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Friday, April 7, 2023

Valve-in-Valve TAVR

Huh?  TAVR is Trans Arterial Valve Replacement.   They replace a bad aortic valve by running a catheter from your femoral artery to your heart and drop the new biprosthetic valve on the failing valve.   

When I had my aortic valve replaced in 2013 with a horse valve TAVR was still riskier than cutting a hole in my chest.  TAVR is no longer risky and a one week recovery time instead of three months (and it was a bad three months in 2013).  My aortic valve is beginning to shows symptoms that it is wearing out and it may need replacement soon.  

Fortunately Valve-in-Valve TAVR procedure can install a new valve over the old one.  This is good.  The suffering after the 2013 replacement made me consider that another such replacement might make say goodbye instead.

The aortic valve opens outward into the aorta so a press fit should allow the new biprosthetic valve to just push the old valve into the wall and operate normally.   There are calcification deposits on the current valve so I assume they will put carotid artery filters in place before doing this to avoid a repeat of the 2014 tragedy.  They put the filters in by syringe then remove them after the danger period.  I am assuming they put the filters in while I am under and probably remove them under local anesthetic.   Perhaps better to be under.  The filters are not huge but I doubt it is pain-free.

Sooner better than later.  I am suffering the exhaustion while exercising that characterized my life from childhood to 2013.  After recovering from the 2013 surgery, I had more energy and ability to walk than I could remember in decades.  My wife and I went on a vacation in 2013 that was the most happy memories of that entire decade.

I am also beginning to cough a lot which is also a symptom of aortic valve stenosis.  First in the morning, I am calling to find out why another six months to the next echocardiogram.  If I can get my energy back and less easily winded, a week in the hospital is well worth it.  The angioplasty is roughly equivalent to TAVR and it was really not bad unlike a stroke or cutting a hole in between my ribs to install my horse aortic valve.  I am just amazed at the skill of the surgeon who did this through a hole about 2" wide and 1/4" wide.  

He was with SOCOM.  It was sort of neat having an all AR-15 surgical team working on me.

Called and pushed a bit.  Referral to surgeon. 

I cannot find it from my phone but a Journal of the American Heart Association article compared Valve-in-Valve TAVR to surgical aortic valve (SAVR) replacement and found TAVR was no more risky than SAVR and had better results in ejection fraction and correcting aortic regurgitation (AR).  It appears that while Valve-in-Valve TAVR is not yet as common as TAVR for native valves the one week recovery time compared to three (in my experience painful) months is well worth it.

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