Cleveland Clinic valves?

[ATHENS1964]

For "me" it was very hard to accept the fact i was born with a defective heart; and even harder to accept that "for me" the only repair worth doing was the one that implies taking a pill for life

And, no matter how much tavi talk goes around, i can not prevent thinking like a mathematical engineer; so here is the question: You place a screw with a nut, the screw goes bad and needs to be changed, 2 options, remove nut and screw or pull out the screw and place a nut "inside" the first nut, of course this will be smaller and the screw thinner...., and so on and so forth....

Now, engineering-mathematical question: How many nuts can you insert inside the first nut always sitting there ?

Can you be 100% the "first" nut will last for ever and accept the second one ?

Doctors are not engineers, hardly comprehend high calculus; so they are told what
they are told by BIG Pharma, simple.

For me, this Tissue valve with the TAVI rethoric; DOES have a place , but it is not the sweet blue pill

A plumber would also say with the sealing what happens to how much teflon is between the nut and there is no rotation there is an anchoring system.

 

[pellicle]

That seems a bit surprising. I mean clearly there's a big difference between missing a day or two of your statin or skipping your anticoagulant therapy for days.

My mate who is a pharmacist says it fits with his experience.
I think we are a very small section of the valve community.

 

[pellicle]

And, no matter how much tavi talk goes around, i can not prevent thinking like a mathematical engineer

As a biological guy I'm going to say there is a big difference between living things and non living things...

 

[MdaPA]

As an aside, in this discussion, what gave me pause was the comment "When I was in [Cleveland Clinic] 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." That seems very inappropriate and a very high pressure tactic. A patient's response to warfarin will not be known for several weeks. That's a decision that can wait until one's INR has stabilized. From a perspective of human compassion and ethical science, the ICU after OHS is the last place to be looking for volunteers for a low INR clinical trial.

From Caro's bio, she got an On-X AV in 2020. Then, according to the guidelines/manufacture, an INR of 1.5 (being the bottom of the range) would be appropriate 3 months after surgery. I searched CC for clinical trails and did not find anything. So was/is it part of a current study?

For patients with an On-X mechanical bileaflet aortic valve with no other risk factors for thromboembolism, the INR goal is 2 to 3 for the first three months after valve surgery; and after three months the goal is 1.5 to 2.
International Normalized Ratio (INR) - StatPearls - NCBI Bookshelf

 

[Keithl]

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.

Your surgeon can like whatever he wants, ultimately your decision. My surgeon left the decision to me, consulted with me and did the On-X I requested even though he seemed to suggest tissue, but he was very goo and not being biased in the consultation.

 

[MdaPA]

I think that the thought process that some cardiac surgeons use is that by the time a tissue valve needs replacement, a non-invasive method (TAVI, TAVR) or something else would be available to repair the valve without cracking the chest.

Agree! That is a big selling point.

My wife was told in her first two OHS's (in 1997 and 2000) that the tissue valves she got could someday be replaced by a non-invasive/catheter approach. Also heard they might even "grow your own valve" and implant that. And that was over 20 years ago! She finally got mechanical AV and MV in 2017 via traditional OHS (but a porcine PV).

 

[pellicle]

My wife was told in her first two OHS's (in 1997 and 2000) that the tissue valves she got could someday be replaced by a non-invasive/catheter approach.

... and we'll soon get Fusion reactors going and the guys at CERN will find the answers with just another few billion euros to build a bigger collider ...

 

[Amy]

I searched CC for clinical trails and did not find anything. So was/is it part of a current study?

My surgeon essentially said, last month, the day before surgery, that he preferred to replace my valve with the on-x so I could be part of the trial to be randomized to take Eliquis (apaxiban) instead of Warfarin.

https://consultqd.clevelandclinic.o...lation-after-avr-with-a-mechanical-valve/amp/
That doesn’t mention a 1.5 INR, but it does say they hope Eliquis is “.... superior to warfarin in the safety outcome of number of major bleeding events” - which sounds like they’re having patients on a lower INR.

 

[MKM]

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

Thanks for sharing this additional information. It gives me so much more to consider!

 

[Keithl]

There has never been a person on this forum who had their cardio and surgeon tell them they made the wrong choice. All choices are a choice for life, failure to operate is a choice for death. I chose mechanical but question that choice ever time my arthritis makes it impossible for me to do something. It's my choice of mechanical and the resultant warfarin that removes the most active drugs for arthritis from my grasp. Beware of the fact that surgeons and cardios are human and driven by the same impulses everyone is.

I switched caridos becasue after I select mechanical his attitide sucked, so while he did not tell me I made a wrong choice outright, his attitude clearly did not agree with my choice. But like some brain/cardio folks he had a huge God complex.

