Still trying to make a final decision - my first post

[normofthenorth]

Norm:

Very Long Term Very Long-Term Survival Implications of Heart Valve Replacement With Tissue Versus Mechanical Prostheses in Adults <60 Years of Age, by Marc Ruel, MD, MPH; Vincent Chan, MD; Pierre Bédard, MD; Alexander Kulik, MD; Ladislaus Ressler, MD; B. Khanh Lam, MD, MPH; Fraser D. Rubens, MD; William Goldstein, MD; Paul J. Hendry, MD; Roy G. Masters, MD; Thierry G. Mesana, MD, PhD, (Circulation. 2007;116:I-294 – I-300.), found at: http://circ.ahajournals.org/cgi/content/full/116/11_suppl/I-294 Quote: “Valve reoperation, often for prostheses that are no longer commercially available, occurred in 89% and 84% of patients by 20 years after tissue aortic and mitral valve replacement, respectively, and was associated with a mortality of 4.3%.”

This website has summarizes cardiac risk indexes:
http://depts.washington.edu/gim/clinical/MCSSyllabus/Cardiac Assess.pdf
Note that “over age 70” adds five points, critical aortic stenosis adds 20 points, and poor general medical condition adds five points to put the patient at or near “high risk”. Reoperations involve working around scar tissue, which is more difficult and adds more risk. Add in all the time on the heart lung machine and the pumphead effect, in addition to the other downsides and risks of the surgery, not to mention the protracted recovery period (and the expense!).

The fact is that if someone needs to get a reoperation and they are elderly and/or in poor health, the risk is significantly higher than for a younger, first time patient. That is why tissue valves historically have been largely reserved for elderly patients that would not be expected to outlive the valve. Because if you put a tissue valve in a person that is younger, the odds are that they will outlive the valve and have to undergo a reoperation. When that time comes, their risk is significantly higher than it was for the first operation. Although there are probably not any statistics kept on it, I’ll bet that there are a lot of folks that forgo having a reoperation when the time comes simply because it is too traumatic or too likely to kill them.

I do not know where you got the 1% and 2% figures and believe that they are too low. Perhaps someone else on the forum can dig something up. When I get time I’ll do some digging around the web. I do know that statistics don’t mean much if you are one of the folks that doesn’t make it.

Dan, many, most, or all of the risk factors you quote are real, but you seem to be double-counting them, as if they are IN ADDITION to the total mortality numbers -- which, you recall, are statistically indistinguishable from the total mortality (and "MAPE") numbers for 50-65-year-old people who opt for mechanical valves and ACT instead. The risk factors and the reop mortality figures -- and even the mortality (= shorter life expectancy) numbers for people who decide to die instead of facing a re-op -- are all included in the total life-expectancy numbers. Enumerating them separately, as if they change the totals, is at least misleading, if not Just Plain Wrong.

About that first study you cite: You've already complained about how out-of-date and irrelevant its raw numbers (and maybe also its comparisons) are, and I think I generally agree. But even back then, dealing with obsolete valves and such, AND showing re-op rates that seem MUCH higher than are shown in more state-of-the-art studies (like the "Gold Standard" study on the Hancock II), they STILL show a mortality of 4.3% for re-ops, INCLUDING all of the scary risks you enumerate. That still leaves 95.7% of re-op patients who at least survive the experience. . . I bet it wasn't too long ago when FIRST-time valve-replacement patients didn't come that close to a guarantee of survival. . .

 

[dtread]

Here is the abstract of a study published in 1995, titled: Reoperation on prosthetic heart valves Patient-specific estimates of in-hospital events, by Jeffrey M. Piehler, MD, Eugene H. Blackstone, MD, Kent R. Bailey, PhD (by invitation), Michael E. Sullivan, MD (by invitation), James R. Pluth, MD, Noel S. Weiss, MD, DrPH (by invitation), Ron S. Brookmeyer, PhD (by invitation), James G. Chandler, MD (by invitation), J Thorac Cardiovasc Surg 1995;109:30-48, http://jtcs.ctsnetjournals.org/

