Valve progression, pre and post op prep, valve selection, timelines

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newarrior

I have mild moderate Aortic Stenosis live Bangkok
Joined
Jun 28, 2019
Messages
526
Location
Bangkok Thailand
Dear All,

I hope all is well.

I have 3 sets of questions so please bear with me)

May 2019 Vmax 3.11 mean PG 22.69
May 2020 Vmax 3.37 mean PG 26.09
Nov 2020 Vmax 3.47 Vmax Mean 28.87

LVEF 70-75%

I am just learnng to interpret echoes.

1) I just came back from a new doctor in Bangkok; they looked at
my 3 echoes since my calcified aortic stenosis was found in May 2019;
they are saying VMAX is the best way to assess progression.
Normal progression rate is .3 a year and when you get to 4.0 then it's
considered severe. They said my progression is rapid, more than normal
and that I will be at severe in 1-2 years and need surgery 2-3 years after that.
Please look at my echoes and let me know further thoughts).

2) Can anyone detail the process from start to finish relating to aortic valve
replacement i.e pre op prep, op, post op prep and complications post op or op and what happens post op ?
What if you are flying 100% solo; what kind of help does one need at home post op ?

3) If one had AVS around age 60 mechanical or non ? TAVI/TAVR or OHS ?
How long do non mechanical valves last ? How bad is the ticking/warfarin with
mechanical ? I am vegan for my heart and my diet is largely made up of greens; does taking
warfarin really exclude greens ?

Complicating all this is living overseas without cardiac coverage; insurance in Thailand
can and will exclude PRE EXISTING i.e. cardiac conditions. Being utterly alone and single AND facing a potential
complete restart in the states at age 58 and all the grief of leaving everything behind in Asia
+ having to deal the with the hassles of restarting from ZERO in the USA at age 58.

Sorry for the long winded email. I have decisions I need to make quickly before my health falters
which will limit my ability to make drastic change.

I love Thailand and Asia but I have concerns about staying here especially if I can't get partial
or full cardiac coverage. The cardiac care is good for OHS but not as good for TAVI/TAVR.

Thanks for your thoughts and prayers.

Blessings to all of you.

Dave Pearl
 

Attachments

  • EchoBumMay2019.pdf
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  • EchoBumMay2020.pdf
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  • EchoBumNov2020.pdf
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Last edited:

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
1,643
Dear All,

I hope all is well.

I have 3 sets of questions so please bear with me)

May 2019 Vmax 3.11 mean PG 22.69
May 2020 Vmax 3.37 mean PG 26.09
Nov 2020 Vmax 3.47 Vmax Mean 28.87

LVEF 70-75%

I am just learnng to interpret echoes.

1) I just came back from a new doctor in Bangkok; they looked at
my 3 echoes since my calcified aortic stenosis was found in May 2019;
they are saying VMAX is the best way to assess progression.
Normal progression rate is .3 a year and when you get to 4.0 then it's
considered severe. They said my progression is rapid, more than normal
and that I will be at severe in 1-2 years and need surgery 2-3 years after that.
Please look at my echoes and let me know further thoughts).

2) Can anyone detail the process from start to finish relating to aortic valve
replacement i.e pre op prep, op, post op prep and complications post op or op and what happens post op ?
What if you are flying 100% solo; what kind of help does one need at home post op ?

3) If one had AVS around age 60 mechanical or non ? TAVI/TAVR or OHS ?
How long do non mechanical valves last ? How bad is the ticking/warfarin with
mechanical ? I am vegan for my heart and my diet is largely made up of greens; does taking
warfarin really exclude greens ?

Complicating all this is living overseas without cardiac coverage; insurance in Thailand
can and will exclude PRE EXISTING i.e. cardiac conditions. Being utterly alone and single AND facing a potential
complete restart in the states at age 58 and all the grief of leaving everything behind in Asia
+ having to deal the with the hassles of restarting from ZERO in the USA at age 58.

Sorry for the long winded email. I have decisions I need to make quickly before my health falters
which will limit my ability to make drastic change.

I love Thailand and Asia but I have concerns about staying here especially if I can't get partial
or full cardiac coverage. The cardiac care is good for OHS but not as good for TAVI/TAVR.

Thanks for your thoughts and prayers.

Blessings to all of you.

