TEE procedure on Tues

[Gail in Ca]

I tested my blood today as per the interventional cardiologist’s office to do it 48 hours before the TEE.
Well, here it is Sunday and my INR is 2.0.
They wanted it no higher than 3.5.
Thought I’d get opinions here on whether I should take extra warfarin tonight to at least get it into range, (2.5-3.5) or test again tomorrow and then give myself more warfarin if it’s still out of range low.
It’s a holiday so I’m not likely to get anyone knowledgeable in the Drs office today. I do have a zoom meeting tomorrow at 9:30am with the np of that cardiologist. Should I wait on upping my dose until I speak to her?
Thanks.

 

[Chuck C]

Hi Gail.
We all clear warfarin at different rates, so all I can speak to is how I react to warfarin and what I would do in your situation.

You are well below 3.5 at this point. If my normal daily dose put me between an INR of 2.5 to 3.5, I can't see how being at a starting point of 2.0 and dosing normally would put me over 3.5. If you have a history of big INR swings and unpredictable reactions, perhaps that changes things. One option would be to take a little smaller than your normal daily dose and then check again Monday morning.

 

[Gail in Ca]

Yes, my thoughts are to take an extra 1/2 tablet tonight. It was trending low as my result was 2.5 on 1/9, my regular testing day. Thanks, Chuck!

 

[QuincyRunner]

Yes, I too would follow Chuck’s advice. I had a TEE last week and beforehand had a similar but opposite dilemma. My INR two days before was 3.5 but I wanted it under 3 because I suspected they would encounter some obstruction in my esophagus (which they did) and I was concerned about bleeding. Next stop is a GI Doc.

 

[Art O Ceitinn]

I had a TEE just before Christmas and the only requirement from the anesthesiologist was to skip my blood pressure tablets the morning of the procedure. My I.N.R. reading was not an issue.

 

[Gail in Ca]

Here I sit waiting for my TEE.
I took an extra1/2 tab of warfarin on Sunday. I decided to check my INR this am and it’s 3.0. So I’m good, under 3.5 for the procedure.

 

[Gail in Ca]

I got the results of my TEE. The interventional cardiologist’s nurse called to say I was not a candidate for mitraclip. The doctor thought it would make my symptoms worse because it’s very tight.
So, she casually mentioned he would do a mitral replacement through the groin, just place it into my natural valve and the anulplasty ring that’s there from my 09 repair. I said he told me he didn’t want to do that before the TEE as off license. But now, I’m apparently a candidate because of the existing ring. I asked about longevity and she said 5-7 years and possibly 10. I’m sorry, but 5-7 years goes by very fast and I wasn’t thrilled with that option. So, they now want a CT of my chest, abdomen and pelvis. Then I want to talk to the robotic heart surgeon again. I think I need to know more of my options now and how my heart is doing. She said it’s good to have a game plan for the future. So, that’s what I know now. I’m a bit bothered by this TMVR option.

 

[Chuck C]

Thanks for the update Gail. That's a bit troubling that she told your that he "will" go through the groin, as if the decision has already been made. 5-7 years is not a long term solution. What then? Likely sugical replacement. It seems that there should be a discussion with the patient as to pros and cons of each option, verses telling what he will do.
With aortic, surgery following TAVI is risky. It's one reason, among many, that doing TAVI with young low risk patients is not a good idea. I imagine the same would be true for mitral valve, but have not looked into this, so I can't say. It would be good to have this as a question with your cardiologist and surgeon- what next after TMVI? Is this a more risky procedure than a standard surgical mitral replacement?

I would encourage you to book consults with both cardiologist and surgeon and ask lots of questions, as well has doing some of your own due diligence to see what the pros and cons are of TMVI.

I recall one member sharing that there was a meeting with an interventional cardiologist, specializing in TAVI, a traditional surgeon and the patient's cardiologist, to discuss the best option. IIRC, the interventional cardiologist thought TAVI, the surgeon thought SAVR and the cardiologist was sort of the tie breaker, encouraging SAVR (surgery), but of course it was ultimately the patient's choice.

So, with respect to your situation, perhaps not a big surprise that the interventional cardiologist is eager to use the technique he specializes in, but it would seem ideal if the surgeon and cardiologist were also part of the discussion as to the best option.

Best of luck!

 

[V__]

Hi @Gail in Ca

Thanks very much for the update!

So, they now want a CT of my chest, abdomen and pelvis.

I presume this is a pre-surgery check on possible "other problems"?

From the mitraclip discussion, it sounded like the valve diameter is not very large (or maybe there is an unusual geometry). Hope it's not an issue for the surgeon, and that the visit goes well.

 

[Gail in Ca]

I just spoke to the nurse and she said the CT they need is to determine if I would be a good candidate for the valve through the groin. It’s a yay or nay test for that procedure. She mentioned that the 5-7 years isn’t what all get and she has many patients with 10+ yrs. Still, 10 years?
I’ll see the Robotic Cardiac Surgeon and discuss the possibility of tissue or mechanical and ask my questions then as well.
I’m putting my appointments on hold until the construction in my home is complete after water damage from a water heater that leaked badly starting at midnight on 12/17/23. It’s taken forever to get money from my insurance to pay for the damage!
Today they’ve started drywall so yay!