There was a great bit of news recently about TAVI, which is transcatheter aortic-valve replacement. This was not invented when I had aortic valve replacement surgery in 2002.
TAVI can be done through a catheter inserted in the groin, and when in position, inflated. This is where the article gets a little shady for me. It says then that a cow’s valve can be implanted. It must be already part of the expandable stent device.
TAVI is indicated in older patients, frail patients, or patients who, for one reason or another would not tolerate well the sternotomy (splitting the sternum) approach. The survival rates are relatively higher than the traditional sternotomy involved surgery, and recovering patients give it very high reviews on improving their lives in the areas of exercise and mobility.
The downside is that stroke is almost five times higher, occurring in 5% of the patients, versus 1.1% rate of stroke in sternotomy involved surgeries.
The operation is much shorter than regular open heart, taking from one to two hours. My surgery was nine hours, five is average. Hospital stay is shortened to about two days from an average of five for open heart.
If you read the last line of the article, the doctor says this can revolutionize heart surgery. Well, yes, no, absolutely, maybe, and I don’t know about that. Right after I had my surgery in 2002, a mechanical gizmo was introduces where the two dissected ends of the aorta were lined up with this valve that had small wires that clamped shut, eliminating aortic suturing. I asked my cardiologist if he had heard about it, and he said yes. I asked what he thought, and he said, “That is for people who don’t know how to do it the right way.”
There is a HUGE difference between a one hour procedure and an eight hour procedure. And for the patients that are using this, and for whom this procedure is indicated, it’s like a LVA (left ventricular assist). It’s the last bus stop before the bus goes over the cliff. So my take is that if the patient is frail, yes, by all means do the less invasive procedure and hope it all works out. HOWEVER, to use the TAVI on relatively stable patients (like me, I was 54 at time of surgery) just because it’s easier, shorter, and cheaper, seems like the cheap used car approach.
AND, as the article says,
“The new procedure — transcatheter aortic-valve implantation (TAVI) — involves routing a large catheter through the femoral artery in the patient’s groin into the heart. When the catheter reaches the aortic valve, a balloon inflates and opens the valve. Doctors then implant a cow’s heart valve, Leon explained.”
I’m unsure how they implant the cow’s heart valve.
And “large catheter” sounds a little risky on an already frail patient.
Now, let’s move on to the cow heart valve. Animal valves eliminate the long term coumadin therapy and monitoring, but the valves can last thirty years. Animal valves run in the ten year range. I took the mechanical valve because I didn’t want to be back in ten years doing all this again, and as of today, I am at 8.5 years. Ten years passes quickly.
As I have always suggested, talk with your doctor, and decide between the two of you. If you have aortic stenosis, are older, are frail, do not think you can tolerate the open heart surgery and recovery and all that goes with it, then go for the TAVI. But I would not make it a decision of convenience. The old Steve Martin movie about the brain surgeon comes to mind where he does brain surgery on an assembly line basis. I’d rather have the nine hour job, and have them make sure that they don’t miss anything.
You don’t want something that might wear out soon, and truthfully, is still a new procedure. Yes, it has good reviews and looks promising, and is right now saving lives of patients who would not have any corrective procedures on their bad aortic valves done at all, so for them it’s all or nothing. If you don’t have stenosis, or meet the other parameters, think more long term. Yes, you will have a few more days on this end, and a few months recovery, but you will get it back in spades on the other end by the life it gives you.
Favorite mark this, and keep an eye on it in case it does not work out. These things have a tendency to quietly go away if something goes awry.
I say, “Good Luck”, “God Bless”, and “Hope it all works out for you” for anyone facing aortic valve replacement. I know what it’s like to have been there, and mine can fail, or start acting up, and I’ll be right back in the line at the OR.
My comments in no way are to disparage the TAVI. New things come along all the time, and look how far heart surgery and bypass surgery and valve replacement has come in OUR lifetimes. And I do honestly hope that something is invented or refined so that bypass surgery and valve replacement can be an easier thing on ANY patient. The article states that they are evaluating using TAVI on lower risk patients as well.
A nine hour surgery, 8 days in the hospital, and four months off work doing rehab was NOT a walk in the park. If they had something new and very proven today, I would have to consider it.