Dave Pearl
Hi Newarrior,
I will just address #1. Honestly, you appear to be a ways off of surgery, so I think you are worrying about things that you don't need to worry about yet for #2 and 3, which is just clouding things. Just my view.

Looking at your numbers again, I have to question your doctor's math. .3 m/s progression per year is normal and by my calculation, your Vmax is progressing slower than normal.

May 2020 to Nov 2020: 3.37m/s to 3.47 m/s. This is only .1 m/s over a 6 month period and if you annualize this rate it is only .2 per year. This is less than normal progress.

May 2019 to Nov 2020. So if you take the past 18 months, normal expected would be .3 m/s progression x 1.5 = .45m/s progression. However, yours went from 3.11m/s to 3.47m/s, for a change of only .36m/s, less than would be expected.

Maybe work out the math yourself, as I have done above and have another discussion with your doctor and ask why he would call this rate of progression rapid. I really don't see what he is talking about. Of course, I am not qualified to interpret echos, but just using basic math I am not seeing your rate of Vmax progression as above normal, but actually below normal.
 

epstns

Premium User
Supporting Member
Joined
Dec 26, 2002
Messages
5,186
Location
Chicago area
I can speak a bit to item number 3.

I was 52 when diagnosed, and I was able to drag things out until surgery at age 63. I'm now 73, and doing fine.

When I began planning surgery, IIRC, they were using similar guidelines for valve selection, with slightly different cut points, e.g. younger than 65 gets mechanical, older gets tissue. That was because at the time, the available data indicated that patients younger than 65 experienced faster deterioration of the then-available tissue valves, to they advised mechanical for them. I was just a bit younger, but discussed things with my surgeon and we decided to go with the Edwards Bovine Pericardial tissue valve. Our thinking at the time was that the valve I received was of a brand new generation, and these valves were projected to have a longer service lifespan than any previous generation of tissue valves, and that I "might" make it through to the end without a second replacement. In addition, we knew of the early tests of TAVR (remember, my valve was implanted in 2011), so we just kept that as a "well. . . maybe" for the potential need for a re-op. We were not planning on it, but I did decide back then that if I must endure another replacement, so be it. I made it through the first, albeit with plenty of complications, so I can do it again. We also joked that if I didn't make it, I would never realize it. . .

Another part of my tendency to choose a tissue valve was a personal aversion to anti-coagulation therapy, which at the time was limited to warfarin, and self-testing was not widely in use yet, so periodic clinic visits were needed. I helped my mother deal with warfarin for a number of years (different reason), so I had some understanding of life with it, and given that I had a choice, I took the tissue valve.

I can't really say much about the sound of the valve, as I have no personal experience with them. I had a number of friends (from the earlier gang at vr.com) who have mechanical valves, and almost nobody found the sound to be life-changing. Many had funny stories about hearing the sound or having others hear the sound and ask things like "Who's wearing that cheap wristwatch?" and maybe one person said it made it hard for them to sleep, but by and large, everyone just got used to it and got on with life.

As a side note, part of my decision to choose the Edwards valve was because my surgeon was a member (may have been leader) of the development team that designed that valve, and he had implanted more of them than any other surgeon in the country at that time. I figured that if he felt it was a good choice for me, who was I to disagree? He and I did disagree on some things, but not on my valve choice.

I should also mention that at my annual echo last month, the report indicated that my valve is functioning as always, with statistics very close to those at time of implant. I think this one is a keeper.
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
1,643
I can speak a bit to item number 3.

I was 52 when diagnosed, and I was able to drag things out until surgery at age 63. I'm now 73, and doing fine.

When I began planning surgery, IIRC, they were using similar guidelines for valve selection, with slightly different cut points, e.g. younger than 65 gets mechanical, older gets tissue. That was because at the time, the available data indicated that patients younger than 65 experienced faster deterioration of the then-available tissue valves, to they advised mechanical for them. I was just a bit younger, but discussed things with my surgeon and we decided to go with the Edwards Bovine Pericardial tissue valve. Our thinking at the time was that the valve I received was of a brand new generation, and these valves were projected to have a longer service lifespan than any previous generation of tissue valves, and that I "might" make it through to the end without a second replacement. In addition, we knew of the early tests of TAVR (remember, my valve was implanted in 2011), so we just kept that as a "well. . . maybe" for the potential need for a re-op. We were not planning on it, but I did decide back then that if I must endure another replacement, so be it. I made it through the first, albeit with plenty of complications, so I can do it again. We also joked that if I didn't make it, I would never realize it. . .

