the point of that article was. It was right there in the Conclusion, and it dealt with the topic of this thread. How did you miss it?

What it looks like to me is that when it comes to longevity after AVR, the actual information out there that is available in peer-reviewed studies comes to some conclusions that are understandably uncomfortable for some people, to the point where they get a bit irrational and maybe even lash out a bit. Calling me a "pessimist" or insinuating that I am a "whiner" who just wants to complain but isn't DOING anything about his health (which is demonstrably false -- how many of you have lost 25% of your body mass?) might help distract you or take the sting away, but it isn't going to change the facts. I'm sorry.

EVERY study that I have seen that deals with survival after AVR has said that the average post AVR lifespan is significantly less than would be expected for the general population, although the gap does get smaller as age at implantation rises. In fact, one study indicated no difference in lifespan if age at implantation is 68 or above. And a person in their 80s who still qualifies for AVR actually has a HIGHER life expectancy than their peers, simply because they were healthy enough at implantation to be deemed capable of surviving the surgery (but THAT is an example of data that needs context if we are to avoid drawing misleading conclusions).

If you can find a peer-reviewed study indicating that AVR has little or no impact on relative life expectancy, let's see it. To date, the only sources I have found that say that are "feel good" blogs. When it comes to peer-reviewed studies, time and again we see the same general conclusions about lifespan after AVR -- much better than without for those who need it, but significantly worse than the general population.

Nocturne, I'm not going to wade through the Internet to find the peer-reviewed articles that will make you feel more optimistic. Any group of people with chronic diseases taken as a whole will statistically show a reduction in lifespan. All things being equal, people with arthritis live less than those without, diabetes, hypertension, coronary artery disease etc etc. This is stating the obvious.

What is becoming increasingly obvious is that you're looking for someone to disprove the bad news that you've extracted from various sources. I was born with a bicuspid valve which stenosed and required replacement. I am now on Warfarin and at increased risk of clots, haemorrhage, endocarditis, pannus. I also had a stent put in last year, so I have an element of coronary artery disease. I would be a total wanker if I thought there was no way this could not affect my longevity. Find your own "peer-reviewed articles" that will promise you eternal life. People aren't "irrationally lashing out" at you here, when they voice an opinion contrary to your manipulative attempts to get others to find the evidence that will disprove that having heart disease can kill you.

 

[Agian]

It's impossible to say exactly what contributed to my diabetes, but certainly once I'd ditched the carbs (complex ones at that) my blood glucose levels came down to non-diabetic numbers !

But, if your blood glucose levels are now normal, wouldn't that mean you don't have diabetes anymore?

 

[Paleowoman]

But, if your blood glucose levels are now normal, wouldn't that mean you don't have diabetes anymore?

No. Because if I eat something with more carbs than I can manage then my blood glucose levels go up unacceptably. Someone without diabetes would manage the carbs but not someone like me with diabetes. I obviously try not to go above a certain amount of carbs - I stick to 30 to 50g carbs per day spaced out evenly - but it sometimes happens. I'm a well controlled diabetic though !

 

[Nocturne]

Nocturne, I'm not going to wade through the Internet to find the peer-reviewed articles that will make you feel more optimistic. Any group of people with chronic diseases taken as a whole will statistically show a reduction in lifespan. All things being equal, people with arthritis live less than those without, diabetes, hypertension, coronary artery disease etc etc. This is stating the obvious.

What is becoming increasingly obvious is that you're looking for someone to disprove the bad news that you've extracted from various sources. I was born with a bicuspid valve which stenosed and required replacement. I am now on Warfarin and at increased risk of clots, haemorrhage, endocarditis, pannus. I also had a stent put in last year, so I have an element of coronary artery disease. I would be a total wanker if I thought there was no way this could not affect my longevity. Find your own "peer-reviewed articles" that will promise you eternal life. People aren't "irrationally lashing out" at you here, when they voice an opinion contrary to your manipulative attempts to get others to find the evidence that will disprove that having heart disease can kill you.

I see someone who is maybe even more scared than I am. It would seem that we have different ways of dealing with our fears. Peace.

 

[JulienDu]

Well, since it was published in a reputable medical publication, I had been giving it some credence, but now that some guy on the internet said that it's "complete ****" with no explanation why, I guess it's not worth considering.

IT S COMPLETE **** :

-Comparing Mech vs Bio on a 12 years span is COMPLETE ****

-Saying that there is a 20 percent risk of major event with mech by multiply 2 percent risk / year by 10 is COMPLETE ****

-Only mentioning survival rate without mentioning side effects of re-operation is COMPLETE ****. So yeah I survived my operation but I have half a dick left now !!!

