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tom in MO

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Jan 17, 2012
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I am 70, but in US Medicare will not pay for low risk patients to have TAVR. I am a candidate for a TAVR trial, as that seems to be the only way I can have it. Certainly don't have Mick Jagger type money to pay out-of-pocket.
It's not a matter of money, but science. I believe that TAVR has not yet been approved by the FDA for low risk patients. Someone in another thread was offered the opportunity to participate in a clinical trial for TAVR in low risk patients. You don't always want to be in a clinical trial if you have a successful alternative. By nature the clinical trial's procedure has not been proven effective. The conservative approach is to go with standard treatment that is proven.

The standard procedure with OHS is a "gold standard" with many successful operations. At 70, you can get a tissue valve and not worry about having a later replacement.

It'll go OK. I believe Medicare will pay for some in-house assistance post-surgery if it's needed. You should let your sister come to help, it'll be a good "catch-up" time for both of you.
 

rich01

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Aug 23, 2018
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350
Location
Virginia US
It's not a matter of money, but science. I believe that TAVR has not yet been approved by the FDA for low risk patients. Someone in another thread was offered the opportunity to participate in a clinical trial for TAVR in low risk patients. You don't always want to be in a clinical trial if you have a successful alternative. By nature the clinical trial's procedure has not been proven effective. The conservative approach is to go with standard treatment that is proven.

The standard procedure with OHS is a "gold standard" with many successful operations. At 70, you can get a tissue valve and not worry about having a later replacement.

It'll go OK. I believe Medicare will pay for some in-house assistance post-surgery if it's needed. You should let your sister come to help, it'll be a good "catch-up" time for both of you.
Results from the TAVR trials show TAVR to be equal or superior to SAVR in most cases. There was an early problem related to strokes, but that was addressed and now the rate of stroke is lower for TAVR than SAVR.

I believe the reason TAVR is not yet standard practice for those over 65 is because SAVR is a cash cow. As more patients have TAVR, the cost of the valves should come down. What will they do with all the cardiac surgeons if TAVR replaces SAVR in the majority of cases?

At my age, 2 or 3 weeks of recovery sounds just fine. My cardiologist says I should be able to drive after a week. Typically a patient goes to hospital and has the procedure, then is released the next day. I have trouble understanding why anyone over 70 would prefer open heart surgery to a catheter in the groin.

That was probably my post you are referencing. In this particular trial, they have already collected enough data to show that TAVR is a viable alternative for low risk patients. They are continuing the trial to collect more information on TAVR, but the SAVR part is completed.
 

tom in MO

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...I believe the reason TAVR is not yet standard practice for those over 65 is because SAVR is a cash cow. As more patients have TAVR, the cost of the valves should come down. What will they do with all the cardiac surgeons if TAVR replaces SAVR in the majority of cases?...
Kind of cynical. But I know how you feel, some people have stated that they believe that's why they let young people choose bioprosthetic valves, guaranteed repeat business :)

About a year ago, one of the unproven aspects of TAVR was the lifetime of the implanted TAVR valve. It may be that all those cardiac surgeons will have to replace those TAVR valves if they don't last as long :)
 

Gazza01

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Jan 17, 2018
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Location
Ascot Berkshire.
Kind of cynical. But I know how you feel, some people have stated that they believe that's why they let young people choose bioprosthetic valves, guaranteed repeat business :)

About a year ago, one of the unproven aspects of TAVR was the lifetime of the implanted TAVR valve. It may be that all those cardiac surgeons will have to replace those TAVR valves if they don't last as long :)
In England they still prefer us to have tissue valves at a young age. I was told it would give me another ten years of healthy carefree living with just an aspirin a day to take, which has been the case.
Plus of course it didn't cost me a penny and won't next time either.
I don't know if you guys are aware of a new copolymer valve about to be tested in animals. A British engineer working alongside a heart surgeon has managed to produce two types of copolymer valves which have had machine trials and are looking as if they may be ready for humans well within ten years. I think it's being done at Winchester university.
 

DRG.