Another part of my tendency to choose a tissue valve was a personal aversion to anti-coagulation therapy, which at the time was limited to warfarin, and self-testing was not widely in use yet, so periodic clinic visits were needed. I helped my mother deal with warfarin for a number of years (different reason), so I had some understanding of life with it, and given that I had a choice, I took the tissue valve.

I can't really say much about the sound of the valve, as I have no personal experience with them. I had a number of friends (from the earlier gang at vr.com) who have mechanical valves, and almost nobody found the sound to be life-changing. Many had funny stories about hearing the sound or having others hear the sound and ask things like "Who's wearing that cheap wristwatch?" and maybe one person said it made it hard for them to sleep, but by and large, everyone just got used to it and got on with life.

As a side note, part of my decision to choose the Edwards valve was because my surgeon was a member (may have been leader) of the development team that designed that valve, and he had implanted more of them than any other surgeon in the country at that time. I figured that if he felt it was a good choice for me, who was I to disagree? He and I did disagree on some things, but not on my valve choice.

I should also mention that at my annual echo last month, the report indicated that my valve is functioning as always, with statistics very close to those at time of implant. I think this one is a keeper.
Steve,
thank you for sharing your story. I am so glad that your biological valve is working for you. It sounds like it is the right choice in your situation. I am also glad that you were able to delay valve surgery as long as you did. I had a choice to make and decided to get mine once I had crossed into the severe category. My stenosis is progressing at a rapid pace. When I graph out the four metrics used to grade severity, I end up going from severe to critical or near critical within 6 months from now. Fantastic news that you had such a robust recovery and, presumably, reverse engineering of the structural changes that happened to your heart under the extreme pressures of severe stenosis. For me, I am opting to get the surgery now, as I have concerns that I might be one of the ones for whom structural damage does not reverse. If I thought that I could stay here in severe for 10 or 11 years without irreversible damage, I would do so, but I'm choosing to get the surgery now while the structural damage is minimal.
Please keep coming with the updates. Hopefully your biological valves is one of the ones that lasts 20+ years.
 

newarrior

I have mild moderate Aortic Stenosis live Bangkok
Joined
Jun 28, 2019
Messages
526
Location
Bangkok Thailand
I can speak a bit to item number 3.

I was 52 when diagnosed, and I was able to drag things out until surgery at age 63. I'm now 73, and doing fine.

When I began planning surgery, IIRC, they were using similar guidelines for valve selection, with slightly different cut points, e.g. younger than 65 gets mechanical, older gets tissue. That was because at the time, the available data indicated that patients younger than 65 experienced faster deterioration of the then-available tissue valves, to they advised mechanical for them. I was just a bit younger, but discussed things with my surgeon and we decided to go with the Edwards Bovine Pericardial tissue valve. Our thinking at the time was that the valve I received was of a brand new generation, and these valves were projected to have a longer service lifespan than any previous generation of tissue valves, and that I "might" make it through to the end without a second replacement. In addition, we knew of the early tests of TAVR (remember, my valve was implanted in 2011), so we just kept that as a "well. . . maybe" for the potential need for a re-op. We were not planning on it, but I did decide back then that if I must endure another replacement, so be it. I made it through the first, albeit with plenty of complications, so I can do it again. We also joked that if I didn't make it, I would never realize it. . .

Another part of my tendency to choose a tissue valve was a personal aversion to anti-coagulation therapy, which at the time was limited to warfarin, and self-testing was not widely in use yet, so periodic clinic visits were needed. I helped my mother deal with warfarin for a number of years (different reason), so I had some understanding of life with it, and given that I had a choice, I took the tissue valve.

I can't really say much about the sound of the valve, as I have no personal experience with them. I had a number of friends (from the earlier gang at vr.com) who have mechanical valves, and almost nobody found the sound to be life-changing. Many had funny stories about hearing the sound or having others hear the sound and ask things like "Who's wearing that cheap wristwatch?" and maybe one person said it made it hard for them to sleep, but by and large, everyone just got used to it and got on with life.

As a side note, part of my decision to choose the Edwards valve was because my surgeon was a member (may have been leader) of the development team that designed that valve, and he had implanted more of them than any other surgeon in the country at that time. I figured that if he felt it was a good choice for me, who was I to disagree? He and I did disagree on some things, but not on my valve choice.

