Sorry my back was bad yesterday and couldnt sit long. and First I want to say again, I would NOT count of a TAVI for a first valve or 1st REDO there still is not much known about longevity or durability especially in younger healthy people. Even though there have been over 60,000 TAVI implanted (as of a few months ago) and some of them in intermediate risk people, they dont know how they will do long term
Lyn, you said "...BUT since they already can place a Cath valve inside another cath valve..." I've heard of cath inside a regular tissue valve, but not two cath-placed valves. Do you have a source for that?
Sorry, some of where I heard of TAVI in TAVI was from different webcasts, but I dont remember which ones, of course there are not that many in the US since Cath valves are so new, and most still alive w/ them are doing well and also some were pulmonary since they have been in use longer and in much younger patients for the most part. I believe it is possible for 2 TAVI valves, but it depends on a lot of things, not only a larger size valve will have the best chance of fitting 2 cath valves inside than a smaller one, but even different brands of valves have better chances of having 1 or 2 valves placed inside than other brands and types of tissue valve. Some tissue valves that are in the same size Aorta and valve, have larger openings than other tissue valves. They would have the best chance of 2 IMO
but here is one study talking about it
http://www.ncbi.nlm.nih.gov/pubmed/23684680 "From a total of 2,554 consecutive patients, 63 (2.47%) underwent TV-in-TV"
a few other studies mention one or 2
Also from germany,
http://link.springer.com/article/10.1007/s00392-013-0632-8
Transcatheter aortic valve replacement (TAVI), though a preferred treatment option in the elderly population carrying increased risks for open heart surgery, may result in prognosis-limiting moderate or severe aortic regurgitation. Here, we report a series of 11 patients from 3 German TAVI centers, suffering from moderate- to high-grade aortic regurgitation after CoreValve implantation, who were subsequently treated by Edwards Sapien XT implantation.
I've seen references in various places saying that the durability of TAVI valves is still largely unknown, as they have only been used in very sick patients who usually die of other causes within five years or so.
Yes, I agree and said, also the trials on younger and healthier people need to be done, to learn more about how they will do longer term or what problems show up down the road especially in 2011, but even now they hadnt done enough or had not been in long enough to know their durability
Altho since the Highest risk, was relatively low, even compared to other heart surgeries, something like chance of mortality 20% SOME of the people might not be as old and frail as some people think. Besides the reason their risk of mortality for surgery might be high for a AVR. they might be relatively healthy, especially after they have a new better working Aortic Valve. I think in the higher risk patients about half are still living 5 years later from the earliest group
Also beside the Partner and SURTAVI trials that were recently approved for intermediate risk people in the trial, not everyone ( I think less than 8% risk?) they also are following the 50,000 ish patients in Europe (I know different countries have different criteria) many who were intermeadiate risk a few years now.
But the US studies from 4, 5 years in the patients still alive the valves are doing well
http://content.onlinejacc.org/article.aspx?articleid=1486723
Mild transvalvular regurgitation was present in 10.3% of patients after TAVI and 9.1%, 14.3%, 11.9%, 9.5%, and 7.1% at 1 to 5 years, respectively. Up to 4 years, no patient had prosthetic valve failure. At 5 years, 3 patients (3.4% of the total cohort) showed signs of prosthetic valve failure. One patient had moderate transvalvular regurgitation and moderate stenosis (aortic valve area 1.2 cm2; mean gradient 26 mm Hg) 5 years after implantation of a Cribier-Edwards valve. Another patient had moderate regurgitation 5 years after implantation of a Cribier-Edwards valve. The third patient had moderate stenosis (aortic valve area 1.1 cm2; mean gradient 23 mm Hg) 5 years after implantation of an Edwards SAPIEN valve. No patient developed severe stenosis or severe regurgitation.
I personally would not count on one preventing a future OHS, but obviously the technology looks quite promising. There's a company that's working on a TAVI valve that would allow the exchange of valves via catheter.
http://www.valvexchange.com/products/index.html
Their site is for marketing
their technology of course, but I still found the discussion on the pros and cons of existing valve choices interesting - including some of the drawbacks of TAVI:
http://www.valvexchange.com/patients/index.html#patientsdilemma
I agree, plus I think it is better to plan on an OHS REDO and be happy if you can have a TAVI, than plan on TAVI and be really disapointed if you need OHS Yes there have been a few threads about valvexchange before. it looks good, There are some very impressive doctors on their board. I hope it works, it seem pretty complicated and I could see where things might go wrong, so it will be interesting to watch. There are a few really interesting things being worked on right now, like Tissue engineered valves like cormatrix, and newer mech valves, even better anticoagulants.
They seem big fans of edwards and the perimount valves and also have pretty much used the perimount as their leaflets, since it is "based on the off-patent design ",
Also I know valve (and all medical companies) companies cherry pick the data on competitors products to make their product look better, some companies are worse at that then others
But its hard to know how truthful some of their statements on TAVI valves are when they try to scare patients from mech valves the way they describe a life w/ Coumadin
even when they bring up interesting studies like the long term on Coum I wonder how many studies showed no difference Also it looks like they havent updated the patients page since they first wrote it, since they say "Transcatheter valve are currently not approved for sale in the US. They have been cleared for use in Europe, but only on only the very sick, inoperable patient who cannot tolerate open heart surgery."
also I thought it interesting when talking about surgical tissue valves they use the word "dead" tissue alot for both pig and pericardial valves,
but when describing their valve "made from chemically preserved bovine pericardium"they never refer to it as dead tissue. They do link to studies for most things, but whenever they mention TAVI longevity, they say things like valve design and will most likely wear out in about 5 years. or Decades of research and the clinical experience with many designs of tissue valve illustrate that such transcatheter valve cannot last more than about 5 years, making it seem like it is fact, not their opinion there are no links even tho percutaneous valves (pulm and Aorta) were in use longer than 5 years, if they were failing early im sure they would show proof
It's just my opinion, but I think if a company has a product that is very good especially if they believe it is better than other choices, they should be a little more honest about the other choices, instead of making the other valves seem terrible.. But Thats marketing
