Hi there
first let me say that I agree with the points raised by dick and honeybunny: its a tough decision and you should go with your gut feelings.
Let me also say that I'd had 2 OHS for my Aortic before my 2011 operation when I was 48, so there is some similarity between us (although valves vary)
rnff2;n860987 said:
Looking at MVR in Jan. Im 43 and have had 2 previous open heart surgeries. I assumed that due to my surgeries and age I would be given a mechanical valve with no other option.
I would have agreed. with that sentiment.
He gave me info about anticoagulant therapy, lifestyle changes and the risk of strokes if I go mechanical and then the risk of reoperation in 10+ years if I go with the bioprosthetic tissue valve.
well this is where I'd perhaps offer some input. Without knowing what he said I'd say that there is a very good possibility he's given you false / outdated data (through no direct fault of his own as AC therapy is not really his speciality).
Firstly most of the information on AC therapy is derived from elderly patients who are the vast bulk of AC therapy recipients.
This is not directly transferable to you. If you take the time to carefully critically read the journal articles which form the basis for AC therapy you will find that most are old, few (except for the very latest) focus on valve recipients, and many are on AC therapy
because they have a history of stroke. This last point of course raises their disposition to stroke (which is why they are on AC therapy).
The next point is AC Therapy Management ... the USA is quite tardy in adopting the modern methods of AC therapy management (especially for younger more mentally competent people). If you ast
dick0236 he will likely agree that he has no problem in testing his INR using a fingerstick PoC (Point of Care {
I know, its such a wanky term innit}) machine. So if you feel competent mentally (and that you are able to post here puts you well outside of the mean of those who form the basis for AC stats) you are likely quite competent to deal with this. Medical professionals (in my experience the worst performers in technical areas of science and maths when I did my Biochemistry degree) make mistakes in understanding and even writing about statistics. Much is written on this. For instance:
https://www.newscientist.com/article...bers-you-read/
The next point is the myths about AC therapy which persist in the upper levels of medicine (especially surgeons and cardiologists) because they are simply
not motivated to learn the answers. I wasn't before I was given my choice. As a person with extensive science background (and a wife with the same) we began researching the reality of AC therapy. There is much bullshit written out there which people accept. I encourage you to read this article about critical thiinking
https://www.newscientist.com/article...st-in-science/
Allow me to quote a point from that (incase you can't read that without subscription)
We have a long tradition of allowing civic affairs to be settled by persuasive rhetoric. That is inadequate for our modern society. But many of the tools used to make science-heavy decisions are also needed to properly evaluate a much broader range of subjects: in particular, critical thinking and numerical analysis. A basic grasp of statistics and probability, for instance, is key to judging the risk from terrorism, say, or how to invest your money (see “How to outsmart your irrational brain“).
But the desired combination of scientific literacy and critical thinking remains rare in public discourse. Perhaps that is because we hope children will learn to evaluate claims rationally if we teach them science. That works for some, but all too often the reaction is: “I’ll never need to use this once I’ve left school.”
With respect to diet, my own findings (and that of many others who are on AC therapy and post here) is that being on Warfarin (known also by trade name of Coumadin) is not anything like the main stream "website" information. There is precious little written in a scientific manner about the effect of diet on INR, less so on active healthy people who perhaps represent 5% of the people on AC therapy. What I have found (and is echoed here dozens of times) is that diet makes precious little difference to INR and perhaps most importantly I believe makes zero difference to your risk of bleed or stroke. There have been cases here of INR = 9 due to distorted consumption of Grapefruit juice
without injury or event. You will not find this written about in the literature, and thus is not under the view of Surgeons and Cardiologists.
He also believes that a reoperation will be low as mitral valve replacements via catheter will be happening in the next few years.
I think that this is wishful thinking. Its been the same words for over the last 10 years ... there are many threads here where people took up a tissue valve only to find that they needed it replaced and TAVI was not yet mature ... so its up to you which way you choose to weight this point. Myself I put it into the arugments about Electric Cars ... which for over 100 years have had the same following of "one day they'll replace petrol" but remain equally expensive relatively as they were in the early 20th Century
http://cjeastwd.blogspot.com/2011/05...-of-being.html
It is true that you may need surgery for another issue, thus a mechanical valve is not a "the buck stops here" operation. However if you had a tissue valve the same would be true, as the operations are normally about something other than valve problems. However the chance of your tissue valve lasting the rest of your life is nil (unless you die soon) but the possibility of the mechanical lasting your life is high.
Its also true that making the choice of AC therapy complicates other medical issues. If you currently have any (diabetes for instance, diverticulitis perhaps) then you will need to manage the treatment of that. But you can manage it.
There is no management strategy for failing tissue prosthesis other than another surgery to replace it.
So please, I encourage you to consider all these points when you are making your informed decision.
Best Wishes
PS: I'd like to quote another segment from that article on critical thinking (underline mine):
more recent polls suggest that US scientific literacy has improved greatly. A Pew survey released in September concluded that “most Americans can answer basic questions about several scientific terms and concepts”: that Earth’s core is its hottest part, for example, or that uranium is needed for nuclear energy and weapons.
But mastery of facts alone is not enough for the internet age. Much of the copious online rhetoric is more viral than factual, so it is just as important that we know how to evaluate sources of information, and how to tell correlation from causation, and opinion from fact – in matters both obviously scientific and otherwise.
This is where we’re falling short of the tail end of PISA’s definition. Kids who don’t see the point of science often lack chances to hone their critical thinking toolkits, particularly their numerical sides. And textbook knowledge doesn’t translate easily to practice: cell biology can seem very remote when deciding who’s really worth listening to about vaccination.
The author does not mention "veracity" which is verified truth ... not only by the peer reviewers but by you. The peer review process is better than Fox News, but still they will not correct assertions which can be supported by the data in their methods. If you read their methods and ask yourself (be critical)
is this the only way to interpret that data?, then you are on the way to getting the stuff which is what journals are really all about.