I should also mention that at my annual echo last month, the report indicated that my valve is functioning as always, with statistics very close to those at time of implant. I think this one is a keeper.

Steve--never heard that those under 65 burn through non mechanical valves faster--is there a reason for this ? So you are in 10 years and the valve is good ? Expecting another OHS ? Or just do TAVI/TAVR if needed ? How are your other valves ? heart ? Diet ? Meds ? Exercise ? Lipoprotein Lp(a) levels ? What was recovery like ?
 

epstns

Premium User
Supporting Member
Joined
Dec 26, 2002
Messages
5,186
Location
Chicago area
@Chuck C , you seem to be very data driven. That is usually a good thing here, as much of the science of heart repair is planned and managed with data. The only caution I will offer right now is that the history of your valve progression is not totally reliable in planning the future. We have a saying here that goes something like "The worse a valve gets, the faster it gets worse." Not wanting to scare you, but just to say that you are probably well advised to act sooner, rather than later, as your projections are quite possibly nearer the best case, not the most likely case.

@newarrior , the comments I make about "younger" patients (at the time of my surgery, they were considered those under 65) relate to the fact that younger patients have much more active immune systems, and the mechanism that attacks the tissue prosthetic valves is believed to be an immune reaction. The patients having stronger immune reactions will attack a tissue valve more vigorously, thus causing it to deteriorate faster.

Now, that may well be "old thinking" as it dates back to time before my valve was produced. My valve is considered to be a "third generation" tissue valve. The "under 65" grouping was the thinking that was prevalent through generations 1 and 2. Each successive generation was/is expected to have a longer service life span, so for my third generation valve, they were more than willing to stretch things and implant mine. IIRC, at the time of my surgery, they were "hoping" for service life spans of 15-25 years for the third generation valves. I haven't looked to see the current statistics, as for me, the choice was made 10 years ago.

I haven't made any plans for when/if my valve needs to be replaced again. I think that will depend upon my age, life expectancy and health/strength at the time, along with the state of TAVR success, longevity, etc. When I initially chose the tissue valve, my surgeon and I discussed the (then) "new" possibility for TAVR, and decided not to depend upon that to make the tissue choice work for me. I decided back then that if I did need another conventional replacement, so be it. And, if TAVR did become a viable option, so much the better. I don't think my mindset has changed so far.

As for my general health now, certainly not perfect. I have several concurrent conditions, all (fortunately) are currently under control. I have had IBS for 20 years of more. Controlled with diet and meds. I have had prostate cancer, which was treated (successfully) with radiation. I have high blood pressure, high cholesterol and some afib. I've also, as I mentioned, had a pacemaker since valve surgery. This may all sound like a train wreck, but every time I see my PCP, he always says "For your age and history, you're a remarkably healthy man." I am typically in the gym 5 or 6 days a week doing free weights (low weight, high reps) and cardio (treadmill) for an hour or so a day. I was a recreational runner/jogger for over 30 years until the beta blockers were prescribed (just after surgery), after that I can't get my maximum heart rate up high enough to support running. I just "power walk" now at a 15 min/mi pace. I can do that for miles, so I guess at age 73 I should be happy.

My wife says I take too many pills (some are prescription, some supplements), but I manage fine. Diet is low fat (for the last 35 years), low sodium (for the last 21 years), with conscientious portion control. I'm small (5'8" tall) and my maximum weight about 5 years ago was 172 lbs. Now, I'm back down around 150.

To avoid letting this post turn into a book, I'll simply say that my recovery was a train wreck. I was the poster child for post-op complications, but I was determined that those were not going to define my life. If you have the patience, you can probably still find my posts from around March through June of 2011, when I was making my way through it all. If you can't find them, PM me and I can try to fill you in.
 
Last edited:

newarrior

I have mild moderate Aortic Stenosis live Bangkok
Joined
Jun 28, 2019
Messages
526
Location
Bangkok Thailand
@epstns Sorr
@Chuck C , you seem to be very data driven. That is usually a good thing here, as much of the science of heart repair is planned and managed with data. The only caution I will offer right now is that the history of your valve progression is not totally reliable in planning the future. We have a saying here that goes something like "The worse a valve gets, the faster it gets worse." Not wanting to scare you, but just to say that you are probably well advised to act sooner, rather than later, as your projections are quite possibly nearer the best case, not the most likely case.

