Mechanical heart valve often the safest choice

[DJM 18]

http://med.stanford.edu/news/all-news/2017/11/mechanical-heart-valve-often-the-safest-choice.html

Mechanical heart valves may be safer in certain cases than valves made of animal tissue and should be used more in heart-valve replacements, especially in younger patients, according to a study by researchers at the Stanford University School of Medicine.

The study also found that unlike what’s recommended in the national guidelines, which say patients ages 50 to 70 undergoing aortic or mitral valve replacement should be given a choice of either a mechanical or biological valve, the best choice in fact can hinge on whether the aortic or mitral valve is being replaced.

The study shows that for patients undergoing mitral valve replacement, a mechanical valve is actually beneficial until the age of 70. On the other hand, for patients undergoing aortic valve replacement, the benefit of implanting mechanical valves ceased after the age of 55.

“This has potential to significantly impact the current national practice guidelines,” said Joseph Woo, MD, professor and chair of cardiothoracic surgery at Stanford, who routinely performs these surgeries. “While our preference is always to repair heart valves whenever possible, there are certain disease processes which necessitate valve replacement. For these patients, given the study’s new and unexpected findings, I am already pondering, ‘How am I going to counsel my patients today?’ The advice may not be the same as the current national guideline recommendations.”

The study was published Nov. 8 in The New England Journal of Medicine. Woo is the senior author. Postdoctoral scholar Andrew Goldstone, MD, PhD, is the lead author.

 

[CazicT]

Interesting, but the article doesn't give a ton of detail. I couldn't find the full study on nejm.

 

[dornole]

Have heard for some time that tissue valves in the mitral position degrade more quickly. Wonder if that's source of this result.

 

[amarG]

Link to the study....

http://www.nejm.org/doi/full/10.1056/NEJMoa1613792?query=featured_cardiology


I am struck by the low survival rates regardless of which valve you pick. According to standard actuarial tables, a 52 year old today has a 89.8% chance of living beyond 67 years of age. But according to the text from the study (copied below), after AVR, the same 52 year old has only a 69.4% chance of living past the age of 67 with a bio valve. And a 73.6% chance with a mechanical valve. That is quite a big drop from the general population survival rates. Wonder why...?



"...Among patients who underwent aortic-valve replacement, receipt of a biologic prosthesis was associated with significantly higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P=0.03) but not among patients 55 to 64 years of age. Among patients who underwent mitral-valve replacement, receipt of a biologic prosthesis was associated with significantly higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P<0.001) and among those 50 to 69 years of age (50.0% vs. 45.3%; hazard ratio, 1.16; 95% CI, 1.04 to 1.30; P=0.01).... "

 

[rakesh1167]

Link to the study....

http://www.nejm.org/doi/full/10.1056/NEJMoa1613792?query=featured_cardiology


I am struck by the low survival rates regardless of which valve you pick. According to standard actuarial tables, a 52 year old today has a 89.8% chance of living beyond 67 years of age. But according to the text from the study (copied below), after AVR, the same 52 year old has only a 69.4% chance of living past the age of 67 with a bio valve. And a 73.6% chance with a mechanical valve. That is quite a big drop from the general population survival rates. Wonder why...?



"...Among patients who underwent aortic-valve replacement, receipt of a biologic prosthesis was associated with significantly higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P=0.03) but not among patients 55 to 64 years of age. Among patients who underwent mitral-valve replacement, receipt of a biologic prosthesis was associated with significantly higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P<0.001) and among those 50 to 69 years of age (50.0% vs. 45.3%; hazard ratio, 1.16; 95% CI, 1.04 to 1.30; P=0.01).... "

Additional risk of endocarditis, clotting, bleeding and reoperations.

 

[dick0236]

...............That is quite a big drop from the general population survival rates. Wonder why...?

.........and then there are many who have exceeded the general population survival rates.........without sacrificing a normal life and lifestyle.

 

[pellicle]

....without sacrificing a normal life and lifestyle.

Well ignoring the problems of hair loss, erectile dysfunction, feeling the cold, inability to exersize, malaise, and the many other problems that warfarin brings as its side effects are well known to facilitate aging and thus the onset of these diseases.

 

[dick0236]

Well ignoring the problems of hair loss, erectile dysfunction, feeling the cold, inability to exersize, malaise, and the many other problems that warfarin brings as its side effects are well known to facilitate aging and thus the onset of these diseases.

Only one of your list has occurred.......and at my age of 82 I'll let you guess which one.

