Aortic valve

[70sdiver]

I was pretty sold on TAVR until talking with people here and doing more research. I then was of the mindset after ruling TAVR out that what I wanted was minimal invasive . My surgeon Dr. Aldea at the university of washington hospital said basically he saw no difference in patient healing time from one or the other but a more complicated surgery . To give you an idea of my heal time I had surgery August 18 and was released home on August 23rd. I started cardiac rehab today but I've been walking over 2 miles a day since the second week.

 

[Chuck C]

I then was of the mindset after ruling TAVR out that what I wanted was minimal invasive . My surgeon Dr. Aldea at the university of washington hospital said basically he saw no difference in patient healing time from one or the other

A couple of years ago I whatched an interview with Dr. Doug Johnson and Dr Lars Svenson of the Cleveland Clinic, in which they discussed minimally invasive procedures. Johnson acknowledges that there was no evidence of any survival advantage to min invasive, and that the outcomes were actually about the same, but that they were shifting that direction due to client demand.

There are definitely some advantages to minimally invasive, but also some well noted disadvantages. The data, at this point, does not show any survival advantage to minimally invasive.

 

[pellicle]

Johnson acknowledges that there was no evidence of any survival mortality to min invasive, but that they were shifting that direction due to client demand.

its always good to see the least knowledgeable group (the patients) calling the shots.

 

[Jerry D]

I was waiting for the less invasive aortic valve replacement, but then I had an "episode"--nearly passing out on a hike up a hill--and my cardiologist said I could wait no more. I had open heart surgery and a bovine valve from Edwards Lifesciences. I was home in 3 days, back to work part-time in 60 days, started cardiac rehab in 10 weeks, and was back paddling a one-man outrigger in 4 months. In a year, I was back to racing 6-man outriggers and coaching the novice. I did end up with A-Fib and A-Flutter a year after the surgery, which I was told was not that unusual, and had an ablation this past December. The A-Fib and Flutter are gone. I raced and coached this past summer, and if I can paddle at race pace for 12 miles at 73 years old, my valve must be in pretty good shape.

 

[Chuck C]

I was waiting for the less invasive aortic valve replacement, but then I had an "episode"--nearly passing out on a hike up a hill--and my cardiologist said I could wait no more.

Hi Jerry.
I believe you said in a previous post that you had your surgery at age 68, 5 years ago. At that time TAVR was approved for high and intermediate risk patients but had not yet been approved for low risk patients. At age 68 and healthy, you would have been low risk.

It is probably just as well that you got a normal tissue valve via SAVR instead of the less invasive TAVR. The 5 year results were recently published for low risk patients and SAVR has shown better survival stats than TAVR for low risk patients. The one benefit of TAVR for you would have been getting back to your active life a little sooner, but it sounds like you got back to things pretty quickly anyway.

With your level of fitness at 73, I'll bet you'll be one of those guys who stays physically active well into their 80s. Hopefully your valve will last until you're 88+, at which time you'll likely be a very good TAVR candidate.

 

[nobog]

Thanks for all the response's and information. When I talked to the first surgeon he explained the the TAVR procedure could be performed up to three times, after that they would have to go in and remove them and "It's a bear of a job" he said. need to know.

That guy is nuts.

 

[pellicle]

That guy is nuts.

or a self promoting type, putting "hope" as bait on the hook and conducting "shock management later" to reel you in when playing the "oh, you aren't suitable for that" card.

basically a c*nt

 

[pellicle]

At age 68 and healthy, you would have been low risk.

but Chuck, we already see that surgeons are allowing the patients to drive the directions of proper surgical decision making. (there's good money on that too)

Viva La Free (meat) Market!!

 

[Chuck C]

When I talked to the first surgeon he explained the the TAVR procedure could be performed up to three times, after that they would have to go in and remove them and "It's a bear of a job" he said. Considering my age and the supposed life of the valve It just doesn't seem like a good way to go.

I think that you are wise to avoid TAVR at your age. From your consult, the plan sounds like it would be TAVR in TAVR when your first TAVR undergoes SVD. There is very little data on TAVR in TAVR and from what studies have been done, the hemodynamics are unfavorable and other serious issues. See publication linked below:

"The results of Hatoum and colleagues are certainly compelling in suggesting that certain TAVR-in-TAVR prosthetic combinations are associated with unfavorable hemodynamics, poor leaflet mobility, blood clotting cascade activation, and potentially quicker prosthetic valve degeneration."

