Reoperation rate comparison

[pem]

At 41, the "overall survivability" edge almost certainly goes to the mech valve, as well as the "re-op avoidance" edge. Your positive attitude toward ACT (and your optimism about future developments) seems to point in the same direction, too.

As long as you don't tell us you're a woman planning to have kids, or a competitive kick-boxer. . .

But I'd still check out the ATS web-site pre-op rather than post-op. I think ATS's claim to a quieter valve is pretty solid. The thrombo stuff is important too, of course, but it isn't 100% clear to me which of the "debate opponents" is right, On-X or ATS.

I'm male and don't do much kick-boxing Again, thanks for the apt observation about my current leanings. I vacillate though, and once I start heading in the direction of a particular valve type, I find myself questioning the choice and re-evaluating the alternatives. Hoping that the amplitude of this oscillation will dampen and converge to a single valve type.

Any thoughts on what would be a good valve for someone who hopes to do recreational running?

 

[pem]

My thoughts are that the Re-Op risk increases over 60, so there is a greater risk in a tissue at 60 and a re-op at 72. The interesting trend is four younger people to have a tissue valve first to give many Warfarin free years, and then a mechanical.

I still have to discuss valves with a surgeon, I am not worried about ACT, but more concerned about the mechanical noise, but I really do not want to EVER re-enter the waiting room once I leave & at 58 one re-op would be a possiblity. With the current state of the NHS finances I also worry that a re-op might be denied due to lack of cost effectiveness, which is happening to an increasing number of treatments. (I wont bring in politics, but I fear the NHS is seriously threatened by the current government).

Your rationale and hedge against NHS denial seems sound.

Thanks for bringing this up. The CC surgeon suggested that approach (tissue first and then mech), but when I suggested that to the local surgeon he thought it should be the other way around since a younger person would be at lower risk for ACT-related issues. So I left scratching my head.

 

[normofthenorth]

Pem, if you go for the mech valve, you'll be doing it to avoid any future OHS. Of course, we're only talking probabilities here, there are no guarantees on ANY of it, so you may end up with a re-op anyway. (And conversely, On-X claims that as many as HALF of us who choose tissue valves to avoid ACT end up on ACT anyway!)

And it's true that if you're 70-ish when you need a re-op, the optimal choice then will probably be a tissue valve, and you'll get to drop the ACT. But I don't see that as a major factor in your decision today. There is a legit argument for tissue (or two) then mech, as long as money and availability are no object, but that doesn't seem to fit your preferences, so forget it. There's also a real possibility that many tissue-valvers (but NOT mech-valvers) who need a reop in 5+ years will be able to get a cath-installed valve instead of OHS. But starting at 41, you might need a few of those before you're through, so it might also be a "forget it" for you. OTOH, if you're as optimistic about tissue-valve developments as you seem to be about mech-valve (ACT) developments. . .

There are many recreational and not-so-recreational runners blogging here and at the cardiac athletes' blog. I don't know if the mech/tissue mix is any different than for non-runners, but there are certainly a goodly number of mech-valve folks running (and blogging) a lot post-op. Me, I'm just getting up to speed-walking a mile at a time (5x/wk) at 3-ish months post-op with my tissue valve, but I hope to return to competitive volleyball, if the rest of my aging bod can take it. In my case, I think ACT would interact badly with a diving-intensive "floor defense", but that's not part of your decision matrix.

 

[pem]

Pem, if you go for the mech valve, you'll be doing it to avoid any future OHS. Of course, we're only talking probabilities here, there are no guarantees on ANY of it, so you may end up with a re-op anyway. (And conversely, On-X claims that as many as HALF of us who choose tissue valves to avoid ACT end up on ACT anyway!)

And it's true that if you're 70-ish when you need a re-op, the optimal choice then will probably be a tissue valve, and you'll get to drop the ACT. But I don't see that as a major factor in your decision today. There is a legit argument for tissue (or two) then mech, as long as money and availability are no object, but that doesn't seem to fit your preferences, so forget it. There's also a real possibility that many tissue-valvers (but NOT mech-valvers) who need a reop in 5+ years will be able to get a cath-installed valve instead of OHS. But starting at 41, you might need a few of those before you're through, so it might also be a "forget it" for you. OTOH, if you're as optimistic about tissue-valve developments as you seem to be about mech-valve (ACT) developments. . .

There are many recreational and not-so-recreational runners blogging here and at the cardiac athletes' blog. I don't know if the mech/tissue mix is any different than for non-runners, but there are certainly a goodly number of mech-valve folks running (and blogging) a lot post-op. Me, I'm just getting up to speed-walking a mile at a time (5x/wk) at 3-ish months post-op with my tissue valve, but I hope to return to competitive volleyball, if the rest of my aging bod can take it. In my case, I think ACT would interact badly with a diving-intensive "floor defense", but that's not part of your decision matrix.

Norm - just wanted to thank you for this post (since I neglected to previously). It really helps me frame the issues and attribute weights properly.