TAVR Update: What Have We Learned During The Past 10 Years?
ฝัง
- เผยแพร่เมื่อ 3 ก.ค. 2024
- www.Heart-Valve-Surgery.com - The use of transcatheter aortic valve replacement (TAVR) devices for aortic stenosis treatment has soared since this non-invasive therapy received its first FDA approval for inoperable patients in 2011. As you may know, TAVR does not require an incision to the patient's chest or ribs during the procedure.
However... Patients with aortic stenosis still have questions about the use of TAVR devices for aortic valve replacement. For that reason, we interviewed Dr. Allan Stewart, the Chief of Cardiac Surgery at Mercy Heart Institute in Miami, Florida, to learn more about the latest research and the newest innovations specific to TAVR.
Questions asked to Dr. Stewart in this video include:
1. Why did you choose to make TAVR a specialty in your practice?
2. Should TAVR be considered a "game changer" for patients with aortic stenosis? Why? Why not?
3. What are the top 3 patient benefits of TAVR compared to surgical aortic valve replacement (SAVR)?
4. What type of patient may be a candidate for TAVR?
5. What have been the results of your patients who receive a TAVR device?
6. What are the newest updates and developments specific to TAVR:
i. Low-risk patient use
ii. Stroke risk
iii. Paravalvular leak
iv. Pacemaker complications
v. New TAVR devices and delivery solutions
7. Can you talk about the prevalence of TAVR failure? How is it managed (SAVR or TAVR valve-in-valve)?
8. What is your #1 piece of advice for patients considering TAVR?
To learn more or schedule an appointment with Dr. Allan Stewart, please call (786) 755-1796 or visit www.heart-valve-surgery.com/s....
Thanks for this information. I have severe aortic stenosis and am expected to have a valve replacement within a year. This really sets my mind at ease about what I'm facing.
I am having this Taver procedure done on June 6! And I absolutely thrilled and can’t wait! ❤
Wow,.it's taken forever for my tests and appointments, have been short of breath for months
Mom is 97. She had an ICH left side in 2018. My sister and I take care of her 24/7. She had a feeding tube for three years and during the Pandemic lockdown, we had enough time on our hands to get Mom to enjoy food once again. Her feeding tube was removed August 2021. Other than the ICH leaving Mom with neurological issues, she is incredibly healthy, strong and very active. Mom is on no meds, has no diseases. Mom had an echo recently. 10 years ago via an echo, Mom had moderate aortic stenosis. Now it is severe. No fainting, gets winded sometimes. Is Mom too old for TAVR? Thank you very much. Best
What care the patient has to follow after the procedure regarding physical excercise and diet. How many months it will take to come out of weakness
Dr. Stewart I am a 70 yr old female and when I was 23 diagnosed with a slight heart murmur. I recently had some heart test at the Sacramento Ca. VA. I was told I have an aortic valve that sticks and a mistrial valve that leaks. I do have short of breath some times . Also a very active person I still run lots of marathons and hiking. Would I be a candidate for the TAVR procedure. I will be seeing my physician soon to discuss all options. Would they have to repair the mitral valve first or can they do both procedures at the same time. Judy
I like his way of thinking, ask him next time where they are at with bicuspid valve and TAVR in his practice? I have severely calcified mod/severe valve on 6 month echo check-ups at the moment. Thanks
Great question !!! I’m in same boat , Mcgragor
@@franksumma9967 I feel like we're still a few years too early, they are doing some bicuspids now, I know that much, but when its heavily calcified not sure. It is what it is, scares me to death though even though I know mortality is much lower than even 20 years ago.
Agree with you Mcgragor !! 👍❤️
there have been many case series reporting success in bicuspid valve patients. The difficulty in making a definitive recommendation is based on two unknowns. The first is longevity. Bicuspid patients tend to be younger and in better health than those with three leaflet valves. This means that patients will outlive their implanted valve, whether it’s a TAVR or a surgically implanted valve. The obvious decision then is when to have the surgery. What I mean is that a TAVr in your 50s is appealing because it gets you back to normal function quicker. However, it pushes the heart surgery down the road, when you may not be as healthy. The operation to take out a TAVR is a bit more complex than taking out the existing valve you were born with. The main advantage of TAVR first is the quick recovery. TAVR inside of failed TAVR is currently not a great option but technology is rapidly advancing and new devices may solve that problem in the future.
Using only our currently available information and not what could exist in the future, the current standard in young patients is surgery first with TAVR in surgically implanted valve in the future. That is only a recommendation, however. I have placed many TAVRs in young bicuspid patients who listen to the recommendation and then say: “I am now properly informed but I still want TAVR now”.
The second unknown is the quality of the aorta. Patients with bicuspid valves often have aneurysms of the first portion of the aorta. In the event that a young patient has a dilated aorta and a bicuspid valve, TAVR is not a good option. It’s important to have proper imagine including a CT scan of the chest before proceeding.
I hope that helps. I’m happy to discuss any questions. Please give me a call if I can be of further help.
@@allanstewart8868 Yes, thanks so much Dr. that does help, appreciate it. I know you are very busy, but does this include heavily calcified valves? I am 53, moderate/severe with no symptoms, everything else looks good and no aneurysm, per echo, but I know I need a CT. My concern is the calcium, can it break off and cause a stroke when you put in a TAVR? Thanks
Hello doctor good day, my dad undergone Aortic Valve Replacement with CABG last 2014 (bioprosthetics) And last week we found out that the he has severe aortic stenosis but asymptomatic. He is only 65 years old. The doctors recommend TAVR. Can i ask what is your take on this? The durability and does it fail overtime? And can TAVR be replaced again when it wears out? Thank you so much Doctor.
