2nd AVR on my horizon : (

[vitdoc]

I had my first aortic valve repair in 1977 with an early tissue valve and annulus enlargement. No one knew the life expectancy of the valve at that time. 5 1/2 years later it started to fail and in 83 I got a St.Jude and warfarin.
On warfarin now for 36 years no significant issues. 2006 aortic aneurys repair with another St. Jude. At the time the surgeon said you don’t want another open heart procedure. I heartily agreed. But that was before TAVR.
So better tissue valves and TAVR make the decision process more complex.
Still every procedure has risk. Calcific embolization for example is one with TAVA. I would be very happy not to be on warfarin but I would dearly not want another procedure open or not. Much decision making now depends a bit on conjecture about what is coming down the road. So you make the best decision you can with the information at hand and with your own biases.
Then try not to second guess. In my business , Retinal Surgery there often are a variety of ways to deal with various surgical issues. I may choose one my associates others. Each may have different pros and cons. Surgeons also have their biases. So listen to the advice but make your own decision.

 

[rich01]

Just wanted to add I asked my interventional cardiologist who performed my TAVR about TAVR in TAVR. He said it is the preferred method, but at some point you might have to go with a smaller valve.

 

[Paleowoman]

Hi @CarolM - just seen your thread as I've been away. I've had high pressure gradients in moderately 'stenotic' range, though the valve is not stenotic, since AVR with Edwards Magna Ease bovine 19mm valve when I was 60 in 2014. Turns out my valve is too small and I have moderate patient prosthesis mismatch and have yearly, sometimes six monthly echos. I know I will probably have to have redo sooner than I had expected. When I do go for redo I would prefer to go for the new Edwards Inspiris Resilia valve as it has a much longer 'life' expectancy than the previous generation of Edwards bovine valves, or the Foldax one mentioned on forum that is still in development testing.

Re the discussion about TAVR - it cannot be done in bioprosthetic valves less than 23mm so that kind of puts them off the table even if they were desirable.

Options that I have discussed with the cardiac surgeon with whom I had a surgical assessment two years ago, are a stentless valve in supra-annular position or a root enlargement or a mechanical valve.

I know I will feel gutted when the time comes as I'm sure you are feeling. Wishing you the very best with whatever you choose.

 

[zelic]

Carol, Sorry to hear about your news. Tough decision but I also decided on a tissue valve at 58 yo. ( I made this decision as I have a rare sensitivity to ACT which made a mechanical much riskier for me). For what it is worth, I do agree with the above comments on going with a MV at 65 after a tissue valve lasting 7 years. The newer Edwards Inspiris Resilia valves may last longer but really too new to know for sure. While the TAVR is interesting you have a small size valve which makes it more difficult and at age 65 in 10 years, rough estimate of the TAVR durability, they would unlikely to be able to put a TAVR in a TAVR - so you would be putting off another OHS. Either way we are lucky to have options !!

 

[CarolM]

Well, I am home just 6 days after OHS # 2. The surgeon again was limited on space in my chest, and I have an Insipirus #21. It is a newer generation valve with an anti-calcification coating. It is also expandable, so TAVR can be done down the road.
Feeling like a train wreck, but blessed to be on the other side. Baby steps forward now.

 

[rich01]

Compared to other options, train wreck is pretty good. As I had TAVR, all I can offer is TAVR is pretty easy and recovery is rapid, so hopefully this is the last time you have to go through this.

Hope your recovery goes smoothly.

 

[Bryan B]

Glad you are back home and on the mend Carol. I have had 2 OHS's as well so I can relate to the "train wreck" feeling...or is it more like getting run over by a cement truck? I had a Ross Procedure done in 2004 and my aortic root started dilating. By 2011 I had to have the valve replaced and the root/ascending aorta repaired after only 7 years.

I struggled as well with whether to go with a mechanical versus a tissue valve as I was only 50 at the time. My surgeon suggested an Onyx valve if I decided to go mechanical. But he was also on the team at Duke doing clinical trials on TVAR, and he felt pretty confident that if I got at least a decade out of a tissue valve then I would be a good candidate for the TVAR procedure.

Well I'm 59 now and my Edwards pericardial bovine valve is still in good shape as it's 9 year anniversary approaches in 4 days. At my last checkup he felt I would probably get another 5-10 years out of it if nothing unexpected occurs, and that TVAR would be the method they use to replace it.

 

[Seaton]

Well, I am home just 6 days after OHS # 2. The surgeon again was limited on space in my chest, and I have an Insipirus #21. It is a newer generation valve with an anti-calcification coating. It is also expandable, so TAVR can be done down the road.
Feeling like a train wreck, but blessed to be on the other side. Baby steps forward now.

Lovely to hear you are back home and recovering, Carol. Wishing you all the very best for the days ahead.

 

[tom in MO]

Congratulations! What are you binge watching ? I did Law and Order and Ken Burns Civil War.

 

[CarolM]

Can't concentrate on much right now. Still a lot of dozing time!

 

[Protimenow]

I hope you recover quickly and uneventfully.

 

[ForeverThankful]

Best wishes on a smooth and quick recovery!

 

[KatherineA]

Happy to read you are home and recovering! Don’t forget to enjoy the rest time.