Evaluated for TAVR Tomorrow

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morellib

Bill M
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Franklin TN
70 year old avid cyclist (over 4,000 miles per year) diagnosed with BAV in 2018. With cardiologist’s approval kept cycling at same level since diagnosis. Good shape with no comorbidities. Two weeks ago echo and MRI showed valve jumped into the severe range so I’m being evaluated tomorrow for my suitability for TAVR procedure which would be my preference if possible to shorten recovery time and get back to rehab. Curious whether others on here have had a successful TAVR and were able to get back to endurance activities like cycling or running. Thank you!
 

Timmay

Grandfather Clock
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Just my very very humble thought …

You’re in GREAT shape. I truly don’t know of any other 70yr olds that bike on average 11 miles a day … ever day. I’m sure it’s more like 25 one day and then something else another day. But still - you’re rocking it.

If you get a TAVR, you’ll need another operation 5-10yr from now - especially because you are so active. You work that valve much more than a normal person of your age.

So what does another operation look like for you at 75-80yr old? They sometimes do a TAVR in a TAVR. However, more than likely you’re looking at Open Heart Surgery once your 1st tissue TAVR goes bad.

Consider doing OHS **now** while you are super healthy and can recover. You don’t want to have to do it later. You have a huge step above others in your age group and a chance at a long life if you make certain decisions now.

Why? Because it’s not “if” you’ll need OHS later if you choose TAVR now … but “when”. So do the OHS now so that they can put in a valve that will last longer.

Example: OHS with an Inspiris Resilia tissue valve. The Inspiris Resilia valve will last longer than a standard tissue valve. AND - with OHS they’ll have full access to get the old bad valve out and put in a nice big tissue valve that will help with your biking. And then later **if** you qualify for a TAVR (it is NEVER a given), then the Inspiris Resilia is setup to expand for insertion of a TAVR.

You’re just so active and fit that a normal path like an immediate TAVR is probably not the best solution for you because you’re setup to live a longer life AND you’re demanding that your valve do more than a normal 70yr old that eats, watches TV, and maybe walks a dog here and there.
 

70sdiver

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Richland wa
I agree with Timmay. I was pretty set on wanting TAVR but after coming on here and researching my options I chose to have open heart with the Inspiris Resilia , Time will tell how long this new valve will last. My surgeon told me I was qualified for the TAVR but he would be doing open heart on me in 5 to 8 years to replace it. The recovery was better than I expected, I was out of the hospital in 5 days and walking 2 miles a day by week 2 . I'm in cardiac rehab right now my surgery was aug.18th and I'll do rehab till the end of Dec. Really research your options !
 

morellib

Bill M
Joined
Nov 20, 2022
Messages
5
Location
Franklin TN
Thanks so much for the reply and your thoughts! Yes, I’ve been weighing those same issues and a lot of that will be discussed with the valve team I’m working with which includes a SAVR surgeon, a TAVR specialist and my cardiologist, all of whom are aware of my desire to do more than walk around the mall in my tennis shoes! There seems to be some literature out there that early studies on TAVR longevity are incomplete and/or inconclusive because of the relatively short time frame they’ve been available and current advances in TAVR valve development may extend their life. I’ve also read about the TAVR in TAVR procedures which are starting to be done. I really want to keep an open mind and pick the one that makes the most sense, even if it is OHS. I’m fortunate to be in Nashville where Vanderbilt has an excellent valve program. Again, many, many thanks for your post. Bill
 

dick0236

Eat the elephant one bite at a time
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Much is being written about TAVR. Edwards Lifesciences, in my area, is running TV ads promoting TAVR as an alternative to OHS. I don't think there are many TAVR's on this forum and it would be helpful to learn what your surgical team has to say in a case, like yours, where the recipient of the valve, is a young and very active 70 year old. Please post what your docs recommend......Vanderbilt is a leading hospital in this technology.
 

