Cleveland Clinic valves?

[MKM]

Hello,
I was wondering if the CC leans towards one type of valve or another. Does the doctor suggest a mechanical (all or most of the time) or do you enter the room with your research and tell them what you want? Since they are the experts, it seems they would have a lot to say on the topic. As you can see, I am working through the process of mechanical vs bio and wanted to know what the experts do. I suspect each patient is different and both valves are used. Thanks for your input.

 

[MdaPA]

I was wondering if the CC leans towards one type of valve or another.

My wife has had 2 OHS's at CC and has received both tissue and mechanical valves.

Does the doctor suggest a mechanical (all or most of the time) or do you enter the room with your research and tell them what you want?

You will /should have treatment options discussed with you by the surgical team (e.g. Cardiologist, nurse) as well as your surgeon prior to the day of your surgery.

I suspect each patient is different and both valves are used.

Yes, your valve disease treatment depends on various factors, like the type of valve disease you have, your age, medical history, etc. as well as your lifestyle and preferences. All of these things will guide your surgeon to help you and him/her make the best decision. Note that once they get in there, sometimes plans are subject to change.

 

[gpr100rs]

You'll find endless discussions on this forum regarding valve selection. I am 63 and had a 25 mm Edwards Inspiris Resilia valve put in at CC on 4-23. At my age, I would say the CC team was definitely leaning biologic and so was I. I found my surgeon presented the pros and cons of each but stressed it was my decision. When I indicated I wanted the Edwards, he said that would be his recommendation. Really driven by age, life style, likely compliance with blood thinners, etc. CC recently did a young professional hockey player who went biologic because he wanted to continue playing and couldn't if he was on Coumadin. But again, if you throw out biologic vs mechanical on this forum you will have no shortage of very strong opinions both ways, though I see with many of the active posters on this forum they lean mechanical. But rest assured, CC is at the very forefront of valve technology!

 

[dick0236]

........ if you throw out biologic vs mechanical on this forum you will have no shortage of very strong opinions both ways, though I see with many of the active posters on this forum they lean mechanical.

This forum is primarily made up of two groups...younger people 60 and younger with a fewer number over 70 who have many years living with artificial valves.....almost always mechanical. Most tissue valves being implanted today seem to be in the group 60s+. Many in that generation, like me, usually have limited computer skill so it doesn't surprise me that fewer of these folks are active on Internet Forums

I'm a believer in mechanical valves for the young to minimize future surgical time and tissue valves for the old who may not have to look at reoperation over age 80.

Forgive the composition of this post, my wife is bugging me to go out to dinner.

Regardless of the valve type selected I would not let a drug(warfarin) play a significant role in my choice

 

[pellicle]

Hi

I was wondering if the CC leans towards one type of valve or another. Does the doctor suggest a mechanical (all or most of the time) or do you enter the room with your research and tell them what you want?

I can't speak to that as I'm Australian. The surgical guidelines make it pretty clear:

and

The very first point on table 18 seems to obviate the idea that the experts should be consulted ... because it implies that an "informed patient" knows better. Makes me wonder why the hell that's there.

The classifications a and b are
The decision is based on the integration of several of the following factors

a Class of recommendation.​

b Level of evidence.

c Increased bleeding risk because of comorbidities, compliance concerns,​

geographic, lifestyle and occupational conditions.​

d Young age (,40 years), hyperparathyroidism.​

e In patients aged 60–65 years who should receive an aortic prosthesis, and those between 65–70 years in the case of mitral prosthesis, both valves are acceptable and the choice requires careful analysis of other factors than age.​

f Life expectancy should be estimated .10 years, according to age, gender,​

comorbidities, and country-specific life expectancy.​

g Risk factors for thromboembolism are atrial fibrillation, previous​

thromboembolism, hypercoagulable state, severe left ventricular systolic​

dysfunction.​

I suspect each patient is different and both valves are used. Thanks for your input.

this is exactly true, and even pretty clear in the reasons given in each of those tables.

Its worth noting that the "level of evidence" is C (opinion) ... I'd prefer A

This is a now older presentation from a senior surgical team member of the Mayo Clinic



I think he has some intelligent input particularly on "levels of evidence".

