Home from TAVR

[rich01]

Went to Wake Forest Baptist Hospital in Winston-Salem, NC for TAVR. Initially it was to be done through the Medtronics TAVR trial, but when FDA approved TAVR for low risk patients, I was switched to Medicare.

Actual procedure took about an hour. I felt some pain because I had asked to have the minimal amount of sedation. The last 10 minutes I asked to have sedation increased as the pain was getting tough to handle. I spend an hour in recovery and then moved to my room. I was supposed to lay flat for 4 hours (1 in recovery and 3 in room), but nurse was late getting back so I was flat on my back for 5 hours. At that point, the urine catheter (condom style) was removed and I was able to walk to the bathroom. I still had some urinary retention, but nowhere near as bad as after stents. I took a flomax at home and then had another after the procedure.

Got maybe 2 hours sleep - they do BP, temperature, and heart rate every 4 hours, they do a blood draw at midnight, they weigh you at 4 pm, and did an ekg at 5 am. A tip for anyone spending the night in hospital - bring a sleep mask.

The procedure went well enough that this morning several people mentioned I would probably be released today. Finally got released at 2PM, so about 30 hours in hospital. A lot of bruising at catheter site, but other than that I feel great. Follow-up appointment is in a month.

 

[Astro]

Went to Wake Forest Baptist Hospital in Winston-Salem, NC for TAVR. Initially it was to be done through the Medtronics TAVR trial, but when FDA approved TAVR for low risk patients, I was switched to Medicare.

Actual procedure took about an hour. I felt some pain because I had asked to have the minimal amount of sedation. The last 10 minutes I asked to have sedation increased as the pain was getting tough to handle. I spend an hour in recovery and then moved to my room. I was supposed to lay flat for 4 hours (1 in recovery and 3 in room), but nurse was late getting back so I was flat on my back for 5 hours. At that point, the urine catheter (condom style) was removed and I was able to walk to the bathroom. I still had some urinary retention, but nowhere near as bad as after stents. I took a flomax at home and then had another after the procedure.

Got maybe 2 hours sleep - they do BP, temperature, and heart rate every 4 hours, they do a blood draw at midnight, they weigh you at 4 pm, and did an ekg at 5 am. A tip for anyone spending the night in hospital - bring a sleep mask.

The procedure went well enough that this morning several people mentioned I would probably be released today. Finally got released at 2PM, so about 30 hours in hospital. A lot of bruising at catheter site, but other than that I feel great. Follow-up appointment is in a month.

Congratulations on your new valve. The recovery with the TAVRs is amazing. Best wishes

 

[Keithl]

Very impressive. I wish there were more stats on their longevity as I had OHS in April and 5 months later feel great, but would have been nice to be out in a few days and back to normal.

 

[tom in MO]

Congratulations. May you rest easy in recovery.

As an aside, if you had been accepted in the trial, would the overall cost have been lower than on Medicare?

 

[rich01]

Congratulations. May you rest easy in recovery.

As an aside, if you had been accepted in the trial, would the overall cost have been lower than on Medicare?

I have additional insurance, so either way it wouldn't cost me anything. I don't know how it would have worked out if I didn't have supplemental insurance.

 

[pellicle]

Went to Wake Forest Baptist Hospital in Winston-Salem, NC for TAVR. Initially it was to be done through the Medtronics TAVR trial, but when FDA approved TAVR for low risk patients, I was switched to Medicare.

fantastic ... I wish you a smooth and uneventful recovery.

I do hope you continue to keep us updated over the years.

Best Wishes

 

[Protimenow]

That's great news. I hope you keep us updated through the years.

(Wouldn't it be great if, ten or fifteen years from now, TAVR is a best practice for replacing all valves? Wouldn't it be great to have to look back on all of us dinosaurs who have these clicking valves in their chests and have to worry about anticoagulation? And wouldn't it be great, 10 or more years from now, for us old dinosaurs to be grateful for all the years we've gotten - and continue to get - from these 'old' mechanical valves (and have no complaints about the warfarin - or, perhaps, some new drug that handles the anticoagulation without required monitoring)?)

If I make it another 10 or 20 or 30(god forbid) years, I'D like to look back, and appreciate how much things have improved for generations that came after me. I hope we will have a functional planet to enjoy it in.

 

[rich01]

1st Update: For the most part I feel fine, but have had a few problems.

Lots of bruising (purple) just above the catheter entry point in groin. At first it spread about 5 inches to right and then spread about 5 inches to left. What's strange to me is this is all above the entry point which is almost healed. Last night I woke up with some swelling and the bruised area really hurt. I put an icepack on it which solved the problem in just a few minutes.

Evidently there is some emotional ups and downs associated with the procedure. Most of the time I have been very upbeat, but a few times a small problem seemed huge and possibly needing treatment at ER. I found eating or drinking something and sitting quietly for a few minutes got me back on an even keel.

