On-X Aortic Heart Valves: Safer with Less Warfarin On-X Aortic Heart Valves: Safer with Less Warfarin

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Degenerated TAVR Not Uncommon After 10 Years

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  • Degenerated TAVR Not Uncommon After 10 Years

    Unfortunate report on the (apparent lack of) TAVR valve durability:

    http://www.medpagetoday.com/Cardiology/PCI/62310

  • #2
    Originally posted by Nocturne View Post
    Unfortunate report on the (apparent lack of) TAVR valve durability:

    http://www.medpagetoday.com/Cardiology/PCI/62310
    I wish they would it more clear who actually participated in the study. At least in the U.S. at that time, most of the patients being approved for that procedure were older and typically not cleared for open heart due to other risk factors.

    I guess I wouldn't expect a super durable valve in the initial round of patients. I anticipate it improving with time. I don't know how far away we are from this being the preferred method vs. traditional open heart (mechanical or tissue) in somebody that is younger with few co-morbidities. Depends how many valves they can stack on top of each other I suppose.
    10/15/2009 - St. Jude Medical Valve / Conduit Graft 25mm. Dr. Robert Hooker Jr at Meijer Heart Center, Spectrum Health Butterworth Hospital, Grand Rapids, MI.

    September 2009 - diagnosed with 4.9 cm ascending aorta with two aneurysm bulges.

    11/21/1990 - St. Jude Medical Valve 23A-101. Dr. Seong Chi at Ingham Regional Medical Center, Lansing, MI.

    Aortic Stenosis and BAV diagnosed in infancy.

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    • #3
      Originally posted by Superman View Post

      I wish they would it more clear who actually participated in the study. At least in the U.S. at that time, most of the patients being approved for that procedure were older and typically not cleared for open heart due to other risk factors.
      Correct

      "Baseline renal failure was a risk factor for valve deterioration (hazard ratio 3.22, 95% CI 1.45-7.15)."
      Bicuspid Aortic Valve. Moderate Aortic Valve Stenosis. Ascending Aorta: 4.1cm
      In the waiting room.

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      • #4
        This is only my personal opinion but for anyone of a somewhat younger age if you're having your valve replaced and durability is your main concern then you should get a mechanical valve. I understand if calcification is a big concern and you believe warfarin may accelerate that process then you have to pick your poison. Unfortunately there is no perfect answer at this point in time.

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        • #5
          Originally posted by cldlhd View Post
          This is only my personal opinion but for anyone of a somewhat younger age if you're having your valve replaced and durability is your main concern then you should get a mechanical valve. I understand if calcification is a big concern and you believe warfarin may accelerate that process then you have to pick your poison. Unfortunately there is no perfect answer at this point in time.
          I would tend to agree with you.

          As I said, if my CAC score was not at sideshow attraction levels, Pellicle's analysis alone would have sold me on the idea of getting a mech valve myself.

          What I have now is hope that by the time I actually need my AVR surgery, there will be options that merge valve durability with freedom from CAC-accelerating meds.

          I honestly do not know what I would pick today, for myself, if I had to choose.

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          • #6
            As there is the possibility you could end up on warfarin anyway and it hasn't been proven that warfarin increases cad rate I would vote mechanical depending on your age , forgive me but I don't recall what it is. You can only control what you can so at this point besides doing research, but trying not to drive yourself crazy with it, all you can do is try to improve your health through exercise and diet, as it seems you are judging by previous posts, and keep your ear to the ground as to ways to slow or possibly reverse calcification. Whether or not they come up with that valve that hits all the sweet spots by the time you need it is out of your control.

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            • #7
              The way the "report" reads to me is that TAVI is doing what it says on the box, and that it's for high risk patients who wouldn't otherwise survive OHS and have a limited life span...

              no surprises there...
              27mm St Jude mechanical AVR, mitral valve repaired.Surgery 4th Nov15 at 39 yrs old. Bicuspid Aorta.40 yrs old.Sternal wires removed 28th Oct 16.