Indeed I did some analysis on some papers myself:
http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
I think that its important to view the "about me" bit at the start as being a significant part of "each patient is different".

Best Wishes

 

[pellicle]

PS it would be good if you'd put some basic stuff such as your DoB (to at least the year) to assist in guidance of information and opinions (because mine at least "depends" on your data ... I gather from "retired" you're over 65

 

[cldlhd]

This forum is primarily made up of two groups...younger people 60 and younger with a fewer number over 70 who have many years living with artificial valves.....almost always mechanical. Most tissue valves being implanted today seem to be in the group 60s+. Many in that generation, like me, usually have limited computer skill so it doesn't surprise me that fewer of these folks are active on Internet Forums

I'm a believer in mechanical valves for the young to minimize future surgical time and tissue valves for the old who may not have to look at reoperation over age 80.

Forgive the composition of this post, my wife is bugging me to go out to dinner.

Regardless of the valve type selected I would not let a drug(warfarin) play a significant role in my choice

"Forgive the composition of this post, my wife is bugging me to go out to dinner."
So wait a minute, they still harass you into your 80's? No statute of limitations?
Second of all now that I'm 52 suddenly 60 doesn't feel quite as old as it used. I'm hoping I never have to make the choice but I can see how a tissue valve, even in the early 60's could lead to needing surgery in your 80's which doesn't sound like fun.

 

[cldlhd]

Hi



I can't speak to that as I'm Australian. The surgical guidelines make it pretty clear:

and

The very first point on table 18 seems to obviate the idea that the experts should be consulted ... because it implies that an "informed patient" knows better. Makes me wonder why the hell that's there.

The classifications a and b are
The decision is based on the integration of several of the following factors

a Class of recommendation.​

b Level of evidence. View attachment 887812​

c Increased bleeding risk because of comorbidities, compliance concerns,​

geographic, lifestyle and occupational conditions.​

d Young age (,40 years), hyperparathyroidism.​

e In patients aged 60–65 years who should receive an aortic prosthesis, and those between 65–70 years in the case of mitral prosthesis, both valves are acceptable and the choice requires careful analysis of other factors than age.​

f Life expectancy should be estimated .10 years, according to age, gender,​

comorbidities, and country-specific life expectancy.​

g Risk factors for thromboembolism are atrial fibrillation, previous​

thromboembolism, hypercoagulable state, severe left ventricular systolic​

dysfunction.​

this is exactly true, and even pretty clear in the reasons given in each of those tables.

Its worth noting that the "level of evidence" is C (opinion) ... I'd prefer A

This is a now older presentation from a senior surgical team member of the Mayo Clinic



I think he has some intelligent input particularly on "levels of evidence".

Indeed I did some analysis on some papers myself:
http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
I think that its important to view the "about me" bit at the start as being a significant part of "each patient is different".

Best Wishes

I agree that age alone shouldn't be the deciding factor. I mean I'm 52 and just tore down a fence, pulled 3 posts out if the ground and removed all the concrete from the holes. Then set new posts ( with help of the wife) . I know people 10 years younger who couldn't do that.
Not patting myself in the back just making the point.

 

[Keithl]

Hello,
I was wondering if the CC leans towards one type of valve or another. Does the doctor suggest a mechanical (all or most of the time) or do you enter the room with your research and tell them what you want? Since they are the experts, it seems they would have a lot to say on the topic. As you can see, I am working through the process of mechanical vs bio and wanted to know what the experts do. I suspect each patient is different and both valves are used. Thanks for your input.

My surgeon had a long conversation with me about valve types and said he would use On-X or St ].Jude depending on what he sees when inside. I forget know, but there was a scenario he mentioned where the St. Jude would be the better solution.His first choice was On-X and fortunately that is what he used.

 

[user 15848]

I was 62 when i met my surgeon; was given choice of tissue or On-x; The surgeon told me one will last you till you are in your high 70s the other will out last you but needs a "Pill" for life; Besides the fact that i would NOT "PLAN" to go back to a Hospital for heart surgery in my 70++s, There was something else...

3 Months before my surgery i went with wife and friend for a trip to a city with hills up and down, and i had to take my belt out so they could pull me up as i could not do it, that was real , that WAS what happened "to me", we are all different.....

