Multiple TAVR

[jumpy]

As I have eliminated the Ross from my choices I am now looking at either tissue or mechanical. The surgeon would like to use the St. Jude but indicated he may be willing to use an ON-X valve if I preferred.

My questions regarding tissue valve are regarding the next valve. As a 44 year old I will be looking at possibly more than two more valves being required. The future seems to be advancing quickly with TAVR valve in valve. In fact there was a 65 year old patient in Montreal who was released the same day after having a TAVR. So, once you have a transcatheter valve, what happens next? Are you committed to future TAVR's and how many "valve in valves" can they do?

I've looked everywhere but I can't seem to find the answer to that. As the technology is new, does the medical community have an answer for this.

I think once I know the answer to this question, I will be able to make my decision on tissue or mechanical.

 

[Fundy]

First, I don't have any answers to your questions. But each valve within a valve results in a smaller valve. I don't think anyone can know what the mortality and stroke risk of reops on replacing a TAVR within a prior tissue valve would be, until they start doing a lot of them. The initial implantation with the Sapien 3 is looking really good though.
http://www.tctmd.com/show.aspx?id=128229

One question I wonder with these TAVR valves is the need for warfarin or not. I think I've seen Sapien articles mention anticoagulation therapy as not needed, but I'm not sure. This Medtronic info on their CoreValve seems to indicate that warfarin may be needed.
http://www.corevalve.com/us/what-sev...ions/index.htm

Myself, I feel that even if they started routinely doing TAVR within a valve today, even if not needing warfarin, and even having experienced low risk reops in those needing them for early valve failures. That if I needed a replacement in ten years or less I think I would still choose the conventional surgery. But maybe not.

However, its not even close to proving up that situation. For instance, will the next ten years even prove that those good Sapien3 results will be maintained. will the outlook stay ok for at least 8-10 years, will it be normal to not use anticoagulation therapies, will removing both those valves and replacing with a more normal tissue valve be a low risk event.

To me, expecting all those things to be OK in ten years seems a bit too much to expect at the moment.

Warfarin necessity, though to me would be a huge want to know thing. It would seem strange to not do a mechanical valve now, in the hopes of using TAVR valves later, if it turns out warfarin is needed with them anyway.