interesting video here about valve choices

[ashadds]

This guy seems to hate a mechanical valve

 

[Todd]

Wow, I don't think I should have watched this ! I have a surgery coming up at the end of this month, my 3rd Aorta valve replacement and I am choosing to go mechanical . Watching this makes me second guess my decision .

 

[pellicle]

. Watching this makes me second guess my decision .

Don't.

This sort of thing has a bunch of assumptions in it and ignores data. Your choice is carefully thought out for your specific situation. You have additional data and criteria.

I didn't go through it but did it address Lp(a)?

What was it's assumption on anticoagulation?

May as well go listen to a valve makers sales pitch (hint, it will be what they have the biggest margin in).

 

[pellicle]

Wow

wow is how I usually feel when digging into the details ... most "pro one side" stuff was "pro bio-prosthesis" then became "pro-TAVR" ... its interesting how that goes when TAVR maximises profits and minimises hospital time so that insurance companies can green light it for "those who it was never intended for"

Lets look into this:

Aortic Valve and Ascending Aorta Guidelines for Management and Quality Measures
Lars G. Svensson MD PhD Chair Writing Committee; David H. Adams MD Vice-Chair Writing Committee; Robert O. Bonow MD Vice-Chair Writing Committee; Nicholas T. Kouchoukos MD Vice-Chair Writing Committee; D. Craig Miller MD Vice-Chair Writing Committee; Patrick T. O'Gara MD Vice-Chair Writing Committee; David M. Shahian MD Vice-Chair Writing Committee; Hartzell V. Schaff MD Vice-Chair Writing Committee; Cary W. Akins MD Writing Committee Member; Joseph E. Bavaria MD Writing Committee Member; Eugene H. Blackstone MD Writing Committee Member; Tirone E. David MD Writing Committee Member; Nimesh D. Desai MD PhD Writing Committee Member; Todd M. Dewey MD Writing Committee Member; Richard S. D'Agostino MD Writing Committee Member; Thomas G. Gleason MD Writing Committee Member; Katherine B. Harrington MD Writing Committee Member; Susheel Kodali MD Writing Committee Member; Samir Kapadia MD Writing Committee Member; Martin B. Leon MD Writing Committee Member; Brian Lima MD Writing Committee Member; Bruce W. Lytle MD Writing Committee Member; Michael J. Mack MD Writing Committee Member; Michael Reardon MD Writing Committee Member; T. Brett Reece MD Writing Committee Member; G. Russell Reiss MD Writing Committee Member; Eric E. Roselli MD Writing Committee Member; Craig R. Smith MD Writing Committee Member; Vinod H. Thourani MD Writing Committee Member; E. Murat Tuzcu MD Writing Committee Member; John Webb MD Writing Committee Member; Mathew R. Williams MD Writing Committee Member

ATS, 95 (2013) S1-S66. doi:10.1016/j.athoracsur.2013.01.083
(that doi can be searched on) if you do, you'll find this table:

So that's pretty sloppy stuff because All and Total just don't add up

Putting that data into a spreadsheet I get this:

Valve​	​	Number​
Mechanical​	​	​
​	all​	16,780​
Tissue​	​	​
​	ATS​	216​
​	Carbomedics​	5,290​
​	Edwards​	39,367​
​	Medtronic​	18,688​
​	St Jude​	11,666​
​	SUM​	75,227​
​	​	​
​	Mech + Tissue​	92,007​

The All in tissue does not fit in with the spreadsheet (so I've omitted it), despite formatting the All indented under Tissue is actually close to the Sum of the provided Tissue groups but not quite right ... sloppy.

I see this again and again in medical stuff and it wouldn't fly in Engineering or any Science paper. You'd be ridiculed and hammered ... so far I'm the only one on the internet I can find taking issue with that.

Standing on the shoulders of Giants ... huh ... now, getting back to that look at the amount for Tissue valve costs $435,716,947.00 ... ho lee sheet ... that's $435Million which almost certainly doubles itself with repeat business. Follow the scent of money I say.

I've written about that in this lengthy post:
https://cjeastwd.blogspot.com/2014/01/heart-valve-information-for-choices.html

Best Wishes

 

[-andrew-]

I haven't watched all of the video yet, but from what I've seen so far it's not one I'd personally be recommending for people preparing to go through valve surgery. It appears that the presentation had a clear objective of highlighting the disadvantages of mechanical values and so selected statistics and examples to demonstrate the point. Whether the motivation is financial or just the professional opinion of one surgeon / researcher / facility, I don't know but it certainly didn't seem to be putting forward a well structured and balanced argument to me. I started to watch it because I'll be needing to make a decision about whether to go for another bioprosthetic option or a mechanical for my 4th surgery and my gut instinct and preference is still to avoid mechanical. So being honest I was looking for some info to back me up! But I wouldn't let anything in the first part of that video influence me much - far to reliant on specific, pre-selected examples - to support that decision. It also looked to focus on relatively short term stats - 10/15 years and so likely didn't fully capture the risk associated with repeat surgeries.

It's also a presentation that is given by a surgeon to what appears to be a group of other surgeons / medical professionals and so the language and terminology used is not always suitable for patients. That's not something that bothers me, but I suspect it would cause unnecessary worry to others.

I'll be watching the rest of it later, but my initial reaction was strong enough to pop this comment on here.

 

[dornole]

It was actually kind of reassuring to me how strongly my surgeon recommended a mech valve for me because it makes it much less likely I will ever see him again. Not that I think he has ANY trouble getting enough patients to operate on. : )

 

[Chuck C]

I have several issues with that video. Here is just one which jumps out at me.

He makes the argument that a young patient needing a mitral valve should consider a biological valve, because only about 20% of those patients will ever need a redo. When he explains why, it is sad- many have died before needing valve replacement. The same study which he uses to make this case shows that for these young patients, the bio valves had about a 50% higher rate of mortality after 10 years. He glosses over this, but take that in for a moment to see how warped his advice is.
Essentially he is saying that the signifcantly higher rate of mortality with this valve means that you will not likely need a redo operation, because you will die before it is needed. So, choose that valve. That is bonkers. Why wouldn't the patient and his team choose the valve which gives the significantly higher survival rate after 10 years?

What about personalized medicine? Sure, if a person has a 10 year life expectancy, due to age or comorbidities, then tissue makes sense. But for a young patient who might have a life expectancy of 30 to 50 years, the high probability of that patient will need a reop done should be taken into account in valve choice. He uses generalized data for life expectancy after valve surgery, to make his argument to choose bio valves. The patient's individual life expectancy should always be taken into account in this decision.