Two month after TAVR....

[Ergo Sum]

Hello... I had my Edward aortic valve balloon procedure close to two month ego. The procedure went well, albeit for 3 - 4 weeks my blood pressure and pulse had been fluctuating a lot. The headaches took a little later to subside, I am not even certain if it is related to the new medication of Metaprolol beta blocker, or not? By the six weeks followup appointment the blood pressure was 121/79 and pulse 62, pretty much normalized. I did start to exercise a week after the operation, just bicycling and walking. Two weeks after the operation I added swimming and Yoga to the exercise and continue doing it 3 - 4 times a week. The type of exercise what I am doing depends on the weather and what I feel like doing. I can exercise more than seven days in a row, but there isn't enough time in a day sometimes.

My cardiologist gave me a heart monitoring device for two weeks a day after the procedure. The report showed one defibrillation event in the 14 days of monitoring, on the fourth day that I didn't feel at all. He referred me to a cardiac electrophysiologist, who actually wants to implant an Implantable Cardioverter Defibrillator (ICD). I have some questions about that.

I understand that every condition is different and it cannot be evaluated in a forum, nor am I looking for it. I am just wondering how may people after a TAVR procedure actually got an ICD implanted? Is it something that pretty much routine?
Thx...

 

[pellicle]

Hi

glad you're on this side now

I am just wondering how may people after a TAVR procedure actually got an ICD implanted? Is it something that pretty much routine?

I'd say the stats are "not uncommon" but variables (not applicable to you, but generally) include age and reoperation. The stats are out there:

https://www.tctmd.com/news/icd-and-...-open-heart-surgery-series-provides-benchmark

Overall, 4.1% of surgical patients required a new implant with either a pacemaker or implantable cardioverter defibrillator (ICD), lead author Newton Wiggins, MD (Cleveland Clinic, OH), and colleagues report in a study published online October 12, 2016, ahead of print in Europace. The rate varied widely across different types of operation, however, ranging from 1.2% for CABG alone to 25% for tricuspid valve replacement.​

and

https://www.jscai.org/article/S2772-9303(22)00169-7/fulltext

Results​

We identified 102,276 patients with HF who underwent TAVR, 13,025 (12.7%) of whom had PPM or ICD placement during TAVR admission. Baseline characteristics are shown in Table 1. Characteristics associated with increased odds of PPM or ICD include: age ≥80 years (OR 1.274 95% CI [1.220-1.330]), male sex (OR 1.147 [1.101-1.196]), atrial fibrillation (OR 1.282 [1.231-1.335]), hypertension (OR 1.115 [1.043-1.191]), diabetes mellitus (OR 1.129 [1.082-1.178]) and chronic kidney disease (OR 1.152 [1.105-1.201]). Race, insurance status, income, and coronary artery disease had no association with PPM or ICD placement.​

Conclusions​

Patients with heart failure who are male, elderly, or with HTN, DM, CKD, or atrial fibrillation should be counseled on their increased risk for need for PPM or ICD following TAVR.​

emphasis mine. Then:

https://www.acc.org/latest-in-cardi...tification-for-pacemaker-placement-after-tavr

The increasing use of TAVR (26,414 procedures in the United States alone in 2014)14 has led to the realization that a proactive approach must be developed for the procedure's most common complication, atrioventricular block (AVB) requiring permanent pacemaker (PPM). This risk has been reported to be as high as 25% with SEV and approximately 7% with BEV, in stark contrast to the reported 3.2-7.1% with surgical aortic valve replacement (SAVR).15-19 The PPM is implanted during the index hospitalization (97.1%) in the majority of the patients, with median time to PPM being three days post-TAVR.​

Best Wishes

 

[Ergo Sum]

Thx @pellicle ... That's lot's of reading and a slew of abbreviation in those documents. Being new to to this does not help either, even if I had high blood pressure for awhile by now.

In general, the percentages aren't that high and you're correct, as of now the conditions do not really apply for me. At lest for now....

 

[pellicle]

Hi

Thx @pellicle ...

welcome

That's lot's of reading and a slew of abbreviation in those documents.

for what its worth the priority for you learning these things is low because you've already had the ICD (if not the TAVR). So this moves very clearly into the purely theoretical ... meaning:

Being new to to this does not help either, even if I had high blood pressure for awhile by now.

