Invasive vs Non-Invasive valve replacement?

[Elgato]

More questions.

Non-invasive seems to be the more advanced technique. My Cardiologist said that I am not a candidate for it and it
is reserved for older, less healthy patients.
I know there is currently a huge battle at UMC between surgeons over this issue.

http://azstarnet.com/news/local/edu...cle_471ae665-d0c0-58b6-8e27-6218465ca62f.html

Why in the world would you ever want to go Invasive if you could avoid it? Is it less reliable? Do some just want to rule it out because they do not do it?

Any insight would be appreciated.

 

[AZ Don]

There are different types of non invasive surgery, some of which are actually higher risk than OHS and so only reserved for those too ill for OHS. I think Cleveland Clinic offers a less invasive alternative for AVR in selected patients and not necessarily just those too ill for OHS - you could check their website, they have a lot of good info. Many believe that the less invasive procedures will improve and be more widely available in the future, including my surgeon. It wasn't an option for me last year.

 

[Paleowoman]

Hi Elgato - I read that link you posted, it's about a surgeon who does "robotic by-pass surgery", I didn't pick up that he does valve replacement surgery.

The non-invasive valve replacement surgery is reserved for people who are too ill or fragile to undergo the invasive technique which is sometimes a full sternotomy or sometimes what's call "minimally invasive" sternotomy or thoractomy - both the minimaly invasive techniques are still invasive and the incision on minimally invasive sternotomy versus full sternotomy can be almost as big (mine is), but it's suposed to lead to quicker healing. The minimally-invasive technique is normally used now and has been for several years for people having just aortic valve replacement - it can't be used for other valves or work on the the aortic root or the coronary arteries.

The non-invasive technique is by threading a valve through an artery and putting it in place almost like a stent is put in place - the diseased valve is 'pushed' aside as the new valve is 'sprung' into place. BUT there is a very high risk of stroke, from my understanding that's becuase the calcifications on the diseased valve are, obviously, not removed as they are in the invasive or minimally invasive technique, but are left there and, although they may be kept aside by the valve stent the chances are they break off and that causes stroke. I might be wrong about that, but that's how I read it. I also read that the mortality after the non-invasive technique is currently 20% in the first year. The technique is too new to know how good it is for fit people, they are only using it in people for whom the invasive technique would be too risky, so they don't know yet if it would be effective for others.

Hopefully this technique will improve…I think we're all hoping that (for our re-dos) !

 

[big_L]

Yes - you're not a candidate for the TAVR unless you're deemed too unhealthy for OHS. In time, if the TAVR continues to appear promising, it should become an option for more patients.

My surgeon told me this about the sternotomy - "One of the most important things for me to do is to get the valve in there correctly, the first time. I need access to do it. The sternum will heal and I'm not as concerned about that. I don't want to have to go back in and redo the valve placement. If you want a smaller incision, I can refer you to a different surgeon" I respected and understood this explanation.

 

[clay_from_nj]

Don't let em fool you. Every time they stick something into you or cut you open, it's invasive. Going in via catheter is less invasive than OHS, but still carries many risks, some of them the same. I would think that one might prefer full OHS with sternotomy over TAVR for the same reasons they might want to build a model ship on the table rather than in a bottle.

 

[ChicagoMammy]

I was told that I have a higher risk of stroke if I had an TAVR because of the nature of my heart disease. I don't like strokes.

 

[neil]

am with you clay, bit like trying to wallpaper the hallway through the letterbox lol, in general ohs isnt a cakewalk but not as bad as your mind thinks it will be, i prefer the idea of them having full access to your heart if possible,

 

[ChicagoMammy]

bit like trying to wallpaper the hallway through the letterbox lol,

Love the analogy neil!

 

[Heart Of The Sunrise]

I am coming up on a year on Tuesday. I had no choice but to go full sternotomy due to the nature of my complex surgery.
See video link in my signature. My 8 inch scar is now all but invisible.

 

[neo]

The main reason mortality is higher on TAVR right now, someone said 20% in 1st year, is because TAVR is only recommended for high risk folks right now. They were high risk to begin with. ALL new technologies, whether valves, drugs, or medical devices, are always tested first on high risk. As they prove, over time, more effective and safer than current technologies in high risk, they are allowed to be used in a greater number of patients. This is to be expected that TAVR is used this way now, but in time hopefully it will be the method of choice. As I understand it, there are many methods they are testing for how to prevent calcifications from breaking off. Everything from nets to little vacuums etc. in the meantime, we have excellent other options. I am very thankful I wasn't born 100 years ago!

 

[river-wear]

The other thing about TAVR right now is that they don't have any data on how long those valves will last. Assuming your projected lifespan is more than 5-10 years, why not fix it right? The technology isn't developed well enough for healthy people yet.

 

[Elgato]

I see a lot of wishful thinking regarding the possibility of Non-Invasive valve replacements in the future.

"I might wind up needing a third valve in my seventies. That's a bad time to go get a new one, although a catheter-delivered valve will likely be a viable option at that point."

Currently the catheter based valves are small, collapsible devices that appear to snap into place.

So, how could you ever expect to remove a full size, stitched valve using this type of procedure?

 

[Paleowoman]

I see a lot of wishful thinking regarding the possibility of Non-Invasive valve replacements in the future.

"I might wind up needing a third valve in my seventies. That's a bad time to go get a new one, although a catheter-delivered valve will likely be a viable option at that point."

Currently the catheter based valves are small, collapsible devices that appear to snap into place.

So, how could you ever expect to remove a full size, stitched valve using this type of procedure?

My understanding is that the 'old' valve is not removed, the catheter delivered valve is snapped into place inside the 'old' valve (hence some of the increased risk stroke as calcifications are not removed but just pushed aside by the valve stent and can break off leading to strokes). Whether the catheter delivered valve will be able to be snapped into place inisde a stitched valve is the question we are all possibly asking !