Sanity with valve choices

[Mister_James]

I have read with great interests the valve selections in here: mechanical versus bioprosthetic; On -X, St Jude; Masters, Regents... Not to mention blood dynamics and flow over valves...

It's good to know we have choices today but an argument on efficiency, blood flow, valve function to me its like a decision on Coke and Pepsi; you cannot be right or wrong.

The best distillation of this argument is, depending on your age, whether you are willing to go through heart failure and open heart surgery again when your are much older. If you can say yes to this, bless you and your choice is clear.

On mechanical valves; the oldest and still functioning valve in here, I believe, the caged ball design of Starr Edwards and not being made anymore. Whether you have tilting disc, bi-leaflet chances are that valve, knock on wood, will be around after you decompose to dirt.

 

[neo]

Sanity with valve choices

Not necessarily go through open heart again. Think TAVR.

 

[pellicle]

Not necessarily go through open heart again. Think TAVR.

you do know that this is not possible in all (or even the majority) of cases dont you?

I mean its a very laudable goal, and perhaps 'one day' but not yet.

Cardiology in Review Vol 12 No2 2013

Careful patient selection, systematic risk stratification, optimal valve sizing, meticulous
procedural techniques, and complications management are all important
elements to achieve good outcomes. However, several critical issues
exist with TAVR that need to be addressed before it can become more widely
adopted. Quality of life improvement and cost-effectiveness of TAVR, when
compared to surgical aortic valve replacement, remain uncertain in lower risk
patients. Stroke, paravalvular leak, vascular complication, bleeding, and heart
block represent only a few of the key concerns in this therapy.

further:http://www.uptodate.com/contents/transcatheter-aortic-valve-replacement

Percutaneous aortic valvotomy was developed as a less invasive means to treat AS but has important limitations. Subsequently developed catheter-based techniques for aortic valve implantation may provide an alternative method for treating AS in patients with unacceptably high estimated surgical risks.

{emphasis mine}

Transcatheter aortic valve replacement (TAVR) has been developed as a treatment for patients with severe symptomatic AS with unacceptably high risk for surgical aortic valve replacement.

and from http://www.cadth.ca/products/environmental-scanning/environmental-scans/environmental-scan-39

Transcatheter aortic valve replacement (TAVR) has emerged as a potential alternative for patients with severe aortic stenosis who are considered to be at high risk or who are ineligible for conventional SAVR due to age and comorbidities.

 

[Mister_James]

Transcatheter addresses one of 3 valves at the moment, with time it may address all valves and be the general standard. I also understand at the moment it addresses stenotic valves not other types of valve failures but again with time, they will get there.

A replacement valve on top of an old replaced valve something tells me they will have to lower your heart rate, control your blood pressure and may be put you on Coumadin.

I think in 15 years if you are under 70 and fairly healthy, it will be OHS. I also think it is prudent to prepare for the worst case scenario than the best case. Also think of the period of time between valve failure and replacement, I have experienced congestive heart failure with A fib and it is not fun. That is my two cents.

 

[clay_from_nj]

Ah, but what will you choose if "TAVR for all" and the "breakthrough anticoagulant" hit the market at the same time?
I'll hold onto my mechanical until they're able to use stem cells to grow me a new valve.
http://www.wakehealth.edu/Research/WFIRM/Research/Engineering-A-Heart-Valve.htm

 

[epstns]

If you really want to cloud the situation, consider all of the statistics. The third generation tissue valves, now being implanted, are expected to have a freedom from explant rate of something over 50 or 60% at 15 years. For me, that means that since I had my tissue valve implanted at age 63, by the time I reach 78 or 80 years of age, I still have a 50-60% chance of my valve being viable. The tissue valves do not all fail at their "use-by" dates.

My take on the whole thing is that there really is only one "wrong" decision - the decision to do nothing when faced with the need for valve replacement. It is all a matter of the probabilities, and how the individual patient's body reacts along the way. Some have early mech valve failures, some have very long-lived tissue valves. We just make our choices and accept the consequences. That is all we can do. If we try to get too deeply into the statistics and probabilities, we would never be able to choose.

 

[Rachel]

My take on the whole thing is that there really is only one "wrong" decision - the decision to do nothing when faced with the need for valve replacement. It is all a matter of the probabilities, and how the individual patient's body reacts along the way. Some have early mech valve failures, some have very long-lived tissue valves. We just make our choices and accept the consequences. That is all we can do. If we try to get too deeply into the statistics and probabilities, we would never be able to choose.

VERY WELL put!!!!!