What if that valve is narrowing now 7 1/2 years later and my doctors are testing and don't have options for me
Hi Allen. Thanks for all the great info over the years. I was scheduled to have mitral and aortic valve replacement but the were postponed because of Covid load on the local hospital and then again the night before surgery because of a throat tumor discovery. Now that I am on the mend from the cancer the valve surgery will most certainly be revisited. Due to my age (50s) and the relatively short life span of these valves, they are steering me away from Tavr and towards mechanical valve with full open chest surgery. I’ve been following this company called Foldax that has trials going with their valves that can be surgically implanted and via Tavr. Do you or any of your colleagues have thoughts or experience with this valve?
Folded is still in feasibility trials so it is unlikely to help with your particular problem. I am 52 and would still have a biological valve despite the understanding that I would likely need another procedure in the future. The decision for mechanical V’s tissue is your decision and should not be made for you, by your treating doctors. Why do you need your mitral valve replaced instead of repaired?
@@allanstewart8868 Hi Allen. I can’t remember exactly the terms they used for my mitral valve issue. I do know that I have a murmur and occasional Afib. I also currently have a Pacemaker. They say a lot of my issues stem from radiation therapy when I was 19years old. I had Hodgkin’s lymphoma back then and it was treated with Chemo and 5 weeks of radiation therapy to my chest. They also want to do ablation when they place the valves. I have to say it’s all scary stuff. I was leaning towards Tavr
@@frankg4819 TAVR in you is a good option. Often, the radiation creates an "unfriendly" environment in your chest with lots of calcium on your aorta and significant scar tissue . This can make a simple surgery significantly more complicated. Surgery is still an option but TAVR will mitigate those risks
@@allanstewart8868 thanks for your input. That was my understanding but they keep telling me that TAVR is not a good option. They had the TAVR specialist come out and he proceeded to tell me an anecdotal story about a 35 year old patient of his needing replacement surgery after 2 years. My cardiologist thought that wasn’t a good comparison case since the man was 35 years old and I am in my 50s. While he was open to me getting TAVR, he felt mechanical was the way to go because of the longevity associated with the valves.
Dr. Stewart, Thanks for being so quick to respond to the patient's questions at our TH-cam channel. We really appreciate all of your education and empowerment for our heart valve patient community!!!
How are surgeons handling calcium deposits disturbed during the procedure, I don’t look forward to a stroke from wandering deposits?
From what I observed in another video I watched in passing, apart form the catheter that is inserted through the inguinal area for the replacement of the new valve, they also insert an additional catheter-like tube through the wrist that contains a special filter. This filter is supposed to catch any calcium deposits and prevent them from reaching the brain. I remember after my mother finished her TAVR procedure, as she was laying in her hospital bed, the staff would periodically keep asking her for her name, date of birth, and other simple questions to make sure she was free of any stroke symptoms as well. Then they gave her an antibiotic called ANCEF which she had a reaction to (ymmv).
Speaking of antibiotics, that's one downside about TAVR patients. From then on every time they need to undergo a dental procedure the dentist is forced to give them antibiotics, even if it's for a simple teeth cleaning. And I'm not a fan of this because it means bye-bye to the good bacteria or intestinal flora in your gut that current research has been showing is so important to one's overall health.
. @mosom217 FYI: Antibiotics are given to me for a shoulder replacement every visit to the dentist. At least it is only one large dose and done instead of for a week or so.
What's the average cost for TAVR for aortic stenosis?
$30K, AZ Heart Hospital, Phoenix, AZ, 1\4\24
WHAT HAPENS AFTER THE TAVI PROCEDURE I WENT TO DENTIST AND HE SAID THERE WAS A RISK OF INFECTION IF HE EXTRACTED A TOOTH
What about on younger patients? How long does TAVR last?
The truth is that we have no real sense on how long TAVR lasts since we only started putting in patients with a greater than 10 year life expectancy, about eight years ago. So far the results have been great and I can reliably say it lasts at least eight years. Now that we are implanting the valve into an expanded group of people who are younger and have bicuspid valves, we have to keep a close eye on longevity. I can say that the valves look good at eight years but that doesn’t give any real insight as to how many more years they will last. We can only go by the information we have.
Hello@@allanstewart8868 Has there been any studies on how long tissue aortic valves last? I know it is a big operation compared to no operation with TAVR. And can they put a TAVR in after a tissue valve has run its life cycle out?
We know it will not last for your life time, but we have only been using TAVR in patients weith longer lifespans, for about 10 years. We can say the valve will last at least about 10 years but cannot make claims about longevity that exceed the length of time it's been inside of a person. The good news is that there is a massive amount of research and funds invested in new devices with better longevity. Meaning when this valve wears out there will be many new options for a replacement device.
Dr. Stewart, It is really special to have you answering patient questions here at our TH-cam channel. Thank you! Thank you! Thank you!
@@allanstewart8868 This is what i'm hoping for. I had an Edwards valve put in me through OHS in 2014 when I was 33. now it's stenotic and they are looking at replacing it with a TAVR. My question is, once the valve is deployed does it integrate itself into the aortic wall over time or can it be retrieved at a much later date and be re-replaced when it fails? I also heard a while back about a valve with replaceable cusps but have not heard much about that in recent years. Thanks for all you do!
learned to grossly overcharge sick old people hear in thailand.
India form 13,000dollars