Mitrals and aortics

[Marty]

There have been queries re: difficulty of surgery for mitral valve replacement vs. aortic valve replacement.One our good heart surgeons just told us that mitral can be more difficult particularly the small valves. Its down deep in a hole while the aortic is more visible and accessible.However competent surgeons have no more leaks with mitrals than aortics. The blood around the mitral comes from the relatively low power atria- low pressure thus is more prone to clots. Mitrals should keep their INR toward the high end 3.5 to 4.Aortics probably OK 2.5 to 3. Other news, amiodarone now given routinely to valve patients pre and post op has cut postop afib dramatically 21% to 10%.Oxycodone drug of choice now for post op pain.

[Nancy]

Thanks for the info. Marty. Joe's doc has just recently been keeping him at the higher end of the INR range, 3.5. We were wondering why. Now we know.

[Zazzy]

Hi Marty,
Thanks for the answer... you said what I thought that my heart surgeon had told me, but I couldn't remember!!

Take care,
Zazz

[Lisa in Katy]

I also remember from my former life that Medicare pays a little more for the Mitral than the Aortic surgery.

[Perrster]

Are there any statistics on the ideal INR for us double-clickers?

[Marty]

Perry, I know of no study specific for double or triple valve patients. Maybe Al knows of one. My gut feeling is you should consider yourself a mitral and keep your INR at the high end of the 2.5 to 3.5 recommendation for mechanicals. Also your cardiologist may have some ideas about aspirin or plavix in combination with warfarin. My guys however were not in favor of it for me.