[HSF] Pericardial effusion post-AVR

Mon Mar 24 23:11:19 EDT 2008

> and regarding mechanical valves in 54 year/old....... there are many people> out there who do not want a re-op, period - even if it means coumadin for> the rest of their lives.> > > -michael

Which is why I question how well people are informed. The patient would be misguided if he thought that 1) He is likely to need a reoperation with a tissue valve and b) he will avoid reoperation with mechanical valve.

He was probably never told that if he got a tissue valve he would on balance of probability never need an operation, is likely to die with his valve well functioning (60% dead within 15 years for a pericardial valve in a 55 yr old), even if he did need a reoperation would likely not be for decades (>75 % freedom from reoperation at 15 years in a 55 year old). And most importantly that even with a mechanical valve he would not be free from reoperation (around 10% at 15 years) and has a higher hazard rate in first decade due to warfarin related morbidity and mortality. Of course given that his life expectancy is most likely somewhere between 10 to 20 years - likely without need for further surgery - it is of questionable logic that he chooses to spend his last decade(s) of life anticoagulated (with inherent risks as he is learning the hard way) to avoid a reoperation that is unlikely.

I suppose the pericardiectomy - or whatever procedure you do - will not count as a reoperation to the surgeon but I bet it does to the patient.

I know the guidelines recommend mechanical valves in patients below 60 but such recommendation often betrays a lack of understanding of competing risks - the greatest risk to a 55 year old having an AVR is not reoperation but death, next being alive with his valve fine, and least risk is needing a valve related reoperation.
(Data from Banbury,  Cosgrove ,  White, Blackstone,  Frater, & Okies. Ann Thorac Surg 2001;72:753–7)

Ani

> Date: Mon, 24 Mar 2008 17:38:37 -0400> From: msfirst at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Pericardial effusion post-AVR> CC: > > as a follow-up - they tapped 1000cc of bloody fluid off.> I asked if they sent it for anything...... response: "oh we will, what do> you want"?> > and regarding mechanical valves in 54 year/old....... there are many people> out there who do not want a re-op, period - even if it means coumadin for> the rest of their lives.> > > -michael> > > On 3/24/08, Ani Anyanwu <anianyanwu at hotmail.com> wrote:> >> > Interesting - just last week we were hearing how a pacing wire that> > perforated an RV in a patient with prior sternotomy could not cause> > tamponade and now we start hearing that tamponade is indeed possible> > distantly after prior sternotomy.> >> > Reinforces why I am often very skeptical of things I read or hear - rarely> > do they represent the whole truth - the task is to find the (hopefully> > little) falsehood in every truth. Even michael's story seems to lack the> > whole truth - puzzles me why (if this has really been building up over a> > year) the fluid would not drain through a catheter.> >> > I also found it interesting that 54 year old patients (or their surgeons)> > still chose mechanical valves and leads me to wonder how informed such> > decisions truly are... that of course is another topic.> >> > Ani> >> >> >> >> > > Date: Sun, 23 Mar 2008 09:44:12 +0530> From: prasannasimha at gmail.com>> > To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Pericardial effusion> > post-AVR> CC: > > Happens rarely especially if anticoagulated (as in this> > case) and> there was possible persistent fluid that prevented adhesions> > from> forming.> Prasanna> > On Sun, Mar 23, 2008 at 2:40 AM, Michael> > Firstenberg <msfirst at gmail.com> wrote:> > 55 year/old s/p mechanical AVR 1> > year/ago (yes 1- year) presented> > with worsening SOB. Echo showed large> > percardial effusion with RV> > compression (which I saw and agree with).> > Attempted perc tap in cath> > lab unsuccessful (with INR=3), repeat under> > ultrasound guidance also> > unsuccessful (INR=1.8). I was called - just> > got a CT scan which> > confirms the effusion and a moderal pleural effusion> > (also now with> > slight drop in HCT).> >> > Granted probably now needs to> > be cleaned out (probably left VATs) -> > but more to the point/question -> > anyone see tamponade 1 year out?> >> > something sounds very odd....> >> >> > -michael> >> >> > _______________________________________________> >> > OpenHeart-L mailing list> >> > Send postings to:> >> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email> > address, or to view archives:> >> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages> > transmitted by the OpenHeart-L are subject to the policies and> >> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> >> > -----------------------------------------> >> > > > -- > Prasanna Simha M>> > _______________________________________________> OpenHeart-L mailing list> >> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to> > CHANGE email address, or to view archives:>> > http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages> > transmitted by the OpenHeart-L are subject to the policies and > disclaimers> > posted at:> http://www.hsforum.com/listdisclaim>> > -----------------------------------------> > _________________________________________________________________> > Amazing prizes every hour with Live Search Big Snap> >> > http://www.bigsnapsearch.com_______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
_________________________________________________________________
Welcome to the next generation of Windows Live
http://www.windowslive.co.uk/get-live