From time to time I get a dull headache at the back of my head. I have checked BP, heart rate, and oxygen saturation and everything seems OK.

On Wednesday I walked about 3/4 of a mile, Thursday about 1 3/4 mile, and 1 mile so far today.

Called local cardiac rehab and they had my referral but not the order that says what they need to do. I'm hoping to start soon.

I was doing so well at hospital I got them to release me even though I did not have anyone to stay with me that night. My sister came the next day (Wednesday) and Thursday evening I told her that I was feeling fine and if she wanted to head back home on Friday she could. That I enjoyed the company and it was comforting to know there was someone around if I needed them, but I doubted if something was any more likely to happen on Friday that it was on Sunday. We discussed again this morning and I assured her I still felt great and I would be fine, so she headed home.

I feel fine to drive but will wait until Saturday or Sunday to take a test drive. The recommendation was 7 days, but I have seen a recommendation as short as 5 days, so Saturday would be 5 days for me.

One thing that I'll mention, but I don't really understand. I feel a closeness and empathy for other people that is new to me. I also have had dreams nightly, where long ago unresolved issues with people are resolved. I wake up and feel at piece with these people from my past. These are not deep, dark experiences, just unresolved personal issues that may have resulted in a breakup or lost friendship, and I find now I have a positive feeling toward these people. Strange, but nice.

 

[Protimenow]

rich01 -- if I had changed from a cranky old grouch to someone who actually felt at peace with crap from the past, resolved old issues in my dreams, and generally felt positive towards people in my past, I'd blame it on hangover from the anesthetics used during the procedure. For me, these feelings would have to come from some outside source.

OTOH -- with your heart functioning more normally, your brain can sense (even if you can't) that there's a better sense of well being. It's getting an adequate source of oxygen in the blood, you're probably doing better, and there's less worry about your general condition. The underperformance of your heart may have contributed to a general 'darkness' in your mood - and you may not have known it. Lifting that burden off of yourself (and even in your mental processes) may have contributed to an overall better feeling.

OTOOH (how many hands do I need -- I think that I've run out of 'other' hands) -- maybe you're just feeling better about things, and your dreams and mood are just revealing themselves. (It worked for you -- I'm still a cranky old grouch -- even if my valve is still clicking away...)

 

[carolinemc]

Went to Wake Forest Baptist Hospital in Winston-Salem, NC for TAVR. Initially it was to be done through the Medtronics TAVR trial, but when FDA approved TAVR for low risk patients, I was switched to Medicare.

Actual procedure took about an hour. I felt some pain because I had asked to have the minimal amount of sedation. The last 10 minutes I asked to have sedation increased as the pain was getting tough to handle. I spend an hour in recovery and then moved to my room. I was supposed to lay flat for 4 hours (1 in recovery and 3 in room), but nurse was late getting back so I was flat on my back for 5 hours. At that point, the urine catheter (condom style) was removed and I was able to walk to the bathroom. I still had some urinary retention, but nowhere near as bad as after stents. I took a flomax at home and then had another after the procedure.

Got maybe 2 hours sleep - they do BP, temperature, and heart rate every 4 hours, they do a blood draw at midnight, they weigh you at 4 pm, and did an ekg at 5 am. A tip for anyone spending the night in hospital - bring a sleep mask.

The procedure went well enough that this morning several people mentioned I would probably be released today. Finally got released at 2PM, so about 30 hours in hospital. A lot of bruising at catheter site, but other than that I feel great. Follow-up appointment is in a month.

So happy you are doing great. Just keep doing what they told you to do when you left the hospital. You keep us posted as you get better. Congrats on the procedure. Hugs for today.

 

[rich01]

Update 2: The bruising seemed to reach its peak yesterday. It really hurt last night so kept an ice pack on it most of the night. I could see that the bruising was not as bad this morning as last night, so I think the worst is over. The bruising was on a line directly below the incision, about 15" wide and 6" at it's deepest.

Drove to grocery store this morning (day 6). It wasn't painful or uncomfortable to drive, but I could feel extra stress being placed on incision area, so I can see why they don't want you to drive until incision is mostly healed.

Tip: Ask your doctor about using an ice pack. I was discouraged by nurse from using it, but I think she meant directly on the incision. I think using it adjacent to the incision to reduce bruising would be a good thing, but run it by your doctor.

Tip: If your ride home is longer than 30 minutes, it is probably a good idea to stop and walk around a little. I think blood and fluids accumulate in your legs after the procedure, and sitting in a car is not conducive to good circulation. I think my bruising may have been reduced if I had stopped a couple of times on the ride home and walked around for a few minutes.

 

[Duffey]

Rich, I think I was more emotional post-avr. I had issues with the trauma inflicted by open heart surgery; my brain didn’t like what I had willing subjected my body to. I’m glad you’re doing well.