Member
Joined
Aug 14, 2017
Messages
10
Location
Ontario, Canada
https://www.cardiovascular.cam.ac.uk/news/next-generation-heart-valves

The polymer heart valve has the distinct advantage of mimicking the structure of a human valve to the extent that blood flow over the valve reflects the natural flow in humans. This reduces the risk of blood clot formation and potentially eliminates the need for life-long anti-clotting drug therapy. The valves are also coated in heparin, thus further diminishing the risk of clotting. BHF-funded Prof Azfar Zaman at Newcastle university has tested the likelihood of blood clot formation for the new valves and has shown that the clotting risk is comparable to that of the animal-derived valves.
 

trinitymcdermott

Active member
Joined
Mar 15, 2017
Messages
28
Location
Seattle, WA, USA
and won't next time
This is the reason we did not go with a biosprosthetic valve for my 11 year old (he is almost 14 now). Not wanting there to be a next time. The body is only able to safely endure OHS a number of timeS - our cardiologist suggests that number is no more than 3 and then the complication rates get dicey. He had already had one OHS as an infant (transposition of the great vessels). They also understand now that in pediatrics, bioprosthetic valves rapidly calcify and may last 3-5 years rather than the 10-30 adults tend to experience before needing another OHS. When I asked about new technologies coming up within that amount of time (perhaps something transcatheter from the groin or bioequivalent (created from his own bone marrow), his cardiologist said we did not want to hang out hats on future technology as they often take so much longer to come out than we expect and the longevity of the valves will not have been established. Not wanting to go into something that yet another OHS may inevitable..
 

tom in MO

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Jan 17, 2012
Messages
1,511
Location
MO USA
This is the reason we did not go with a biosprosthetic valve for my 11 year old (he is almost 14 now). Not wanting there to be a next time. The body is only able to safely endure OHS a number of timeS - our cardiologist suggests that number is no more than 3 and then the complication rates get dicey. He had already had one OHS as an infant (transposition of the great vessels). They also understand now that in pediatrics, bioprosthetic valves rapidly calcify and may last 3-5 years rather than the 10-30 adults tend to experience before needing another OHS. When I asked about new technologies coming up within that amount of time (perhaps something transcatheter from the groin or bioequivalent (created from his own bone marrow), his cardiologist said we did not want to hang out hats on future technology as they often take so much longer to come out than we expect and the longevity of the valves will not have been established. Not wanting to go into something that yet another OHS may inevitable..
Wise advice and a good chosen path.

I was talking to the head of a group that does testing on new medical treatments and they said that about 80% of the treatments never make it to market, i.e. fail.
 

newarrior

Have mild AS live in Thailand
Joined
Jun 29, 2019
Messages
129
Location
Bangkok, Thailand
I am 58 can't find a girlfriend to save my life...I am more afraid of depression and loneliness than I am of my cardiac conditions...I have been trying to find a partner since 1980..
 
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newarrior

Have mild AS live in Thailand
Joined
Jun 29, 2019
Messages
129
Location
Bangkok, Thailand
@newarrior, is there an opportunity in Thailand to do some volunteer work? Volunteering gives you a chance to think about things other than your problems, lets you meet new people, and is generally considered an attractive attribute by others.
Been volunteering for over 3 years..>Still lonely and close to just ending it all
 

rich01

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Joined
Aug 23, 2018
Messages
350
Location
Virginia US
Been volunteering for over 3 years..>Still lonely and close to just ending it all
Are you familiar with Cognitive Behavioural Therapy (CBT)? You can find a lot of information online, but a good book is Cognitive Behavioural Therapy For Dummies. CBT is loosely based on Stoicism. The basic idea is when your actions don't get you what you want, it is your beliefs that you need to change. That until you change your beliefs, your actions will continue to get the same results.
 

tom in MO

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Joined
Jan 17, 2012
Messages
1,511
Location
MO USA
I agree with dornole. Sounds like you need professional assistance. I know lots of people w/o girlfriends or boyfriends and they do not feel that way. I used to volunteered in a mental hospital for ~20y...there is no shame in needing help.

When it comes to the original topic, you can hire someone to help you out after surgery. You really only need assistance for at most a month.
 

newarrior

Have mild AS live in Thailand
Joined
Jun 29, 2019
Messages
129
Location
Bangkok, Thailand
I have been in counseling over 30 years..Trying a new anti depressant this week..I have tried many..I have what's known as "treatment resistant depression.... I also hate being single but my personality doesn't lend itself to being in a relationship...
 

newarrior

Have mild AS live in Thailand
Joined
Jun 29, 2019
Messages
129
Location
Bangkok, Thailand
Are you familiar with Cognitive Behavioural Therapy (CBT)? You can find a lot of information online, but a good book is Cognitive Behavioural Therapy For Dummies. CBT is loosely based on Stoicism. The basic idea is when your actions don't get you what you want, it is your beliefs that you need to change. That until you change your beliefs, your actions will continue to get the same results.
I have tried CBT for days on end everyday for many months and it hasn't helped...I tried working through David Burns books and worksheets on my own and in conjuction with a therapist as recently as 2018-2019
 

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