“Reoperation on prosthetic heart valves is increasingly under consideration for both clinical and prophylactic indications. To determine the correlates of hospital events, including in-hospital mortality, new persisting neurologic deficit, and length of postoperative stay, a three-institution study of 2246 consecutive prosthetic valve reoperations performed on 1984 patients between 1963 and 1992 was undertaken. The combined experience ranged from high-risk patients coming moribund to the operating room to an important number of well individuals undergoing prophylactic reoperations on potentially failing valves. The risk-unadjusted hospital mortality was 10.8%, neurologic deficit at hospital discharge 1.1%, and length of stay 10 days (median). Multivariably determined correlates of outcome included age at reoperation, degree, severity, and acuity of impairment of cardiac function, extensiveness of valvular heart disease, coexisting morbid conditions, number of previous heart operations, and concomitant procedures. The risk-adjusted hospital mortality for the first elective reoperation in a good-risk patient was 1.3% (90% confidence limits 0.3% to 4.4%), neurologic deficit 0.3% (90% confidence limits 0.02% to 1.8%), and length of postoperative stay 7 days (90% confidence limits 4 to 13), emphasizing the wide variance in outcome events. Equations were developed to permit wide application of the results of the study for quantitatively estimating the risk of outcome events based on individual preoperative patient characteristics. These estimates should be useful for informed patient consent, considerations of prophylactic valve replacement, and cost and resource use. (J THORAC CARDIOVASC SURG 1995;109:30-48) “

Here is another study I found from JAMA, 2000; 283(15): 1947-1948, http://jama.ama-assn.org/content/by/year
It is titled: Final Report on Mechanical vs Bioprosthetic Heart Valves by Mike Mitka. Unfortunately I cannot access the whole study, only an excerpt of the first 150 words.
Quote: “A long-term follow-up study presented at the annual meeting here of the American College of Cardiology has given surgeons a clear answer to the question of whether to perform heart valve replacement with a mechanical or a bioprosthetic device. The answer is: It depends. Shahbudin H. Rahimtoola, MD, of the University of Southern California School of Medicine, presented the final report of the Veterans Administration Randomized Trial. He said the results demonstrate that for the first 10 years of use there is no difference in mortality rates between valve types but that after 10 years the mortality rate climbs higher for those with a bioprosthetic valve compared with those with a mechanical—but that difference is seen only in patients who had the valve replacement surgery when they were under age 65. Therefore, Rahimtoola recommended using a mechanical valve for those under age 65 and a bioprosthetic for those … “ (end quote)

Here is a more current study although it was small. It is titled Perioperative Risk of Redo Aortic Valve Replacement, by Stephan Christiansen, MD, Michael Schmid, MD, and Rudiger Autschbach, MD, from Ann Thoracic Cardiovasc Surg., Vol 15, No. 2 (2009), pgs 105 – 110. I found it at: http://www.atcs.jp/pdf/2009_15_2/105.pdf

There were 63 patients in this study of AVR redos between 2001 and 2005. The mean age was 56.4 plus or minus 14.3. 43 patients had an uneventful postoperative course. 28 patients had postoperative complications; e.g., need for a pacemaker, re-exploration for bleeding, temporary renal insufficiency, cerebral confusion, low cardiac output, wound infection, or intestinal ischemia. Four of the 63 patients expired after the redo operations. The study concludes that “Conventional reoperative AVR is associated with enhanced perioperative risk.”

 

[normofthenorth]

Dan, I think one of the things you've proved is that it REALLY MATTERS WHERE and WHEN you get your heart surgery, and maybe ESPECIALLY your re-op!

I haven't checked out WHERE that final study of 63 unfortunate patients was done, but I plan to, because I want to stay FAR AWAY from there whenever I might possibly need a re-op!

You quote and make bold the "risk-unadjusted hospital mortality" rate from that big old study (published 1995, operations 1963-1992!), as if it's the most important number -- and DESPITE the fact that they said that many of their surgical subjects were half-dead on their way INTO the surgery! I don't think it's fair to consider the mortality rates of "Hail Mary" surgeries when considering whether to get a "mortal" tissue valve instead of an "immortal" mechanical one.

Most importantly, you FAIL to make bold what seems more like the "bottom-line" answer to the question we've been debating, a few sentences later: The risk-adjusted hospital mortality for the first elective reoperation in a good-risk patient was 1.3%. As you may recall, I'd guesstimated above, that normal re-ops for tissue valves that reached their "best-before dates" might have a mortality of 2%, as opposed to 1% for initial AVR OHS. According to this study, you should have taken my offer of 2% and run like a bandit, instead of debating it!