 

[ottagal]

Thanks for keeping us posted and hoping that the bruising settles down. You have had a heart procedure and I think it would be natural to experience a roller coaster of feelings from this. I know for me, there was a vulnerability I felt going through OHS that I didn't expect would happen. Take care and please continue to keep us posted on your recovery. Onward and upward....

 

[tom in MO]

...One thing that I'll mention, but I don't really understand. I feel a closeness and empathy for other people that is new to me. I also have had dreams nightly, where long ago unresolved issues with people are resolved. I wake up and feel at piece with these people from my past. These are not deep, dark experiences, just unresolved personal issues that may have resulted in a breakup or lost friendship, and I find now I have a positive feeling toward these people. Strange, but nice.

I had a similar thing happen to me but not in relation to past unresolved issues, but with increased empathy. I never would cry during movies, weddings or funerals, but after OHS I feel a lot more empathy. I actually got teary eyed during movies and at a funeral. The feeling subsided a little, but is still there, I just can control it better. It got me in trouble a couple of times for being a bit too emotional about some things that went wrong.

 

[rich01]

Update 3: Went to see a local cardiologist today because I am having so much pain in my groin. The incision has healed fine, but the area below it is painful, especially when lying down. He didn't think it was anything serious, but scheduled me for an ultrasound tomorrow to be sure. He gave me a prescription for a pain killer, but I will try ice and Tylenol for now.

I think what he was saying is that with all the bruising caused by the catheter, it takes a while for it to all drain away. He did say if it was more than that it should be fairly simple to correct. They squeezed me in today, so didn't have time to get much detail on anything.

The local hospital serves at most 100k population, so I doubt if the ER staff is up to speed on complications from TAVR. I just hope this is a minor problem and not something that requires a trip to the ER. I talked to a nurse at the hospital where I had TAVR, but it is difficult for them to assess the severity of a problem over the phone. Usually they say call back if it gets worse or go to the ER if it is an emergency. One drawback of not having valve replacement done locally.

 

[LoveMyBraveHeart]

Update 3: Went to see a local cardiologist today because I am having so much pain in my groin. The incision has healed fine, but the area below it is painful, especially when lying down. He didn't think it was anything serious, but scheduled me for an ultrasound tomorrow to be sure. He gave me a prescription for a pain killer, but I will try ice and Tylenol for now.

I think what he was saying is that with all the bruising caused by the catheter, it takes a while for it to all drain away. He did say if it was more than that it should be fairly simple to correct. They squeezed me in today, so didn't have time to get much detail on anything.

The local hospital serves at most 100k population, so I doubt if the ER staff is up to speed on complications from TAVR. I just hope this is a minor problem and not something that requires a trip to the ER. I talked to a nurse at the hospital where I had TAVR, but it is difficult for them to access the severity of a problem over the phone. Usually they say call back if it gets worse or go to the ER if it is an emergency. One drawback of not having valve replacement done locally.

When Mathias had his cath procedure, he had a horrible burning/stinging pain below the incision and down into his inner thigh. He was advised that the surgeon could have nicked a nerve in his leg that can cause the pain he was experiencing. He couldn't walk well for days, couldn't put weight on the affected leg, and the pain didn't subside with pain relievers--he was prescribed gabapentin instead. It worked wonders for him after about 5 days of taking it on a strict schedule. I hope you can get to the bottom of it, I know how hard it was for Mathias...leg and foot pain is challenging!

 

[Astro]

Update 3: Went to see a local cardiologist today because I am having so much pain in my groin. The incision has healed fine, but the area below it is painful, especially when lying down. He didn't think it was anything serious, but scheduled me for an ultrasound tomorrow to be sure. He gave me a prescription for a pain killer, but I will try ice and Tylenol for now.

I think what he was saying is that with all the bruising caused by the catheter, it takes a while for it to all drain away. He did say if it was more than that it should be fairly simple to correct. They squeezed me in today, so didn't have time to get much detail on anything.

The local hospital serves at most 100k population, so I doubt if the ER staff is up to speed on complications from TAVR. I just hope this is a minor problem and not something that requires a trip to the ER. I talked to a nurse at the hospital where I had TAVR, but it is difficult for them to assess the severity of a problem over the phone. Usually they say call back if it gets worse or go to the ER if it is an emergency. One drawback of not having valve replacement done locally.

