having had 3 OHS when I read someone else write this I can relate.
Personally I detest surgery and don't want to have another if I can avoid it. I am a surgeon...
I wish I had other options, but given that I started young and averaged 20 years between valve replacements I can't complain.
... I would love not to have to take warfarin but it is not that big a deal. Surgery and procedures done multiple times have risks that mount up also.
well one thing is for sure, warfarin management has become a much more accessible thing and gives well established better results.
As one ages its almost a good thing to be on a drug which prevents those nasty "strokes" which can strike unexpectedly
and I enjoy hearing some of the comments that are attributed to some of the cardiac surgeons. Things like you can have a Ross procedure then when the aortic valve fails a TAVR when the pulmonary valve fails probably an open heart but maybe by then a TAVR like procedure then .....
I am sure that there are some corner cases for all variants, but I've been on record here a number of times saying that in the majority of cases the Ross has no solid justification in the modern surgical repertoire. Spoil two valves to do surgery on one? Its madness from any perspective. The most that you can say is "its no worse than a bioprosthesis"
By and large its an anachronism for surgeons who like the challenge. I have yet to read an actual sound justification for it outside paediatric applications
I think its best put here:
https://www.ahajournals.org/doi/10.1161/circulationaha.108.778886
Despite the marked improvements in prosthetic valve design and surgical procedures over the past decades, valve replacement does not provide a definitive cure to the patient. Instead, native valve disease is traded for “prosthetic valve disease,”
So why anyone would add a second diseased valve is bizarre to me. Futher it goes on to say:
.. and the outcome of patients undergoing valve replacement is affected by prosthetic valve hemodynamics, durability, and thrombogenicity.
given that clotting issues (thrombogenicity) are so well controlled now unless there is a compelling case to avoid anticoagulation durability should be what the patient would seek ...
Ultimately it is the patient that has to decide assuming that they have enough information to decide
In my experience here there are two issues I see time and time again
- many think they know something but usually just don't
- many have the data at hand but appear to be simply incapable of comprehending it. So without the ability to understanding of what all that data means you may as well give it to them in Greek or Chinese for all it matters
I can't count the amount of times that pre-surgery someone was horrified of the prospect of warfarin, gradually in discussion they are introduced to
- what they thought they knew was highly distorted or wrong
- the restrictions on their life were exaggerated or wrong
- the management of ACT could actually be taken into their own hands and they could get control of their lives and health (like has also happened for diabetics
One fellow here was in tears eating his "last greek spinach dish" that his mum made him before surgery ... during his recovery we had a number of phone calls, he got a coaguchek, he tested ... now he still eats his mums cooking and is glad.
I often feel frustrated that so many suffer emotionally so much due to the misinformation presented to them.
Oh well ... I do what I can, but there must be thousands out there that are led down dark paths being told "its the only way"
The only thing I'd disagree with on your post is this:
its lies, bloody lies, statistics and maps.
:-D