Commentary: TAVR-in-TAVR—Be a good host for your guest

Transcatheter aortic valve replacement (TAVR) prostheses' durability is a very legitimate issue, and it is increasingly being studied in a prospective fashion.1,2 It is clear that durability of TAVR prostheses is less of a concern in elderly patients, patients who are not operative candidates...

www.jtcvs.org

So, that is not a spot you want to be in at a relatively young age. If someone is 85 years old, gets a TAVR to avoid OHS then let's say that TAVR lasts them 8 years. So, maybe this would be a good candidate for TAVR in TAVR to give him a few more years and avoid a risky OHS. But, not someone your age to consider in my view.

As to him telling you that you can do a TAVR 3x? So TAVR in TAVR in TAVR? I am almost certain that he is miskaken about this. It's a moot point for you, as you're not going that route, but anyone who is told they can do TAVR 3x in the same valve needs to get another opinion about that. I had the TAVR discussion with my team not too long ago and TAVR in TAVR is a thing, but not TAVR in TAVR in TAVR.

 

[priley]

Well, After meeting with Dr Badhwar at WVU, I believe I found one of the finest surgeons around. I was determined to see what Cleveland offered but after meeting him I made the decision to have him do the surgery. He is going to do a robotic aortic valve replacement. After reviewing my CT's done before the visit, He and his associate Dr Wei told me I was a great candidate for the robotic procedure and made me feel confidant in my decision to proceed with him and the WVU team. Adam in your book when you KNEW who your surgeon would be, I understand that now. I was ok with the first surgeon but after meeting Dr Badhwar I KNEW who was going to be my surgeon. They went to work today performing test after test to make sure all is well and I still have some more tests to do but I am scheduled for the 1st week in November. I signed the papers for a tissue valve but I am still unsure (as I told the nurse) so now to figure on which valve will be the best for me. Surgery again in 10 years or doing warfrin, ticking and no greens. I'm gonna do some searching on here as to how people do on warfrin and the side effects etc. Regrets on going with either valve. At 60 I feel almost like it's 6 of one and a half a dozen on the other on which valve to do. He did say he would only do a valve in valve once not 3 times like the other surgeon said.

 

[Chuck C]

I signed the papers for a tissue valve but I am still unsure (as I told the nurse) so now to figure on which valve will be the best for me. Surgery again in 10 years or doing warfrin, ticking and no greens

Thanks for the update. To be clear, you can eat greens on warfarin- lots of them if you like. I eat tons of greens daily. There are several threads here which discuss this.

 

[DJ-Rae09]

To be clear, you can eat greens on warfarin- lots of them if you like. I eat tons of greens daily.

Yep, you can eat greens no problems. also drink beer too

Wafarin is no big deal, self testing is easy as! Prick ya finger once a week and done, takes less than 5 minutes!

 

[pellicle]

Surgery again in 10 years or doing warfrin, ticking and no greens

despite thousands of posts here saying that warfarin is no big deal and the no greens is just bullshlt (indeed the opposite is true, you should eat more greens on warfarin) I just don't know what to say any more other than "who keeps spreading this BS?"

Interaction Between Dietary Vitamin K Intake and Anticoagulation by Vitamin K Antagonists: Is It Really True?: A Systematic Review

Educational advice is often given to patients starting treatment with vitamin K Antagonists (VKAs). A great emphasis is made on nutritional information. Common belief is that dietary vitamin K intake could counteract the anticoagulant effect by VKAs and ...

www.ncbi.nlm.nih.gov

In conclusion, the available evidence does not support current advice to modify dietary habits when starting therapy with VKAs. Restriction of dietary vitamin K intake does not seem to be a valid strategy to improve anticoagulation quality with VKAs. It would be, perhaps, more relevant to maintain stable dietary habit, thus avoiding wide changes in the intake of vitamin K. Based on this, until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.​

people apparently make "informed" decision based on false information.

