Tissue Vs Mechanical

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Jmprosser.lab

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I have my yearly cardio today! Always a creepy, scary day for me. I’m only at the moderate stage(have been here for 4 years) with a 4.0 ascending aorta, but my cardios at Cleveland Clinic and UCLA have always said it could be surgery time in 3years or 10 or 25. Hard to predict.

Was wondering: with the news recently that TAVR is going to start becoming more common, will that eventually effect the choosing of tissue vs mechanical?
 

dick0236

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..........my cardios at Cleveland Clinic and UCLA have always said it could be surgery time in 3years or 10 or 25. Hard to predict.

Was wondering: with the news recently that TAVR is going to start becoming more common, will that eventually effect the choosing of tissue vs mechanical?
Your docs are really hedging their bet:rolleyes: when they say it could be 3 to 25 years 'till you need corrective treatment for your valve issue. If it happens in 3 years todays science probably will play a part in your decision making but if it happens in 25 years todays science will have little, if any, relevance. The good news is that when it happens you will get fixed..........and maybe even cured.
 

Astro

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TAVI's are potentially a game changer by avoiding open heart surgery. The trials so far are promising. Initially they looked at high risk patients (people who have significant medical problems that would make them poor candidates for open heart surgery) and found the TAVI group did at least as well as the open heart surgery group. Next they looked at intermediate risk patients. Once again the TAVI group did at least at well as the open heart surgery group. Earlier this year, two studies were published that looked at low risk patients. The TAVI group did at least as well as the open heart surgery. But...

1) The patients were older than 70 years
2) The patients all had tricuspid aortic valves (bicuspid valves were excluded)
3) The patients only had stenosis, not regurgitation
4) The patients did not have aortic dilatation

If you don't meet the above criteria, it may be that open heart heart surgery is safer. We don't yet know from the studies.

TAVIs have tended to be used in patients where the TAVI is expected to outlive the patient. How long will TAVIs last? As long as tissue valves? Maybe, we don't know yet. What do you when the TAVI wears out? Place another TAVI or then do open heart surgery? Once again, it is not clear from the studies.

Personally I am always a bit wary of shiny new things in medicine. Most of them lose their shine once proper research has occurred. I'll watch the literature with interest. It would be great if more people can avoid open heart surgery. We will see with time.

[B]Jmprosser.lab[/B], I suspect that a TAVI isn't a solution for you (but this might change). I have decided that a TAVI isn't the solution for me but I'll need my surgery a lot sooner than you.
 

Astro

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The question posed didn’t ask about the pros and cons of TAVR, it asked if TAVR would affect future valve choices.
Potentially if TAVR can be given to younger people then by the time this wears out a tissue valve could be used rather a mechanical valve. However, this is presently unproven.
 
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Duffey

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Potentially if TAVR can be given to younger people then by the time this wears out a tissue valve could be used rather a mechanical valve. However, this is presently unproven.
The thread starter posed a “what if” question so all replies are speculative. My reply, if TAVR becomes a viable option but can only be used with tissue valves, then the number of mechanical valves would most likely be reduced.
 

jlcsn2015

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For me the given answer is perfect, for others seems to be an issue that TAVI or not, it will have to be done again, and "for me", thats is the key, and yes Big Pharma is always out there.... always..
 

trinitymcdermott

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Funny, I’m reading this while sitting in a conference listening to interventional cardiologists discuss TAVR’s (etc). 😉
I believe TAVR’s are going the way of the AAA’s, open is becoming the gold standard as we have longer term data showing the safety and efficacy for younger patients (longer life expectancy remaining). Minimal anesthesia, one day hospitalization, next day discharge, minimal disruption on other issue (ex if you have an aortic aneurysm not ready to treat yet).
 

pellicle

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Hi
For me the given answer is perfect, for others seems to be an issue that TAVI or not, it will have to be done again, and "for me", thats is the key, and yes Big Pharma is always out there.... always..
not being sure which given answer did if for you I'll add a few points.
Most of the "noise" in conferences and literature is about hope, and looking for potential, less so about ongoing issues. Most (literaure analyses) focus on 5 or 10 year outcomes. Not 30 or 50 year outcomes. I find this interesting as when I had my homograft (at 28) the literature around that went on to to 29 year followups (starting with patients before me and ending with patients after me).

Some things not mentioned (perhaps because they are assumed common asumptions) is that "you'll be old" and that valve surger is done on the older population. This is largely quite true, but for people like you and I (well who I was) such assumptions are invalid as a premise.

So this then requires one to ask the question "what about longevity" and "what do you do about that replacement". These questions are left over there in the dark corner with the elephant who remains silent (perhaps muzzled?).

Valve in Valve replacement is also done by TAVR but of course comes at a cost of increased complications (over the first TAVR) and reduced valve area (which is a bad thing for anyone who wants to regain their fitness and keep doing **** (cycling, skiing, cross country running ...) but not so much of a problem for the elderly (who may be quite inactive in comparison).

While the surgical techniques will improve the next questions which remains un-addressed is "materials science" ... can we get it to last longer than stuff that was designed for the tips of missiles? (for this is the origins of pyrolytic carbon of which modern mechanical valves are made).

I understand the reasons for wanting a system which reduces the need for AC therapy (notice I wrote reduces) because (from reading here) most people are either 1) trapped in a medical system which ensnares you in the hands of the incompetent 2) due to lifestyle or temperament some (much fewer) are very bad at managing their INR and their drug compliance and come to some (often minor) harm as a result.

So the answer is not straight forward and not without compromise.

Speaking as one who's been through 3 AVR and emerged fine (not without struggle) I can say that knowing all the possible stages for failure along the way that I'm pretty happy to be here and be as healthy as I am (never thought I'd say those words again).

Myself I see many technical advances hold promise and then vanish. Conspiracy is often used to explain that, however a more rigorous examination of why usually shows that "the promise was let down by the details". Remember ... its not just your life you are betting, its your life being healthy (being dead seems to pose little disturbance to the dead).

Best Wishes
 

trinitymcdermott

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I believe TAVR’s are going the way of the AAA’s, open is becoming the gold standard as we have longer term data showing the safety and efficacy for younger patients (longer life expectancy remaining).
EDIT: Meant with AAA’s open surgery is no longer the gold standard as endovascular placement of grafts and treatments of the aneurysms have. Even out longer so they have more experience on how long these will last. Still a 40’year old would be more likely to get an open procedure rather than percutaneous as the expected lifespan is well beyond the length of time we anticipate the graft to last (not saying they need the same amount of time, just enough to reasonably speculate).
 

pellicle

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