@newarrior , the comments I make about "younger" patients (at the time of my surgery, they were considered those under 65) relate to the fact that younger patients have much more active immune systems, and the mechanism that attacks the tissue prosthetic valves is believed to be an immune reaction. The patients having stronger immune reactions will attack a tissue valve more vigorously, thus causing it to deteriorate faster.

Now, that may well be "old thinking" as it dates back to time before my valve was produced. My valve is considered to be a "third generation" tissue valve. The "under 65" grouping was the thinking that was prevalent through generations 1 and 2. Each successive generation was/is expected to have a longer service life span, so for my third generation valve, they were more than willing to stretch things and implant mine. IIRC, at the time of my surgery, they were "hoping" for service life spans of 15-25 years for the third generation valves. I haven't looked to see the current statistics, as for me, the choice was made 10 years ago.

I haven't made any plans for when/if my valve needs to be replaced again. I think that will depend upon my age, life expectancy and health/strength at the time, along with the state of TAVR success, longevity, etc. When I initially chose the tissue valve, my surgeon and I discussed the (then) "new" possibility for TAVR, and decided not to depend upon that to make the tissue choice work for me. I decided back then that if I did need another conventional replacement, so be it. And, if TAVR did become a viable option, so much the better. I don't think my mindset has changed so far.

As for my general health now, certainly not perfect. I have several concurrent conditions, all (fortunately) are currently under control. I have had IBS for 20 years of more. Controlled with diet and meds. I have had prostate cancer, which was treated (successfully) with radiation. I have high blood pressure, high cholesterol and some afib. I've also, as I mentioned, had a pacemaker since valve surgery. This may all sound like a train wreck, but every time I see my PCP, he always says "For your age and history, you're a remarkably healthy man." I am typically in the gym 5 or 6 days a week doing free weights (low weight, high reps) and cardio (treadmill) for an hour or so a day. I was a recreational runner/jogger for over 30 years until the beta blockers were prescribed (just after surgery), after that I can't get my maximum heart rate up high enough to support running. I just "power walk" now at a 15 min/mi pace. I can do that for miles, so I guess at age 73 I should be happy.

My wife says I take too many pills (some are prescription, some supplements), but I manage fine. Diet is low fat (for the last 35 years), low sodium (for the last 21 years), with conscientious portion control. I'm small (5'8" tall) and my maximum weight about 5 years ago was 172 lbs. Now, I'm back down around 150.

To avoid letting this post turn into a book, I'll simply say that my recovery was a train wreck. I was the poster child for post-op complications, but I was determined that those were not going to define my life. If you have the patience, you can probably still find my posts from around March through June of 2011, when I was making my way through it all. If you can't find them, PM me and I can try to fill you in.

Good jobs in regards to having a partner and taking care of your health mate. I am only in my 50's but have tons of issues as well some going back to my 30s even though I have been a fanatic on my health. thanks for the under 65 data. Seems as if anyone gets a valve under 65 metal is the way to go so as to avoid a 2nd OHS. I am about 5 8 5 9 but down to 160 due to Esselstyn vegan diet which also got rid of hypertension and has kept my heart healthy.. Why the pacemaker post OHS ? Any suggestions pre and post op if flies 100% solo ? I am overseas no partner etc etc so dangerous deal-may have to start from ZERO at age 58 in USA soon which I dread
 

epstns

Premium User
Supporting Member
Joined
Dec 26, 2002
Messages
5,186
Location
Chicago area
My pacemaker became a necessity immediately post-op due to intra-operative damage to the nerve bundle that "connects" my atria to my ventricles. This bundle transmits the "beat" pulse from the top of my heart to the bottom. . . until surgery. During surgery for aortic valve replacement, in a small percentage of patients (@pellicle - do you have a citation?), the nerve bundle runs too close to the area the surgeon needs to cut out to replace the valve, and the nerve conductivity is damaged or lost. In my case, my native valve was heavily calcified, and the surgeon had to "cut wide" to get it out. The replacement went in just fine, but the nerve conductivity became sporadic. I had a few days of random heart rate and rhythm problems immediately post op, including lengthy periods of time when my heart would just stop. Believe me, it is not cool to be laying in bed, looking at your own monitor, and to see it go "flat line." That happened to me numerous times. Each time I would go "lights-out" and then, 20-30 seconds later, I would awaken to see a whole crowd of very concerned looking docs and nurses looking down at me. My surgeon said "These things usually resolve in a couple of days." The electrophysiologist said "We can often control these things with meds, within a week or two, probably in hospital. . . or we can implant a pacemaker." I simply asked him "Do you have a pacemaker on hand?" "Yes." "What are we waiting for?" My mother had a pacemaker (for a different reason) and it was a non-issue for her, so I just went with it. Haven't regretted my choice, even though surgeon was not happy because I then counted as a "post-op complication." I just wanted to get back to my life, and I have.
 