At the opposite end of the risk spectrum from your scary-but-tiny study of 63 unfortunate patients, here's a newer and much more reassuring study of 558 fortunate (though tiny) patients at Texas Children's Hospital, Houston: "Repeat Sternotomy in Congenital Heart Surgery: No Longer a Risk Factor", Ann Thorac Surg 2008;86:897-902. doi:10.1016/j.athoracsur.2008.04.044, ats.ctsnetjournals.org/cgi/content/full/86/3/897 . Here's the whole Abstract (though the FULL TEXT is available at that link):

Background: The risk of repeat sternotomy (RS) is often taken into account when making clinical management decisions. Current literature on RS suggests a risk of approximately 5% to 10% for major morbidity. We sought to establish the true risk of RS in a contemporary pediatric series.

Methods: All RS between October 2002 and August 2006 were analyzed (602 RS in 558 patients). Median age was 3.6 years (range, 0.1 to 45.1); weight, 14.2 kg (2.0 to 112.2). Operations performed at RS were Glenn 22% (131), Fontan 21% (129), aortic valve repair/replacement 12% (72), right ventricle-pulmonary artery conduit 11% (67), Rastelli 7% (39), heart transplant 5% (31), and other 22% (133). Forty-seven percent of patients (280) had single-ventricle physiology. Incidence of second sternotomy was 67% (406), third 28% (166), fourth 4% (24), fifth 0.8% (5), and sixth 0.2% (1). A major injury upon RS was defined as one causing hemodynamic instability requiring vasopressor support or emergent transfusion; femoral cannulation or emergent cardiopulmonary bypass; and any morbidity. A minor injury is any other injury during RS.

Results: The incidence of a major injury was not different between RS (0.3%; 2 of 602) and first-time sternotomy (0%; 0 of 1,274; p > 0.1). Incidence of a minor injury was 0.66% (4 of 602). No injury resulted in hemodynamic instability, neurologic injury, or death. Two patients (0.3%) required a nonemergent blood transfusion secondary to injury. (Nonemergent was defined as adminstration rate of less than 0.2 cc/kg/min and less than 10 cc/kg in total.) Femoral cannulation was performed in 4 of 602 RS cases (< 0.6%). Sternal wound infection was 0.5% (3 of 602); reoperation for postoperative bleeding was 1% (8 of 602). Median intensive care unit stay was 3 days (1 to 174); median hospital stay was 7 days (1 to 202). Hospital survival was 98%.

Conclusions: Repeat sternotomy can represent a negligible risk of injury and of subsequent morbidity or mortality. Therefore, the choice of management strategies for patients should not be affected by the need for RS. [BOLD added.]

The authors conceded that re-dos -- repeat sternotomies -- were a bloody nuisance for the surgical team. But -- at least with a first-rate surgical team, on their best behavior while operating on these high-risk kids -- the re-dos DO NOT bring any higher risk of mortality or morbidity than the initial surgeries.

To me, one of the key "take-home messages" is one that Lyn and others have repeated several times already: If you're going for a re-do, go to a surgeon and an institution that are experienced with them!! These guys at Texas Children's Hospital seem to be very good at what they do. I think one interesting question for our underlying discussion (comparing the mostly-re-do risks of tissue valves to the mostly-ACT risks of mech valves) is this: Have time and technological advancement decreased the mech-valve risks as much as these revolutions in re-do surgeries have decreased the tissue-valve risks? It might also be true that we can all expect to do OK with AVR at our local hospital, UNLESS we're headed for a re-do, in which case it makes sense to take a trip to Houston or Cleveland or Toronto or. . .

