Hi
For me the given answer is perfect, for others seems to be an issue that TAVI or not, it will have to be done again, and "for me", thats is the key, and yes Big Pharma is always out there.... always..
not being sure which given answer did if for you I'll add a few points.
Most of the "noise" in conferences and literature is about hope, and looking for potential, less so about ongoing issues. Most (literaure analyses) focus on 5 or 10 year outcomes. Not 30 or 50 year outcomes. I find this interesting as when I had my homograft (at 28) the literature around that went on to to 29 year followups (starting with patients before me and ending with patients after me).
Some things not mentioned (perhaps because they are assumed common asumptions) is that "you'll be old" and that valve surger is done on the older population. This is largely quite true, but for people like you and I (well who I was) such assumptions are invalid as a premise.
So this then requires one to ask the question "what about longevity" and "what do you do about that replacement". These questions are left over there in the dark corner with the elephant who remains silent (perhaps muzzled?).
Valve in Valve replacement is also done by TAVR but of course comes at a cost of increased complications (over the first TAVR) and reduced valve area (which is a bad thing for anyone who wants to regain their fitness and keep doing **** (cycling, skiing, cross country running ...) but not so much of a problem for the elderly (who may be quite inactive in comparison).
While the surgical techniques will improve the next questions which remains un-addressed is "materials science" ... can we get it to last longer than stuff that was designed for the tips of missiles? (for this is the origins of pyrolytic carbon of which modern mechanical valves are made).
I understand the reasons for wanting a system which reduces the need for AC therapy (notice I wrote reduces) because (from reading here) most people are either 1) trapped in a medical system which ensnares you in the hands of the incompetent 2) due to lifestyle or temperament some (much fewer) are very bad at managing their INR and their drug compliance and come to some (often minor) harm as a result.
So the answer is not straight forward and not without compromise.
Speaking as one who's been through 3 AVR and emerged fine (not without struggle) I can say that knowing all the possible stages for failure along the way that I'm pretty happy to be here and be as healthy as I am (never thought I'd say those words again).
Myself I see many technical advances hold promise and then vanish. Conspiracy is often used to explain that, however a more rigorous examination of why usually shows that "the promise was let down by the details". Remember ... its not just your life you are betting, its your life being healthy (being dead seems to pose little disturbance to the dead).
Best Wishes
when they say it could be 3 to 25 years 'till you need corrective treatment for your valve issue. If it happens in 3 years todays science probably will play a part in your decision making but if it happens in 25 years todays science will have little, if any, relevance. The good news is that when it happens you will get fixed..........and maybe even cured.
