Edwards Resilia Inspiris Aortic Valve

[bizinsider]

My valve was then sized so a TAVR could handle the replacement,

They always put the biggest size valve they can wedge in there - that was just a line to make you feel good.

Actually, he was very specific on size and if you met him you would realize he doesn't mess around or b.s. - no need to. He's extraordinarily solid and serious. I think we all know that we won't even know if I can have a TAVR done until the time comes.

 

[esvaja]

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 !

where did you have your surgery done? Pls & thx.

 

[Maineiacs]

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.

Hello
I’m in Maine where I had my first aortic replacement 9/11/2018
.Bioprothetic Percerveal-S Size L. I have the best and brightest at my doorstep in Boston but will travel to the Cleveland Clinic when I need a replacement. After after 7 months I developed blood clots on two of the leaflets, and those clots ended in a two CVA’s in 2019, and one in October 2020. Yes I’m on ACT. Lars Svenson MD is the premier Aortic Specialist. I will have him do my up and coming surgery, whenever that will be. Good Luck. Gosh speed.

 

[bizinsider]

Hello
. Lars Svenson MD is the premier Aortic Specialist. I will have him do my up and coming surgery, whenever that will be.

He did my surgery eight months ago. bio-Bentall + CABGx1. He and his team are beyond fantastic.

 

[Chuck C]

I'm waiting with baited breath to see the Commence 5-year trial results for the Resilia. They are supposed to be published soon. Anyone have the inside scoop on the prepublication data? Edwards told me that it should be published in early 2021. The 4-year was May of 2019. I wonder why such a lag between the 4 year and the 5 year. Perhaps delays from Covid?

 

[Chuck C]

This Tuesday will mark six months for me with the Inspiris Resilia at the recommendation of my cardiologist and surgeon. I am 38 (was 37 at the time), and had pretty much made up my mind to go mechanical after spending time on this forum. But the surgeon said – his words, mind you – "You'd be crazy to go mechanical nowadays." The idea is that because he was able to put in a large valve and because I did not have any other issues with the surrounding arteries, etc., that subsequent surgeries should be easier via minimally invasive or even TAVR. (Edit: my cardiologist is with UCLA Health, and my surgery was at Ronald Reagan Medical Center at UCLA.)

In terms of medications, I am on 6.25 mg of carvedilol twice daily, and a baby aspirin in the morning. Plus a big pawful of vitamins and supplements. My resting heart rate and blood pressure have never been better, and while I presented as "asymptomatic" when my valve regurgitation was discovered, my stamina and overall health has greatly improved since the replacement. While I've read lots of folks here who are getting on great with coumadin, in the three months post-surgery I was on it, we could never get it to stabilize.

It's a very personal decision, which valve to go with, based on a lot of factors. I'm grateful that this new generation of tissue valves was developed in time for my surgery, and I'll definitely keep everyone here in the loop as time goes on!

Stay safe, everyone!

"my cardiologist is with UCLA Health, and my surgery was at Ronald Reagan Medical Center at UCLA.) "

UCLA was my last consultation two months ago. Do you mind sharing who your surgeon was? At this point I am leaning towards the Resilia aortic valve and will most likely have this done at UCLA Ronald Reagan Medical Center, like you did.

 

[bizinsider]

At this point I am leaning towards the Resilia aortic valve and will most likely have this done at UCLA Ronald Reagan Medical Center, like you did.

Hi Chuck. My surgeon led the Resilia trials but when I had my surgery last March he chose the Carpentier-Edwards Perimount, an old tried/true valve. My choice was really between a mechanical or that. I was 67 at the time. He felt that, at that time, the older valve would be best for me. I remember reading some studies at the time that left me with the impression the Resilia was not suited for my procedure, which included a root and ascending aorta. Then again...my view, considering who the surgeon was and his experience - especially with the Resilia - was to go with whatever he felt was best. (FWIW: I was not a patient who was intimidated by my surgeon. I questioned him about everything he was doing, why he chose what he chose, etc. My goal was to wind up with the best results. With valves, as we all know, duration is anybody's guess. I was given around 8-15 years. The way I calcify, I'm supposing sooner rather than later.)

 

[Chuck C]

Hi Chuck. My surgeon led the Resilia trials but when I had my surgery last March he chose the Carpentier-Edwards Perimount, an old tried/true valve. My choice was really between a mechanical or that. I was 67 at the time. He felt that, at that time, the older valve would be best for me. I remember reading some studies at the time that left me with the impression the Resilia was not suited for my procedure, which included a root and ascending aorta. Then again...my view, considering who the surgeon was and his experience - especially with the Resilia - was to go with whatever he felt was best. (FWIW: I was not a patient who was intimidated by my surgeon. I questioned him about everything he was doing, why he chose what he chose, etc. My goal was to wind up with the best results. With valves, as we all know, duration is anybody's guess. I was given around 8-15 years. The way I calcify, I'm supposing sooner rather than later.)

