Heart Valve Choices - an update of related information

Some years back (ten years back) I wrote this blog post on heart valve choices in the hope of adding a small voice into a large and noisy discussion room.

In that post I mention a video presentation by Dr Schaff of the Mayo, which for various reasons I believe fell off the Mayo Website for no reason other than administrative.

I recently found this updated presentation of his on YouTube and see that his views have remained the same (facts often don't change) and his inclusion of TAVI is a welcome addition.

 So here is his presentation:

It doesn't surprise me that the Mayo is using the YouTube platform, because administratively it is far easier to off load storage and server loads onto YouTube than bear it yourself. Many Universities are also doing the same thing.

I strongly recommend that if you're in the market for a valve and under 70 years of age you watch that and think carefully not only about what he says, but how many surgeons at his conference who are unaware of the actual data. For example stroke risks:

Worth noting the graphical presentation "steps" suggests that less data exists for Bioprosthetic when you look at the last "step". I would submit that this is likely due to bioprosthesis being on average removed by that duration of time.

All too often I hear "surgeons know better" ... the reality is "maybe they do" combined with "it depends on the specific question".

Anyway, with any discussion of mechanical valves we must understand the other issues that come with that (and will as you'll see in the presentation may well come with bioprosthesis anyway)

One of the topics introduced there is Anti-Coagulation Therapy (AKA Blood Thinners) and the misconceptions of patients about this. I've written blog posts about that for example here, as well as an entire series on INR related issues, which of course includes that post.

As well as deciding about the valve we need to decide about what we think we will want for ourselves in 10 or 15 years time ... do you just want to be still managing a medication (you'll have more of them by then anyway) or staring down your next surgery?

Lastly (and not unimportantly) I recommend this discussion too:

https://www.medscape.com/viewarticle/838221

It covers some interesting topics. You may have trouble with that page (depending) because the audio is not rendering properly on Chrome on Windows (but is ok on Linux and Android phone). You should see a media player like this:

or perhaps a link advising you to update your Flash plugins (omg). If it doesn't work then you may be able to download the MP3 file directly using this link https://bi.medscape.com/pi/editorial/studio/audio/2015/core/838221.mp3 (which I took from the HTML I got).

I hope you find this helpful in your analysis of what's best for you in the long term.