Northernlights
Well-known member
Interestingly the ACC/AHA guidelines on valve disease and replacement were updated this year:
'The choice of type of prosthetic heart valve should be a shared decision- making process that accounts for the patient’s values and preferences and includes discussion of the indications for and risks of anticoagulant therapy and the potential need for and risk associated with reintervention. (Class I)
A bioprosthesis is recommended in patients of any age for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired. (Class I)
An aortic or mitral mechanical prosthesis is reasonable for patients less than 50 years of age who do not have a contraindication to anticoagulation (Class IIa)
[ this is a noteworthy change from the 2014 guidelines which referred to patients less than 60 years]
For patients between 50 and 70 years of age, it is reasonable to individualize the choice of either a mechanical or bioprosthetic valve prosthesis on the basis of individual patient factors and preferences, after full discussion of the trade-offs involved (Class IIa)
A bioprosthesis is reasonable for patients more than 70 years of age (Class IIa)
Replacement of the aortic valve by a pulmonary autograft (the Ross procedure), when performed by an experienced surgeon, may be considered for young patients when VKA anticoagulation is contraindicated or undesirable (Class IIb)'
Many people know very clearly whether they want mechanical or tissue anyway , but for those who are worrying about choosing, and fall into the 50-70 bracket I hope the new guidelines will remove some of the stress. It's all good! I hope you anyway are cheered at least by the fact that at your age any choice you make will fall within the new guidelines!
I had my valve replaced at 60 and didn't feel the recovery was a problem at that age. Physical functioning after surgery is driven by your general fitness, the valve's hemodynamics ( mainly affected by valve size) and whether your heart has recovered from any problems caused by the previous stenosis or regurgitation ( again affected by valve hemodynamics). I don't have any limitations myself and agree with Steve that life after replacement ( and before!) is what you make of it.
I will however give one piece of dogmatic advice : I don't take supplements but I would say that no supplement can 'balance' a junk diet. It will help your future health enormously if you move to a Mediterranean- type diet and you will also eat far nicer food! At the very least, I like Michael Pollan's injunction 'Eat food [ i.e . real food] , not too much, mostly plants'. When I lived in the US I was amazed at the amount of highly processed and junk food. Such a shame when good simple food is one of life's great pleasures and very easy to achieve.
'The choice of type of prosthetic heart valve should be a shared decision- making process that accounts for the patient’s values and preferences and includes discussion of the indications for and risks of anticoagulant therapy and the potential need for and risk associated with reintervention. (Class I)
A bioprosthesis is recommended in patients of any age for whom anticoagulant therapy is contraindicated, cannot be managed appropriately, or is not desired. (Class I)
An aortic or mitral mechanical prosthesis is reasonable for patients less than 50 years of age who do not have a contraindication to anticoagulation (Class IIa)
[ this is a noteworthy change from the 2014 guidelines which referred to patients less than 60 years]
For patients between 50 and 70 years of age, it is reasonable to individualize the choice of either a mechanical or bioprosthetic valve prosthesis on the basis of individual patient factors and preferences, after full discussion of the trade-offs involved (Class IIa)
A bioprosthesis is reasonable for patients more than 70 years of age (Class IIa)
Replacement of the aortic valve by a pulmonary autograft (the Ross procedure), when performed by an experienced surgeon, may be considered for young patients when VKA anticoagulation is contraindicated or undesirable (Class IIb)'
Many people know very clearly whether they want mechanical or tissue anyway , but for those who are worrying about choosing, and fall into the 50-70 bracket I hope the new guidelines will remove some of the stress. It's all good! I hope you anyway are cheered at least by the fact that at your age any choice you make will fall within the new guidelines!
I had my valve replaced at 60 and didn't feel the recovery was a problem at that age. Physical functioning after surgery is driven by your general fitness, the valve's hemodynamics ( mainly affected by valve size) and whether your heart has recovered from any problems caused by the previous stenosis or regurgitation ( again affected by valve hemodynamics). I don't have any limitations myself and agree with Steve that life after replacement ( and before!) is what you make of it.
I will however give one piece of dogmatic advice : I don't take supplements but I would say that no supplement can 'balance' a junk diet. It will help your future health enormously if you move to a Mediterranean- type diet and you will also eat far nicer food! At the very least, I like Michael Pollan's injunction 'Eat food [ i.e . real food] , not too much, mostly plants'. When I lived in the US I was amazed at the amount of highly processed and junk food. Such a shame when good simple food is one of life's great pleasures and very easy to achieve.
