TAVR For Minimally-invasive Aortic Valve Replacement

TAVR stands for transcatheter aortic valve replacement. It is a minimally invasive procedure where the replacement valve is inserted through the femoral artery. No heart-lung machine or opening the chest. The new valve is actually jammed right inside the old one, which is shoved out of the way.

Needless to say, this is a great option which has the potential for less side effects and shorter rehab. Until recently it was considered only to be suitable for patients for whom the conventional procedure would put them at higher risk. It was also thought to be only suitable for people with normal three leaf valves that had aortic stenosis, but not the congenital condition of a bicuspid valve. At least that was the status quo at the time I got my valve replaced in August 2017.

But the times they are a-changin’. I don’t know the status internationally, but in the US, TAVR has been approved for clinical trials for low-risk patients, so should not be that far away from more widespread use. And it can now be used for bicuspid valve replacements. I learned of this in Adam Pick’s heart valve surgery newsletter where the story of a yoga enthusiast, Jean Frank is told.

She is doing fine after her TAVR, and says ” I had heart surgery.  It was too easy!” Now well along in her recovery, she is back to enjoying her yoga and plans to become an instructor.

For impressive visual evidence of how well TAVR works, there’s Mick Jagger dancing vigorously (at 75 years old) 6 weeks after his TAVR. Six weeks after my heart valve replacement, I was just starting cardiac rehab and finally getting over the hump about fluid retention around my lungs. I could exercise pretty well at moderate intensity but may have been gasping if I tried anything as intense as Mick Jagger’s routine.

This procedure is definitely looking good and hopefully will get full approval for more widespread use soon.

So how do I feel about all this? Am I jealous that I went through a more invasive surgery with longer and more difficult rehab? Nah! First of all, along with my replacement, I got the Cox-Maze III procedure done to fix my afib, which is still the “gold standard”. If I had fixed the valve with TAVR, I still might have had a problem with afib, and have had to do a followup procedure such as ablation or the less invasive “mini-Maze” to address it, which may or may not have had as good of an outcome. Certainly I would discuss those options with my surgeon if I needed the replacement now, but I don’t think it’s useful to dwell on “might-have-beens”, especially since my outcome was just fine. Anyway going through the longer and more difficult rehab motivated me to right a book about my story and start this blog. All’s well that ends well.

I do take comfort from how well TAVR is working though because I may have it in my future. Tissue replacement valves like mine have a finite life, so in 15 years or so I may need a new one, and TAVR has been shown to work well for that purpose.

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