 

[dtread]

Reoperations for valve surgery: perioperative mortality and determinants of risk for 1,000 patients, 1958-1984, BW Lytle, DM Cosgrove, PC Taylor, CC Gill, M Goormastic, LR Golding, RW Stewart and FD Loop, Ann Thorac Surg. 1986;42:632-43

One thousand consecutive cardiac reoperations for valve surgery in 897 patients were reviewed to determine in-hospital mortality and indicators of risk. Subgroups based on the number of previous cardiac procedures and the valve or valves replaced or repaired at reoperation (aortic valve, mitral valve, tricuspid valve, or multiple valves and mortality [deaths/number of procedures (% mortality)]) for those subgroups are as follows: (Table: see text) Predictors of increased risk for a first aortic valve reoperation were advanced age (p = .0002), endocarditis (p = .0018), female sex (p = .014), impaired left ventricular function (p = .039), and number of coronary vessels obstructed by 70% or more (p = .055). For a first mitral valve reoperation, the predictors were advanced age (p less than .0001), preoperative shock or cardiac arrest (p = .01), previous aortic or tricuspid valve operations (p = .02), type of mitral valve procedure (risk for repair of periprosthetic leak was greater than mitral valve replacement which was greater than mitral valve-conserving operation [p = .05]), and impaired left ventricular function (p = .059). For a first multiple valve reoperation, the predictors were diabetes (p = .04) and ascites (p = .02), whereas patients undergoing mitral valve replacement and tricuspid valve operations were at decreased risk (p = .01). Comparison of second reoperations with first reoperations indicates risk increases for multiple operations (p = .01) but not for aortic or mitral valve procedures. Rereplacement of a prosthesis (p = .007), coronary bypass grafting at reoperation (p = .006), and advanced age (p = .06) increased the risk for second reoperations. Age is the most consistent predictor of risk for patients undergoing valve reoperations.

Akins CW, Buckley MJ, Daggett WM, Hilgenberg AD, Vlahakes GJ, Torchiana DF, et al. Risk of reoperative valve replacement for failed mitral and aortic bioprostheses. Ann Thorac Surg. 1998;65:1545-52.
Background. One factor influencing the choice of mechanical versus bioprosthetic valves is reoperation for bioprosthetic valve failure. To define its operative risk, we reviewed our results with valve reoperation for bioprosthetic valve failure.
Methods. Records of 400 consecutive patients having reoperative mitral, aortic, or mitral and aortic bioprosthetic valve replacement from January 1985 to March 1997 were reviewed.
Results. Reoperations were for failed bioprosthetic mitral valves in 219 patients, failed aortic valves in 153 patients, and failed aortic and mitral valves in 28 patients. Including 26 operations (6%) for acute endocarditis, 153 operations (38%) were nonelective. One hundred nine patients (27%) had other valves repaired or replaced, and 72 (18%) had coronary bypass grafting. The incidence of death in the mitral, aortic, and double-valve groups was respectively, 15 (6.8%), 12 (7.8%), and 4 (14.3%); and the incidence of prolonged postoperative hospital stay (>14 days) was, respectively, 57 (26.0%), 41 (26.8%), and 8 (28.6%). Only 7 of 147 patients (4.8%) having elective, isolated, first-time valve reoperation died. Multivariable predictors (p < 0.05) of hospital death were age greater than 65 years, male sex, renal insufficiency, and nonelective operation; and predictors of prolonged stay were acute endocarditis, renal insufficiency, any concurrent cardiac operation, and elevated pulmonary artery systolic pressure.
Conclusions. Reoperative bioprosthetic valve replacement can be performed with acceptable mortality and hospital stay. The best results are achieved with elective valve replacement, without concurrent cardiac procedures.
Advanced patient age, a significant risk factor for death in this study, was also noted by Cohn and associates [8] and Tyers and associates [11]. Also, both of those studies identified concomitant procedures as predictors of death. We found a trend toward increased mortality with concomitant procedures that did not achieve multivariable statistical significance. Additional concurrent operations were significantly associated with prolonged postoperative hospital stay.
Nonelective operation, a significant predictor of mortality, was also documented as a predictor of death by Mazzucco and coworkers [10]. The fact that almost 40% of both mitral and aortic valve failure necessitated nonelective reoperation suggests that the contention that bioprosthetic valves fail slowly and with sufficient time to allow elective intervention does not hold for a substantial number of patients.

The studies show inconclusively that the older you are, the greater the risk. And while it does matter where you get the surgery done, the risk is still greater than when you're younger. If you're old, you're at greater risk. There is no disputing that. If you want to go by "risk adjusted" statistics that is your choice. Personally I prefer to go with non-risk adjusted statistics that show you the real numbers; i.e., just how many folks didn't make it. If your point is to try to convince me that I should have gotten a tissue valve so that I could look forward to a reop when I'm around 70 you have failed.

