13-year run ending, question re: TAVR

[ks1490]

I suppose all good things must come to an end as I was recently diagnosed with serious regurg in my tissue valve which has served me well for 13 years. This is my first time back on this site in 12 years, it was so helpful to me back then. Based on reading only a few posts, I am reading here that replacing my tissue valve with another tissue valve via a TAVR procedure may only last 5-10 years instead of the 10-15 I got on the first valve. When people quote the 5-year figure, is that for TAVR when it's the first procedure done, or for tissue valves inserted into already-surgically implanted tissue valves? **Also - any recommended questions for the doctor whom I meet next week? Thank you.

 

[Survived03]

I suppose all good things must come to an end as I was recently diagnosed with serious regurg in my tissue valve which has served me well for 13 years. This is my first time back on this site in 12 years, it was so helpful to me back then. Based on reading only a few posts, I am reading here that replacing my tissue valve with another tissue valve via a TAVR procedure may only last 5-10 years instead of the 10-15 I got on the first valve. When people quote the 5-year figure, is that for TAVR when it's the first procedure done, or for tissue valves inserted into already-surgically implanted tissue valves? **Also - any recommended questions for the doctor whom I meet next week? Thank you.

Hello ks190, it sounds like you had a pretty good run the last 13 years. Bravo! May I ask how old you are? I'm in a similar situation whereby my valve sparing aortic aneurysm repair has lasted 19+ yes, and well beyond what the data showed back in 2003. I am closing in on aortic valve surgery due to aortic stenosis. What I have found, and I realize it is unique to my surgery, is that size does matter. If you qualify for TAVR that is a great thing. But again, depending on age it may or may not be the best option. I would ask the surgeon about the size of the valve that you have today and what are they planning on replacing it with; regarding size and life span and future options. I am finding that the decisions are multifactorial. Your age, lifestyle, type of valve, lifespan of valve, and personal choices. TAVR always sounds like the best option at the moment but think about the "what next" given the averages. I am currently evaluating all these factors. I'm sure I have left off other critical questions to ask but it's impossible to go at this without looking at the end game. Keep us posted on your path to decision making. Cheers.

 

[pellicle]

Hi

and welcome back

I suppose all good things must come to an end as I was recently diagnosed with serious regurg in my tissue valve which has served me well for 13 years. This is my first time back on this site in 12 years,

I guess that before I can say much more it'd be good to know some basics, because if you're 48 my answers will be different to if you were 68

So, speaking generally TAVR only looks good if you only look 1 year ahead. I think that's pretty much what I see when I read posts of first timers and they don't see past the surgery (its like they think they'll die and forget to plan for life after).

The older you are and the shorter you can reasonably look down that timeline the better TAVR makes sense.

If you aren't 78 then the problem is that the valve will start to wear out and they (based on data) don't have an expectation of lasting longer than your previous bovine.

If you are not expecting 30 more years of living then I'd suggest that a tissue valve like the Resilia will likely give you a good chance of getting over 15 years and then a valve in valve will last probably 10. But remember, when you put a valve into a valve you make the size of the hole less. The smaller the hole seems to be correlated with SVD being sooner. SVD is why your present bovine failed. SVD is well known but somehow in the USA its a dirty little secret that's swept under the marketing carpet.

Lastly I'll say that the only valve presently on the table which has good durability is a mechanical. Warfarin is not hard to work with and its your best bet of avoiding reoperation.

Lots of the details in this depend on the age and health you are now.

My most sincere advice is to bet safe, because the risk assessment you may make may not be what you get.

Did you have BAV? Is Aneurysm part of the possible future (it is if you have BAV)

Best Wishes.

