Thanks for sharing your story. The fact that your biological valve lasted 10 years brings up another issue regarding valve choice. (If my math is right you had your first AVR at about age 57, is that right?) This is the reason that I am leaning towards a mechanical valve. I've been told, and the literature seems to support, that at my age of 53, I can expect a biological valve to last about 10 years. The Edwards Resilia valve gives some hope that it may last longer, but with 5 years of human data, this is certainly not proven. So, if I go with the current expectations of valve life for biological valves for folks in my age bracket- I would be looking at valve procedure #2 at about age 63 if my replacement valve is a biological valve. Then, at age 63, I either face another OHS or TAVR. My cardiologist said that the hope at that point would be to avoid OHS and go TAVR and the hope would be that the TAVR would last 15 years, taking me to 78. Then we would probably do valve operation # 3 as a TAVR in TAVR at 78. There is a lot that I don't like about that scenario personally. 1) Ten years is a short period of time to have to face valve surgery again and there are plenty of folks in my age range for whom their biological valves are only lasting 7-8 years. 2) I have some real reservations about TAVR for young individuals, and I think anyone under 70 is young in the valve replacement world. A high risk 85 year old, I think TAVR makes all the sense in the world, with the risks posed by OHS. But, someone in their 50s and 60s, I really have to question TAVR, especially given that we really don't have long term data on TAVR, and certainly limited data for TAVR in young active people. Also, the outcome studies comparing SAVR to TAVR, while arguably having better short term outcomes for TAVR at year 1, seem to even up after about 3 years and break in favor of SAVR by year 5 in the most recent publications. 3) There is very limited data on valve in valve in valve: that is to say, TAVR as a valve in valve following the biological valve, followed by TAVR in TAVR. That is getting to the point where there is a lot of junk in there an the AVA is not likely to be very big at that point. My cardiologist says that by the time that I am that age I will likely not need to have nearly as much cardiac output through the valve to support my activities. Well, my dad is 78 and plays tennis hard 4 days per week. My mom at 78 walks 5 miles per day and sometimes goes swimming. I plan to be active at 78, like my parents, and I don't like the idea of having a very small valve opening with 3 artificial valves sharing space in the annulus. And, keep in mind this scenario of estimating the age for each procedure is assuming the first TAVR gets me 15 years. This would be a far from certain assumption. I think that a more realistic estimate might be 10 years and one could make the case for even less. Using 10 years as the estimate for how long the first TAVR biological valve will last me, the same as the estimate for the life expectancy for my first biological valve, and now I am looking at surgery #3, the TAVR in TAVR, at age 73. That would seem to be not the best place to be at age 73. We are really on uncharted territory when we talk about valve in valve in valve.Excellent thread Chuck C and contributors, very informative.
To add on why certain tests.
My sept 2020 echo indicated my 10 yr old prosthetic bio aortic valve is failing and an aortic redo/replacement is needed soon, .456 was my echo result. Interventionist upon revue of echo scheduled a CT scan.
My dec 2020 CT scan with contrast, determined that an OHS procedure is less risk vs. a TAVI procedure.
Am meeting with OHS surgeon next week. By my understanding, an angiogram will next be scheduled to determine condition of arteries.
The CT scan with contrast also picked up a cyst on pancreas, so i will be scheduled for an MRI for pancreas and a follow up with a different surgical team
Two surgeries now seem likely for me and soon.
So, it really makes me look hard at the option of going with a mechanical valve, and hoping that this will be the last procedure that I will ever need.
Sorry for taking a bit of a trip down a rabbit hole with valve choice, but this is clearly something that I must also deal with at this time as I weigh my options with my cardiologist and surgeon. When I hear stories like yours, about how long folks are getting out of their biological valves, especially those in my age range, it is of great help to me as we weigh valve choice. So, thanks again for sharing your story.
I wish you the best of luck both of your surgeries. It is good that they found the cyst on your pancreas and can deal with that now. Please keep us posted on your recovery.