Upcoming SAVR - Thanks for the support!

[NewValveAt57]

Hi Everyone,

I'm a 57yo male with a bicuspid aortic valve with stenosis. I don't yet have a surgery date, but it could be as early as next month (October). The surgeon mentioned the valve options, but seems to lean toward Inspiris Resilia valve (bovine tissue). I just worry that the SAVR followed by TAVR on TAVR (assuming I live long enough) is even realistic as it isn't significantly tested. I am working to get other opinions just to see if there is any variation, but I know I need the valve replaced due to fatigue when doing cardio. Fortunately, the arteries are clear, no significant aneurism yet and I have great spousal support. I appreciate this forum, reviewing the thoughts on mechanical versus tissue valves, what to expect post surgery, and so on.

 

[pellicle]

Hi

I'm a 57yo male with a bicuspid aortic valve with stenosis...The surgeon mentioned the valve options, but seems to lean toward Inspiris Resilia valve (bovine tissue). I just worry that the SAVR followed by TAVR on TAVR (assuming I live long enough) is even realistic as it isn't significantly tested

well firstly the resilia isn't a bad choice and you could (depending on activity) get 20 years from it. TAVR isn't a certainty for people at this point, so you may actually face another SAVR down the track

The alternative as you know is mechanical and if you've read much here then you know that INR management isn't a big deal and as long as you actually are compliant with your ACT you'll be fine.

However, has your surgeon discussed with you potential for aneurysm? I'd suspect that's low (because you're over 50 and I'd have expected it to have emerged by now anyway.

Follow up if you want a discussion on ACT and INR management (or read my blog posts link below)
https://cjeastwd.blogspot.com/search/label/INR
Best wishes

 

[dick0236]

As one of the more senior, as in old, members (87) of this forum, I am always concerned about significant surgeries on patients in their late 70's and beyond. I'd look closely at your decision on valve type. A tissue valve now will, almost certainly, mean another procedure around +/-80. A mechanical valve now will probably last your lifetime even if you make it to 90+.

I am not a doctor, only an old man who has had a mechanical valve for most of his life ( age 31 to 87+). I'd get a valve that would probably last my lifetime......you will have enough other medical issues to deal with after 80.

BTW, if it's warfarin that is bothering you.......don't worry. It is no more bothersome than some of the other drugs I take.........it's all in how you manage your ACT (Anti-Coagulation Therapy). Warfarin has actually required me to be more than just a passive patient and has led to my long-term success in living a normal post-surgery life.

 

[NewValveAt57]

As one of the more senior, as in old, members (87) of this forum, I am always concerned about significant surgeries on patients in their late 70's and beyond. I'd look closely at your decision on valve type. A tissue valve now will, almost certainly, mean another procedure around +/-80. A mechanical valve now will probably last your lifetime even if you make it to 90+.

I am not a doctor, only an old man who has had a mechanical valve for most of his life ( age 31 to 87+). I'd get a valve that would probably last my lifetime......you will have enough other medical issues to deal with after 80.

BTW, if it's warfarin that is bothering you.......don't worry. It is no more bothersome than some of the other drugs I take.........it's all in how you manage your ACT (Anti-Coagulation Therapy). Warfarin has actually required me to be more than just a passive patient and has led to my long-term success in living a normal post-surgery life.

Thanks for your response, Dick. I agree that a tissue valve now means one or two more surgeries and although the surgeons I have spoken to have both recommended the SAVR/TAVR/TAVR series, I can see that as being more risky than warfarin for life. This is why I appreciate the input from others here. Warfarin has a very bad reputation, apparently, but it may be simply because there are those who aren't good at managing it who bring it's reputation down.

 

[pellicle]

but it may be simply because there are those who aren't good at managing it who bring it's reputation down.

that is exactly the problem. The worst at managing it are often the clinics. There is often more fights than there should be between what a ("we cover our arses first") Clinic and other medical practitioners.

Worse, management around other drugs is often compounded by absolute ignorance on the part of Dr's who don't actually know much at all (I'm being kind here) about managing INR and dose.

Best Wishes

 

[NewValveAt57]

Hi

well firstly the resilia isn't a bad choice and you could (depending on activity) get 20 years from it. TAVR isn't a certainty for people at this point, so you may actually face another SAVR down the track

The alternative as you know is mechanical and if you've read much here then you know that INR management isn't a big deal and as long as you actually are compliant with your ACT you'll be fine.

However, has your surgeon discussed with you potential for aneurysm? I'd suspect that's low (because you're over 50 and I'd have expected it to have emerged by now anyway.

Follow up if you want a discussion on ACT and INR management (or read my blog posts link below)
https://cjeastwd.blogspot.com/search/label/INR
Best wishes

Hi Pellicle,

Thank you for your insight. I'll certainly read your blog post as well. I believe I'm the type of person that could manage my INR, so long as it doesn't have side effects that give me grief for other reasons. I know about the bruising, but what about other common side effects I read about such as liver, gall bladder, or gastrointestinal issues?

Best wishes to you as well!

 

[dick0236]

.........I know about the bruising, but what about other common side effects I read about such as liver, gall bladder, or gastrointestinal issues?

It is true that bruising can be a nuisance but it is not a given that you will always bruise more being on warfarin. I recently took a hard fall on a grass bank and fractured three ribs but had no bruising of my chest area.....go figure. I've been on this forum for 17 years and can't recall any postings of organ damage caused by warfarin......nor have I had a doctor warn me of such a risk. I have lost friends to liver and gastrointestinal damage, but it was caused by personal behaviors......not an anti-coagulant.