 

[ks1490]

Thank you for your insight. May I ask what is SVD? I did not have a bicuspid valve, I did have an aneurism which was addressed with the first surgery and is in good shape

 

[ks1490]

Hello ks190, it sounds like you had a pretty good run the last 13 years. Bravo! May I ask how old you are? I'm in a similar situation whereby my valve sparing aortic aneurysm repair has lasted 19+ yes, and well beyond what the data showed back in 2003. I am closing in on aortic valve surgery due to aortic stenosis. What I have found, and I realize it is unique to my surgery, is that size does matter. If you qualify for TAVR that is a great thing. But again, depending on age it may or may not be the best option. I would ask the surgeon about the size of the valve that you have today and what are they planning on replacing it with; regarding size and life span and future options. I am finding that the decisions are multifactorial. Your age, lifestyle, type of valve, lifespan of valve, and personal choices. TAVR always sounds like the best option at the moment but think about the "what next" given the averages. I am currently evaluating all these factors. I'm sure I have left off other critical questions to ask but it's impossible to go at this without looking at the end game. Keep us posted on your path to decision making. Cheers.

Thank you for your reply. I'm 55. My Edwards valve was the largest one that they made, the dimensions escape me at the moment.

 

[pellicle]

Hi

assuming you were asking me

.... May I ask what is SVD?

Structural Valve Degradation (SVD)

There's a lot written on it, its the primary problem with bioprosthetic valves.

The following is very detailed
https://www.ahajournals.org/doi/10.1161/JAHA.120.018506

Abstract​

​

The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability​

since they are known to fail with an average lifespan of 12 years one has to ask why they are "increasingly becoming the treatment of choice" (and who's choice they are meaning)

I did not have a bicuspid valve, I did have an aneurism which was addressed with the first surgery and is in good shape

excellent (although to me an aneurysm without Biscupid Aortic Valve and a valve that is also calcified is a little rarer).

I see you are 55 now, you don't mention if you are in good health or how fit you are or indeed your activitiy levels. That your body destroyed a bioprosthetic valve in under 15 years suggests you are fit and active. Curiously that's exactly the people who should choses a mechanical valve at an age under 50yo.

Eg

https://www.newsweek.com/my-turn-climbing-everest-bionic-heart-99749
I suspect you were perhaps misled about

• the potential durability of a tissue (bioprosthetic) valve
• the horrors of warfarin and the limitations of mechanical valves
• the difficulty and restrictions of "constant INR testing"

in your previous discussions here.

I haven't checked the thread history, but unless you are medically contra-indicated to being on warfarin I recommend you give it a good look now. Amusingly proponents of bioprosthetic valves love to cite "but the new ones, they've fixed that, it was in the Edwards sales pamphlet" You were probably told that 12 years back ... strangely after being here for over 10 years I still see the valve durability being about what it was 20 or 30 years ago in those age groups.

Just in case you do consider a mechanical for your next valve surgery:
https://cjeastwd.blogspot.com/2014/09/managing-my-inr.html
As Dr Schaff says in that presentation "run don't walk from any sugeons office" who says there is no problems with serial redo operations.

In case you haven't see this 2009 presentation I recommend you grab a notepad and a cup of tea / coffee and follow through this carefully



last point: "follow the money" ... and there is more money in offering more expensive tissue valves and redo-operations than a mechanical and warfarin.

Best Wishes

 

[treichert0312]

I had the SVD structural valve degradation after 8 years, pig valve broke after a solid workout. The doctors that first treated me were surprised that I did not get mechanical valve at age 46, and that I was insistent on the TAVR. But after a little more discussion with previous surgeon it became apparent that I would need mechanical valve. That happened in June 2022.
Now I am post op with mechanical valve, daily warfarin treatment, no sweat. All those warfarin nonsense fears are gone.
Glad you are on this website - I did not find this until after my most recent surgery. It would have been nice to know all this earlier.

 

[tom in MO]

Thank you for your reply. I'm 55. My Edwards valve was the largest one that they made, the dimensions escape me at the moment.

At 55 I went mechanical. For you, I'd suggest mechanical especially since your last one only went 13 years on your first. However, my driver is no more operations than I have to have.