... no need for this to feed into your BP and if it is then just push it aside and eat the dessert (maybe also a small port).

In general, the percentages aren't that high and you're correct, as of now the conditions do not really apply for me. At lest for now....

more than anything what I would hope you'd do is just slowly filter through the data so that later, over time, when your're in consultation with your team the gradual familiarisation of these terms may make the whole thing less likely to be a bunch of word salad.

Meanwhile I'm back to boot sectors, GRUB and why won't my computer start up properly (I had a hand in causing that).

Best Wishes

 

[Ergo Sum]

I did have the TAVR done already and ICD is the next recommended device. While I am certain that my cardiologists have the best intention, I am at the point to evaluate the pros/cons of this device. That and what else could be next after the ICD? Two month ego, I've been "organic" and now devices are are lining up to get into me it seems.

Meanwhile I'm back to boot sectors, GRUB and why won't my computer start up properly (I had a hand in causing that).

Maybe you should not mess with the boot sector, or backup its configuration at least?

 

[dornole]

What do you mean that monitoring showed a “defibrillation event?” You don’t have an ICD right, so how could you have a defibrillation event?
You mean an episode of arrhythmia? What kind?

I recently had OHS (mitral valve replacement and tricuspid repair), developed heart block and had a pacemaker put in a week after surgery (but not an ICD, I don’t have the kinds of arrhythmias that require one). From the stats Pellicle shared I’m guessing the tricuspid repair was the risky part. To me 25% isn’t a low risk. I had no idea that TAVR carried a higher risk of heart block than OHS either. Always trade offs I guess.

 

[Ergo Sum]

My bad, it's not defibrillation, it was fibrillation according to two cardiologist. I've got confused with the ICD and misspelled it. The event showed up in the heart monitoring log on the fourth day after the TAVR:

The notification did not result in anyone contacting me, seen the cardiologist about two weeks later. The event lasted about 2 - 3 seconds and frankly, I was actually making a pizza that Saturday night and didn't feel it. Yes, the pizza tested great....

Just today, I've received a different heart monitor, presumably to see, if there's any changes in the heart condition.

 

[pellicle]

Sorry I misunderstood if you'd had a TAVR or just a "had my Edward aortic valve balloon procedure"

which I interpreted as meaning "Balloon valvuloplasty" ... for the purposes of ... "is a minimally invasive cardiac procedure that widens a narrowed heart valve to improve blood flow"

pardon me.

Maybe you should not mess with the boot sector, or backup its configuration at least?

a very good point, however I have unfortunately a complex system and I was bitten by an unexpected outcome. I have a dual boot (I'm sure you understand this) and my primary boot is into Ubuntu; Win11 is the other one. I use Win less and less since leaving work (as a dev), but it has some software that I do prefer (photoshop at least). So I finally caved to the gentle suggestions from Ubuntu to upgrade from 22.04 LTS to 24 ... that had a number of issues which I didn't like but the killer was that it would not mount my NTFS drives (and all my backups are on NTFS). There appeared no way to do a roll back and so I backed up my files and reinstalled Linux back onto the partition for that. Long story short, that's where it all went astray.

:-D

 

[Ergo Sum]

pardon me.

No need to, it had been my fault for not being more accurate in my description.

Dual boot system can be a royal pain, especially after updating one OS to the later, later version. You could run Windows intallation and select repair boot record, that could fix it. You may need to edit GRUB's bootrecord in that case. Either way, backup the bootrecords before you make changes. I used to have triple booting system, but had enough. I install the OS on separate drives and use the BIOS/EUFI to select the drive to boot from. That way the updates don't mess up the the other OS booting...

 

[pellicle]

I used to have triple booting system, but had enough. I install the OS on separate drives and use the BIOS/EUFI to select the drive to boot from

I'm totally on board with that ... both things now boot, but I just don't have grub working as it should yet ... but its close.

In the best interests of the rest of the readers I'll now go back to just struggling with this in slow motion silence ... an hours motorcycle ride always helps restore my perspective on the importance of this.

Living out of the city in the countryside means that roads like that are 5 minutes away (and then hours of them)

I hope your ails soon plateau for a little while

Best Wishes.