Edwards Resilia Inspiris Aortic Valve

[2leafer]

Hi Everyone,
Hope all my VR friends are doing well. I just got back from my second valve replacement at The Cleveland Clinic. Some of you old timers may remember me when I had my bicuspid aortic valve replaced in February of 2010. At that time Dr Gillinov chose the Edwards bovine Perimount valve #2700. It lasted a month shy of 8 years before it gave up the ship. I had no symptoms but my echo revealed both severe stenosis and severe regurgitation. I decided to return to The Cleveland Clinic traveling solo from Central Oregon. This time I chose Lars Svensson to do the surgery. On Thursday January 18th he replaced my worn out valve with the new Edwards Resilia Inspiris heart valve. It was just approved by the FDA in July of last year. During my pre-op appointment Dr. Svensson told me about the valve and that the surgeons were very excited about the new technology. He said it had been doing very well on sheep ;>))) and so far so good on the 300 test patients that were 3 years into the testing phase. He said that he had been using it for only the last few weeks. Aside from the new treatment to the bovine pericardium the valve is designed to mate up with the Edwards TAVR valve which I will most likely have to have as I am only 68 years old. Surgery went extremely smooth. I was out of ICU on Friday the day after surgery and released from the hospital on Monday 3 days later. I stayed at the Holiday Inn on campus and returned for my final follow up appointment 2 days later on Wednesday and flew back to Oregon on Thursday January 25th, one week after surgery. I have to admit that the first 24 hours was a bear compared to my first go around as this time I had a full sternotomy versus a mini the first time but in hind sight it could have been a lot less painful if I had used the pain relief more frequently. The care was superb as was with my first time. I never thought that the hospital gruel could have gotten worse but it did, it was awful. Well, I just thought I'd let some of the old timers know I was back. I'm hoping that this new valve will last me a whole lot longer that my last one which had perforations in two of the three leaflets and a tear, no calcification whatsoever though. If anyone else that reads this has the new Edwards Inspiris Valve I'd love to know about it so please make a post. Best Wishes to everyone. 2Leafer

 

[hx77]

Hi 2Leafer,

Thank you for letting us know Inspiris Resilia is now clinically available in US, or at least at Cleveland. Congratulations on your quick recovery from the OHS! Any explanations why your first valve has perforations? This does not seem a common issue.

John

 

[honeybunny]

Good to know; thanks for sharing. Best of luck with it. I'm in a clinical trial for the Edwards Intuity Elite Rapid Deployment aortic valve, implanted 09/15. It was described to me as a sort of bridge between traditional surgery and TAVR. It was going strong at my October checkup.

 

[SomeoneSomewhere]

Hi, I've also had an Inspiris Resilia valve fitted in October 17 and I can't say I'm 100% happy about it as I feel the valve opening and closing. It's a new valve and no one seems to know more about it but I did call Edwards and it was confirmed I should not hear it. Is my valve faulty? I would be interested to hear what you have experienced and also to hear from any medical team.

 

[Paleowoman]

Hi, I've also had an Inspiris Resilia valve fitted in October 17 and I can't say I'm 100% happy about it as I feel the valve opening and closing. It's a new valve and no one seems to know more about it but I did call Edwards and it was confirmed I should not hear it. Is my valve faulty? I would be interested to hear what you have experienced and also to hear from any medical team.

SomeoneSomewhere I haven't got the new valve but I have an Edwards Magna Ease valve implanted four years ago and it is noiser with the leaflets opening and closing than my bicuspid valve was, which wasn't especially noisy. This was first explained to me that as it's new it is a different sound from what my brain is used to and it takes several months for the brain to adjust to new internal sounds. With me, though, it transpired that the valve I was given is a bit too small for me so there is turbulence and maybe that is why as it is now being described as a "very loud flow murmur" ? Regardless, when doctors listen to my heart they can get very confused by the loudness of the valve - I'm used as a patient for an exam that doctors take to advance up to specialist status - one doctor thought I had a mechanical valve !

If the loudness of the valve opening and closing continues to bother you do keep telling your cardiologist and make sure you are checked out.

PS - you should have had a post surgery echo which would have checked that the valve is working fine with the leaflets opening and closing properly with no "rocking". If your cardiologist is concerned he will doubtless order another echo, or you could ask for one.

 

[kathykc]

Hello 2Leafer,

Appreciate your helpful post. My husband will have his first aortic valve replacement this year (age 66, aortic valve regurgitation). We are learning the ropes of this process. One is where to get the surgery. I assume since you went to Cleveland Clinic twice, that it met your needs/expectations. For your first surgery, did you need to visit Cleveland Clinic for an appointment with a cardiologist before you selected a surgeon? Because we live in Northern Nevada, we are also looking at Stanford. Any advice on either of these cardiology departments? My husband is researching valve selection and this forum has been very informative. Thanks so much and hope you are doing well.