 

[priley]

Well I'm supprised because the greens thing was brought up at the meeting I had yesterday. Is the blood work done at home on a regular basis and checked by a lab on occasion or done at home / lab only? I take medicine daily but I have been known to look in my pill box and see opps I didn't take any yesterday.This is thyroid and cholesterol and I won't die or have a stroke If I miss it. If you missed it and it got out of whack, What then? Does it fix itself or how would you know if a clot it on the valve that may break away and cause a stroke. I'm fair at taking my meds but not perfect. I'm being honest.

 

[pellicle]

Well I'm supprised because the greens thing was brought up at the meeting I had yesterday

if you read the above journal article and then ask yourself "why would someone need to research this topic and write that" were this not a "thing" which has grown a life of its own.

like the Authors say: until controlled prospective studies provide firm evidence that dietary vitamin K intake interferes with anticoagulation by VKAs, the putative interaction between food and VKAs should be eliminated from international guidelines.

So don't feel I'm saying anything about you so much as about the medical establishment which perpetuates these myths.

Fundamentally the best thing you can do with ACT management is to get out of the orthodox system (especially in the USA) and go self management.

You'll note that the members here from the UK do largely self manage and a few of us from Australia too ...

its a sad state of affiars.

 

[Unicusp]

Yep, you can eat greens no problems. also drink beer too

Wafarin is no big deal, self testing is easy as! Prick ya finger once a week and done, takes less than 5 minutes!

I agree. Diet is up to you. Can eat or drink anything and easily adjust Warfarin dosage accordingly. Zero side effects. Home testing takes a couple minutes once weekly. I adjust my dosage as necessary and advise PCP. Very easy.

 

[Chuck C]

Well I'm supprised because the greens thing was brought up at the meeting I had yesterday.

I'm not at all surprised. Many medical professionals, who should know better, don't bother to keep up on the best practices for warfarin management. There have been several studies about eating greens (foods that contain vitamin K) while on warfarin and, as Pellicle noted, it turns out that the studies in recent years have found no basis to halting the consumption of green and that there is actually a benefit to consuming such foods high in vitamin k, in that they help the stability of INR while on warfarin. So, greens and other foods that contain vitamin K are actually a positive when a person is on warfarin. This, of course, would be a part of a plan which includes competent warfarin management.

Not only do foods rich in vitamin k help for INR stability, but they also are one of the healthiest foods for heart health in general.

 

[Chuck C]

Well I'm supprised because the greens thing was brought up at the meeting I had yesterday

Also, if I was consulting with a surgeon and he was giving me such advice about not eating greens on warfarin, I would take it as a sign that he has not kept current on the published medical literature on this topic. In my view it is irresponsible for a person to give medical advice on something which they are not keeping up on. I would think twice about letting such a person remove a sliver from my finger, let alone remove my aortic valve. But, that is just me. I guess sometimes even the most competent individuals have blind spots. Perhaps this is his only one.

 

[carolinemc]

I was pretty sold on TAVR until talking with people here and doing more research. I then was of the mindset after ruling TAVR out that what I wanted was minimal invasive . My surgeon Dr. Aldea at the university of washington hospital said basically he saw no difference in patient healing time from one or the other but a more complicated surgery . To give you an idea of my heal time I had surgery August 18 and was released home on August 23rd. I started cardiac rehab today but I've been walking over 2 miles a day since the second week.

I had double bypass and replacement of the Aortic Valve with a St. Jude's' leaflet Aortic valve and healed within a few weeks. Now for the muscles took a trauma from bypass surgery and they healed within a year's time. it is usually different for each person and depending on the type of surgery and what is replace with what. Each person does heal in different rates.

 

[carolinemc]

I'm not at all surprised. Many medical professionals, who should know better, don't bother to keep up on the best practices for warfarin management. There have been several studies about eating greens (foods that contain vitamin K) while on warfarin and, as Pellicle noted, it turns out that the studies in recent years have found no basis to halting the consumption of green and that there is actually a benefit to consuming such foods high in vitamin k, in that they help the stability of INR while on warfarin. So, greens and other foods that contain vitamin K are actually a positive when a person is on warfarin. This, of course, would be a part of a plan which includes competent warfarin management.

Not only do foods rich in vitamin k help for INR stability, but they also are one of the healthiest foods for heart health in general.

It is how much of the Greens you eat. If you are consistent and not eating tons, you will do fine. Most of us are not lettuce eaters and we eat occasionally. I do that, and when the INR is too high, they will recommend eating more lettuce., within reason.