Support Group for Mechanical & Artificial Heart Valve Surgery & Using Warfarin
** Before you read this blog post in its entirety let me reiterate that this decision (MHV v tissue valve) is an incredibly personal (and difficult!) decison and that their are nearly equal advantages to having one procedure or the other. This decision is ultimately made between yourself and your medical professional and should be based primarily on their professional opinion and recommendation.
Background: It appears that their 'seems' to be quite a spirited difference of opinion going on that has been underway (albeit very much under the radar) for some time between surgeons/cardiothoracic specialists choice/advice between the US and the UK/Europe over what is best for patients - MHV or tissue valves. Of course - in many cases of course the patients condition prohibit one or the other being used and the decision is quite clear cut.
However, unless it is an emegency procedure where you simply don't have a choice (Type A Aortic Dissection or similiar!) and your procedure is scheduled some time in the future you normally have the opportunity to thoroughly research this decision. By this I do NOT mean that you are trying to verify/justify your medical professionals opinion but I believe that you do have the right to equip yourself with as much information as possible to help you decide.
From recent anectdotal information both online and offline as well as other sentiment that I am seeing/hearing it 'appears' that in the US tissue valves are more strongly promoted than MHV because of the issue of warfarin being a real lifestyle negative and difficult to control/live with, risk of bleeding from injury etc etc. The opposite (or a much more relaxed opinion) 'appears' to be the case in the UK and Europe in that MHV's seem to be more widely promoted (accepted) than in the US and that their also appears to be a much more relaxed attitude and acceptance that warfarin is NOT the 'bogyeman' that is is promoted as being in the US.
Further evidence of this seems to exist re tissue valves being overall preferred over over MHV's with the latest Q2 financial results from the major companies supplying both types of valves (predominately US) appearing to indicate that the sale of MHV's is static at best and in most cases down on last year and previous years in the US but slightly ahead in the UK and the US.
If you have read this far - yes - their is an "elephant in the room" here. The question is begging.. How MUCH should we ask of our medical professionals regarding what valve is best for us if their is any sort of bias/not full understanding of a lifelong warfarin regime by the medical profession? I have heard/seen (and continue to) a LOT of anectdotal evidence of doctors and medical professionals simply not understanding warfarin at all - here in the UK as well as the US.
I do not want to also get into a debate for other reasons for the choice of one type of valve over the other (MHV v tissue valves) and the much espoused comment for tissue valves which is being repeated "mantra like" in the medical community (which only have an average life of 10 years or so) that "medicine is advancing at such a rate that in 10 years or so their will be a whole new fix for replacement of tissue valves in 10 years" (note: even with new stent technology - only applicable for an incredibly small percentage of valve replacements now and in the future).
Don't also forget the enormous cost of continually applying new medical technology v the current 'chest crack' surgery for valve replacement ..somewhere the medical care system in whatever country has to draw a line under what it can afford in order to do the job professionally with least possible cost and what the patient insurance covers. (Another subject not to get into... :-) )
Personally - It is 10 years next year since my MHV implant - years which have flown by... and I for one am INCREDIBLY thankful I don't have to undergo THAT chest surgery and recovery ever again... as I would if I had a tissue valve.
Back to the main point of this missive which is not actually about one type of valve over the other, but how/what the medical profession really understands/thinks about warfarin and MHV implants. It is my PERSONAL opinion that their is a quite deep lack of REAL knowledge of warfarin as it applies to MHV patients both here and indeed worldwide.
To this end, I believe that we as the MHV Support Group have now reached the necessary stage of maturity that we should now form an overall mission statement along with a set of short and long term objectives, with foremost in our list of objectives the ability to draw up an extensive "Living with Warfarin" document that I hope can help be a living document that can help newcomers to warfarin as well as overcome the myths and prejudices surrounding warfarin both in the public domain as well as being hopefully a respected source of information in the medical community.
I would therefore welcome feedback on this blog and the formation of a mission statement and in particular the Living with Warfarin section.
Last, but not least, I am delighted and honoured to announce that we (The MHV Support Forum) have become a foundation member of ACSMA (AntiCoagulation Self Monitoring Alliance) of which members include ROCHE, Atrial Fibrillation Charity, AntiCoagulation Europe, Childrens Heart Federation STARS (Syncope Trust And Reflex anoxic Seizures). Our aim is to promote self monitoring of warfarin and in the process of doing so help to demystify and promote wafarin for what it is - a safe and effective drug (when taken within the proper guidelines) that in most cases minimally impacts on our lifestyle.
This is obviously a major post and milestone in the timeline of the MHV Support Group and will gather many comments and observations. All are welcome so please don't be shy - have your say so we can get a real concensus flowing here!
Founder MHV Support Group
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