 

[Daniel758]

Just received the Inspiris Resilia valve on 4/17/2018 (first timer) and I can’t hear it at all. Zero noise. and extremely smooth with no issues so far. Out of the hospital on day four as well.

According to surgeon and research, the valve’s supposed to last 2-3 times longer than previous generation tissue valves, and minimizes calcification.

We’ll see.

To me, not having to deal with blood thinners, lower stroke risk, etc. was worth taking a risk on a new technology.

Good luck!

 

[dixitworld]

Hello Kathy,

Which surgeon are you looking in Stanford? Ping me if you get chance

 

[SomeoneSomewhere]

SomeoneSomewhere I haven't got the new valve but I have an Edwards Magna Ease valve implanted four years ago and it is noiser with the leaflets opening and closing than my bicuspid valve was, which wasn't especially noisy. This was first explained to me that as it's new it is a different sound from what my brain is used to and it takes several months for the brain to adjust to new internal sounds. With me, though, it transpired that the valve I was given is a bit too small for me so there is turbulence and maybe that is why as it is now being described as a "very loud flow murmur" ? Regardless, when doctors listen to my heart they can get very confused by the loudness of the valve - I'm used as a patient for an exam that doctors take to advance up to specialist status - one doctor thought I had a mechanical valve !

If the loudness of the valve opening and closing continues to bother you do keep telling your cardiologist and make sure you are checked out.

PS - you should have had a post surgery echo which would have checked that the valve is working fine with the leaflets opening and closing properly with no "rocking". If your cardiologist is concerned he will doubtless order another echo, or you could ask for one.

Hello Paleowoman, it's been a while since I checked in here so apologies for the delay. It is now coming up to 8 months since my congenital bicuspid aortic valve and ascending aorta replacement - 2 ops in one and there is no difference to my earlier sensation. I still feel the pulsation and now I don't know if it is the heart I feel or the valve opening/closing or both. I have been checked out by my cardiologist on many occasions and there is nothing wrong with my Edwards Lifescience Resilia valve and nothing wrong with my ascending aorta either. I really don't know what to do. I was informed by my cardiologist I have to learn to live with the sounds which is very hard for me as I am very in tune with inner self. Sometimes I also feel like I have pneumonia but I know I haven't. As my fault is a birth defect my life has changed drastically to the worse.

How are you now-a-days?

 

[SomeoneSomewhere]

Just received the Inspiris Resilia valve on 4/17/2018 (first timer) and I can’t hear it at all. Zero noise. and extremely smooth with no issues so far. Out of the hospital on day four as well.

According to surgeon and research, the valve’s supposed to last 2-3 times longer than previous generation tissue valves, and minimizes calcification.

We’ll see.

To me, not having to deal with blood thinners, lower stroke risk, etc. was worth taking a risk on a new technology.

Good luck!

Congratulations and you are very lucky. I'm so happy for you. I envy you not hearing or feeling your valve. I feel mine all the time 24/7 and it's making me crazy. I just want to be alone. I hate my op and my life now-a-days. Do you have to take any medication?

 

[Warrick]

Congratulations and you are very lucky. I'm so happy for you. I envy you not hearing or feeling your valve. I feel mine all the time 24/7 and it's making me crazy. I just want to be alone. I hate my op and my life now-a-days. Do you have to take any medication?

Hi, I have a mechanical valve which like many of us with mechs hear the clicking most of the time, so with regards to valve noise you are not alone !!

Theres been times when i can hear the opening click, the blood rushing thru it and the closing click, all clearly audible. I think i hear it when theres a lot of noise but now I've realised thats the "feeling it " side of it. The sound to me is the worst part of this whole thing... but you do tune out to it eventually!!

So as hard as it is to swallow you have to accept it and accept your op and this is your life now and the only way to make it better is changing YOUR view on it.
Maybe you have post surgery depression.. I did, it's quite common apparantly but knowing this doesn't make it any easier and it burns inside, a bit of professional help can go a long way.

Everyone wants you to feel better, especially everyone on here and we are complete strangers but we are all connected by this

 

[pellicle]

Hi

if I may add to Warrick 's view

Congratulations and you are very lucky. I'm so happy for you. I envy you not hearing or feeling your valve. I feel mine all the time 24/7 and it's making me crazy. I just want to be alone. I hate my op and my life now-a-days. Do you have to take any medication?

