TAVR/TAVI: Recall of SAPIEN 3 Ultra Delivery System Due to Burst Balloons During Surgery

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hx77

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I have only had my bovine since February, but it is fine and I am really glad. I am 56. I had minimally invasive surgery so no cracking the breast bone. I just do not understand why this is not more readily available to people.
Hi, Thank you for mentioning minimal invasive surgery. I am also very interested in it but I haven't found a lot of information. Do you mind sharing your surgeon's name?

Any known cons of a minimal invasive AVR?

John
 

Protimenow

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A 'minimally invasive AVR' is probably a TAVI - transcatheter aortic valve implantation. This is a tissue valve. The length of time that a TAVI/TAVR 'valve replacement' will last before it fails is still somewhat unknown, and, at this time, probably hard to predict. There's no long-term history for these valves.

If they have to replace a TAVI with another TAVR, the size of the replacement will be smaller - reducing the blood flow through the aorta. It's possible that, some time in the future, they may develop better valves or procedures - but who knows how long this would take to develop. Will a better alternative become available before yours fails? I don't think I would bet MY life on it.

I'm sure that, although the procedure is less invasive, it also comes with risks. Surgical errors, implantation device problems, early rejection and other issues should probably be checked out. Ask your surgeon for her opinion. Do as you've done here -- try to get as much information as you can.

Getting a TAVI/TAVR isn't as simple as getting a tooth pulled - they don't crack your chest to do it, but I'm sure that there's still a fair amount of recovery time (I haven't had this myself).

So - what do the doctors on this forum think? Am I wrong? What do you see as possible negatives?

John and I would like to know.
 

AnnieP

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I have noticed increased SOB last 12 months and ai
@hx77
I second this

sure you will also get the possibilities of complexity of management of INR and compounding influences of other drugs, but this will most likely represent less difficulty than all the follow up sessions with your cardio as the tissue valve inevitably collapses (because Structural Valve Degradation is not linear and so will be monitored more closely as it comes).

Then you have the issues surrounding the valve replacement. If you are luck it goes though no problems.

Some alternative views to ponder, think of questions to ask and ask them until you are satisfied.
I think the basis of metal verses age comes down to informed choice/ consent the pro’s cons of each side effects ( including those of warfarin). What happens if I do have this procedure? What happens if I decline and what alternatives are there ? Certainly in N Z this is the underlying premise of our Health and disability commission.
I was 50 and after considering my life style ( on call community midwife and my passion diving ) warfarin was off the list so a composite was the only other option. Now 11 years down the track so far so good 😊 but it may well have gone belly up but I was informed and you live with choices you make.
 

rich01

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A 'minimally invasive AVR' is probably a TAVI - transcatheter aortic valve implantation. This is a tissue valve. The length of time that a TAVI/TAVR 'valve replacement' will last before it fails is still somewhat unknown, and, at this time, probably hard to predict. There's no long-term history for these valves.
TAVR and minimally invasive surgery are 2 different things. With minimally invasive surgery, they are able to go between the ribs to operate on the heart. Minimally invasive surgery for valve replacement requires heart/lung machine.
 
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pellicle

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Hi

I think the basis of metal verses age comes down to informed choice/ consent
Im not entirely sure what you mean bu metal, but if you mean the pyrolytic carbon valves of today ...?

the pro’s cons of each side effects ( including those of warfarin). What happens if I do have this procedure? What happens if I decline and what alternatives are there ?
Agreed, sadly thr information there is usually lacking badly...

( on call community midwife and my passion diving ) warfarin was off the list
Interesting, why?

None the less, informed patient decision is exactly the goal and ee all have to live with the decisions we make. That said decisions are vexed in my view reflects how good both choice outcomes are.
 
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Paleowoman

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TAVR and minimally invasive surgery are 2 different things. With minimally invasive surgery, they are able to go between the ribs to operate on the heart. Minimally invasive surgery for valve replacement requires heart/lung machine.
Minimally invasive surgery is also how "mini-sternotomy" (approx 4 inch sternotomy instead of full length) is described. So minimally invasive can either be between the ribs or a shorter sternotomy incision. Either way it's open heart surgery and heart lung machine the same as a full sternotomy, and really quite invasive, though I understand that the between the ribs incision has a quicker recovery since bone isn't cut.
 
