Tavr Surgery Decision

[r2abby]

I am a 68yr old having to decide between tavr surgery for replacing my aortic valve or having them do the more traditional surgery. I live along and still work so I thought that the tavr would be better for me but I cant find alot of information on ones done here in the US. I am a veteran and will need to have the surgery done at a Va hospital. The one in Indianapolis said they don't do that type of surgery and suggested that I look into the one in Ann Arbor Mich. Has anyone on had open heart surgery at the Ann Arbor Mich. VA hospital.

 

[Paleowoman]

Have they told you why they suggested TAVR as an option ? Normally that is only done on people too frail to undergo traditional valve replacement surgery. There's not much information on TAVR really as it's only been done so far on frail people who are too ill, it's not being done yet on others so there are no long term studies on it. You probably need a lot more information from your cardiologist and cardiac surgeon.

 

[pellicle]

Hi

I am a 68yr old having to decide between tavr surgery for replacing my aortic valve or having them do the more traditional surgery.

I would only recommend it to someone I hated or despised. The data on recovery and post-operative complications only looks "favourable" when you take into account that the usual recipients are so frail that deaths door is just down the hall. They are using these people (to whom its not unethical) as human lab experiments to develop the technology.

When it becomes main stream AND they solve the problems AND its got a great history then I'd say go for it. To me its like gambling but with a sort of bet that you put down everything you have (thinking of the line from "The Unforgiven" about taking everything he ever had and everything he ever will have) for the remote possibility that you may get "even up" performance with a Tissue Prosthetic and certainly not equal life span to a mechanical.

Always remember that surgeons make money by cutting and doing surgery: its not harmful to them if you need to come back for more. As with all humans, not everyone shares the same ethical value system and there is always a range.

In short: go traditional and stop thinking of this with the sort of logic you would apply to buying a new appliance. Its not about convenience for a few weeks, its about your life.

 

[Fundy]

well the recent Sapien 3 results look good to me. However, if it were me deciding in rather good health, they really haven't been doing this long enough as pellicle mentioned.

For you to even be able to choose this as an option in the US you would need to be high risk or maybe approved for an intermediate risk trial. Or maybe there is a TAVR approved in the intermediate risk level.

The one year mortality comparison in the Sapien 3 high risk study is less than 9% versus an almost 25% for standard surgery. So that looks appealing from that standpoint.
http://www.invasivecardiology.com/n...alve-demonstrate-high-survival-and-low-stroke

The 30 day outcome press release regarding the same Sapien 3 valve looks very good to me as well.
http://www.tctmd.com/show.aspx?id=128229

If I were high risk facing a 25% mortality rate with standard surgery anyway, I'd probably actually choose the TAVR option. But as i mentioned, in good health I'd rather go the with the standard surgery.

 

[honeybunny]

Firstly, thank you for your service. My brother is a Viet Nam vet and uses the VA in Brooklyn for a number of problems. In my opinion, our vets are treated shamefully and I'm sorry they are not helping you get more information. If the VA is your only option, I'd recommend sticking close to home and going with traditional and not wear yourself out emotionally and physically investigating a procedure that you probably won't be qualified to undergo. I had my surgery last week. I'm 61, a 44-year smoker (quit in March) who is in fair health and I've done great with the traditional surgery. Find local doctors you feel good about and let them take care of you. Wishing you the best.

 

[dornole]

It doesn't seem to make sense that TAVR is MORE dangerous than open heart surgery, but for now, it is for most. So they only do it on people who are too frail to survive open heart. That probably ain't you if you're still working? I'm kinda surprised your doc told you to ask Ann Arbor.

 

[Zoltania]

Being concerned about the effects of surgery when you live alone is very understandable. I was worried about that for myself too, but found that my out-of-town loved ones were more than willing to come and stay with me for a while. It turned out that my friends were also champions and really came through to help me with rides, meals, or anything else I needed. You might be surprised at how willing people are to help. There is also the option of staying in a rehab center for the transition from hospital to home if you can't get any live-in help at home.

If you search the archives, you'll find other discussions of living alone and recovering from surgery, including this one:

http://www.valvereplacement.org/for...12-home-alone-how-much-help-did-you-have-need

Hopefully you will be able to choose the best surgical option for you without needing to consider your living situation.

 

[epstns]

I think if you're otherwise in decent health, I would most definitely go the traditional open-heart surgery. We're about the same age, and if I was in need of a valve, I would do that. I would probably choose a tissue valve (at age 68, the docs would probably offer that first) rather than a mechanical, but either is a good choice if it is right for you and your lifestyle. I would not go the TAVR unless you fit the other typical (in the US) criteria of being too frail to handle the traditional surgery. The promise of faster recovery may be so, but there is also the unknown of the potential after-effects of the TAVR (more likelihood of clots, strokes, valve failure, etc.) to me would over-shadow the faster recovery. Recovery from traditional open heart surgery is not trivial, but even people much older are going through it all the time.

I'm glad you've found us to come and ask questions. We can probably help you to make the decisions that will be best for you. Thank you for your service to our country, for it is people like you who have kept our lives secure for generations.

 

[almost_hectic]

As I understand it, if youre in otherwise decent health you will not be given the choice. Healthy patient get the open heart surgery as TAVR is only for the frail and weak who couldnt survive OHS. TAVR is an amazing step in the right direction but its still not the best course of action aparently is thats the view of the medical community. Otherwise nobody would be cut open.

 

[Duffey]

I think almost_hectic is correct with his reply. I have a friend, who was almost 80 when it was time for avr, and she was told she was not a candidate for TAVR. Her health was determined to be too good. She had traditional avr and has recovered completely. Were you offered the option by your surgeon?