I'm 6 years post (third) OHS surgery and having had a few I can say that its not easy. I too hear my valve pretty much all the time when its quiet, but not when I'm doing things (like my drive this week to Canberra and back). In the first months post surgery I was quite unhappy with it. However I struggled through it because I wanted strongly to be a good husband for my wife. She didn't know much about this stuff (as I met her well after my 2nd OHS).

She died of cancer and I was left living ... still ticking ...

Then I got the infection arise ... still ticking ... and had a surgery to attempt to fix that infection ... still ticking

That didn't work and I had to have a second surgery to try again to fix that infection ... still ticking ...

I sat thinking about wanting to die ... still ticking
I thought about all the times when my wife told me she could hear me ticking ...
I have had many people tell me that they can hear me ticking ... I can too.

One day I decided that of all the **** which happened to me that I was ticking was so insignificant that I'd be a fool to tear myself up about it.

I have long long long thought (since my early 20's) that I do not want t let drugs and alcohol (simple chemicals) ruin my life as it has many of my (some of them dead) friends and family.

Right now I'd rather be ticking than facing a 4th surgery .. or dead.

Its a choice you make ... to focus on the ticking and be angry ... no peace lies in that path.

Just like all the people around me who are dead, injured, facing hip and knee replacement surgery (yes, I'm still only 54) I got a surgery which the only side effect is I tick.

I (and you) can choose to hate that or embrace it.

what you pick will be the sole determinate of your own happy life or fucked up life. ... only you can pick ....

Something to read from my blog:
http://cjeastwd.blogspot.com/2013/03...re-effect.html

I hope you choose to take the gift given you and not lament it for something as simple as feeling something different as a result of a life saving surgery ... the option was serial life saving (and life eroding) surgeries ... just like INR management, your (mental) health is in your own hands.

I hope that you don't need to go through what I went through to see the most important point; Being alive and ticking is better than being dead and not.

Reach out if you want to talk, I've always got time for valvers.

 

[Paleowoman]

Hello Paleowoman, it's been a while since I checked in here so apologies for the delay. It is now coming up to 8 months since my congenital bicuspid aortic valve and ascending aorta replacement - 2 ops in one and there is no difference to my earlier sensation. I still feel the pulsation and now I don't know if it is the heart I feel or the valve opening/closing or both. I have been checked out by my cardiologist on many occasions and there is nothing wrong with my Edwards Lifescience Resilia valve and nothing wrong with my ascending aorta either. I really don't know what to do. I was informed by my cardiologist I have to learn to live with the sounds which is very hard for me as I am very in tune with inner self. Sometimes I also feel like I have pneumonia but I know I haven't. As my fault is a birth defect my life has changed drastically to the worse.

How are you now-a-days?

SomeoneSomewhere I understand where you are coming from. My bicuspid valve was a birth defect and my life has changed for the worse having AVR, now four years ago. It's not so much the noise with my replacement valve, though I still hear it most times, but the fact that it's too small - "moderate patient prosthesis mismatch" - which means I have not recovered to my pre-surgery level of fitness. I was asymptomatic prior to surgery and now I am definitley not as fit or well as I was prior to surgery - thankgoodness this is now acknowledged as when it was all brushed aside I felt 'betrayed' in a sense. This began to show up almost straight away after surgery when my pressure gradients were highish and kept rising. They seem to have stabilised at mean 31 mmHg, peak 58 mmHg for the past year, but I'm none too happy to have gone through surgery to end up worse - only real difference is that the valve leaflets are not calcified but the effective orifice area is only 0.76 cm2 which is less than prior to surgery.

My hearing is highly sensitive so I empathise with you. I don't feel grateful for having had surgery. I'm annoyed with myself and with the surgeon !

 

[SomeoneSomewhere]

Hi, I have a mechanical valve which like many of us with mechs hear the clicking most of the time, so with regards to valve noise you are not alone !!

Theres been times when i can hear the opening click, the blood rushing thru it and the closing click, all clearly audible. I think i hear it when theres a lot of noise but now I've realised thats the "feeling it " side of it. The sound to me is the worst part of this whole thing... but you do tune out to it eventually!!

So as hard as it is to swallow you have to accept it and accept your op and this is your life now and the only way to make it better is changing YOUR view on it.
Maybe you have post surgery depression.. I did, it's quite common apparantly but knowing this doesn't make it any easier and it burns inside, a bit of professional help can go a long way.