pellicle

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Messages
10,262
Location
Queensland, OzTrayLeeYa
Hey

uring surgery for aortic valve replacement, in a small percentage of patients (@pellicle - do you have a citation?), the nerve bundle runs too close to the area the surgeon needs to cut out to replace the valve

this one seems to simply be cited by 60 other papers, its old and I think that given the evidence nobody has done significant further research (there may be some meta-analysis), but the theory is sound and I don't think anyone wants to be part of a "controlled study"


Its been discussed here a bit (including by me) and given its proximity its a stand out feature for damage in reops (well hidden by) where scar tissue is going to make it tricky to access.

I genuinely don't believe many (I can think of one or two exceptions) of the readership of this forum truly understand what scar tissue is beyond seeing it on the surface. Few now have done any "dressing" of an animal (Julien Du was an exception) to understand what a surgeon confronts.

However this is good reading to understand the anatomy

PS: this shows the relationship between those nerve clusters (nodes)
 

pellicle

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Messages
10,262
Location
Queensland, OzTrayLeeYa
also @epstns

This link (according to google) suggests the following:
The reported incidence of permanent pacemaker im- plantation after rAVS in literature is between 10% and 26% [5, 8, 17, 19]. Postoperative pacemaker implantation was indicated in 22.6% (n 35) of our patients and 20 of these (57.1%) suffered from prosthetic valve endocarditis​

where rAVS = redo Aortic Valve Surgery.

Bottom of page 1123 has an interesting figure:

1615593444461.png


I suppose when ranked on a log scale its looking less significant, but to my reading its not insignificant...

I'm quite sure I've been quite lucky with my history (not without capricious luck to balance it overall however)
 
Last edited:

MdaPA

Well-known member
Joined
Jul 8, 2020
Messages
269
The replacement went in just fine, but the nerve conductivity became sporadic. I had a few days of random heart rate and rhythm problems immediately post op, including lengthy periods of time when my heart would just stop. Believe me, it is not cool to be laying in bed, looking at your own monitor, and to see it go "flat line." That happened to me numerous times. Each time I would go "lights-out" and then, 20-30 seconds later, I would awaken to see a whole crowd of very concerned looking docs and nurses looking down at me. My surgeon said "These things usually resolve in a couple of days."
The same thing happened after my wife's 2nd OHS to replace her MV (but not for her 1st and 3rd OHS). Her heart rate would drop too low, the alarms/bells would go off and everyone would come rushing in to the room. The temp pacemaker would then kick-in and bring her heart rate back-up to normal. Quite a scary thing!

They said, in simple terms, the hearts electrical system had to form a "new path" and that it normally takes a few days to resolve itself. If not, she would need a permanent pacemaker. It did clear up in a few days as they said. The very first night the temp pacemaker did not kick-in, the following day they removed it and discharged her. It was a bit scary as we would have like her to stay a few more days to make sure she truly didn't need it!

Also wondering why she didn't experience this again after her 3 OHS to replace 3 valves (AV, PV and MV)?

Do you know if your pacemaker has kicked-in and/or is pacing you heart now? i.e. did your heart find a new path by now?
 

Chuck C

Well-known member
Joined
Dec 5, 2020
Messages
1,643
also @epstns

This link (according to google) suggests the following:
The reported incidence of permanent pacemaker im- plantation after rAVS in literature is between 10% and 26% [5, 8, 17, 19]. Postoperative pacemaker implantation was indicated in 22.6% (n 35) of our patients and 20 of these (57.1%) suffered from prosthetic valve endocarditis​

where rAVS = redo Aortic Valve Surgery.

Bottom of page 1123 has an interesting figure:

View attachment 887625

I suppose when ranked on a log scale its looking less significant, but to my reading its not insignificant...

