Joint Statement on Aortic Valve Replacement in Low-Risk Patients Issued by Society of Thoracic Surgeons and European Association for Cardiothoracic Su

[pellicle]

Sure, if you didn't already know this I would be stunned.

I'm a bit surprised to read this comment. Of course I already knew this, but maybe others didn't? Perhaps you didn't know this, but I don't write here to announce what I've learned. While some people write here to ask questions others write to answer them.

I also know that some people lurk here and never post (they've occasionally announced this when joining) and so I (and I'm sure others also do) write to address the unspoken questions which arise from thinking about the subject (but not doing any reading on the topic).

Best Wishes

 

[DrCooper]

personally I think that while the primary purpose of this place support, discussion and learning is also of significance.

So unless its our professional domain the only time we get to work through what we are learning is by discussing it here with peers.

What I'm saying is posting something, discussing it, then changing your mind isn't something you should be ashamed of. Indeed the opposite is true, it shows character.

Best Wishes

Happy to learn.
I think my reverse engineering of the age groups is kind of ok, but my statement that aortic disease is an “elderly” disease is probably wrong.

In the study they excluded all patients with bicuspid valves, which is the vast majority of patients getting the surgery below 60 (and a big portion of people in this forum). In that way it makes sense these numbers eg mean 75 std 5.7 years old as acquired valve disease in tricuspid valves happens in the 70s and 80s.

I’m wondering though why clinicians are making that distinction and how transferable are any findings from the old acquired aortic disease to the young congenital one.

 

[pellicle]

Hi

I’m wondering though why clinicians are making that distinction and how transferable are any findings from the old acquired aortic disease to the young congenital one.

I'm predicting you won't like my answers, but its an intersection set of:

• its not their primary focus
• they didn't and don't have a good academic and questioning mind
• lazy

Because I've met a few who do make that distinction and do clearly know its not transferrable with ease.

HTH

 

[carolinemc]

Mine was congenital, and I suspect that many of us here also have had congenital heart issues. I was born with a bicuspid aortic valve.

These defects are commonly undiagnosed and undetected. I was 23 when mine was heard as a murmur by a med student. (I had been suffering with symptoms of it, probably all my life, but it all seemed normal to me because I really had no 'normal' to compare it to -- in P.E., I was the slowest, not being able to keep up with the others (because my heart was working harder than others), I overheard a coach once tell a student that I 'had no guts', not knowing that I couldn't wrestle because I couldn't wrestle -- ironically, I heart that this coach died of a heart attack while running a lap during one of his classes. Maybe HE had an undiagnosed heart issue (maybe his 'heart attack' was aortic dissection or another cardiac issue.

My murmur was heard before birth, as they thought I was going to be twins. Back in the 1960's. And there are heart issues that was never checked for that they are checking kids nowadays. Needs work but they are doing better.

 

[newarrior]

That's probably big numbers illusion (the study database has 42000 patients).

5.7 is one standard deviation. I round it to 6 in my example below.
Assuming normal distribution (which is very likely not the case):

• ~34%: 69-75
• ~34%: 75-81
• ~14%: 63-69
• ~14%: 81-87
• ~2.5%: 57-63
• ~2.5%: 87-93

Most likely, data are skewed somehow towards the lower values with sporadic values / outliers in the young adult ages (20-50).

Population means and standard deviations are such poor metrics... I wish we had access to the actual raw data from all these studies rather than aggregated massaged statistics.

But in any case it's crystal clear we are in a disease of elderly patients

Kind of depressing in a way then if you get the disease before you're 63. I think my disease must have started in my 40s but I probably didn't understand what it was and nobody brought it to my attention until it was discovered when I was 56. My surgery is going to be in a few weeks at 61. I feel bad for people that had the disease much younger.

 

[newarrior]

Happy to learn.
I think my reverse engineering of the age groups is kind of ok, but my statement that aortic disease is an “elderly” disease is probably wrong.

In the study they excluded all patients with bicuspid valves, which is the vast majority of patients getting the surgery below 60 (and a big portion of people in this forum). In that way it makes sense these numbers eg mean 75 std 5.7 years old as acquired valve disease in tricuspid valves happens in the 70s and 80s.

I’m wondering though why clinicians are making that distinction and how transferable are any findings from the old acquired aortic disease to the young congenital one.

Interesting and again I feel depressed because I got the disease at least in my 40s and I'm tricuspid. It's got to be because of high lipoprotein along with probably a couple years of high blood pressure, low HDL which seems to be genetically determined, times I became overweight.. it does seem like this group is mostly bicuspid mostly younger and because people are getting the disease younger most people are typically going mechanical for obvious reasons.