Superman

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Grand Rapids, MI, USA
How long are they lasting in the wild? And can they place a second TAVR inside a TAVR? Those would be my starter questions. As a follow up to the second question, if they can, how often do they in practice? If it’s 50/50 or less - I’m not sure if that’d be enough for me.

If all those answers give you the warm fuzzies, I think it’d be great to have that as an option.
 

morellib

Bill M
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Franklin TN
Superman and dick0236– Thanks for the input. The data is mixed on longevity “in the wild” with several early studies showing a 5-8 year life and some later studies showing similar lives to surgical valves. Not as much history or data to go on. Edwards has its Sapien 3 Ultra TAVR valve which is designed to provide better coronary artery access if needed and is also specifically designed to accept a second TAVR valve if needed. Looking forward to what they say tomorrow…
 

pellicle

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Hi

he data is mixed on longevity “in the wild” with several early studies showing a 5-8 year life and some later studies showing similar lives to surgical valves.

I'd encourage you to personally read the studies and to examine not just the abstract of those but to dig in and look in a critical manner. I've done a bit of a deep dive myself on valves (not TAVI) but you can use this as a structure or "template" on how you read and regard what is written.

In that analysis I covered only durability, and so other issues are not addressed. I take and express why in that the idea that if hard data is not available for something then be careful on how you project data out into the future.

This publication for instance is not a peer review study, but more of an analysis of a study of the durability of TAVI vs SAVR. I guess I should mention that some call it TAVI and others TAVR ... its the same thing. TAVR stands for transcatheter aortic valve replacement. TAVI stands for Transcatheter aortic valve implantation (eg). Its a nuance of thought as to use of Replacement or Implantation.

Finally, if you don't have an academic background in science (which does help) I recommend you read and understand this guide (from a well regarded Australian University) well. Its summarised as:

Critical thinking is a kind of thinking in which you question, analyse, interpret, evaluate and make a judgement about what you read, hear, say, or write. The term critical comes from the Greek word kritikos meaning “able to judge or discern”. Good critical thinking is about making reliable judgements based on reliable information

Best Wishes
 
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pellicle

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Hi @morellib , I would take this

And can they place a second TAVR inside a TAVR? Those would be my starter questions. As a follow up to the second question, if they can, how often do they in practice? If it’s 50/50 or less

and add to it the following "frame of reference" for your analysis:
how long do you anticipate living for (all things being equal).

Because you don't want to find yourself in need of a surgical OHS type intervention 10 years from now when the valve in valve of the TAVI is at end of life.

remember, each time you insert something into a hole the hole becomes smaller (which is why I prefer to think of TAVI not R which implies replacement which may be a false premise.

Myself I'd have a good hard look at a Inspiris Resilia or even perhaps a St Jude mechanical depending on what you think are the probabilities that you'll need AntiCoagulation Therapy anyway in later years.

We indeed have 80 year olds on ACT here and probably the most common finding of people who start ACT is "wow, its nothing like I feared it would be".

I'll again recommend my above blog post to you.

Best Wishes
 

pellicle

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Thank you for this info and insight
you're welcome, its why we're here. Not to give medical advice but to give insight on frames of reference and alternative questions to consider.

Best Wishes

(ps there were some changes in my above replies, maybe refresh the page and glance it over)
 

pellicle

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oh and incase you miss this point in my blog post above:
This is interesting because it fits in with a presentation and criticism of an earlier version of these guidelines by the Mayo Clinic. I strongly urge anyone to sit through this presentation. Presented in 2010 URL ,

I recommend you take a cup of coffee and listen to Dr Schaff
 

pellicle

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hey at the risk of flogging this, I wanted to also share this post from another member. I think its perfectly phrased as it discusses a point I exactly mention but which is over the heads of newbies.


The point is that from the perspective of psychology this discovery is often a shock and sets people into a "survive the event" procedure, which isn't properly warranted and is very frequently only seen by the patient in the light of their recovery and the inevitable next surgery.

This surgery has been done now for over 50 years, and we are getting exceptionally good at it, so much so that SAVR (Standard AVR) is mentioned as "the gold standard" and other things are compared to it (rightly so).

