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Back to Back TAVRs

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Gregg

Member
Joined
Jan 31, 2012
Messages
17
Location
Saint Charles, IL
Coming up on my 9 year anniversary of my aortic valve replacement and starting so show moderate stenosis which will probably require having it replaced in the next year our two (I had my bicuspid valve replaced when I was 45 at Northwestern by Dr. McCarthy).

I had a chance to meet with Dr. Robert Bonow (who is one of the leading cardiologists at Northwestern and former president of the AHA) and he said that I am a good candidate for a TAVR replacement this time around. I asked if the valve were to last 10-15 years, which would put me at 65-70, would I then need to have surgery to replace both the valves. Dr. Bonow said that when the TAVR goes into place the wire mesh essentially gets absorbed into the heart wall which makes a future surgical replacement very difficult. Rather, he said that since my current valve is fairly large at 27mm that there should be not be an issue with replacing the TAVR valve with another TAVR valve in the future.

So, bad news is that I will need my current valve replaced in the next year or two but good news is that more than likely I will not be looking at another OHS. This is the first I had heard of back to back TAVR replacements and I thought I would pass it on for others in a similar situation.

Gregg
 

rich01

Well-known member
Joined
Aug 23, 2018
Messages
302
Location
Virginia US
Yes, TAVR in TAVR is accepted practice, but I think you are being overly optimistic about a valve lasting for 10-15 years.
 

rich01

Well-known member
Joined
Aug 23, 2018
Messages
302
Location
Virginia US
The problem is TAVR was used primarily for critically ill patients, so there is not a long history of TAVR in patients who are expected to live 10, 20, or more years. There was also the change from 1st generation to 2nd generation TAVR valves, so it will probably be at least a few more years before statistics are available.

Europe is ahead of US in use of TAVR, so statistics might be available from there sooner.
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
7,268
Location
Queensland, OzTrayLeeYa
ome data:

SVD = Structural Valve Degradation
as I read it, key points [my personal comments in square braces]:
  • A total of 241 patients (79.3 ± 7.5 years of age, 46% female) with paired post-procedure and late echocardiographic follow-up (median 5.8 years, range 5-10 years) [so not long really, but within the maximum rage you get the lower end of the tissue prosthetic spectrum]
  • There was one case (0.4%) of severe SVD 5.3 years after implantation (new severe AR).
  • There were 21 cases (8.7%) of moderate SVD (mean 6.1 years post-implantation; range 4.9-8.6 years)
  • The authors concluded that long-term transcatheter aortic valve function is excellent; with 91% of patients in this study remaining free of SVD between 5 and 10 years post-implantation [long term means long for someone who hasn't got long to live]
myself even at 56 I'd hope to get 10 years more ... I mean statistically speaking Australians life to over 80, if I picked something which would only reliably get me between 5 and 10 then I'm setting myself up for a path of (first) gradual decline due to the onset of valve function decline) and then the hit of a surgery and recovery.

I am glad that these tools exist for those who (are between 72 and 85 years of age and) would like to try and get a few more years.

To me the answer of TAVR depends on part of the basic premise: how old are you now. Remember "younger" is a relative term

 

jcgtok17

Well-known member
Joined
May 13, 2017
Messages
65
Location
Tokyo, Japan
Coming up on my 9 year anniversary of my aortic valve replacement and starting so show moderate stenosis which will probably require having it replaced in the next year our two (I had my bicuspid valve replaced when I was 45 at Northwestern by Dr. McCarthy).

I had a chance to meet with Dr. Robert Bonow (who is one of the leading cardiologists at Northwestern and former president of the AHA) and he said that I am a good candidate for a TAVR replacement this time around. I asked if the valve were to last 10-15 years, which would put me at 65-70, would I then need to have surgery to replace both the valves. Dr. Bonow said that when the TAVR goes into place the wire mesh essentially gets absorbed into the heart wall which makes a future surgical replacement very difficult. Rather, he said that since my current valve is fairly large at 27mm that there should be not be an issue with replacing the TAVR valve with another TAVR valve in the future.

So, bad news is that I will need my current valve replaced in the next year or two but good news is that more than likely I will not be looking at another OHS. This is the first I had heard of back to back TAVR replacements and I thought I would pass it on for others in a similar situation.

Gregg
Gregg, This is good news as far as I am concerned. I'm just over 3 year in on a St. Jude Medical GT tissue value, also 27mm and hope my next 2 rotations are TAVI (both procedures are covered under the universal healthcare systems of Japan and Canada). Good health! JCG
 

Freebird

Well-known member
Joined
Sep 27, 2019
Messages
115
I’m 58 and just four weeks past my first OHS with a 25mm tissue valve. When I asked a similar question to my surgeon his thinking is my next surgery would most likely be OHS and save the TAVR for the third round when I’m older. He didn’t sound too keen on TAVR in TAVR just yet. I remain hopeful for the future but trying to remain realistic about the future. 😀
 

rich01

Well-known member
Joined
Aug 23, 2018
Messages
302
Location
Virginia US
I’m 58 and just four weeks past my first OHS with a 25mm tissue valve. When I asked a similar question to my surgeon his thinking is my next surgery would most likely be OHS and save the TAVR for the third round when I’m older. He didn’t sound too keen on TAVR in TAVR just yet. I remain hopeful for the future but trying to remain realistic about the future. 😀
Let's say you get at least 10 years on your valve. At 68 I would think you would be a good candidate for TAVR. I had mine at age 70. I expect major improvements to happen in the next 10 years, so by the time you need a new valve, hopefully they will have new valves that last much longer.
 