-Saying that a re-operation has the same risk of a first re-operation is COMPLETE ****. The risk of having a Pacemaker for exemple increase at a re-do surgery because of all that stinky scar tissue that hide your nodes.

-Saying that bio valve is cost effective because no blood draw or warfarin is COMPLETE ****. Is the writer aware of the cost of an open heart surgery or a TAVR vs the 50 dollars yearly cost of warfarin ???

IT S COMPLETE **** says a reputable random cave man on internet

 

[cldlhd]

Maybe survival after avr is lower than average partly due to some of the reasons for the surgery in the first place. Obesity, sedentary lifestyle, smoking , not enough sex , laughter or fun?

 

[JulienDu]

Maybe survival after avr is lower than average partly due to some of the reasons for the surgery in the first place. Obesity, sedentary lifestyle, smoking , not enough sex , laughter or fun?

Yeah good point. I do not see any where on that subject where they make a difference between individual that are born with a BAV and individuals whose life style **** up their good Tricupside Valve.

 

[cldlhd]

Exactly, if most people with normal trileaflet aortic valves live a reasonably healthy lifestyle than that valve is more likely to last 80 years. If they smoke 2 packs a day and never get off their arse and their valve needs replacing then they die prematurely is it because of the surgery or the way they live which caused the need for surgery?

 

[Paleowoman]

All the studies I've seen on AVR have been of people who obviously had degenerative calcific aortic valve disease - people in their 70's or older with tricuspid aortic valve that's got calcified, and they have all sorts of other things wrong. The studies may sometimes mention a few younger patients without saying why they had AVR, but they lump them together with the calcific degenerative AVRs. I've not seen any studies which focused on AVR soley in patients who had BAV and who are basically fit and healthy. It's pretty annoying when you're trying to get information about AVR and valves..

 

[pellicle]

Maybe survival after avr is lower than average partly due to some of the reasons for the surgery in the first place. Obesity, sedentary lifestyle, smoking , not enough sex , laughter or fun?

this is a point that I've made in the past to Noct ... but he's far more interested in reading the studies proving his view that he's going to die young than getting out and doing things. Changing towards an active and happy lifestyle is a difficult thing for some. I believe strongly that its the deciding factor and that the studies are about fundamentally unhealthy people.

Just by having BAV and a subsequent AVR does not mean you have to be inactive and a slob. Each time before my surgeries I have put on weight ... to approximately 30% over ideal. Each time after surgery I've put in effort to combat that (which I've said many times). I fight back to be healthy because I know what the alternative is like.

Sit down and die or get up and live

 

[cldlhd]

this is a point that I've made in the past to Noct ... but he's far more interested in reading the studies proving his view that he's going to die young than getting out and doing things. Changing towards an active and happy lifestyle is a difficult thing for some. I believe strongly that its the deciding factor and that the studies are about fundamentally unhealthy people.

Just by having BAV and a subsequent AVR does not mean you have to be inactive and a slob. Each time before my surgeries I have put on weight ... to approximately 30% over ideal. Each time after surgery I've put in effort to combat that (which I've said many times). I fight back to be healthy because I know what the alternative is like.

Sit down and die or get up and live

I like to have a balance but sometimes it's difficult. I went swimming today and generally I'm pretty active but as I'm on vacation until the end of the week I'm having a beer right now and the wife is making spaghetti for dinner.... I can't quote any particular studies but I seem to remember valve replacement due to BAV and all else being equal you can expect a normal lifespan.

 

[Agian]

I see someone who is maybe even more scared than I am. It would seem that we have different ways of dealing with our fears. Peace.

I doubt you'll find one person on this forum who hasn't been scared. As a general rule, most anxious folks are good people.
You had a scan that shows you have a high Calcium Score. There is evidence that CAD disease can not only be halted, but is also reversible.
Any potential valve replacement you need is so far in the future that you will be a candidate for the Lapeyre Furtiva (or equivalent), a tri-leaflet mechanical valve that doesn't need Warfarin.
I figure you shouldn't need any more heart scans, as your head is so far up your arse that you can see your own heart close up.
Deal with your risk factors and get on with your life. You'll be fine.

 

[Warrick]

I figure you shouldn't need any more heart scans, as your head is so far up your arse that you can see your own heart close up.
.

...................

 

[jmo3]

Here's a counterpoint perspective from the Mayo Clinic: http://aats.org/valve/presentations/2013/Thursday/14 Schaff 145 mechanical vs bio AATS.pdf

 

[pellicle]

Here's a counterpoint perspective from the Mayo Clinic: http://aats.org/valve/presentations/2013/Thursday/14 Schaff 145 mechanical vs bio AATS.pdf

I'm glad they've still got that up in some form ... the "audio visual presentation" has either been taken down (and well, it was flash, so soon to be unsupported) or moved.