Everyone wants you to feel better, especially everyone on here and we are complete strangers but we are all connected by this

Ah thank you! I read somewhere that when the pericardium is cut one can experience the echo sound of the heart as the fluid will be less around the heart and they rarely stich the pericardium back together for obvious reasons. I just hope in time that the pericardium will heal and I will have less sensation of the pulsation.

The reason I didn't want a mechanical valve is because of the noise and because one has to take anticoagulant for the rest of one's life. I have people in the family who has taken warfarin and I have seen the side effect of it and for me this was not an option.

 

[SomeoneSomewhere]

SomeoneSomewhere I understand where you are coming from. My bicuspid valve was a birth defect and my life has changed for the worse having AVR, now four years ago. It's not so much the noise with my replacement valve, though I still hear it most times, but the fact that it's too small - "moderate patient prosthesis mismatch" - which means I have not recovered to my pre-surgery level of fitness. I was asymptomatic prior to surgery and now I am definitley not as fit or well as I was prior to surgery - thankgoodness this is now acknowledged as when it was all brushed aside I felt 'betrayed' in a sense. This began to show up almost straight away after surgery when my pressure gradients were highish and kept rising. They seem to have stabilised at mean 31 mmHg, peak 58 mmHg for the past year, but I'm none too happy to have gone through surgery to end up worse - only real difference is that the valve leaflets are not calcified but the effective orifice area is only 0.76 cm2 which is less than prior to surgery.

My hearing is highly sensitive so I empathise with you. I don't feel grateful for having had surgery. I'm annoyed with myself and with the surgeon !

Hi, I'm sorry to hear. It is awful to come out worse than before the op. I did too. Can they do anything to make you better e.g change the valve to a bigger size?

The specialists keep saying one's life should be great after the AVR op but what they don't realise is that if one is 100% well before the op e.g able to do exercises without a breathing problem then one cannot come out for the better. If one has breathing issues then yes but not the other way around. I had a great surgeon doing my operation but still I am annoyed with life having been thrown this upon me. I'm the only one in the family with this condition and I was informed that I have been able to sustain the op until now because I have lived a healthy lifestyle. I had no idea I had this condition until last year.

 

[SomeoneSomewhere]

Hi

if I may add to Warrick 's view



I'm 6 years post (third) OHS surgery and having had a few I can say that its not easy. I too hear my valve pretty much all the time when its quiet, but not when I'm doing things (like my drive this week to Canberra and back). In the first months post surgery I was quite unhappy with it. However I struggled through it because I wanted strongly to be a good husband for my wife. She didn't know much about this stuff (as I met her well after my 2nd OHS).

She died of cancer and I was left living ... still ticking ...

Then I got the infection arise ... still ticking ... and had a surgery to attempt to fix that infection ... still ticking

That didn't work and I had to have a second surgery to try again to fix that infection ... still ticking ...

I sat thinking about wanting to die ... still ticking
I thought about all the times when my wife told me she could hear me ticking ...
I have had many people tell me that they can hear me ticking ... I can too.

One day I decided that of all the **** which happened to me that I was ticking was so insignificant that I'd be a fool to tear myself up about it.

I have long long long thought (since my early 20's) that I do not want t let drugs and alcohol (simple chemicals) ruin my life as it has many of my (some of them dead) friends and family.

Right now I'd rather be ticking than facing a 4th surgery .. or dead.

Its a choice you make ... to focus on the ticking and be angry ... no peace lies in that path.

Just like all the people around me who are dead, injured, facing hip and knee replacement surgery (yes, I'm still only 54) I got a surgery which the only side effect is I tick.

I (and you) can choose to hate that or embrace it.

what you pick will be the sole determinate of your own happy life or fucked up life. ... only you can pick ....

Something to read from my blog:
http://cjeastwd.blogspot.com/2013/03...re-effect.html

I hope you choose to take the gift given you and not lament it for something as simple as feeling something different as a result of a life saving surgery ... the option was serial life saving (and life eroding) surgeries ... just like INR management, your (mental) health is in your own hands.

I hope that you don't need to go through what I went through to see the most important point; Being alive and ticking is better than being dead and not.

Reach out if you want to talk, I've always got time for valvers.

Hi, yes when I read your story I guess I am blessed and you are so right. You must have a mechanical valve? What I don't understand is how some people don't feel their bio valve and some people do. I would like to know why and this to me is very difficult to comprehend. There must be a technique used when performing the op as to prevent the candidate from feeling these feelings in the aftermath and it would be very interesting to hear from any surgeons their view.

 

[pellicle]

Hi

You must have a mechanical valve?

yes, I do. My first surgery when I was 10 was a "repair" my second (at 28) was a homograft and my third (at 48) was a mechanical. Here's hoping that this one does me the distance. A 4th OHS would be undesirable and have far more risk (especially considering any potential embers of infection).