Freebird

Well-known member
Joined
Sep 27, 2019
Messages
115
Let's say you get at least 10 years on your valve. At 68 I would think you would be a good candidate for TAVR. I had mine at age 70. I expect major improvements to happen in the next 10 years, so by the time you need a new valve, hopefully they will have new valves that last much longer.
Yes but what happens at 78 and 88? His theory is it might be better to do OHS while I'm younger and save the TAVR(s) for older age. Who knows. I mean the math really changes if I get 15 years out of a valve doesn't it? None of it is too predictable.
 

rich01

Well-known member
Joined
Aug 23, 2018
Messages
302
Location
Virginia US
Yes but what happens at 78 and 88? His theory is it might be better to do OHS while I'm younger and save the TAVR(s) for older age. Who knows. I mean the math really changes if I get 15 years out of a valve doesn't it? None of it is too predictable.
He doesn't have to make a decision until his new valve needs to be replaced. It doesn't make sense to me why his cardiologist would have said SAVR. Trying to decide now what to do in 10 or 15 years isn't practical as one doesn't know what the options will be then.

I'm just saying TAVR could very well be a good option at that point in time. Technology is rapidly changing and there are new valves that are supposed to be one and done. Maybe in the next 10 years they will figure out why our valves calcify and have treatments to slow down or even stop calcification.

I doubt if I will live to 90, so even with current technology, I think I am good with the option for one valve in valve procedure. I've only had my valve 1 year, but no sign of calcification so far.
 

LinH

Member
Joined
Aug 17, 2020
Messages
10
Coming up on my 9 year anniversary of my aortic valve replacement and starting so show moderate stenosis which will probably require having it replaced in the next year our two (I had my bicuspid valve replaced when I was 45 at Northwestern by Dr. McCarthy).

I had a chance to meet with Dr. Robert Bonow (who is one of the leading cardiologists at Northwestern and former president of the AHA) and he said that I am a good candidate for a TAVR replacement this time around. I asked if the valve were to last 10-15 years, which would put me at 65-70, would I then need to have surgery to replace both the valves. Dr. Bonow said that when the TAVR goes into place the wire mesh essentially gets absorbed into the heart wall which makes a future surgical replacement very difficult. Rather, he said that since my current valve is fairly large at 27mm that there should be not be an issue with replacing the TAVR valve with another TAVR valve in the future.

So, bad news is that I will need my current valve replaced in the next year or two but good news is that more than likely I will not be looking at another OHS. This is the first I had heard of back to back TAVR replacements and I thought I would pass it on for others in a similar situation.

Gregg
We thought my 83 year old mother was a for sure candidate for her second aortic replacement with TAVR, 5 weeks ago. It got more complicate when we learned her Mitral also needed replacement and tricuspid repaired. However heart surgeon said that TAVR was not the best option long term for her. He said it was a therapeutic, and not overall best long term solution. So she had sternum OHS and doing amazingly well. Maybe get more doctor opinions. TAVR From my understanding is not quite there yet. Although it is amazing for certain candidates and has come a LONG way and will be the future way to go for heart valves patience. God Bless!
 

Freebird

Well-known member
Joined
Sep 27, 2019
Messages
115
We thought my 83 year old mother was a for sure candidate for her second aortic replacement with TAVR, 5 weeks ago. It got more complicate when we learned her Mitral also needed replacement and tricuspid repaired. However heart surgeon said that TAVR was not the best option long term for her. He said it was a therapeutic, and not overall best long term solution. So she had sternum OHS and doing amazingly well. Maybe get more doctor opinions. TAVR From my understanding is not quite there yet. Although it is amazing for certain candidates and has come a LONG way and will be the future way to go for heart valves patience. God Bless!
This was the “vibe” I got from my surgeon when he suggested OHS again while I’m “younger.” I’m sure he doesn’t want to cast doubt on TAVR in the right situation, but he seems to lean more conservatively In its current form. I could be wrong in my interpretation of his comments, but that was my sense.

That said, none of this matters until the time we need to actually face the next procedure. May we all be well!
 

tom in MO

Well-known member
Joined
Jan 17, 2012
Messages
1,428
Location
MO USA
Tissue valves can last 4-15 years depending upon the person.
TAVR inside a TAVR means a smaller valve diameter from what God gave you.
Be careful. Not even a cardiologist can predict your future from other people's statistics.
 
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nobog

Well-known member
Joined
Jun 14, 2019
Messages
81
Tissue valves can last 6 months to 20 years - I've seen both.
 

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