What is the connection ?

Well, tissue valves Are Not better than native ones, no matter what Big Pharma says for its recurrent revenues plans goals, SO, when valve fail is not like an ON and OFF swtich, you start feeling "AGAIN" as i was feeling during the last months of my natural valve , "most likely" or something similar, and then you have to go back to the "Doctors" who the older they get, the more insensible they become; ALL of Them, (there are 12 in my family );

So, NOPE, i was not going to plan for that experience, to be out of breath and need people to push me around out of breath, and place my loved ones AGAIN through the same experience

SO, Yes, i take a PILL , and i wish i Didn't Have To, BUT;
"for me" , that is better than REPEAT the bad experience
of a DEGRADING VALVE

That is "MY Perspective" we are ALL different, with different opionions

But, my 2 doctor sisters, young and old told me the same thing, GO Mech....

 

[MKM]

My wife has had 2 OHS's at CC and has received both tissue and mechanical valves.


You will /should have treatment options discussed with you by the surgical team (e.g. Cardiologist, nurse) as well as your surgeon prior to the day of your surgery.


Yes, your valve disease treatment depends on various factors, like the type of valve disease you have, your age, medical history, etc. as well as your lifestyle and preferences. All of these things will guide your surgeon to help you and him/her make the best decision. Note that once they get in there, sometimes plans are subject to change.

Thanks for your words and input, I appreciate it.

 

[MKM]

My surgeon had a long conversation with me about valve types and said he would use On-X or St ].Jude depending on what he sees when inside. I forget know, but there was a scenario he mentioned where the St. Jude would be the better solution.His first choice was On-X and fortunately that is what he used.

Thanks for sharing. I never thought there would be so much research and pros/cons about valve types. I will keep on learning. Surgery scheduled for mid-June.

 

[MKM]

My surgeon had a long conversation with me about valve types and said he would use On-X or St ].Jude depending on what he sees when inside. I forget know, but there was a scenario he mentioned where the St. Jude would be the better solution.His first choice was On-X and fortunately that is what he used.

Thanks for sharing. My doctor suggested tissue valve but I know that I have the final say. I appreciate your response.

 

[MKM]

I was 62 when i met my surgeon; was given choice of tissue or On-x; The surgeon told me one will last you till you are in your high 70s the other will out last you but needs a "Pill" for life; Besides the fact that i would NOT "PLAN" to go back to a Hospital for heart surgery in my 70++s, There was something else...

3 Months before my surgery i went with wife and friend for a trip to a city with hills up and down, and i had to take my belt out so they could pull me up as i could not do it, that was real , that WAS what happened "to me", we are all different.....

What is the connection ?

Well, tissue valves Are Not better than native ones, no matter what Big Pharma says for its recurrent revenues plans goals, SO, when valve fail is not like an ON and OFF swtich, you start feeling "AGAIN" as i was feeling during the last months of my natural valve , "most likely" or something similar, and then you have to go back to the "Doctors" who the older they get, the more insensible they become; ALL of Them, (there are 12 in my family );

So, NOPE, i was not going to plan for that experience, to be out of breath and need people to push me around out of breath, and place my loved ones AGAIN through the same experience

SO, Yes, i take a PILL , and i wish i Didn't Have To, BUT;
"for me" , that is better than REPEAT the bad experience
of a DEGRADING VALVE

That is "MY Perspective" we are ALL different, with different opionions

But, my 2 doctor sisters, young and old told me the same thing, GO Mech....

So much to think about. I am happy I asked the question to this forum. I appreciate your real-life experience. It helps me in so many ways.

 

[cldlhd]

As but most things there is pros and cons with each but I also think part of it is surgeons don't look at surgery as quite of a big deal as we patients do. After all this is what they do at work every single day so I don't care who they are they have to kind of get used to it. I clearly remember my surgery and my nervousness ahead of it but for my surgeon I'm sure it was one of thousands of surgeries he's done in his life. So maybe that's why the idea of a reop down the road doesn't feel like such a huge thing to them.

