TAVR trial for low risk! Bright future ahead!

[neo]

Guys, the future is almost here. TAVR will be the standard of care before we know it! Check out the new low risk trial with the Medtronic Corevalve. Really exciting about the valve-in-valve stuff too!

http://www.streetinsider.com/dr/news.php?id=11344486

 

[pellicle]

interesting, but probably won't help people who already have other branded valves already in place (for their reops) nor any of us who also needed aortic repair for aneurysm.

but good to see development ...

 

[neo]

There are TAVR manufacturers that have showed Valve-in-Valve working inside competitor valves. Theoretically, they should fit even better inside prosthetic valves than native, since the failing prosthetic is perfectly circular.

 

[pellicle]

except that valve in valve normally reduces the diameter and while I don't have data to hand those other manufacturers are not this one, so that may not be an option.

All I'm saying is that its not "screaming football enthsuiasm" but just gradual positive steps in the right direction ...

 

[neo]

One would think valve-in-valve procedures would be more difficult in the smaller valve sizes, maybe not. Interesting that this tavr is "repositional".

 

[epstns]

All-in-all, I'm encouraged to see continued progress in this area. I'm one of those patients having a competitor's tissue valve, and it would be "comforting" to know that TAVR was becoming more likely to be practical. But at the moment, I am not expecting anything beyond what we already know for sure. I continue to live my life expecting that a second traditional open surgery for valve replacement may be in my future. This way, if TAVR does not gain approval for valve-in-valve usage, I won't be disappointed. If TAVR does gain approval, then I'll be happily surprised. . .

 

[neil]

all good news,

 

[neo]

That is a great way to look at it. I am also similarly cautiously optimistic. However, the speed of these product approvals is amazing. Just this morning, Edwards got approval for TAVR in pulmonic procedures...

http://finance.yahoo.com/news/edwar...wMwBHJlZ2lvbgNVUwRzeW1ib2wDRVc-?.tsrc=applewf

Whatever the case, the argument for going biologic has never been stronger, even if it is open heart right now.

 

[neo]

That being said, right now I would probably prefer an open heart biologic that is expertly fitted and sewn in by a surgeon. But it does look like, someday after this trial concludes and has results, that TAVR may be preferred in low risk.

 

[neo]

VIV already approved even for smaller sizes...

"During the VIV procedure, the CoreValve System is placed inside a failing surgical heart valve with an inner diameter from 17-29 mm through a low-profile, 18Fr delivery catheter, which is approved for use with all four CoreValve sizes (23mm, 26mm, 29mm and 31mm), as well as three delivery approaches (transfemoral, subclavian and direct aortic)"

http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2030903

 

[Duffey]

As Neil said, any advancement in any area of valve replacement is good to hear. Thanks for sharing.

 

[JulienDu]

Looks like you Zombie guys will live forever hahaha

 

[neo]

Not likely, haha.... Another thing to consider is that TAVR technology would be most likely to first use tissue derived from stem cells in the future. Imagine have a TAVR procedure, or VIV, using tissue that doesn't degrade? Study below:

http://www.ncbi.nlm.nih.gov/m/pubmed/22917460/

 

[JulienDu]

Yeah, looks like my wife is in a very reproductive mood and my problem ( like most of yours ) is genetic, so to me it is a great news for my kids ( though they had no murmur when they were born unlike me, better have them checked now) and all my future grand children. As for me I am a doomed Terminator haha.

 

[neo]

Of course, the terminator is indestructible... Can't beat that!

 

[cldlhd]

Yeah, looks like my wife is in a very reproductive mood and my problem ( like most of yours ) is genetic, so to me it is a great news for my kids ( though they had no murmur when they were born unlike me, better have them checked now) and all my future grand children. As for me I am a doomed Terminator haha.

If she's in "a reproductive mood" what are you doing out here?

 

[JulienDu]

If she's in "a reproductive mood" what are you doing out here?

hahaha that is a good one. Well to be honest she is working while I sit home alone with my valve.

 

[cldlhd]

hahaha that is a good one. Well to be honest she is working while I sit home alone with my valve.

Well that can be good also.

 

[rnff2]

When I was deciding which type of valve to choose, mechanical vs tissue, TVAR (actually TVMR) came up in conversation with my cardiologist. He feels that valve in valve is not going to be good long term for multiple repairs/replacements. He said maybe the first time, but you can't keep putting smaller and smaller valves inside of valves, you eventually run out of room. He said that it's a great thing for those that need a valve fixed and OHS isn't an option, but for the majority of patients, especially younger patients, he wouldn't recommend it as an option because blood flow still ends up compromised due to the smaller valve size.

I'm all for advancements in medicine and hopefully this ends up being the next great thing for all valves, not just aortic. It will be interesting to watch the advancements as they are made and how quickly they happen.

 

[cldlhd]

I'm no cardiologist or surgeon but fwiw I agree that it could be a great thing for people who can't have ohs but with multiple valves within each other it does seem like flow would definitely be compromised. Maybe I'm simplifying it but I view it from a mechanical perspective . I've done a lot of work with pumps and valves ( water not blood ) but I believe the principle is the same . There's all kinds of formulas written by people smarter than me regarding pipe and valve sizes, coefficient of friction etc and their effect on pump efficiency. Obviously you don't want the perfect to be the enemy of the good but I also don't view surgical results in black and white as in success or failure. There are definitely shades of grey as in " the surgery was a success but..."