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    tishee_76's Avatar
    tishee_76 Posts: 64, Reputation: 4
    Junior Member
     
    #1

    Mar 20, 2007, 08:16 AM
    A matter of the heart.
    Hi helpful peoples..
    Is there a doctor in the house?

    I'm having half informed luck trying to find up-dated (2005+) information on mechanical aortic heart valves and the new predications of their life span when used in younger patients..
    The reason being, I got told I wouldn't need more surgery if my body accepted an alien valve and had no warfrin problems..
    I was reading a 2006 medical journal mag. (waiting in docs surgery) and it stated that wearing of the valve can be expected in patients that received them when they were 25years or younger..

    I live in Australia though American sites were more specific but absolutely chock-a-block with questions already so they won't take any more for the day.. I've tried the last 3days but with no success.. (Aussies are sleeping when they reset the questions I gather)

    I do have a cardiovascular doc appointment in 3months and I'm sure he'l explain his way out of what he previously stated to me, but, 3 months = 90days = long wait!

    Any information is groovey, I realise not all words are gold (even medical journals.. :rolleyes: ) I will be getting professional advice, just hoping for any little point in the right direction even..

    Thanks guys..
    J_9's Avatar
    J_9 Posts: 40,298, Reputation: 5646
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    #2

    Mar 20, 2007, 10:06 AM
    What is your age and do you have any other medical condtions such as Rheumatoid Arthrtis?

    How long have you had the valve?
    tishee_76's Avatar
    tishee_76 Posts: 64, Reputation: 4
    Junior Member
     
    #3

    Mar 20, 2007, 10:15 AM
    Thanks and age 30
    Had human aortic graft at 18
    Mechanical aortic replacement 22

    No arthrtis (as yet) ha
    Just warfrin and valve that's enough at the minute
    J_9's Avatar
    J_9 Posts: 40,298, Reputation: 5646
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    #4

    Mar 20, 2007, 10:18 AM
    Here is an article I found from Medscape. If you cannot get into the link, I have copied and pasted the info I think you are looking for.

    Here is Brain Food for you Tish dear!! :p

    Prosthetic Valves

    The main difference between mechanical and bioprostheses can be summed up by a simple comparison: the need for life-long anticoagulation with warfarin (Coumadin) vs the need for a repeat operation. In other words, mechanical valves last forever but are associated with an inherent risk for thrombus formation and embolization (thromboembolic complications), and therefore necessitate life-long anticoagulation therapy, which is accompanied by its inherent risk of bleeding (hemorrhagic complications). This poses a great dilemma for young patients who do not want to take warfarin because an active lifestyle will likely increase the risk of injury and hemorrhage. In addition, warfarin use must be carefully monitored as measured by the INR, and noncompliant patients as well as those who live in remote areas may have only limited access to such monitoring. Under these circumstances, the risk of a repeat operation outweighs the risk of taking warfarin.
    Another important factor to consider, especially with mechanical valves, is their track record as far as design malfunction is concerned. Therefore, the number of years a certain valve design has been in use without any mechanical malfunctions is of paramount importance in deciding which valve to use. The implications for such failures are huge. Not only can they put a patient's life at risk, but also the financial and litigation burdens could be enormous.
    It is not surprising that the pace of progress in the introduction of new prosthetic devices into clinical practice is very slow. It takes, on average, between 8 and 10 years for a new device to be approved by the United States Food and Drug Administration (FDA), and the process is similarly long for regulatory agencies in other countries. It is not unusual for new valve devices to be subjected to clinical studies when the previous models are just approved and introduced into clinical practice.
    Mechanical Valves

    Forty-five years ago, the ball-and-cage valve was the first commercial mechanical valve introduced to clinical practice. It was a high-profile valve and required intense anticoagulation. The valve subsequently underwent modification with changes made in the ball structure (silastic, stainless steel). Concerns about increased thrombogenicity and the less than perfect hemodynamics led to the next generation of valves -- tilting disc valves (Bjork-Shiley, Medtronic Hall, and Omniscience valve designs). One modification to the Bjork-Shiley valve, in which it was reshaped to form a convexo-concave valve, faced a serious problem with strut fractures and led to a significant decline in the use of these valves.
    Constituting the third generation of mechanical valves, the bileaflet valve was first introduced into clinical practice in 1977 by St. Jude Medical (Minneapolis, Minnesota) and is in widespread use today. The device is a low-profile valve that has excellent hemodynamics, requires less intense anticoagulation, and has had no reported structural failures. Other bileaflet valves approved by the FDA are manufactured by CarboMedics, Inc. (Austin, Texas), ATS Medical, Inc. (Minneapolis, Minnesota), Baxter Edwards CVS (Irvine, California), Sorin Biomedica (Saluggia, Italy), Medtronic (Minneapolis, Minnesota), and Medical Carbon Research Institute (Austin, Texas).
    Candidates for mechanical valves are usually young patients who have no contraindications to warfarin therapy. Women of childbearing age who want to have children should not take warfarin because of its association with congenital defects. Patients with any bleeding tendencies or those likely to be exposed to repeated injuries should also avoid taking the drug. The rationale for using a mechanical valve in younger patients is related primarily to the long-term durability of the mechanical prosthesis with no concerns about structural valve degeneration or the need for repeat surgery. The only exception to this rule is the development of prosthetic valve infective endocarditis, especially with the virulent staphylococcal infections. Under these circumstances, annular abscess formation can lead to perivalvular leak and the need for premature repeat valve replacement.

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