Transcatheter aortic valve replacement effective in younger, healthier patients
nytimes.com
nytimes.com
For some reason, the heart surgeon decided not to replace it when he had me opened up. Maybe I'll have the joy of undergoing another $160k operation to fix the valve using this technique.
By the way, in case you're wondering, open heart surgery kind of sucks. I wouldn't recommend it unless you absolutely need it.
Ask your doctor if open heart surgery is right for you! (If your local cardiologist advertised on TV)
For most non emergency surgeries (some heart surgeries are in that category, you can plan in advance), europe does make sense, especially insurance is not good.
At some point i thought that could be oretty good way to balance out cost here.
I flew to Poland instead, and had it removed at another private clinic for £80.
All the staff in the top clinic in London are Polish anyway.
Paying crazy amounts of money for medical procedures is just dumb. I cannot understand why Americans would pay tens or hundreds of thousands of dollars for surgery when they could fly to Europe, live the highlife, and also buy a house with the change.
There are quite good reasons to not replace, not least of which is that replacement valves are nowhere as good as your native, particularly if it’s still functioning.
Ie if metallic, you need to be on anticoagulants for life which can be a massive pain and cause other complications. Metallic last for around 30 years.
If porcine/bovine or possibly human, then they degrade much faster, 10-15 Years is the average.
So, depending on your age, and depending on the repair your aorta needed, the surgeon likely decided that since you will have to undergo the knife at some point again anyway (either for graft replacement for the Dacron that now makes up the proximal part of your aorta) or eventually due to the valve, you might as well minimise the complexity by only doing one thing at a time.
Plus, since we first started doing TAVIs (transcutaneous aortic valve repairs) they are getting better and better - see article - so possibly you wouldn’t need the on-pump surgery.
Interesting that it costs you $160k; in the Australian public health system a valve is about $30k.
Source: I did my honours thesis on cardiothoracic surgery (actually on mitral valve repair, but spent a lot of time in cardiothoracic theatres dealing with aortic valve-disease)
I'm not sure a valve will cost $160k. That was the cost of open heart surgery with a double bypass and aortic aneurysm repair. I ended up paying about $8k of that after the insurance did its part.
I would definitely prefer a less invasive procedure. Recovery would probably take less than five months, for example.
Ex-gf's ex husband needed a valve replaced at 25 due to damage from an infection. That lasted 15 years. So at 40 he had to have it replaced again. And at 55 he died because they can only do it twice. So yes I suspect your surgeon wanted to push that as far into the future as possible. And every decade that passes is an opportunity for better treatment.
> I would definitely prefer a less invasive procedure.
Cross fingers. My friends brother is a young[1] cardiac surgeon that does really whack less invasive valve replacements. So this stuff is becoming available.
[1] Gosh he's like in his only his late thirty's!
Fucking hell, that's brutal, why can they only do it twice?
But depending on the damage to the aortic root, that is going to be the primary determinant on if they are going to be able to undergo repeated procedures. I have heard of TAVIs being placed inside precious tissue replacements so that’s potentially the next route for a lot of people, which would mean basically x3, the third replacement being more streamlined than the previous two
43yr old senior software dev
The flow dynamics of newer metallic valves (like the Onyx) are superior in many ways. Not the least of which is consistency and durability, with a reduced risk of aortic dissection. Always go with a metallic.
> can be a massive pain and cause other complications.
The complications are not from the valve, of course. The complications are from the surgery which can disrupt electrical pathways (scarring of the chambers) with a worst-case pacemaker (additional risks and effects). _AVOIDING THAT RANDOM STRUCTURAL RISK IS THE BREAKTHROUGH_
The blood thinner is a cautionary medication for the newer valves by policy, until there are a few decades of field data. That being said, taking Sodium Warafin can cause common side effects like light sensitivity and chronic constipation. The excessive bleeding is overblown for a standard long cycle INR target of 2-3. When you get over 4 (due to triple doses or some other unusual circumstance), you will start to have bleeds that don't stop easily, in my experience.
1) it's a big decision that the surgeon might not have felt comfortable making
2) there are safer valve replacements coming out (neither metal nor animal) that the FDA (in America) should eventually be approving. This caused one surgeon I'd spoken to to wisely delay the decision. Perhaps this article is describing the specific valve but it seemed to be metal.
3) I dont know how bad the regurgitation is on the valve, it might not have been time
My 0.02 - see the absolute best surgeon you can get for this (in NYC his name is Takayama, don't know where you are). And depending on your root/valve dance, get a "gated ct-scan" rather then a run of the mill that most doctors recommend.
That said, I wish you the best.
At that time, I made the optimistic prediction that by the time I needed a replacement, they will be able to grow me a new valve from my stem cells, and install it laparoscopically.
Well, 50% ain't bad, I guess.
You never know when they'll figure out scaffolding, could be sooner than you think. Could be later. Hopefully sooner.
> Aortic valve replacements have been performed for decades, and surgeons know the valves placed during surgery last at least 10 to 15 years. It remains to be seen if TAVR valves will fare as well. The question is especially important for younger patients. The average age of subjects in the current studies was the low to mid 70s, younger by a decade or more than most patients getting TAVR now.
If anyone here needs a new aortic valve, you might also want to read about the latest results on the less-known Ross procedure and whether it might be suitable in your situation. It's been a thing since the 1960s especially for young patients (children) but I hadn't even heard of it until last year: https://en.m.wikipedia.org/wiki/Ross_procedure
Ouzounian, Maral et al. 2017. The Ross procedure is the best operation to treat aortic stenosis in young and middle-aged adults. The Journal of Thoracic and Cardiovascular Surgery https://www.jtcvs.org/article/S0022-5223(17)31124-8/fulltext
Sheesh. For-profit hospitals are a foreign concept to me. Seems incredibly cynical to crack open someone's chest, leaving them with a very slow and painful recovery, to then think about profit instead of patient welfare.
This article reminds me of Steve Yegge's dad and his experience with heart failure and having to go through a bypass surgery, post which, unfortunately, his femoral artery [0] burst, compounding more hardships on what had been an already tough ordeal. He wrote a letter to the hospital staff once he was back living his normal life: https://sites.google.com/site/steveyegge2/really-no-big-deal
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[0] https://en.wikipedia.org/wiki/Femoral_artery#Clinical_signif...