Shopping?

[Gribur]

I am from Ontario Canada and I am still just starting this journey. i start tests next week for BAV replacement. I see in the States that you choose your surgeon and valve etc, not yet sure how it works in canada. I have been looking at valve choices and it is an impressive list.I am not sure what my cardiologist said after he mentioned surgery as i turned into jello and my mind went immediately to the dark side. I am pretty sure he mentioned some valves and said something about the ROSS and a patient my age who wasnt doing so well due to long time on the bypass machine? Here are my perspectives, 37 years old, getting married this weekend, 3 beautiful children 4,5 and 6. I want the safest, least complicated most often done surgery as possible. I want it to last as i never want to do this again, and I want to be able to play with my children as they grow, so I assume this will become more intense. I see a lot of people going in for multiple surgeries as they went tissue then mech, i dont want that. The On x valve catches my attention but opinions from you guys would be great.
What valve will meet my criteria of safe, easy, post sergury dependability and normal life and one one surgeons use the most. I just want them to "set it and forget it"
ty guys
Larry

 

[Greg~]

Larry,
As soon as my cardio told me I needed an AVR I was fairly sure I would select a mechanical valve. I’m 52 and I didn't want to go through this type of surgery again. But I wanted to weigh all of the options because this is a very critical and personal decision. The cardio and surgeon will have their preferences, and you need to spend some time fully discussing their points of view with them. But in the end, they'll tell you this is your decision and of course, that can make it a tough one. If you're leaning toward a mechanical valve I would highly recommend you discuss anticoagulation with your surgeon and cardiologist and also read through the Anti-Coagulation section of this forum. And I would highly recommend the Famous Tobagotwo Writings On Valve Selection sticky in this section. Knowledge is power and you don't want to go into this decision ill equipped.
My decision was my own and I felt very comfortable with it. I wish you the best.

 

[Bill B]

Each surgeons usually has a valve s/he generally prefers for AVR but nearly all of them will tell you they will put in whatever you want. I don't think there is any concrete way for lay persons like us to select the best valve by reviewing the available literature. The medical literature just doesn't address that question (other than tissue versus mechanical, and even that general issue is a bit of a mess to sort out). Manufacturers of newer valves tout potential advatages with their new design features, but have far less experience data and very little proof if any of actual advantages. So, although the choice is usually up to you, baring some circumstance, say, small aortic annulus, which might dictate a specific choice, it's a largely unsolvable puzzle. I fussed over it for several months thinking I could collect and evaluate the information to make an informed choice. Fortunately, my surgeon made a rather strong recommendation, and I finally decided I was in no position to contradict that. Find a good surgeon and ask him/her what s/he would do.

 

[djteako]

Hi Griber .
I'm not too sure about Ontario , but here in Alberta things are definately different than our niegbours to the south . We don't really have the option of "shopping" for a surgeon , or a particular valve . Your surgeon will be assigned to you , though you should have the option of asking for another one if you don't feel comfortable with thier choice . Valve brand is also the same . You can ask your surgeon for a particular one , but if they or the hospital has a particular preferance , then thats pretty much what you have to go with .

 

[Madsometimes]

I'm in the UK, and I was referred to my surgeon by my cardiologist. The surgeon she chose was one with a lot of experience with my condition, and I could not have chosen a better person myself. If you trust your cardiologist, then they should be well placed to recommend the best surgeon for you.

When I saw the surgeon, we discussed the pros and cons of tissue vrs mechanical valves. I asked the surgeon what she would recommend for me, and she said mechanical but that it was my choice. I went with her recommendation. The brand of valve was not discussed, and it was only after my surgery that I discovered that I had an ATS valve, and that was only because I was reading my hospital notes when I was bored

My valve is quiet, and I think my surgeon made a good choice. She does this everyday, has trained for many years, whereas my knowledge of different brands of valve has been taken from google. I certainly don't think that doctors are always right in every instance, but I do think their opinion carries a lot of weight.

 

[Greg a]

I'm in the UK, and I was referred to my surgeon by my cardiologist. The surgeon she chose was one with a lot of experience with my condition, and I could not have chosen a better person myself. If you trust your cardiologist, then they should be well placed to recommend the best surgeon for you.

When I saw the surgeon, we discussed the pros and cons of tissue vrs mechanical valves. I asked the surgeon what she would recommend for me, and she said mechanical but that it was my choice. I went with her recommendation. The brand of valve was not discussed, and it was only after my surgery that I discovered that I had an ATS valve, and that was only because I was reading my hospital notes when I was bored

My valve is quiet, and I think my surgeon made a good choice. She does this everyday, has trained for many years, whereas my knowledge of different brands of valve has been taken from google. I certainly don't think that doctors are always right in every instance, but I do think their opinion carries a lot of weight.

Where you are going, London Health Sciences, you would have a very tough time finding a poor or trouble surgeon. Our system is much like the NHS in the UK where a cardiologist will have a preference to where he will refer his patients. You can take comfort in the fact that this is the first step in forming your health care team....your GP quarterbacks the team and strted the ball rolling by their coice of cardiologist who will help you with the surgeon. As to the valve type it really depends on your lifestyle and what you are planning. I used to think that hands down I would choose mechanical then my dad had tissue for over twenty years going to his rest without a need for re-op (he was done in Toronto at Mt Siani) and today the technology is changing at almost the speed of light and here in Ontario it is an amazing ride with Ottawa, London, Trillium and now St Mary's doing 80% of bypasses on "beating Heart surgery" http://www.trilliumhealthcentre.org/programs_services/cardiac_services/documents/3049_Trillium_HEART_Book.pdf and recently at St Mary's a portal beating surgery for mitral prolapse has grabbed international attention for Dr Salasidis . It may soon be that a Cath procedure of valve replacement will be common place thus shortening recovery and no need for ACT. I now feel that I would go with whatever the surgeon is MOST COMFORTABLE USING and the procedure they work best with