The patient needs to calm themselves (seldom done) and quell their anxiety (seldom possible for some) and to look towards their future in the same way as before they hit this bump in the road. There is every reason to expect life will go on more or less as it had before the surgery. Perhaps you may need to take another pill (are you taking anything now?) and probably you'll need to evaluate which valve you want and why, but you should keep an eye to the future (for it has a habit of occurring anyway).

I always say "live for today, don't forget to plan for the future too".

1668983853298.png
 

Chuck C

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1,793
Welcome to the forum!

At 70 and in good physical condition, you are almost certainly in the "low risk" category.

I understand the temptation of TAVR, as the recovery is very quick compared to SAVR. My next door neighbor stopped by last night and informed me that his father in law's pig valve failed, after 12 years, and he just had a TAVR. He was out of the hospital in 36 hours. They also told him to expect it to last about 5 years- he's 75.

Something that you may want to consider is that the mortality rates are higher for TAVR after the first year, compared to SAVR. True, perhaps the new TAVR valves will do better than those in the studies, but remember that these would also be compared against newer tissue valves, which will also possibly show lower mortality rates.

At 70, you would be a prime candidate for a Resilia tissue valve. At 70 and in good condition, you should do fine in the surgery and this valve could easily be one and done for you. It is built on the Magna Ease platform, and Magna Ease typically will last 15-20 years for someone your age. There is also a good possibility that the Resilia will last even longer, given its anti-calcification treatment. Whereas a TAVR might put you in a bad spot in a few years. As another poster mentioned, being a physically active 70 year old, you're likely to have a longer than average life expectancy and there might come a time when you regret getting a band aid procedure of sorts, in order to get back to biking a little sooner.

I had my surgery about 20 months ago and am also very physically active. For me, recovery basically meant doing brisk walking for a few weeks until I got the ok to up it a little with running and biking. I was back with a green light to go at it hard by 3 months. The time passes really quickly.

It's a personal choice and only you can make that decision. I like that you're getting input from a medical team involving your cardiologist, a TAVR specialist and a SAVR specialist. As long as you go in informed, and it sounds like you are, there is no wrong choice. No matter what you choose, we will support you 100%. Please feel free to ask any questions.
 

Timmay

Grandfather Clock
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I really like a lot of what Chuck and pellicle said above. I wanted to highlight a particular comment …

“there might come a time when you regret getting a band aid procedure of sorts, in order to get back to biking a little sooner.”

I appreciate this comment because it acknowledges a line of thought that physically fit individuals value and trend towards: Exercise and Health.

Thus, it’s tempting to choose a path that gets us back to that sooner. Not many know this but before I knew anything, I was hoping to do a TAVI (tissue valve). Once I did all the research - it was clear that a SAVR with mech valve was my best choice (because I was 50).

Be patient. Put exercise on the back burner and think about a long and productive life. No matter what, you WILL get back to biking. It’s in our blood. We can’t help it. 🤣😂🥳😁
 

skeptic49

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If you opt for OHS and a tissue valve at 70 you may never need a replacement and perhaps no need for anticoagulants. With TAVR I would guess that the chances that you would need another replacement are significantly higher. BTW, I will be 74 in January and I am an avid walker and active scuba diver. My tissue valve appears to be in excellent shape coming up on eight years.
 

morellib

Bill M
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Franklin TN
I want to thank each and every person who sent their thoughts. They were very helpful in getting my arms wrapped around the “easy now versus better later” discussion. My appointment today with a surgeon and the TAVR surgeon made all the points everyone was making and they recommended OHS over TAVR although respectfully left the decision up to me based on my desires. On reflection, I decided to go the surgical route with the Inspiris Resila, scheduled before year end. Thanks again to all, and onward! See you on the road late Spring! Bill
 

dick0236

Eat the elephant one bite at a time
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Thanks for coming back and giving us the summary of your discussion with your surgical team. Your age and active lifestyle seem to dictate that the new Edwards valve should serve you well. Good luck to you!
 

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