 

[ottagal]

Very interesting read folks! I am learning alot!

One of my concerns with the two studies that DTRead quoted is they are dated. First study is from 1986 (25 years old) and the second is from 1998 (13 years old). I am sure there is good data in there, but I am a little biased in terms of results from more recent studies.

 

[Lynlw]

Noone is trying to convince anyone they chose the wrong valve or even convince anyone what kind of valve to choose. The fact is study after study show the odds are very good you will live a long happy life no matter what kind of valve you choose.

I did want to point out the 10.8 risk was NOT just first time REDO since one of the things to consider were "number of previous heart operations"
three-institution study of 2246 consecutive prosthetic valve reoperations performed on 1984 patients between 1963 and 1992 was undertaken. The combined experience ranged from high-risk patients coming moribund to the operating room to an important number of well individuals undergoing prophylactic reoperations on potentially failing valves. The risk-unadjusted hospital mortality was 10.8%, neurologic deficit at hospital discharge 1.1%, and length of stay 10 days (median). Multivariably determined correlates of outcome included age at reoperation, degree, severity, and acuity of impairment of cardiac function, extensiveness of valvular heart disease, coexisting morbid conditions, number of previous heart operations, and concomitant procedures. The risk-adjusted hospital mortality for the first elective reoperation in a good-risk patient was 1.3%

I am not surprised at all the risks for any heart surgeries were high when they count surgeries in the 60s and 70s, the rates are even much better now than they were in the 80s which is why many big centers recomend tissue valves for younger and younger patients, the fact REDos are safer AND newer valves last longer..of course it isn't risk free. but when you weigh the risk of a REDO of a tissue valve you are receiving TODAY (IF you even need OHS and don't have it replaced by cath) the risk are about the same as the risk for major events on a life time of Coumadin.

please ignore any spelling I have a bad fever..back to bed

 

[dick0236]

After wading thru a few of these statistics laden posts, I am reminded of the old adage..."figures don't lie, but liars figure" and I am becoming more afraid:tongue2: of getting "old":redface2::wink2:. If you look hard enough....for long enough, you can find a study to reinforce your position or discredit another's position.

I like the "stats" that my docs gave me way back in 1967. "The valve is designed to last 50 years and you are 31 with a life expectancy of 73....therefore you have an eight year cushion". At that time, I had just graduated college with a "minor" in mathematics and I liked those odds.....still do:thumbup:

I don't mean to be flippant about a subject as serious as OHS....but we are "beating this dead horse...again":thumbd:

There is NO perfect answer for heart valve replacement:confused2::smile2:.

 

[normofthenorth]

Originally Posted by dtread:

If your point is to try to convince me that I should have gotten a tissue valve so that I could look forward to a reop when I'm around 70 you have failed.

If that's a joke, I don't get it. And I sure hope you haven't been trying to convince me to regret my decision(!).

I believe that the "risk-adjusted" statistics just try to attribute bad outcomes to their various causes. So if somebody (e.g.) came into the OR needing an op AND dying from something else, and they ended up dying from that prior something else, the death isn't attributed to the valve replacement surgery unless it should be. In the amazing re-op study of the kids ("Repeat Sternotomy in Congenital Heart Surgery: No Longer a Risk Factor"), they also had some kids die, but not from the "repeat sternotomy" -- according to the authors, of course. When you look at risk-NOT-adjusted stats, you'll discover that we're all eventually going to die, so attributing causes and dividing the groups into sub-groups seems important to arrive at meaningful conclusions.

Yes, it's true that very old people generally do worse in surgery (though their tissue valves last much longer), and those of us who need a tissue-valve "re-do" will be older when we need it -- hopefully MUCH older! ACT seems to bring increasing risks with advanced age, too, which may (again) help explain why the bottom-line survival numbers are statistically identical, even starting with 50-65-year-old patients and including some pretty dicy first-generation valves.

Dan, the point about the total risks being a saw-off is that we can all make choices that are right for each of us, based on the NATURE of the risk and how it interacts with our personal values, without somebody else being able to say we're crazy because the TOTAL risks are so skewed in one direction or the other. Until you reach maybe 65 -- or even older if you really prefer ACT complications to a re-op -- nobody can do that, because the total risks are essentially identical. And until you get much younger than that (maybe 40's?) I don't think the total risks get so skewed in the opposite direction that they compromise a personal, value-based decision. That's how the numbers look to me, anyway.

