Hi
In terms of the homograft, from the research I've read I'd second you on the history front. Where did you find the information about the surgeon dependency?
like much that you read over time you don't see it written in bullet points, you learn about it and infer. So looking at the facts:
- like Ross procedure surgeons specialise in it
- like Ross procedure it has mixed outcomes (which may quite well be related to the surgeons skill and experienc
- when you look at the morphology of the valve leafelets they are simply one of the most amazing piece of equipment in the human body, they are sensitive to an extent that handling requires a level of precision usually associated with NASA. Both at extraction, and in implantation. Cryogenic storage and limited shelf life are also key issue in success (I had to wait for a donor) Something to read here if you're interested in tissue morphology http://circres.ahajournals.org/content/113/2/186
Tissue bioprosthetic valves will degrade over time, its a known factor and the only ones selling up increased durability are the makers and the elderly;
Aortic Bioprosthetic Valve Durability: Incidence, Mechanisms, Predictors, and Management of Surgical and Transcatheter Valve Degeneration
I think I did, when I think of skiing, I think it must always include steep slopes! Cross country skiing must be a good workout, maybe I'll be able to try it in Norway this year.
it was pretty obvious based on what you said ;-) (in fact I assumed it meant you didn't watch it) ... I'm sure you'll enjoy Norway, that video was shot in Eastern Finland
where I've spent some time, and where my lovely wife was from (indeed she got me into skiing and introduced me to the beauty of the north.
firstly you go on to mention the single most significant reason to avoid going a mechanical (almost as an aside) :
you are a younger female who may wish to choose to have children.
Every other thing you mention is either the typical unsubstantiated fear mongering or insignificant in reality ...
On the warfarin front, it's the additional years I'd be spending it taking it that would concern me
Given that well managed INR will sit you in pretty much the "age related risk group" for either bleeds or thrombosis events (
which is amazing since you will have a thrombosis generating device inside you) is pretty good. Further this is about the longest historied prescription drug which has been actively and intensively studied with the express purpose of finding a fault in it (
not least by the drug companies who seek to spend millions to replace it so that they can make millions more), and what have they discovered? Almost nothing.
happy to start taking it a bit later on in life however.
That's the spirit, and given you are a bicuspid patient (
are you? or was that a mistake based on the thread title?) another significant issue for you (driving reoperation) is eventual aortic aneurysm (which hopefully if your Cardio has not mentioned you will discuss this with them).
My third operation was essentially driven by the discovery of a rather well developed aneurysm, and while my homograft valve was worsening it was not at the point that everyone would agree that it needed replacement surgery yet. The aneurysm on the other hand was a "we need to do this as an urgent priority"
As a young female as well I'm keen to avoid warfarin if possible and cardiologists are the ones that push this to be honest. They've not even recommended a mechanical.
I suspect mainly because of the following:
- warfarin is good ONLY if its taken strictly and testing is strict - young patients are about #2 in the list of "non compliance" patients (as they call it) with dementure patients being #1
- as mentioned you're a young female who may later wish to have children
- the general trend it so move towards tissue prosthesis now, which I can only assume is based on the factors of; we think you'll be non-compliant and come to harm; we assume its likely you'll need an additional surgery, so why shoot for a permanent solution; we can't think outside out view of you're older (and forget we're looking at a younger patient.
I'm actually quite pleased about this as it makes the decision making process easier for me and I (hopefully) will be spared the hair thinning effects of warfarin whilst young, which I've seen happen to a lot of people. A bit shallow I know, but I'd rather it happened naturally first.
It's so reassuring to see people like yourself though, still getting to do fun activities and live life.
Thanks for the stoicism tip. From a first read it has a lot in common with the tenets of buddhism.
you're welcome.
I once heard it phrased that given time all religions arise to promulgate similar ideas, because they are driven by the desires that are common to humans, science however will always discover and teach the same things (in an iteratively corrective manner) because it studies the same thing - the physical nature of the universe and its laws (even quantum mechanics). So while religious teaching may look similar, given time any creatures which may arise after humanity is gone using Science will discover the atoms, discover physics and chemistry in the same ways and those writings will be virtually identical eventually even the maths.
Best Wishes
