39 years old..tavr vs mechanical?

[Bodhisattva]

I met with the surgeon and he was amazing. I am scheduled for surgery on the 21st. SO SOON.......we talked all options and I am almost 100 percent sure I will do mechanical.

That's great to hear Mldelag1. Sounds like you and your surgeon are an amazing team. Go team! Right, about 2 1/2 weeks away. Of course your heart is probably thinking the sooner the better. Do you have enough time to prepare? If it feels too soon to get everything done without all kinds of time pressures, maybe there is the option to push surgery out, maybe just a week, maybe like to the 28th? Although the sooner you get it done, the sooner you will be looking back at this time like a dream you had once.

 

[honeybunny]

Thanks for the update. Absolutely come here for INR management support. Wishing you the best and looking forward to seeing you on the other side. FWIW, I think for you mechanical is the way to go and it appears you are comfortable with that decision, which is more than half the recovery battle.

 

[sood]

I was faced with a similar decision 4 years ago when I was 35. Mechanical vs Tissue. It came down to one thing for me, data. There is just no history and data yet on TAVR. I got an on-x mechanical. My surgeon said that there is a .5% increase each year in my chance I'll need another surgery in the future. So he said in 40 years my chances of needing another operation will be 20%. For me that was enough to decide on a mechanical. If I had done a tissue I'd start worrying about my next surgery now.

 

[cldlhd]

I was faced with a similar decision 4 years ago when I was 35. Mechanical vs Tissue. It came down to one thing for me, data. There is just no history and data yet on TAVR. I got an on-x mechanical. My surgeon said that there is a .5% increase each year in my chance I'll need another surgery in the future. So he said in 40 years my chances of needing another operation will be 20%. For me that was enough to decide on a mechanical. If I had done a tissue I'd start worrying about my next surgery now.

Just curious as to what the basis for the .5% increase per year?

 

[Agian]

Just curious as to what the basis for the .5% increase per year?

Yeah, me too. Interesting statistic, but where did it come from?

 

[dick0236]

......My surgeon said that there is a .5% increase each year in my chance I'll need another surgery in the future. So he said in 40 years my chances of needing another operation will be 20%. For me that was enough to decide on a mechanical........

I've never heard that "stat" before, but it is very reassuring.......an 80% chance you won't need a mechanical valve ex-planted after 40 years.....and, who knows, maybe you too will have a good chance for 50 years.

 

[erik]

For those young people (40+) considering mechanical/tissue: there will soon be a new tissue on the market, the Edwards Inspiris. Its TAVR ready and most important, the tissue had a new kind of treatment that delays the proces of calcification. Tests only done on animals, promising!. http://www.edwards.com/ns20160929
They start implementing first in Europe and later in US. Do you want to be one of the first generation of humans to be implanted? that's the question. But maybe it will last 20 years in 40+ age people??
Anybody has a opinion about this valve?

 

[J.retiredguy]

I am 65 and diagnosed with moderate/severe aortic stenosis. Gradient numbers are .9 and 1.1. I have absolutely no symptoms but my cardiologist strongly recommends I get a TAVR. He said I "qualify" for this study. Well, lucky me. The doctor reluctantly agreed to re-run the tests in six months. I have no calcification, regurgitation, enlargement, swelling, chest pains or breathlessness. So.........based on these gradient numbers the cardiologist is pushing for this procedure. It seems to me that until I present at least one of the symptoms I should hold off on TAVR. Unfortunately, the literature states that on occasion the first indication is sudden death. YIKES!! Any thoughts? Retiredguy922

 

[pellicle]

I...my cardiologist strongly recommends I get a TAVR. He said I "qualify" for this study. Well, lucky me.
...Any thoughts? Retiredguy922

nothing I've ever read nor hear from anyone suggests that qualifying for TAVR is "luck you" ... I'd call it more like "we think you're so unhealty you'll die soon anyway"

maybe things are changing.

Nothing I've read suggests that you'll get more than 10 years from a TAVI/R maybe 7 , a valve in valve is then of course going to shrink that valve diameter ... what is yours?

After that one packs it in (usually less than you got from the first) then a regular OHS is needed to replace that whole mess ... when you're weaker and older.

You could be luckier than that ... but then I don't like needing luck.

 

[cldlhd]

If you have no calcification then where is the stenosis coming from? I always thought that was the main culprit but I've been told before that I don't know everything.