Hi Bizinsider,
In my view, they do not come any better than Lars Svensson when it comes to valve surgery, and I think it is a good call to go with is recommendation, but ask lots of questions, which you did. The Carpentier-Edwards Perimount has been around for decades, with long term study data and it seems like a great choice. Because I have very high Lp(a) it is likely that my replacement valve will calcify faster than average, plus at my age the valves generally calcify faster as well. So, for these reasons, I am willing to go with the Resilia, which is designed to resist calcification, despite the lack of long term data. We soon should have 5 year data for the Resilia from the Commence study and 6 year data from the European study. I'm hopefully years out from my surgery date, and it would be nice to see a few more years of results on the Resilia before making the decision. But, given the likelihood that a typical biological valve will only last 10 years or less for me, I think I would take my chances with the Resilia given the very good outcomes so far. BTW, my aorta diameter is normal, at least at this point, so it would be just a replacement of my valve.
Take care,
Chuck

 

[bizinsider]

Hi Bizinsider,
In my view, they do not come any better than Lars Svensson when it comes to valve surgery, and I think it is a good call to go with is recommendation, but ask lots of questions, which you did. The Carpentier-Edwards Perimount has been around for decades, with long term study data and it seems like a great choice. Because I have very high Lp(a) it is likely that my replacement valve will calcify faster than average, plus at my age the valves generally calcify faster as well. So, for these reasons, I am willing to go with the Resilia, which is designed to resist calcification, despite the lack of long term data. We soon should have 5 year data for the Resilia from the Commence study and 6 year data from the European study. I'm hopefully years out from my surgery date, and it would be nice to see a few more years of results on the Resilia before making the decision. But, given the likelihood that a typical biological valve will only last 10 years or less for me, I think I would take my chances with the Resilia given the very good outcomes so far. BTW, my aorta diameter is normal, at least at this point, so it would be just a replacement of my valve.
Take care,
Chuck

I think your "youth" likely bodes well for that. ;-)

As far as I'm concerned the clock is ticking for me on a replacement. The current setup was sized for a TAVR, so we'll see what they do and use years forward. BTW, in my final year or two pre-surgery I had graduated to the every 3 month scan plan. For the ever-other-one, I refused to have CTs b/c of the dye, radiation. At Scripps, here in San Diego, they have a single MRI that could see things pretty well. The kicker - nothing, of course, was as detailed and as good as the pre-surgery CT. However, it wasn't until they sent inside that they realized that my "probable bicuspid" was a unicuspid. The other kicker: While my valve was deteriorating, with special focus on my left ventricle, the urgent focus of my scans was was because of my aneurysm, which was at 4.8-4.9 cm, just below the 5.0 guidelines. As it turns out, it was my valve that forced the timing of the surgery. So many variables and unknowns!

 

[Chuck C]

I think your "youth" likely bodes well for that. ;-)

As far as I'm concerned the clock is ticking for me on a replacement. The current setup was sized for a TAVR, so we'll see what they do and use years forward. BTW, in my final year or two pre-surgery I had graduated to the every 3 month scan plan. For the ever-other-one, I refused to have CTs b/c of the dye, radiation. At Scripps, here in San Diego, they have a single MRI that could see things pretty well. The kicker - nothing, of course, was as detailed and as good as the pre-surgery CT. However, it wasn't until they sent inside that they realized that my "probable bicuspid" was a unicuspid. The other kicker: While my valve was deteriorating, with special focus on my left ventricle, the urgent focus of my scans was was because of my aneurysm, which was at 4.8-4.9 cm, just below the 5.0 guidelines. As it turns out, it was my valve that forced the timing of the surgery. So many variables and unknowns!

Hi Bizinsider,
I watched a video a few months back with Lars Svensson and Doug Johnson of Cleveland Clinic in which they discussed their results for the Carpentier-Edwards Perimount and I believe that 20 years out, about 50% of the valves are still functioning without needing replacement yet, so you may be a long long ways off from needing TAVR. Although I'm thinking that they must only be including those who have survived the 20 years, so that data might be a little skewed, but regardless, a lot of those valves are lasting 20+ years.

Yes, there are indeed so many variables. I'm curious, I see that you had your MRI at Scripps near your home. Cleveland Clinic was obviously a great choice for your procedure in March of this year, being ranked #1 for valve surgery and I have considered having mine done there when my time comes. But, in our area there are some pretty amazing clinics as well. I live about an hour north of you in Temecula. I've had consultations at Scripps, Cedar Sinai and UCLA and have been very impressed with all three. I like to look at the survival scores of individual surgeons as well and all three clinics have surgeons who score as high as the Cleveland surgeons. At this point I'm leaning towards having my surgery in S. Cal, with so many good choices here. Was it a tough decision to travel across the country to have your surgery and do you see any downsides to doing so? I believe you said that you will go back to Cleveland for your next procedure, is that correct?

 

[bizinsider]

Hi Chuck,

If I had to have my valve replaced by surgery in the foreseeable future I would go back to CC and Dr. Svensson. TAVR, I would very likely go to Scripps since they have been on the leading edge – depending on which IC was doing the work. Since you're local and we both have consulted locally, feel free to DM me and we can catch up by phone.

