Interesting (long) Piece on TAVI / TAVR

[mina]

I stumbled upon the below this a.m. My apologies if it has already been posted. I looked briefly and didn't see it.

I've read such conflicting things about TAVI in younger people. I don't have a position myself and urge readers to consider the source of this article (International Consortium of Investigative Journalism) - not to suggest they're not reputable, but to acknowledge that I don't know much about the organization.

https://www.icij.org/investigations...xpanded-heart-valve-use-risks-patient-safety/
I'm not considering this choice for myself. I've been happily clicking away for almost 7 years, after contracting endocarditis in my early 30s. And I've had two pregnancies (and subsequent children) on this valve. No complaints from me - in fact I'm grateful every day.

 

[tom in MO]

Thanks for posting this. Sometimes people don't realize medicine is a high-dollar business and doctors, hospitals and medical device makers are corruptible.

Some ladies go tissue to "have kids" but you are the example that shows you can do it on a mechanical valve.

 

[Gordo60]

Yes good article. Tissue vs mechanical valve even with recent advances (but awaiting longer term data) is still a difficult decision.

 

[pellicle]

I stumbled upon the below this a.m. My apologies if it has already been posted. I looked briefly and didn't see it.

I hadn't seen that before, but I've "noted" it now ;-)

I love the start: "Jeanne McArdle was 85 when her doctor said that she needed her heart valve replaced. "

so right there you know TAVI isn't pitched at 35 year olds

Then:
"The companies that make it, the researchers who study it and the doctors who spread its use around the world acknowledge that the TAVR valve’s durability is unknown. A consensus document written by four major heart societies in the U.S. has called for caution in treating patients who might outlive the device by decades. "

but one has to ask that if you get a TAVI done younger (you know, like less than 40) "because I'm too active to have surgery" it may also work to take decades off you life later ...

 

[pellicle]

Thanks for posting this. Sometimes people don't realize medicine is a high-dollar business and doctors, hospitals and medical device makers are corruptible.

this ^^^^^^^

Some ladies go tissue to "have kids" but you are the example that shows you can do it on a mechanical valve.

An earlier post by Mina
https://www.valvereplacement.org/th...d-like-to-hear-your-opinion.43601/post-792878

 

[marvsehn]

Before having my surgery in 2012, I discussed this with 2 surgeons, one at Cleveland Clinic and one at Duke. Both only recommended this (TAVR) as a potential option for those not expected to survive surgery. Those interested should investigate how it works, a valve in a valve.

 

[tom in MO]

Before having my surgery in 2012, I discussed this with 2 surgeons, one at Cleveland Clinic and one at Duke. Both only recommended this (TAVR) as a potential option for those not expected to survive surgery. Those interested should investigate how it works, a valve in a valve.

At my local hospital, 7 years ago too, my surgeon and cardiologist said the TAVR was not proven enough for younger patients (I was 55) and my surgeon was part of the clinical trials. I was told that TAVR was not to be considered the "savior" for tissue valves that need replacement later because nobody knows what a failed biological valve will need until it fails. TAVR was for high risk patients, as it apparently still is.

Both of them said (after I made my choice though) that standard open heart surgery with a mechanical valve for younger patients (<60yo) was the least risky route to death by a cause other than my heart

 

[mina]

Thank you all for your responses. Great discussion and helpful information. I've always thought TAVI/TAVR was for the very old and/or sick, too, but an article from the New York Times, which I read almost two months before finding the investigative piece I first posted, told such a different story.

https://www.nytimes.com/2019/03/16/health/aortic-valve-replacement-heart.html?searchResultPosition=1
I guess this is a very clear example of why considering sources is so important. As pointed out in excellent comments made by others, of course the doctors heading the trials will have rosy views on their findings. Between these articles and everyone's excellent comments, though, I think someone considering TAVI/TAVR has some good food for thought.

And, excellent sleuthing, Pellicle. That post was made before I had the children. Which is probably why it's so much longer and had such great detail. Tom, there are are a few of us on this site, and more out there in the world, who have had a successful pregnancy or two on a mechanical valve. I know when I first had my surgery I poured over this site looking for anything on pregnancy with a mechanical valve. I was looking for hope and any hard data. I found both. I hope these posts will help others, as they did me.