Valve Selection "Worksheet"

[cday]

Here is a very nice website on Aortic Valve Stenosis:
http://www.cigna.com/healthinfo/hw179837.html

With a "Should I have surgery worksheet?" and a
http://www.cigna.com/healthinfo/uf4513abc.html#uf4513abc-Intro

"What kind of valve?" worksheet
http://www.cigna.com/healthinfo/uf4587.html#uf4587-Intro

This is not the flowchart on valve selection I mentioned on another thread that I had stumbled upon a couple of weeks ago (and since have lost), but this one appears to be very helpful. I will post if I find the other one.

Cindy

 

[Karlynn]

Thanks for posting that. It's interesting to see "worksheets" for people to help work out their issues.

 

[Brookwood]

I do think some of the logics in these articles are problematic.

For example in http://www.cigna.com/healthinfo/uf45...l#uf4587-Intro

"Mechanical valves last at least 20 to 30 years in most cases. The greater durability of a mechanical valve makes it less likely that you will have to replace the valve in your lifetime."

and then

"In general, mechanical valves are the preferred choice for children, teens, and adults age 60 and younger, all of whom will likely outlive a tissue valve and need another valve replacement."


I am 40 years young. If I go mechanical this time and suppose the valve lasts 30 years, I'd have to prepare for my second OHS at 70.

If I go tissue this time and suppose the valve lasts 15 years, my second OHS would be at an age of 55. I can then switch to mechaincal and hope I won't need a third OHS.

Which one makes more sense?

EJ

 

[Susan BAV]

...I am 40 years young. If I go mechanical this time and suppose the valve lasts 30 years, I'd have to prepare for my second OHS at 70.

If I go tissue this time and suppose the valve lasts 15 years, my second OHS would be at an age of 55. I can then switch to mechaincal and hope I won't need a third OHS.

Which one makes more sense?...

This is one of the things I considered also. Everyone's choice is pretty individual though, frequently based on a number of pieces of information that only they may be fully aware of.

And what makes more sense to one person may not make much sense to another.

From what I have read, however, on average ACT may be safer for a middle-aged person than an elderly person. This is in part due to the aging process including developing comorbidities and declining abilities to appropriately manage the medications, among other things.

 

[Lynlw]

I do think some of the logics in these articles are problematic.

For example in http://www.cigna.com/healthinfo/uf45...l#uf4587-Intro

"Mechanical valves last at least 20 to 30 years in most cases. The greater durability of a mechanical valve makes it less likely that you will have to replace the valve in your lifetime."

and then

"In general, mechanical valves are the preferred choice for children, teens, and adults age 60 and younger, all of whom will likely outlive a tissue valve and need another valve replacement."


I am 40 years young. If I go mechanical this time and suppose the valve lasts 30 years, I'd have to prepare for my second OHS at 70.

If I go tissue this time and suppose the valve lasts 15 years, my second OHS would be at an age of 55. I can then switch to mechaincal and hope I won't need a third OHS.

Which one makes more sense?

EJ

I wonder what part the fact this is written by an insurance company plays into what they write. it seems to me, insurance company would prefer people to get mechanicals valves instead of having to pay for repeat surgeries.

 

[lisou]

Thanks for posting Cindy, very interesting, especially that I'm in the middle of making that decision. I'm leaning more on mechanical due to being only 42, and thinking that 10 years sure goes by fast.

Thank again

 

[dick0236]

To Brookwood and Susan BAV

You both make compelling arguments. I think I am prone to agree with Susan, get the mechanical for the long haul and, if needed, get the tissue in old age, if possible, when the risk of surgery and/or bleeding problems usually becomes greater. This is a question that I sometimes ponder now that I have reached "older age".If I should need another valve surgery I will certainly consider a tissue valve if it is an option. Here is the rub. Based on my last three echos my valve may well last my lifetime so the question of a reop may never come up. The problem is in making assumptions as to timing future events, especially medical events. That is often a very "slippery slope".

 

[Karlynn]

I've had my mech since I was in my early 30's. I hope it lasts a lifetime, but if it doesn't, I most likely would go tissue if I had it replaced after I'm 60. Before that, I'd probably go On-X.

 

[Brookwood]

To Brookwood and Susan BAV

You both make compelling arguments. I think I am prone to agree with Susan, get the mechanical for the long haul and, if needed, get the tissue in old age, if possible, when the risk of surgery and/or bleeding problems usually becomes greater. This is a question that I sometimes ponder now that I have reached "older age".If I should need another valve surgery I will certainly consider a tissue valve if it is an option. Here is the rub. Based on my last three echos my valve may well last my lifetime so the question of a reop may never come up. The problem is in making assumptions as to timing future events, especially medical events. That is often a very "slippery slope".