 

[Duffey]

I am 65 and diagnosed with moderate/severe aortic stenosis. Gradient numbers are .9 and 1.1. I have absolutely no symptoms but my cardiologist strongly recommends I get a TAVR. He said I "qualify" for this study. Well, lucky me. The doctor reluctantly agreed to re-run the tests in six months. I have no calcification, regurgitation, enlargement, swelling, chest pains or breathlessness. So.........based on these gradient numbers the cardiologist is pushing for this procedure. It seems to me that until I present at least one of the symptoms I should hold off on TAVR. Unfortunately, the literature states that on occasion the first indication is sudden death. YIKES!! Any thoughts? Retiredguy922

I have a friend who at the age of 76 underwent aortic valve replacement. She was in good health and other than a little breathlessness when she walked her daily two miles, no symptoms. She was evaluated for TAVR and was told that under no circumstances did she qualify. She underwent conventional open heart surgery and experienced no problems either during the surgery or afterwards. So . . . I can't imagine why a cardiologist would be pushing you to have TAVR.
The literature can state that on occasion the first indication is sudden death, but that is extremely unlikely in this day and age.
I would suggest that you find another cardiologist and get a second opinion.

 

[FredW]

... Younger patients tend to calcify tissue valves faster than older folks, so they often are not recommended to younger patients. (That is, unless you are still considering adding to your family.

Steve, this is the first time I heard that younger patients calcify tissue valves faster than older folks. Can you point me to your source of that? As an older folk with a six month old tissue valve, I'm trying to figure my odds of out living a need for a second OHS. I want 15 years.

 

[pellicle]

this is the first time I heard that younger patients calcify tissue valves faster than older folks. Can you point me to your source of that? As an older folk with a six month old tissue valve, I'm trying to figure my odds of out living a need for a second OHS. I want 15 years.

its funny how the things which are spoken of dozens of times a year seems to slip under the radar. But (sorry) you aren't younger folks ;-)

This is sooooo done and dusted that its actually in surgical guidelines

http://www.onxlti.com/clinical-updat...valve-failure/

https://www.hindawi.com/journals/isrn/2013/728791/
Children and young adults have the highest rate of early primary tissue failure and calcification due to several factors including a more competent immune system [9, 11, 12]. Today the rate of BHV failure at 10 years after implantation is <10% in elderly patients over 70 years of age and 20–30% in patients less than 40 years of age [13].


This is just a starter with the first results found in (literally) 30 seconds

There are threads and threads and threads on this here and every time a younger patient asks about "which valve" I raise this point as a good reason why they should strongly consider a mechanical.

As I always say : if you WANT longer life from the valve as a primary consideration then pick a mechanical ... its QED

PS:
From
Guidelines on the management of valvular heart disease (version 2012)
[IMG2=JSON]{"data-align":"none","data-size":"full","src":"https:\/\/c2.staticflickr.com\/8\/7372\/12220845216_261cceb5c3_o.jpg"}[/IMG2]
point (d) on the table
[SUP]d[/SUP] Young age (,40 years), hyperparathyroidism

This link also supports that: http://jamanetwork.com/journals/jama/article-abstract/2107781

 

[pellicle]

. . . I can't imagine why a cardiologist would be pushing you to have TAVR.

at the urging of the companies and to assist in the gathering of experimental data ... aka "test subjects"

 

[pellicle]

Point
I believe strongly in informed decision. It is my observation that many are not given much information. I try to provide information and veracity. Veracity is to support your opinions with some reasons, not just faith.

One does not need to agree with my views or the reasons. But at least I provide them so that anyone who questions had a basis for reviewing both my and their own positions.

If sometimes I come across as a cranky old fart it's probably because some times I'm a bit cranky and I'm always old. My apologies. It's hard to pretend I'm a robot information poster with no feelings.

 

[epstns]

pellicle - You're no more cranky than I. Figure that one out. . . it is just that when I am cranky, most of the folks around here never even realize it. I'm just a passive-aggressive crank. . .

 

[cldlhd]

Point
I believe strongly in informed decision. It is my observation that many are not given much information. I try to provide information and veracity. Veracity is to support your opinions with some reasons, not just faith.

One does not need to agree with my views or the reasons. But at least I provide them so that anyone who questions had a basis for reviewing both my and their own positions.

If sometimes I come across as a cranky old fart it's probably because some times I'm a bit cranky and I'm always old. My apologies. It's hard to pretend I'm a robot information poster with no feelings.

So wait a minute, I believe you're 53 and you say that makes you old so at 47 am I officially old? I might want to hear from Dick on this subject...

 

[epstns]

They say that "middle age" is from 35 to 65, so you guys are just middle-aged. I, on the other hand, skipped right over that (or did I just zoom through it?), so I should always get my senior discounts now.

 

[Duffey]

Steve, this is the first time I heard that younger patients calcify tissue valves faster than older folks. Can you point me to your source of that? As an older folk with a six month old tissue valve, I'm trying to figure my odds of out living a need for a second OHS. I want 15 years.

Fred, at the age of 73 you are on course to get 15 years out of your tissue valve, and I imagine the valve will last your lifetime. I was 52 when I received a bovine valve, and my 12th anniversary will be here the first of June. Age Does matter when choosing a valve, and most would agree that you made the right choice.

 

[pellicle]

and most would agree that you made the right choice.

including me