New member with the usual dilemma

[Evgenii]

Hello, last time I've been checked (2 years ago) the annulus was 30 mm. This had been described as too large for Ozaki by dr. Chernyavsky from the Sechenov clinic in Moscow. Sure, the annulus can be reduced, but apparently for some reason doing the Ozaki on the reduced annulus is not applied commonly. Though I did not investigate that, somehow I believed that Ozaki is not reliable in such circumstances.

https://www.mediasphera.ru/issues/k...udistaya-khirurgiya/2013/3/031996-63852013314

this issue is being resolved, at least by some surgeons

 

[pellicle]

Interesting

this issue is being resolved, at least by some surgeons

Myself

After 6 and 12 months after the operations all patients underwent transthoracic echocardiography. Stabilization of annulus diameter without development of stenosis or insufficiency was achieved in all patients in both early and long-term postoperative periods.​

I regard long term as more than 12 months. I mean if you are going to die in three years maybe that's OK. Myself I'd be wanting to know the 18 year outcomes

 

[pellicle]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306127/

Degenerative valve disease is on the rise with greater than 100,000 valve operations performed in the US alone per year. *The majority of those procedures employ tissue bioprostheses to avoid the attendant risk of anticoagulation*, especially in the elderly. Though traditionally this approach has been considered a superior option to avoid anticoagulation, more recent analyses have demonstrated a significant incidence of previously unrecognized thrombosis associated with bioprosthetic valves, especially with the more recent advent of the transcatheter aortic valve replacement implantations. Bioprosthetic valve thrombosis is a major cause of either acute or indolent bioprosthetic valve degeneration, and often has an elusive presentation causing delayed recognition and treatment. The literature has extensively addressed the risks and benefits of anticoagulation following bioprosthetic valve replacement to prevent bioprosthetic valve thrombosis (BPVT), *without conclusive evidence-based recommendations*. The duration of anticoagulation following an episode of BPVT is unclear, *and lifelong anticoagulation has been suggested*. The increasing use of transcatheter aortic valve replacement as an alternative to surgical aortic valve replacement in various risk groups has introduced new challenges with regards to valve thrombosis, *which have been poorly studied with regards to optimal treatment and prevention*. The increasing use of valve-in-valve procedures is expected to bring on further uncharted challenges.​

I think more than warfarin etc. This is the main issue of the valve replacement.

As previously suggested by Dr Schaff of the Mayo



more current video

 

[Evgenii]

Myself I'd be wanting to know the 18 year outcomes

in 18 years even a heart that has not undergone surgery can become very sick

 

[pellicle]

in 18 years even a heart that has not undergone surgery can become very sick

Or you can remain very healthy... The outcome can depend on the choice you make.

Knowing statistics helps you to choose do you put your money on "black" or "green"

Risk reward ratio

 

[V__]

in 18 years even a heart that has not undergone surgery can become very sick

In principle, yes, this can happen. But many things can happen. One way to look at it is how likely is something to happen. That's why in the studies of the valve surgery outcome there is frequently a comparison of the outcome with a representative sample of people without the surgery. The purpose is to factor out the impact of the valve surgery from all other factors that can play out in persons life.

For example, a median age for surgery is something like 65 years. So if one does 10-year study, then, of course, a portion of the patients will pass away due to age and other diseases that have nothing to do with the surgery. So to find out the valve surgery effect they would compare that with "normal people" without the surgery and see if they have the same life longevity and other parameters.

Must say these methods look rather advanced. But this is what was necessary to figure out that "waiting until the last moment" for surgery was not a good idea. And that an earlier intervention has better outcome in terms of longevity and heart function.