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Paleowoman

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Wrong on all counts on the "minimally invasive" procedure. No mini-sternotomy.
In the UK the "minimally invasive" procedure can be either a mini-sternotomy or a through the ribs incision. Both require the patient to be on bypass/heart lung machine. But here from the Annals of Cardiac Surgery: http://www.annalscts.com/article/view/5476/6298 though I've seen some US sites explaining the same. Certainly, though, a between the ribs procedure sounds less invasive as bone isn't cut.
 
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Much less invasive. You are on bypass, but a very short time and through the groin incision which is also small. I actually went back to work 8 days post op. Not that it was easy, but so much easier than the traditional procedures. Dr. Doolahb has an incredible success rate and I guess I just really want others to have the chance to have this procedure. He sees people from out of the area all the time, but so few even know this is an option.
 

Keithl

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The surgeons I talked discouraged even the mini-sternum cut as it cuts down on their visibility, so going between the ribs for valve replacement seems like too much risk. Watch OHS on you tube and you can see all the advantages of having an open enough space to work. When I went to Cleveland Clinic they wanted to do full crack and I let them, at that point your sternum being split open 4 inch valve 8-10 is probably not a huge difference on recovery.
 

Keithl

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Much less invasive. You are on bypass, but a very short time and through the groin incision which is also small. I actually went back to work 8 days post op. Not that it was easy, but so much easier than the traditional procedures. Dr. Doolahb has an incredible success rate and I guess I just really want others to have the chance to have this procedure. He sees people from out of the area all the time, but so few even know this is an option.
Kudos to him, and congrats to you, but not sure I would risk it.
 
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The success rate is great. He is in the top 3% of CV surgeons in the US. I just want people to know that this is an option. I am not trying to "sell" anything. LOL. It is less risky.
 

rich01

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For the most part, the medical field is slow to change - unless it pays better than current practices!
 

Protimenow

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Rich01 - I hear you. Yes, slow to change. It's often about the money.
Doctors seem to be comfortable with what they learned when in Medical School, however long ago that is.

Continuing Medical Education (CME), to some, seems to be a necessary evil in order to maintain their licenses and to stay in good standing with whatever organizations they belong to.

As long as a doctor keeps up with the CME requirements, and does what is needed to maintain his or her license, (s)he can keep practicing. I personally know of a doctor who is in his late '80s and still practicing. (He's probably not performing many difficult procedures, referring those that he can't do to others, but most likely still capable of the basic Primary Practice stuff - and he probably keeps up with the journals, too. But I think he may be something of an exception).

Learning a new procedure takes time, effort, and the ability to continue to learn. It also, often, takes peer pressure to force a change.

I'm not trying to indict all medical professionals - it would be good to get a responses from the M.D.s on this site.
 

jlcsn2015

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Also, repeat procedures makes them more money, reccurent revenues is the motto of business entities...
 

nobog

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Also, repeat procedures makes them more money, reccurent revenues is the motto of business entities...
Being "in the business" I can assure you that is not the attitude, nor the mantra of the company. A surgeon would prefer to never see you again. We are dealing with what is "state of the art" when it comes heart valve prosthesis and implant procedures - still, they are not perfect. Although now considered commonplace, a valve replacement, in my opinion, is really a modern marvel, of which millions have benefited to lead a more normal life.
 

hx77

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Go to UTSW - Dr. Doolahb and you will find the info. He said he can do this procedure for almost anybody:
Thanks for the information! I will follow up your lead. Do you know any drawbacks of minimal invasive AVR?

Is minimal invasive (or robotic assisted) CABG more complicated than minimal invasive AVR? The reason I asked is because 2 years ago one surgeon told me he would not do minimal invasive (or robotics assisted) on me for both AVR+ CABG. I just checked his profile and found minimal invasive AVR (but not CABG) is listed as his interest. Since I talked to that surgeon, I received a PCI procedure so for now I only need AVR. I will call to schedule an appointment with that surgeon Monday.
 
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If you can email me I can give you the email for his nurse and she will be happy to see if you are a candidate. Is there a way to do that privately? They looked at my echo via email when I started my journey...
 
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