Best,
Herb

 

[Chuck C]

Hi Chuck,

If I had to have my valve replaced by surgery in the foreseeable future I would go back to CC and Dr. Svensson. TAVR, I would very likely go to Scripps since they have been on the leading edge – depending on which IC was doing the work. Since you're local and we both have consulted locally, feel free to DM me and we can catch up by phone.

Best,
Herb

Hi Herb,
From everything I have read about Dr. Svensson and his informational videos I have watched, I am very impressed with him and even more so after reading your other posts in which you mention him.
I was evaluated for TAVR at Scripps by Dr. Curtiss Stinis and I was very impressed with his knowledge and experience. I think I would feel totally comfortable getting a TAVR there, but it appears that is probably not an option for me given my level of calcification and the uneven distribution of it on my two leaflets.

Take care,

Chuck

 

[bizinsider]

Hi Herb,
From everything I have read about Dr. Svensson and his informational videos I have watched, I am very impressed with him and even more so after reading your other posts in which you mention him.
I was evaluated for TAVR at Scripps, Dr. Curtiss Stinis and I was very impressed with his knowledge and experience. I think I would feel totally comfortable getting a TAVR there, but it appears that is probably not an option for me given my level of calcification and the uneven distribution of it on my two leaflets.

Take care,

Chuck

A friend had Dr. Stinis do his TAVR. My cardiologist told me he is world class.

 

[Maineiacs]

Hi Bizinsider,
In my view, they do not come any better than Lars Svensson when it comes to valve surgery, and I think it is a good call to go with is recommendation, but ask lots of questions, which you did. The Carpentier-Edwards Perimount has been around for decades, with long term study data and it seems like a great choice. Because I have very high Lp(a) it is likely that my replacement valve will calcify faster than average, plus at my age the valves generally calcify faster as well. So, for these reasons, I am willing to go with the Resilia, which is designed to resist calcification, despite the lack of long term data. We soon should have 5 year data for the Resilia from the Commence study and 6 year data from the European study. I'm hopefully years out from my surgery date, and it would be nice to see a few more years of results on the Resilia before making the decision. But, given the likelihood that a typical biological valve will only last 10 years or less for me, I think I would take my chances with the Resilia given the very good outcomes so far. BTW, my aorta diameter is normal, at least at this point, so it would be just a replacement of my valve.
Take care,
Chuck

Best surgeon ever. Was at Lahey Burlington MA heart proven. Aorta guru... now at CC as you know!
stacy

 

[Maineiacs]

I'm waiting with baited breath to see the Commence 5-year trial results for the Resilia. They are supposed to be published soon. Anyone have the inside scoop on the prepublication data? Edwards told me that it should be published in early 2021. The 4-year was May of 2019. I wonder why such a lag between the 4 year and the 5 year. Perhaps delays from Covid?

https://academic.oup.com/ejcts/advance-article/doi/10.1093/ejcts/ezaa311/5952768?login=true

 

[Chuck C]

https://academic.oup.com/ejcts/advance-article/doi/10.1093/ejcts/ezaa311/5952768?login=true

Great! Thank you!

 

[Daniel758]

Update on my Inspiris Resilia...

I’m coming up on 3 years in April and, absolutely no issues so far.

All echos and follow ups have been good, no Afib, energy levels great, completely silent, zero limitations and feeling light years better than the years before surgery.

Work rehabbing/flipping houses, hike the Sierras, camp, swim, do yard work, etc., just like a “normal “ person.

Daily meds are 1/4 tab of 25 mg Atenolol and a baby aspirin. (I get an occasional palpitation without the Atenolol)

How long this valve will last, who knows, but so far so good.

For me, not having to deal with anticoagulants, ticking, strokes, bleeding or anything else heart related while I’m relatively young is worth whatever comes in the future.

Who knows what’s to come for anyone at any time anyway.

Will heart issues eventually get me or will it be something else?

We’ll see but I’m not going to waste good years worrying about it whatever it is.

Overall, very grateful for the new life and to live in a time where these devices and surgeries exist.

Good luck to all here and, while don’t post often, I really enjoy keeping up with this forum.

 

[dick0236]

Overall, very grateful for the new life and to live in a time where these devices and surgeries exist.

Amen to that!!

 

[FishnFool]

Good to hear, I had my Resilia valve put in Nov 19 2020. I am working out daily, doing yard work and already feel better than the few years before surgery. One note my valve does make noise. Only time will tell but good to hear from others who have the same valve.
Not sure what will take me out, but Im getting busy living my best life at 55.

 

[Chuck C]

The 5-Year results of the Commence Trial, for the Resilia valve, were just published this month. There is also a much smaller European study with 5 year results published a few months ago. It is good to know that they are showing good hemodynamics at 5 years.
Edwards’s 5-Year-Data from COMMENCE Trial Shows Safety and Efficacy