 

[caro]

Hi! My surgeon at CC likes tissue for everyone. He did discuss both options, but his preference was clear. Prefers inspiris. I think CC was one of if not first hospital to use them. I went with mechanical though. Talked to cardiologists and people who have had AVR. This forum has also been SO helpful to weigh pros and cons. My dad got his mechanical in his 50’s. Has had it over 15 years now.

 

[Amy]

Don’t forget that big hospitals and their surgeons have ‘financial relationships’ with industry, and it’s hard to imagine that not affecting their recommendations at all.

you can find at least some info on this onyour surgeon’s page on the CCwebsite under ‘Industry Relationships’.

One current example I just pulled off now:

Dr. Roselli receives fees of $5,000 or more per year as a paid consultant, speaker or member of an advisory committee for the following companies:

• CryoLife, Inc.
• Edwards Lifesciences LLC
• W.L. Gore and Associates, Inc

 

[Unicusp]

This is a now older presentation from a senior surgical team member of the Mayo Clinic



I think he has some intelligent input particularly on "levels of evidence".

Indeed I did some analysis on some papers myself:
http://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html
I think that its important to view the "about me" bit at the start as being a significant part of "each patient is different".

Best Wishes

Thanks Pellicle. Very interesting video from the Mayo Clinic. Pretty conclusive to me. The presenter does make the comment that "surgeons tend to favor implanting tissue valves for reasons unknown". This ought to be investigated further. I don't normally believe in conspiracy theories, but the evidence is clear on mechanical vs tissue. And it seems that the first recommendation from most surgeons is a tissue valve. They then gauge the patients response. My very well known surgeon at the CC also first suggested the latest and greatest tissue valve out there. When I challenged him on longevity and the benefits vs the SJR or On-X, he quickly retreated and agreed with the mechanical.
So, it comes down to patient research and self-education.
To me, it still appears that they (surgeons) have some kind of incentive to recommend tissue valves. Yes, it would be unethical but it has happened in the past.
I have a good example of this issue. When I was at the CC this past February for my surgery, my wife met another lady in the waiting area. Her husband was also in surgery for AV replacement by another well known surgeon. A few days later on one of my walks I visited him in his room to chat. I discussed what I had done and chose the On-X and the reasons why and then he mentioned that he had a tissue valve implanted. He did not know which specific brand nor why tissue was chosen. Only that it was what his surgeon recommended. He was 62 and here's the real kicker; he was already on Warfarin for other reasons!!
And the video also brought up the true sad state of affairs in the US regarding self-testing. Another profit motivated setup that helps prevent people from self-testing. They make it near impossible to do it on your own without going thru a testing service that then can charge the insurance companies inflated rates for their "service".
Many opportunities for improvement!

 

[caro]

Wow, @Unicusp that is scary he didn’t know why he chose it AND he’s already on Warfarin. I guess it’s also not surprising, unfortunately. During my first consultation with my CC surgeon, he talked about benefits of tissue, and I was sure I’d get tissue as a 30 year old. He made it sound like a no brainer. Few months went by, and I chose mechanical. Had similar experience as you where he ended up agreeing with me on mech after initially pushing tissue. I told him I wanted to avoid several more surgeries if possible. He said, “well AHA does recommend mech for someone your age too and TAVR isn’t approved for someone even close to your age.” When I was in ICU, someone came by and asked if I’d be interested in keeping my INR at 1.5 for a study. I said “no” right away. He asked if I was a doctor or nurse! The other unusual thing someone said to me at CC was when the discharge nurse who worked with my surgeon told me how much she hates warfarin. She said, “I could never be on warfarin the rest of my life. Look at me. You can tell I like to eat.” I was confused. The surgery went well though, and I was fortunate to have great nurses in ICU and in step down.

 

[Cactus52]

I'll give my 3¢ worth. When I consulted with the CC and Dr. Unai (who I recommend highly) they talked to me about the Osaki procedure which is where they make you you a new valve with pericardium material. I am a pilot trying to get my medical back (which I did in April and my flight surgeon who is a cardiac transplant guy in Dallas) had never heard of it. He recommended with my age (52) that I go with a OnX valve, the FAA considers it bullet proof and it was easy to get back in the air. He had never heard of the Osaki either and there is not a lot of info out there in it which made me a bit leary.