I'm quite sure I've been quite lucky with my history (not without capricious luck to balance it overall however)
" I suppose when ranked on a log scale its looking less significant, but to my reading its not insignificant.. "

I would agree that it is not insignificant. In fact, it looks pretty darn significant to me. It is on a similar scale to saying there is no significant difference between 5 inches and 7 inches. It occurs to me that only someone who wants the lines to be blurred would come to such a conclusion with those statistics. I have found when I look at the studies that say "no significant difference" between mechanical and biological long term outcomes, it is almost always, if not always, funded by a party that has a vested interest in having blurred lines.

It looks like there is about 18% difference in survival between biological and mechanical in the study you reference above. 96 folks in the biological group group. 18% of 96 is about 17. I bet the difference feels pretty significant to the families of those 17 individuals.
 
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pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
10,262
Location
Queensland, OzTrayLeeYa
" I suppose when ranked on a log scale its looking less significant, but to my reading its not insignificant.. "

I would agree that it is not insignificant. In fact, it looks pretty darn significant to me. It is on a similar scale to saying there is no significant difference between 5 inches and 7 inches. It occurs to me that only someone who wants the lines to be blurred would come to such a conclusion with those statistics. I have found when I look at the studies that say "no significant difference" between mechanical and biological long term outcomes, it is almost always, if not always, a party that has a vested interest in having blurred lines.

It looks like there is about 18% difference in survival between biological and mechanical in the study you reference above. 96 folks in the biological group group. 18% of 96 is about 17. I bet the difference feels pretty significant to the families of those 17 individuals.
It's a small sample size (statistically) but that's what one usually has to work with in medical research.
 

epstns

Premium User
Supporting Member
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Chuck, my heart never did find an alternate electrical path. They quote pacing percentages separately for the atria versus the ventricles. My pacemaker is only used about 10% of the time for my atria (upper chambers). For my ventricles, however, it is used over 90% of the time.

That is not to say that I would drop over dead if the pacemaker failed. I learned this firsthand, about 4 years ago when my ventricular pacing lead failed. The lead did not come detached, nor could they see a defect, but it became "high impedance" (an elecrtonic term that means that it took way too much current for the required pulse beat to get through) after about 5 years in place. This sort of event is not rare, but is not common either. I had the lead removed and a new one implanted. They also implanted a new pacemaker at the same time. As for what happened when I noticed the lead failure . . . my resting heart rate went down to less than 50 BPM. I was able to exercise, work, everything else, but I was not at "top" performance. They call this phenomenon having an "escape rhythm." This means that although my conductivity paths are flawed, the heart still beats well enough to keep me alive, even though it is "out of timing."
 

newarrior

I have mild moderate Aortic Stenosis live Bangkok
Joined
Jun 28, 2019
Messages
526
Location
Bangkok Thailand
Chuck, my heart never did find an alternate electrical path. They quote pacing percentages separately for the atria versus the ventricles. My pacemaker is only used about 10% of the time for my atria (upper chambers). For my ventricles, however, it is used over 90% of the time.

That is not to say that I would drop over dead if the pacemaker failed. I learned this firsthand, about 4 years ago when my ventricular pacing lead failed. The lead did not come detached, nor could they see a defect, but it became "high impedance" (an elecrtonic term that means that it took way too much current for the required pulse beat to get through) after about 5 years in place. This sort of event is not rare, but is not common either. I had the lead removed and a new one implanted. They also implanted a new pacemaker at the same time. As for what happened when I noticed the lead failure . . . my resting heart rate went down to less than 50 BPM. I was able to exercise, work, everything else, but I was not at "top" performance. They call this phenomenon having an "escape rhythm." This means that although my conductivity paths are flawed, the heart still beats well enough to keep me alive, even though it is "out of timing."
I thought a lower pulse rate was good ? I have been clocking in at 54 when at rest..I exercise a lot and have my whole life...Athletes have resting HR of 40
 

epstns

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A lower pulse rate is good, as long as it supplies enough blood to your body and as long as it can increase with demand. Where it becomes a problem is when it is out of synchronization between the upper and lower chambers of the heart, as mine is at risk to do without the pacemaker.
 

newarrior

I have mild moderate Aortic Stenosis live Bangkok
Joined
Jun 28, 2019
Messages
526
Location
Bangkok Thailand
A lower pulse rate is good, as long as it supplies enough blood to your body and as long as it can increase with demand. Where it becomes a problem is when it is out of synchronization between the upper and lower chambers of the heart, as mine is at risk to do without the pacemaker.
Understand
 

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