 

[pellicle]

I know about the bruising, but what about other common side effects I read about such as liver, gall bladder, or gastrointestinal issues?

so, with over 50 years and literally millions of people on it for long term no side effects aside from mismanagement have been reported in a scientific manner. You can bet your trousers that if Big Pharma could point a finger at the dangers of "warfarin gives erectile dysfunction" (or hair loss, or ...) then they'd be screaming that.

They aren't.
I often joke that:
warfarin is associated with:

• hair loss
• erectile dysfunction
• wrinkles
• feeling the cold
• feeling hot
• greying of hair
• onset of menopause

this thread is also interesting

https://www.valvereplacement.org/threads/replaced-aortic-valve.888483/post-915093
Superman has found it caused weight loss, weight gain and children to be born

https://www.valvereplacement.org/threads/warfarin-causes-dementia.887582/post-898208
Slipkid quite astutely identified this issue
https://www.valvereplacement.org/threads/replaced-aortic-valve.888483/post-915059
however this stigmata is quite acceptable IMO

 

[Superman]

Welcome to the forum!

Even if you already made your decision, lots of good reads here about just getting through the process of OHS. What to consider at home. Things like getting out of bed aren’t easy. Coughing hurts. Getting to follow up appointments. All things to have a bit of a plan going in. Look for those threads or ask your own questions as well.

As far as SAVR, TAVR…. Surgeons have been promising this since at least 2008. We’ve had quite a few second operations for folks who chose tissue based on Surgeons belief in the future. Someday perhaps they’ll be right. But for now, I would base your decision on what you would do if a second open heart surgery was a certainty. You may arrive at the same choice, and that’s okay.

I don’t know what they’re batting these days on valve in valve TAVR, but it doesn’t seem better than a coin flip. I’d say worse but it’s possible those that have successfully had a TAVR after SAVR don’t come back and update.

 

[tom in MO]

that is exactly the problem. The worst at managing it are often the clinics. There is often more fights than there should be between what a ("we cover our arses first") Clinic and other medical practitioners.

Worse, management around other drugs is often compounded by absolute ignorance on the part of Dr's who don't actually know much at all (I'm being kind here) about managing INR and dose.

Best Wishes

Beg to differ. I used a clinic for many years until they started charging and I found I didn't need them. My clinic did a fine job. What I learned from the clinic nurses taught me how to manage my own dosing. My cardio looks at my INR and dosing paperwork at my yearly checkup and has no problems with it. My Coumadin Clinic nurses taught me well. Maybe Australian clinics and medical professionals have a greater problem with warfarin than those in Missouri

 

[Survived03]

I don’t know what they’re batting these days on valve in valve TAVR, but it doesn’t seem better than a coin flip. I’d say worse but it’s possible those that have successfully had a TAVR after SAVR don’t come back and update.

I agree that there is a paucity of data regarding the SAVR-TAVR, let alone SAVR-TAVR-TAVR. But looking at just SAVR-TAVR they have demonstrated good enough results for me to take the leap with Edwards Inspiris Resilia at age 62. We are all laying some sort of wager on the line.

I have attached a link to some abstracts to consider. Full disclosure, I did not purchase the full publications in order to dive into these particular studies.

https://pubmed.ncbi.nlm.nih.gov/33129775/
Placing oneself in a comparable patient demographic category may be tough without all the date. I hope this helps. NewValveat57 let me know if you have any specific questions.
Good luck.

 

[pellicle]

I’d say worse but it’s possible those that have successfully had a TAVR after SAVR don’t come back and update

its also possible that the stats are slanted to present an argument that's more favourable to interventional cardiologists who are competing with hospitals vs surgeons

 

[DJ-Rae09]

Hi,

Good luck with your surgery and recovery!

I'm just over 1 year since my AVR surgery with a mechanical aortic valve, I'm 43 yo. Honestly for me nothing has changed apart from being a Cyborg now I went mechanical because of my 'youngish' age and wanted a 'one and done' outcome.

For me, the first 3 weeks post OHS were the hardest. But once I got into week 4-5 and beyond things started to improve and by week 6 I felt pretty much back to normal, back to work etc.

Be patient with recovery and let it happen. Celebrate the small wins and try not to get to down, it's all temporary! Walk every day as you can.

 

[NewValveAt57]

Update:
I have surgery scheduled for 10/3. I saw another surgeon for a 2nd opinion (in another major city) and was given the same prognosis, so I'm moving forward with my local surgeon. I'm going with a tissue valve (bovine), so crossing my fingers that it'll last 10+ years. Thanks for all the input from the group.

 

[Survived03]

I have surgery scheduled for 10/3. I saw another surgeon for a 2nd opinion (in another major city) and was given the same prognosis, so I'm moving forward with my local surgeon. I'm going with a tissue valve (bovine), so crossing my fingers that it'll last 10+ years. Thanks for all the input from the group.

Good luck!

 

[tom in MO]

Good luck!

 

[Chuck C]

Good luck with your procedure! Please keep us posted and we'll see you on the other side

 

[Mrviking9!]

Good luck !!! And hope you have a speedy recovery

 

[Croooser]

Here's hoping for a successful surgery and a rapid and complete recovery.