Sorry if it sounded like I was preaching one option over another. That was not my intention. I was simply trying to point out a logic gap in the "worksheet". I don't think one can come to the conclusion that "mechanical valves are the preferred choice for children, teens, and adults age 60 and younger" just because "statistcally, mechaincal lasts 10 to 20 years longer than tissue in most cases".

BTW, the Ross processure should not be excluded from the "worksheet" IMHO.

Have a good night!

EJ

 

[Susan BAV]

Sorry if it sounded like I was preaching one option over another. That was not my intention...

Actually, me neither.

 

[Ross]

If it helps any, it goes against the most recent thinking of the pros according to Al Lodwicks sticky up top. I'm assuming it's just older information that I was educated with. You guys know I'm just an old fossil.

 

[netmiff]

I have been told that my not-quite-one-year-old mechanical valve has been stress-tested to an equivalent of about 150 or 200 years (can't remember the number, but it sure will outlast me!)

tissue or mechanical - personal decision, about as emotional as Ford or GM for some people

 

[Rick]

Risks vs. risks -- what if boils down to

Risks vs. risks -- what if boils down to

I have not had surgery but know I will require it. I do agree with everyone in terms of this being a personal choice/ Though 38, I am leaning toward a tissue valve, despite not having any special needs for this and considering a Ross procedure,though not yet convinced on this.

I have read that life expectancy is similar regardless of which you choose, mechanical vs. tissue.

My personal views:
1. When your risks occur:
No one wants a second OHS -- the choice is not between a second OHS with a tissue valve and no issues with a mechanical. I'd rather take the risks of a 2nd or 3rd reop in a controlled environment at a good facility and with a good surgeon than the risks of a clot or bleeding event at a time not under my control. What if I am on an airplane or during a hike etc? Perhaps if I lived nearby a major center, I'd think differently.
2. Rate of improvement
Given that statically the choice makes no difference, I go to secondary factors like rate of improvement. What is improving faster? The science improving (i) Coumadin and/or material science (results of ON-X valve) versus (ii) longevity of tissue valves and operating technique (percutaneous operations and reduced scarring methods). I cant tell but I think that the longevity of tissue valves probably is what is most improving. If I am wrong and the ON-X valve proves to be a huge advancement soon, when I need surgery (estimated at 3-5 years), I will likely get a mechanical, otherwise tissue.
3. Actual experience / quality of life from repeat OHS
I have not had OHS so if my first one is just a horrendous experience, I may choose a mechanical second time around...some people on the site seem to say OHS is hard but manageable and others say its a nightmare.


Ross procedure...I dont know yet what to believe. If only a 25% reop rate in 20 years, then great but if 25% in 10 yrs then not great. A second reop after a Ross is supposedly much harder than after a tissue. Also, some data may be skewed because Ross patients are a biased sample in itself: younger and better fit. If not, they would not be Rossed. I am hoping that Dr. Stelzer in NY publishes his 20 year numbers prior to my surgery.

I think that site doesnt place Ross as an option and points to mechanical because this reduces an insurance companies' total payments and evidence suggest life expectancy is roughly similar.

Anyways, always wanted to express my thoughts on the matter and hadnt yet.


Rick

 

[rhino19]

Rick we are in the same boat as you. My husband is 38 and scheduled for OHS in 2 weeks. He has chosen for a tissue first. He has excepted that it wont last a lifetime and crosses his figures he is in the later part of the expectancy. Then when reop is done, hopefully around the time he can retire, then he will go mechanical. With his lifestyle, children, job (cop) and great discussions with several doctors it seems to be agreed as a wise choice for him. We too looked at the Ross procedure in great detail and discussed it with several doctors. It turned out not to be the route for him. More surgery then he needed or wanted.

Good luck this is a real hard decision to make and yes each person has to take there own situation into count, there is no right or wrong answer. I agree and hope as you do that the time reop comes arround medicine will have advanced even more

 

[geebee]

.....I think that site doesnt place Ross as an option and points to mechanical because this reduces an insurance companies' total payments and evidence suggest life expectancy is roughly similar.

Are you talking about the Cigna site? Just wanted to clarify. Thanks.

 

[Rick]

Rhino,
I am still a bit shocked by all this given my age. Does your husband have BAV or why do they think he needs surgery at an earlier age than most? My best wishes on your husband's surgery -- please tell him there are are many of us in this situation. Also, I am always positively impressed with spouses who do research and support their husbands/wives.... personally, my wife told me she did not want to hear it and we are now separated.

Geebe,
Yes, I was referring to the Cigna site.

Rick