What I don't understand is how some people don't feel their bio valve and some people do. I would like to know why and this to me is very difficult to comprehend.

as far as I know its based on scar tissue. Keeping in mind that scar tissue is not only what we see on the surface and call "a scar", scar tissue goes as deep as the surgery and forms around everything that was cut, moved aside or even just "exposed to oxygen". This forms differently in different people (and based on my own experience differently at different stages of life).

Scar tissue also forms in the bones too (which one is sawn through in surgery) and can form so called "adhesions" between things which were not once joined (but become so by the scar tissue).

So this then increased the acoustic coupling between things. For example, put a mechanical clock to your head and you'll hear the ticking conducted through your skull.

Same thing.

I'm sorry your relatives had such difficulty with Warfarin, but in my experience this is 90% due to mismanagement by clinics. I "self manage" and strongly recommend it (as do quite a few of us here ...)

In my previous post I meant to also mention that grief is something which you will feel at any loss (in this case the loss of what you previously thought of yourself and how you perceive yourself). Its important to keep this in mind and make sure that "feelings" don't become habits.

There are many stories of people with mechanical valves on warfarin who do all manner of things (far in excess of what I do). For example:

I encourage you to read this story:
http://chicagoheartsurgery.com/veronika-meyer-climbs-everest-after-heart-valve-surgery/

and then sit back and think about what it is you think are your limitations and restrictions created by warfarin and the mechanical valve (which btw pretty much will never wear out).

Best Wishes

 

[Warrick]

Ah thank you! I read somewhere that when the pericardium is cut one can experience the echo sound of the heart as the fluid will be less around the heart and they rarely stich the pericardium back together for obvious reasons. I just hope in time that the pericardium will heal and I will have less sensation of the pulsation.

The reason I didn't want a mechanical valve is because of the noise and because one has to take anticoagulant for the rest of one's life. I have people in the family who has taken warfarin and I have seen the side effect of it and for me this was not an option.

I hope you do find in time you feel the sensation less too, the edwards valve does so seem to be an attrative option, I sometimes mull over if I ever need another valve would I go tissue over mechanical again, and I think the noise would be the mitigating factor, head over heart..

I remember the cardiac nurse telling me as things healed the noise would reduce... I felt ripped off and misled abit, but its the time/get use to it thing
I guess this is what you feel with a noisey tissue valve ?

My father has taken warfarin for the last 30+ years with an unrelated to mine AVR, although I never really knew anything of warfarin it wasn't a deciding issue,it was just a pill my dad took every day when i was a kid, he never mentioned the sound as an issue
So i guess thats how i went mechanical

 

[Paleowoman]

It is awful to come out worse than before the op. I did too. Can they do anything to make you better e.g change the valve to a bigger size?

The specialists keep saying one's life should be great after the AVR op but what they don't realise is that if one is 100% well before the op e.g able to do exercises without a breathing problem then one cannot come out for the better. If one has breathing issues then yes but not the other way around.

They can't change my valve to a bigger size because the mortality risk is too great due to the scar tissue. Originally the surgeon could have put a bigger valve in supra-annular position or done an aortic root enlargement to give me a bigger valve - no idea why she didn't. So it will be a matter of waiting until the valve degenerates at which point the mortaility risk of not doing surgery will be greater - of course I'm not so naive as to not realise that the current mortailty risk will be greater then due to my age increasing ! I've got an Edwards Magna Ease valve so the valve leaflets will degenerate at some point so I am having regular echos to watch that. When I have the valve re-do the new surgeon I am under suggested I might need a mechanical valve as that gives a bigger valve area (and more noise). Since you have an Edwards Resilia Inspiris your valve should, in theory, not degenerate, at least not until many years.

It took ages for the cardiologist who I am under to realise that my life was not great after AVR, he probably didn't like to think it. It was a great relief to me when the cardiac surgeon I’m under acknowledged it in black and white in his report last November. I hope your cardiologist will realise you are not where you were pre-surgery, or that you do get back to your level of pre-surgery health and fitness one day !

 

[Alchemist]

Having an interest in the Resilia Inspiris, I was drawn to this thread and very moved by the posts by Pellicle, Someone Somewhere and Paleowoman on not just the mechanics of AVR and living with our choices and outcomes but our very interesting relationship with our heart.

Early on during my time in the Waiting Room I came across this video, strangely poignant and still haunting:

https://www.wnycstudios.org/story/heartbeat/

I hope it helps.