Regarding valve choice, etc. you might want to watch:
A Department of Cardiovascular Surgery Grand Rounds Conference from the Icahn School of Medicine at Mount Sinai presented by Dr. Anelechi (Ani) Anyanwu - a no BS presentation. I will be undergoing AVR likely within the next 3 months. I am 62 and want to get back to playing squash. While INR management is claimed to be "easy" Dr. Anyanwu's talk makes clear the heightened risk of being on blood thinners and the thrombogenic risks posed by mechanical valves. Biologic valves don't last as long and, given my age, will likely require a redo - TAVR vs OHS - when I am in my mid-70's. So, mechanical valve = bleed (i.e., sudden death)- ticking - thrombosis - blood thinners vs biologic valve = 10-15 yr valve life (with gradual breakdown and potential years of decline in function) - redo surgery - possible blood thinner (yes, there's no guarantee you won't need a blood thinner with a biologic valve). I am wrestling with these issue, but will likley rely heavily on recommendation by Dr. Roselli at Clevland Clinic. Trust your surgeon on timing of surgery and valve recommendation. Sounds like you're in good hands.
I noted in another post what a disservice, I believe, this doctor is doing in giving misleading, non scientific based anecdotes against mechanical valves. It is really as if he is intentionally trying to drum up fears and promoting myths based on random comments from a message board. What medical professional would ever do such a thing? No examples of people who have successfully had mechanical valve- who aren't suicidal from the ticking? Who don't wear gloves around the house, who feel totally comfortable wearing a bikini at the beach, and who don't fear driving, or who still get an erection, despite being on warfarin? Talk about misleading fear mongering!
Another example of how I question how much of a scientific mind he has is some of the case studies he presents near the end and suggests that the audience, presumably cardiologists and surgeons, answer his question as to which valve to choose. A 48 year old patient is presented whose biological mitral valve only lasted 8 years and needs a reoperation. biological or mechanical. When one of the doctors answers mechanical, based on the patient's age, the presenter countered that this was not good thinking because the patient was not likely to need mitral valve reoperation with a biological mitral valve. To support this, he presents a study showing that life expectancy is only 15 years after mitral valve surgery, for "all comers". Why would you use all comers data when the patient is only 48 years old, almost certainly much lower than the average age of a mitral valve replacement patient? Even though the patient's first biological valve only lasted 8 years, the presenter argues that the chances that this 48 year old would need another valve operation, should he choose biological, is only 20-30% and the reason that this is so low is that the patient would likely be dead by then. I am totally unconvinced with how he uses selective studies to support this claim, that have very little, if any, application to the patient in question. You can't use an "all comers" study to predict life expectancy for a 48 year old. Keep in mind, the previous bio valve only lasted 8 years, so if the next one also lasts this long, it would take the patient to 56. So, the logic behind concluding that the patient will only have a 20-30% chance of outliving another biological valve is flawed at best, in my view. Take a look at the study linked below with younger mitral valve patients: 74.3% 15-year survival for mitral valve replacements in patients aged 18 to 50.
https://www.jtcvs.org/article/S0022-5223(17)31770-1/pdf
So, in my humble opinion, I think the analysis for this patient was flawed.
Usually when a presentation like this is given, it is customary for the presenter to give their conflicts of interest, in fact, I believe most medical platforms require this. I was really curious about whether there are some conflicts of interest with Dr. Anyanwu. None given before the presentation, in which he cherry picks gloom and doom data. So, out of curiosity, I checked his bio at Mt Sinai. Please note that there is a link for industry relationships on Dr. Anyanwu's bio page and here is what it says:
"Physicians and scientists on the faculty of the Icahn School of Medicine at Mount Sinai often interact with pharmaceutical, device and biotechnology companies to improve patient care, develop new therapies and achieve scientific breakthroughs. In order to promote an ethical and transparent environment for conducting research, providing clinical care and teaching, Mount Sinai requires that salaried faculty inform the School of their relationships with such companies.
Dr. Anyanwu has not yet completed reporting of Industry relationships."
So, according to his bio, he has been with Mt. Sinai since 2004 and has not yet completed their industry relationship reporting, which they require? I have no way of knowing if this doctor has conflicts of interested. Given his, in my view, very skewed presentation, I am really curious to know if he has any.