Best wishes rich01. Hopefully the bruising resolves by itself. Distance is a challenge with medical services.
Increasing pain, redness, shortness of breath, fever or feeing generally unwell might be signs of something more than bruising.
Regards

 

[rich01]

2 Week Update: I felt great the first few days and then things went downhill.​

• I had a lot of purple bruising that started about day 3. From what I understand, the problem is that sometimes the femoral artery leaks and blood pools in the nearby areas. It should resolve over a couple of weeks and mine is about 90% gone, so not a problem. There are different methods such as a seal, a suture, and pressure on the wound for 15 to 20 minutes used for sealing the artery. Some people have little bruising and some a lot. Check with your doctor if bruising is painful or does not start clearing up after a week or so.
• Something is swollen, I assumed it was femoral artery, but it could be a muscle. I only had about 5 minutes with local cardiologist who checked heart and listened to femoral artery and said it sounded fine. Nurse did an EKG which I assume was fine as they didn't discuss it with me. Sent me for ultrasound and haven't heard back, so again I am assuming nothing urgent found. I have found some reports that this might take several weeks to resolve. It hurt a lot at first, but has lessened in pain to the point I can sleep without having to take acetaminophen.

There are also muscles and ligaments in that area that might be involved. The femoral nerve also sits near the femoral artery and bleeding from the artery can cause contraction of the nerve. I would think the lymphatic system may also come into play. Maybe recovery for me will just take a little longer than normal.​

• I have a pain that runs up my right side from my groin to my chest, about to my right nipple. This is not a constant pain, but gets more pronounced over the day, being worse at bedtime. I also have heart burn with it. I don't believe this area was involved in the TAVR procedure, so have no idea what may be causing it. I used to have slight chest pain and heart burn, primarily on the left side of my chest, but since getting 2 stents it completely went away.
• My energy level was better before TAVR. After I got the stents (PCI), I noticed no difference in energy or stamina. I had TAVR 2 weeks after PCI and for the 1st 3 days after TAVR my energy and stamina was the same as before TAVR. SInce then, I have less energy, less endurance, and less motivation than before.
• My LV Ejection Fraction (EV) also is lower after TAVR than it was before. I had 3 echos during the prior year with these EFs (60%, >55%, 60%) and after TAVR was 55%. Does this improve over time?

There are a couple of other problems that I think started after my cardiac cath last January. I can't say the cath caused them, but I don't remember having the problems before and I did notice them after.

I have a couple of ideas as to what is causing all these problems, but don't have any idea what type of doctor would take the time and have the knowledge to look at everything going on in the groin. The cardiologists seem to have a very limited view of anything other than the incision and femoral artery. My integrative doctor seems reluctant to provide what she considers to be primary care. Urologist doesn't seem to look at muscles and arteries. I'm thinking about seeing my chiropractor who is great at seeing the big picture.

As you can probable tell, I am frustrated with the lack of information and don't know if my problems are serious or I just need to be patient. I am not depressed, just not feeling as good as I did before TAVR which is not what I was led to expect.

​

 

[Duffey]

I expect that it takes a certain amount of time to recover from any type of valve replacement, whether open heart or TAVR. You don’t have the same point of reference that others who have undergone open heart, have. As I read your account, it sounds to me that your recovery is progressing pretty well. I remember it taking me at least three months to feel good and maybe six months to feel “normal”. My EF was never as high post-op as it had been before valve replacement, but I was in pretty good shape going into the surgery. Hopefully you’ll continue to improve and all the complications you’re experiencing will resolve.

 

[rich01]

I just spoke with local cardiologist's office. Ultrasound showed no problem with femoral artery, so that's a big plus.

The person I spoke to was relaying my current symptoms to the nurse and while I was waiting I wrote down "Femoral artery may be pinching the femoral nerve" causing the discomfort on the right side of my body. When the person came back on the phone that's exactly what she told me.

The way I figured it out is I am ok discomfort wise when I first get up and over the day I start having a pain that runs from my groin to my chest with associated heart burn. I've also noticed the swelling in my groin area where the catheter was inserted is swollen at night, but not very much in the morning. Every day I seem to recover a little faster from the swelling and it no longer hurts, so hopefully I just need to take it easy for a few more days.

Another thing I am concerned about is my fatigue. I'm wondering if I might have slight anemia. I found these articles when I did a search for anemia TAVR:

ANEMIA AND MORTALITY IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR): A SYSTEMATIC REVIEW AND META-ANALYSIS

Anemia Carries Consequences for TAVR Patients

Nearly two-thirds of TAVR patients have anemia before or after their procedure, according to a study published online November 29, 2014, ahead of print in the American Journal of Cardiology. The condition correlates with poor functional status at baseline and at 6 months.​

​

Nine in 10 cases are treatable, and half arise primarily from iron deficiency, report Josep Rodés-Cabau, MD, and colleagues at the Quebec Heart and Lung Institute, Laval University (Quebec City, Canada). ...​

My hemoglobin was fine before TAVR, but the 1 lab I have since then had it as only 12.1 g/dl and the paper recommends at least 13 g/dl. Some of the other values associated with red blood cells are also low. Time for more research and probably liver for dinner.