 

[dornole]

Well ignoring the problems of hair loss, erectile dysfunction, feeling the cold, inability to exersize, malaise, and the many other problems that warfarin brings as its side effects are well known to facilitate aging and thus the onset of these diseases.

You're joking, right - these are not warfarin side effects but general downsides of a long life?

As if people needed more reasons to be worried : o

 

[dick0236]

You're joking, right - these are not warfarin side effects but general downsides of a long life?

As if people needed more reasons to be worried : o

Point taken. Unfortunately its like yelling "fire" in a crowded movie theater. My apologies.

 

[pellicle]

You're joking, right

absolutely! So tongue in cheek that I'd just about rupture ... a list assembled by all of the baseless fears from the uninformed which have been debunked here.

- these are not warfarin side effects but general downsides of a long life?

exactly, the only known side effect of warfarin is to give you a longer life.

The only requirement on warfarin is to be pay attention to what your're doing ... not unlike driving which harms people yet is not as feared as universally (yet).

 

[CazicT]

"...Among patients who underwent aortic-valve replacement, receipt of a biologic prosthesis was associated with significantly higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P=0.03) but not among patients 55 to 64 years of age. Among patients who underwent mitral-valve replacement, receipt of a biologic prosthesis was associated with significantly higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P<0.001) and among those 50 to 69 years of age (50.0% vs. 45.3%; hazard ratio, 1.16; 95% CI, 1.04 to 1.30; P=0.01).... "

This would also mean a 45 year old has only a 69.4% chance of making it to 60 with a tissue and 73.6% with a mechanical.. Wow, I really hope there is something going on here that i'm missing... I was planning on living to 80+ (or even longer, but I didn't want to be greedy, lol)

 

[dick0236]

"........ I was planning on living to 80+ (or even longer, but I didn't want to be greedy, lol)

Sounds like a reasonable plan to me. Be careful when reading some of these "studies". Sometimes they have already formed their opinion......and selectively use statistics to prove their point. There is an old axiom that states "figures don't lie......but lyers figure"

BTW, I never expected to live to 80.......but I did. Those who have this life saving surgery BEFORE irreversible heart damage is done have an excellent chance to live a normal life......and probably little chance without the surgery.

 

[ozsky]

Sounds like a reasonable plan to me. Be careful when reading some of these "studies". Sometimes they have already formed their opinion......and selectively use statistics to prove their point. There is an old axiom that states "figures don't lie......but lyers figure"

BTW, I never expected to live to 80.......but I did. Those who have this life saving surgery BEFORE irreversible heart damage is done have an excellent chance to live a normal life......and probably little chance without the surgery.

i really really like what u said here，Dick，encouraging me alot

 

[Nocturne]

Link to the study....

http://www.nejm.org/doi/full/10.1056/NEJMoa1613792?query=featured_cardiology


I am struck by the low survival rates regardless of which valve you pick. According to standard actuarial tables, a 52 year old today has a 89.8% chance of living beyond 67 years of age. But according to the text from the study (copied below), after AVR, the same 52 year old has only a 69.4% chance of living past the age of 67 with a bio valve. And a 73.6% chance with a mechanical valve. That is quite a big drop from the general population survival rates. Wonder why...?



"...Among patients who underwent aortic-valve replacement, receipt of a biologic prosthesis was associated with significantly higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P=0.03) but not among patients 55 to 64 years of age. Among patients who underwent mitral-valve replacement, receipt of a biologic prosthesis was associated with significantly higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P<0.001) and among those 50 to 69 years of age (50.0% vs. 45.3%; hazard ratio, 1.16; 95% CI, 1.04 to 1.30; P=0.01).... "

Oh boy.

Folks don't cotton to that topic of discussion 'round these parts, pardner.

Look here -- see that circle? It's really a cone! It's both! It's neither! HUZZAH!!!

See? Ya got NOTHIN' ta worry about!

 

[pellicle]

Look here -- see that circle? It's really a cone! It's both! It's neither! HUZZAH!!!

I am pretty sure it's a triangle...

See? Ya got NOTHIN' ta worry about!

So we keep telling you
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[Agian]

Trolling masterpiece; just for laughs. See below.

https://www.youtube.com/watch?v=NPQVaUFF6eE

 

[mikeccolella]

https://jamanetwork.com/journals/jama/fullarticle/2247145. The JAMA study shows NO difference in survival between mechanical and bioprosthetic valves in patients 50-69 years old.