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              • #8
                Originally posted by cldlhd View Post
                to slow or possibly reverse calcification. Whether or not they come up with that valve that hits all the sweet spots by the time you need it is out of your control.
                You can't reverse calcification. Plaques are 20% Calcium. So, a 60% stenosis could theoretically become a 12% stenosis, because it is the lipid content only that can be reversed. CAC scores don't reverse, but can be slowed. Calcium reflects 'mature plaque'; these contribute to angina. It is soft plaques that have the thin caps. These rupture and become susceptible to the clots which cause occlusion. This equates to dead heart muscle downstream.

                Bicuspid Aortic Valve. Moderate Aortic Valve Stenosis. Ascending Aorta: 4.1cm
                In the waiting room.

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                • #9
                  Originally posted by Warrick View Post
                  The way the "report" reads to me is that TAVI is doing what it says on the box, and that it's for high risk patients who wouldn't otherwise survive OHS and have a limited life span...

                  no surprises there...
                  Of course. If people didn't have comorbidities, they wouldn't qualify for a TAVI, in the first place.
                  They say in Germany, half of the valve replacements are TAVI. So, I would like to see the research coming out of there.
                  Bicuspid Aortic Valve. Moderate Aortic Valve Stenosis. Ascending Aorta: 4.1cm
                  In the waiting room.

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                  • #10
                    Again - I would expect that research will be forthcoming. There is just too much interest in TAVI not to study it and expand its use as far as is appropriate, given the results. Like most other advanced medical treatments, though, the longer one can wait for treatment, the more robust that treatment is likely to be.

                    The moral - Stay in The Waiting Room as long as you can, regardless of what condition you're considering treating.
                    Go Class of 2011!

                    Steve Epstein
                    9 Years in The Waiting Room, then on February 28, 2011,
                    AVR with 23mm Edwards Bovine Pericardial Tissue Valve, Model 3300TFX, Pacemaker - Boston Scientific Altrua 60 DDDR IS-1 and CABG (LIMA-LAD) at Northwestern Memorial Hospital, Chicago by Dr. Patrick McCarthy and the most wonderful team of professionals I could ask for. New pacemaker (Boston Scientific L101) and ventricular lead, July, 2016.

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                    • #11
                      There's some great work being done here. One of the local cardios is a whiz kid with TAVI.
                      We won't get decent data for a few years.
                      Bicuspid Aortic Valve. Moderate Aortic Valve Stenosis. Ascending Aorta: 4.1cm
                      In the waiting room.

                      Comment


                      • #12
                        Originally posted by Agian View Post
                        You can't reverse calcification. Plaques are 20% Calcium. So, a 60% stenosis could theoretically become a 12% stenosis, because it is the lipid content only that can be reversed. CAC scores don't reverse, but can be slowed. Calcium reflects 'mature plaque'; these contribute to angina. It is soft plaques that have the thin caps. These rupture and become susceptible to the clots which cause occlusion. This equates to dead heart muscle downstream.
                        I would tend to agree but I wouldn't be quite as absolutely sure. I'm pretty skeptical so I don't jump in when some supplement website claims something will cure everything and make your hair, and possibly other things, fuller and thicker. On the flip side it takes quite a burden of proof before medical science or science in general will declare something as fact so just because claims of things like k2 removing calcified plaque haven't been 100% proven and accepted as fact doesn't mean it's out of the realm of possibility. The experts were once sure the earth was flat.
                        The only thing I don't get is the numbers. When I first had a ct angio in April 2014 they said I had calcification in one spot in one artery. They told me it was 50% stenosed. Three months later I had a cardiac cath and the surgeon said he saw no soft plaque at all within my artery and apparently the calcification was all within my arterial wall. He said my arteries were "large and clear". Twenty one months after the first ct angio I had another and they told me it was 30% stenosed. So if only 20% is calcified and the other 80 is soft plaque and only the hard stuff shows up in the scan then where was the soft plaque in my cath? If that area was 50% stenosed with calcified plaque then there should have been a hell of a lot of soft plaque. I realize these scans are all open to interpretation but a drop from 50 to 30% is pretty significant. Bones lose calcium so why not soft tissue?

                        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566462/
                        Last edited by cldlhd; January 4th, 2017, 04:18 PM.

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                        • #13
                          Agian, who is the cardiologist that is a whiz kid with tavr, I can't get the private msg to work. Ugh

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