 

[caro]

From Caro's bio, she got an On-X AV in 2020. Then, according to the guidelines/manufacture, an INR of 1.5 (being the bottom of the range) would be appropriate 3 months after surgery. I searched CC for clinical trails and did not find anything. So was/is it part of a current study?

For patients with an On-X mechanical bileaflet aortic valve with no other risk factors for thromboembolism, the INR goal is 2 to 3 for the first three months after valve surgery; and after three months the goal is 1.5 to 2.
International Normalized Ratio (INR) - StatPearls - NCBI Bookshelf

Must be a current study. I didn't hear him out on specifics. I cut him off when he said 1.5. It was probably after a few months at a higher range, but I have no idea.

 

[caro]

I switched caridos becasue after I select mechanical his attitide sucked, so while he did not tell me I made a wrong choice outright, his attitude clearly did not agree with my choice. But like some brain/cardio folks he had a huge God complex.

Also switched cardios for same reason. SO glad I did. Love my current cardiologist.

 

[Protimenow]

... and we'll soon get Fusion reactors going and the guys at CERN will find the answers with just another few billion euros to build a bigger collider ...

Pellicle - you must have seen Back to the Future. I'm still waiting for a Mr. Fusion for my car.

 

[tom in MO]

I switched caridos becasue after I select mechanical his attitide sucked, so while he did not tell me I made a wrong choice outright, his attitude clearly did not agree with my choice. But like some brain/cardio folks he had a huge God complex.

Maybe he needed the added monetary compensation he gets from a tissue valve.

My cardio told me some "good news" in his opinion. Recent guidelines indicate that routine echos are no longer needed for modern mechanical valves. That's another lost revenue stream for some cardios My cardio has got a full practice though.

 

[Amy]

I switched caridos becasue after I select mechanical his attitide sucked, so while he did not tell me I made a wrong choice outright, his attitude clearly did not agree with my choice.

Same thing happened here, but i think it was because I wanted to go out of state for the surgery instead of going with either of his ‘recommended’ surgeons. Actually the first nurse I talked to, via phone consultation, at the CC told me that could happen - that your cardiologist would refuse to see you because you chose somewhere else to have the surgery - and to my mind, developing an unbearable (and unjustified, I would say) attitude toward the patient such that they feel uncomfortable under your care and choose to change cardiologists, is nearly the same thing as refusing to see them.

 

[Meanjellybean]

I switched caridos becasue after I select mechanical his attitide sucked, so while he did not tell me I made a wrong choice outright, his attitude clearly did not agree with my choice. But like some brain/cardio folks he had a huge God complex.

I had a similar experience with my Cardiologist.
He was pushing for me to get valvoplasty for several years then to have a tissue valve with the thought of TAVR in the future.
I declined and chose mechanical and he basically said that he wants nothing to do with my surgery. That I need to organise everything with the surgeon myself and he will not help facilitate in any way.
That was pretty crappy to hear as I have been seeing my Cardiologist for over 13 years regularly.

I don't know why they get stuck on their own opinion and best way forward.
I though he was upset as he wanted me to be a case for TAVR and that it would be a "win" for him in his own research for me to go on that path..

 

[dornole]

Man what a jerk. My cardio was a leader in transcatheter mitral valve replacement research (first in US) and always pointedly told me "that's not for you!" Which it isn't because I'm too young and healthy. I always felt like he cared about me first and since he retired, my new guy is even kinder, he could be a freaking therapist. Does seem like a fair number of surgeons and cardiologists prefer the patient be unconscious though.

 

[slipkid]

....Does seem like a fair number of surgeons and cardiologists prefer the patient be unconscious though.

In my experience doctors IN GENERAL prefer the patient to be "unconscious", that is silent, do as you're told, do not ask ANY questions at all no matter how well informed or framed they might be, never EVER dare to point out when they are making a mistake (even though it could kill you).

 

[dornole]

Hasn't been my experience at all, like I said above -- always been able to get doctors, teachers and other to work with me, whether through luck, my approach or a combination I couldn't say. Definitely a huge advantage in terms of care.

 

[Chuck C]

In my experience doctors IN GENERAL prefer the patient to be "unconscious", that is silent, do as you're told, do not ask ANY questions at all no matter how well informed or framed they might be, never EVER dare to point out when they are making a mistake (even though it could kill you).

I have certainly visited doctors in my life who have this attitude. However, my experience with the cardiologist and surgeon team that handled my aortic valve surgery was not this way at all. Just the opposite. They covered all options with me, discussing pros and cons, but made it very clear that it was my decision. It was clear that 1) it was my choice of when to get surgery, once I had crossed the line into severe- get it done now or wait for symptoms. 2) My choice of the valve type, tissue or mechanical. 3) my choice of which mechanical valve. They offered their opinions, in some cases strong opinions, but made it clear that ultimately the choice was mine and that they would support my choice regardless of which choice I made.