 

[Lily]

There are instances where the surgeons have made the decision as to what type of valve a person should get; as time has passed, and technology marches forward, this seems to happen less often; but occasionally still, a person wakes up with a different valve than they expected. It's good to be able to trust that the experienced surgeon knew what they were doing and why, and made that call based on a broad range of knowledge, wisdom, and foresight. But when the surgeons leave the choice up to us, it would seem that either option is a reasonable choice -- this personal choice that each of us can make the best of, as we enjoy the wonderful opportunity to extend our lives. And so consider that there may not necessarily be a right or wrong choice. As Dick said, "There is no perfect answer for heart valve replacement."

 

[dtread]

Here is an interesting study I found that makes some very good points:

The ‘Threshold Age’ in Choosing Biological Versus Mechanical Prostheses in Western Countries, byDavid J. Wheatley, The Journal of Heart Valve Disease 2004;13 (Supplement 1): S91-S94. http://www.icr-heart.com/journal/maysup2004/12211_Naples_29_r1.pdf

The now well-recognized structural valve deterioration of bioprostheses, commencing at about six to eight years after surgery, was demonstrated, as were bleeding problems associated with the anticoagulation necessary with mechanical valve use. Thromboembolic risks were identical for each valve type. The need for reoperation and its associated risk (overall 30-day mortality of 14%) influenced the recommendation of the group that bioprostheses be restricted to single AVR where life expectancy was not thought to exceed 10 years. It is notable that in this trial, at five years 15% of the aortic, and 36% of mitral bioprosthesis patients, were receiving anticoagulants. By 15 years, the figures had risen to 33% and 57%, respectively. A bioprosthesis therefore is no guarantee of freedom from anticoagulation. The risk of reoperation for failed aortic or mitral bioprostheses has been highlighted by Akins et al. (13).

Although these authors achieved a low mortality of 4.8% for elective first time reoperation, almost 40% of
their patients required reoperation on an urgent or emergency basis, with higher mortality.

The fit, otherwise healthy patient even in their mid-70s with a family history of longevity may
well be better served by a mechanical valve. Structural valve deterioration seems inevitable if the patient lives long enough (10), and reoperation - even in the best of hands - is not without significant risk (13). The demonstration of low bleeding and thromboembolic risk in the elderly with a low-intensity, carefully supervised anticoagulation regimen, should make the outlook for the elderly patient with a mechanical valve very satisfactory (11,12).

The above makes a lot of sense to me.

To assume a known risk by getting a tissue valve (and the consequent reops) in order to lessen the risk of a possible event (thromboembolism) makes little sense to me. Particularly when anticoagulation management has improved so dramatically. And patients are now allowed to control their own anticoagulation with home monitoring, which allows the patient to control their own destiny. I wonder how those folks feel who got a tissue valve, only to have to take anticoagulation anyway? So they get to have a reop and if they had gotten a mechanical in the first place they wouldn't need the reop.

 

[dick0236]

To assume a known risk by getting a tissue valve (and the consequent reops) in order to lessen the risk of a possible event (thromboembolism) makes little sense to me. Particularly when anticoagulation management has improved so dramatically. And patients are now allowed to control their own anticoagulation with home monitoring, which allows the patient to control their own destiny. I wonder how those folks feel who got a tissue valve, only to have to take anticoagulation anyway? So they get to have a reop and if they had gotten a mechanical in the first place they wouldn't need the reop.

I live in a patio home community, almost entirely made up of retirees over 65. Within my circle of neighbor friends, I know of six currently on warfarin. Two of us have mechanical valves and the other four take warfarin for A-fib(no valve issues). I'm sure if I canvassed the other homeowners, I would find several more on warfarin....A-fib, clotting and other blood problems often follow aging. Before a person makes a valve choice, perhaps they should visit an ACT clinic and ask the people waiting to be tested..."Why do you take warfarin? If that is not possible, ask your cardio for his estimate of patient reasons for using warfarin. It will be an eye openor.

Might make your decision a little easier.

