two current views on TAVR in the literature

[pellicle]

for those not afraid of the research and reading rabbit hole I present the folowing:

The "nay" case:
http://circ.ahajournals.org/content/.../2332.full.pdf

The "yeah" case:
http://circ.ahajournals.org/content/.../2321.full.pdf

just be careful that you understand the terms properly and read carefully (not read into either what you prefer to read).

Younger may mean something different to a surgeon than it does to me or you.

so check the ages they really mean...

 

[DJM 18]

There is a great saying: "Things always take longer than we expect to happen but when they finally do happen, they happen faster than we ever expected possible." These are early days in TAVR and it will take much longer than many expect for the technology to be available to young/healthy patients.

But the very good news is that part of the reason it will take longer than expected is because the alternative is EXCELLENT. I recently posted the 25 year results from Yale in which they made this very point. In other words, there is no magic pill for a 40 year old with a bicuspid valve in need of surgery but there is a great procedure with great outcomes that allows such a patient to have a very near normal life expectancy.

 

[ottagal]

Thanks Pellicle. Will tuck these two articles away to read when I have a little time.
Always good to get 2 perspectives.
I always find one challenge with whatever study I read (pro or con) is that the research looking 'back in time' perhaps, before self monitoring came into effect for mechanical or 3rd generation bio valves were around....
Ahh...if we only had that crystal ball!

 

[dick0236]

Ahh...if we only had that crystal ball!

Today I am celebrating my 82nd birthday. Neither me....... or any of my docs, have been able to find that "crystal ball" to explain why I'm still here. I've actually outlived the "design life of 50 years" of my valve. Had I had that crystal ball it would have made my life a helluva lot simpler. Do what makes sense to you....mechanical or tissue.....TAVR or OHS. One thing is for sure......you don't have a crystal ball, so all you can do is what make sense at this time
'cause nobody knows what's in the "crystal ball" a few years down the road.

 

[honeybunny]

dick0236

Hippo birdie to ewe, Dick!!!

 

[pellicle]

Today I am celebrating my 82nd birthday. Neither me....... or any of my docs, have been able to find that "crystal ball" to explain why I'm still here.

well Gee Dick ... we don't need any crystal ball to say Happy Birthday ... and be happy you made it this far

and I hope many more

 

[Paleowoman]

dick0236 Wishig you a VERY HAPPY BIRTHDAY ! Congratualtions to you and to your valve for keeping you going !

 

[Agian]

Happy Birthday.

 

[dick0236]

Thank you for the well wishes but I didn't mean to hijack this thread. My point was that no one has the crystal ball that will show you the perfect decision. Even tho my surgeon told me the "design life of my valve was 50 years' I doubt he thought I would last that long.....nor did I. Back in 1967 there where only one or two choices for valve replacement and now there are a dozen or so......and a few years down the road there may be a dozen+ more. Do your homework, study your options, narrow it down to two choices........and then "flip a coin"......'cause either of those last two choices will work until you can find that elusive crystal ball.

 

[Agian]

Just to clarify, crystal balls do indeed exist. However, there is no evidence that one can tell the future by gazing at them.

 

[pellicle]

Just to clarify, crystal balls do indeed exist. However, there is no evidence that one can tell the future by gazing at them.

Indeed, had evidence that mine are quite sensitive to kicks back when I did karate ... no wonder I moved to Aikido

 

[epstns]

Drat, pellicle, there goes another keyboard. I hate cleaning coffee spray out of them. . .

 

[pellicle]

Drat, pellicle, there goes another keyboard. I hate cleaning coffee spray out of them. . .

its ok mate ... they weren't broken (well that I know of) ... but it took me a while to stop wondering.

PS: I really loved those old IBM keyboards ... indeed to this day I still use a Thinkpad cos they have the best tactile feel when typing (the opposite of apple)

 

[ForeverThankful]

Today I am celebrating my 82nd birthday......

Happy Birthday Dick!!!!!

 

[ottagal]

Today I am celebrating my 82nd birthday. Neither me....... or any of my docs, have been able to find that "crystal ball" to explain why I'm still here. I've actually outlived the "design life of 50 years" of my valve. Had I had that crystal ball it would have made my life a helluva lot simpler. Do what makes sense to you....mechanical or tissue.....TAVR or OHS. One thing is for sure......you don't have a crystal ball, so all you can do is what make sense at this time
'cause nobody knows what's in the "crystal ball" a few years down the road.

Happy 82nd Birthday Dick! You are an icon! So glad it has all worked out for you.
Said with wisdom and years of experience under your belt.

Perhaps, I used the 'crystal ball' expression too flippantly...I certainly recognize there is no crystal ball and we can only make the best informed choices with the information we have at that point in time...

 

[d333gs]

Hi, I am new to the waiting room;Moderate leaky aorta valve: Question: Is the TAVR tissue or mechanical ? There is a reference here to it being "Tissue" under 'Valve-within-valve — How does it work?" http://www.heart.org/HEARTORG/Condi...t-is-TAVR_UCM_450827_Article.jsp#.Wo-4s9QrLs0

 

[pellicle]

Hi

Hi, I am new to the waiting room;Moderate leaky aorta valve: Question: Is the TAVR tissue or mechanical ?

its a tissue or bio-prosthesis. As its delivered via a long thin tube the valve must be designed to scrunch down and then expand in place.

[IMG2=JSON]{"data-align":"none","data-size":"full","src":"http:\/\/heart.ucla.edu\/images\/TAVR\/tavr-program.jpg"}[/IMG2]

There is a reference here to it being "Tissue" under '

Valve-within-valve — How does it work?" http://www.heart.org/HEARTORG/Condit...p#.Wo-4s9QrLs0

basically they go in with another tube (up your artery) and cut out the leaflets from the old valve (which is now calcified) and put in the new one. This is not without risks (as identified in that "nay" article which discusses the risks of chunks of old calcium breaking off and causing strokes. Because the debris from removal can do that they now put in little traps to hopefully get the worst of the bigger chunks.

its a well known and researched problem (but I bet they don't mention it to you up front)

https://www.ncbi.nlm.nih.gov/pubmed/25946445

and

https://www.ncbi.nlm.nih.gov/pubmed/28895285

note wording in conclusions "warrants further research"

Read that Nay article carefully ... you owe it to yourself.

 

[pellicle]

one more

(wasn't going to risk a 3rd edit)

https://www.icrjournal.com/articles/managing-stroke-during-transcatheter-aortic-valve-replacement

nice pictures too

 

[epstns]

PS: I really loved those old IBM keyboards ... indeed to this day I still use a Thinkpad cos they have the best tactile feel when typing (the opposite of apple)

Well, if you want to use a desktop computer, a company named PCKeyboards purchased the design and production rights to the old IBM/Lexmark buckling spring keyboards. I've been buying mine from them for about 15 years. They make several varieties and styles, and are true to the old designs. Nice tactile feel, satisfying clicky sound, long life. They even have a flat-fee rebuild service if you manage to wear one out. I use them at home and at the office. I keep one spare so that I can send them out for cleaning/refurb/repair and not have to use one of those dratted "mush-boards" that are the mass-market products today.

 

[pellicle]

great Pro Tip ...

.... They even have a flat-fee rebuild service if you manage to wear one out. I use them at home and at the office. I keep one spare so that I can send them out for cleaning/refurb/repair and not have to use one of those dratted "mush-boards" that are the mass-market products today.

will get one for my next desktop (which will be probably soon)