It makes no difference to me what valve a person chooses, but the decision should not be swayed by inaccurate, misleading half-truths. Personaly, for me, warfarin management has been a piece of cake.....after I learned too follow a few simple rules.

 

[ALCapshaw2]

My Coumadin Clinic at The Heart Center in Huntsville, AL serves 3000 anticoagulation patients.

The #1 reason for taking Coumadin / Warfarin is Atrial Fibrilation (A-Fib) accounting for over 60% of patients. A-Fib becomes increasingly common for people over 65-70 years of age.

The #2 reason is Deep Vein Thrombosis (DVT) at around 20%

Valve Replacement patients account for approximately 10%

Clotting Disorders and other misc. reasons also account for around 10%.

'AL Capshaw'

 

[OldManEmu]

Al I found it surprising that your clinics second most common reason for warfarin

is Deep Vein Thrombosis (DVT) at around 20%

I have always associated DVT with long distance travel or being bed ridden/immobile.

 

[ALCapshaw2]

Here are the numbers from my original post on July 31, 2008:

QUOTE:

Patient Demographics at My Coumadin Clinic

The recent thread / poll asking how many Tissue Valvers were on Coumadin made me curious about the Patient Demographics at my Coumadin Clinic so I asked the Charge Nurse for their numbers.

MY Coumadin Clinic Patient Demographics are as follows:

328 Patients with Heart Valves - presumably mechanical? = 11.4%

2000 Patients with Atrial Fibrilation = 69.4%

552 Patients with other factors (DVT, Clotting Disorder, etc.) = 19.2%

2880 Total Patients served by 4 Certified Registered Nurse Practicioneers (CRNP) and several Technicians and other staff members in Huntsville, Alabama, "The Rocket City" (Home of NASA's 'Rocket Team', The Redstone Arsenal, and a lot of Low, Medium, and High Tech Industries).

'AL Capshaw'

(Yes, I realize this does NOT answer the question about what percentage of Tissue Valvers are on Coumadin, but it does point out that the vast majority of patients on Coumadin are on it because of Atrial Fibrilation and to a lesser degree, Deep Vein Thrombosis - DVT, and Clotting Disorders).

END QUOTE

 

[Lily]

I am scheduled for surgery jan 17th and still trying to decide on non stinted - or stinted or ross procedure- i must make final decision by monday- non stinted may qualify for min invasive. Any one with advice is welcome- My doctors left me the options without blood thinners- and was not pushy about the Ross- due to me being 52 - even though he teaches the procedure widely- so now my time to decide has come. ANY HELP APPRECIATED !!

Now am I reading this correctly, you would prefer not to be on anticoagulation therapy (ACT)? Is that your original question? It defies my ability to explain how or why the thread went off in the direction that it did :rolleyes2: But as it happens too often in life, some possibly need to validate the personal choice that they made by putting others' personal choices down. I hope you found some helpful factual information in the thread though. Best wishes with your decision and for a successful surgery and recovery

 

[neil]

lily..........mmmmmmmm thats what i was thinking,

 

[JUST-WAITING]

JUST-WAITING just got closer - using the vast info you have provided and all the info I could attempt to digest- As a Paramedic for 20 years+ - I am amazed at the knowledge of the people that gather here. Thanks folks!!! You are amazing-


I am going with the Ats 3f- valve - even though it does not have the history of most valves - I like the design, concept and future possiblities- I want to remain active and was really down to the Ross procedure and this option. Due to being 52 and after researching this I think it will be better than what I have.

 

[Lynlw]

I am so glad to see you posting. I was hoping all the thread hijacking didn't drive you away Someone else (maybe beancounter?) got that valve a couple months ago and is very happy. Will someone be able to update us before you can get online?

 

[JUST-WAITING]

Beancounter has been a real help- and the whole website has helped - ther are so many conflicting reports and opinions on the the Ross and every website and AHA/ Mayo Clinic / and many more
I believe that I have picked poss- higher tech and less history but less risk than the Ross. -

 

[Lynlw]

Beancounter has been a real help- and the whole website has helped - ther are so many conflicting reports and opinions on the the Ross and every website and AHA/ Mayo Clinic / and many more
I believe that I have picked poss- higher tech and less history but less risk than the Ross. -

I think it is pretty interesting. I'm curious what did you mean by the future possibilities that you liked?