Aortic Stenosis & Valve Replacement

Posted by onthego3 @onthego3, Dec 14, 2016

Anyone have this non operable problem according to doctors and tests.its called aortic stenosis

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@ej0104

I had TAVR done 4 1/2 years ago at age 89, now almost 94, also needed a pacemaker and on Eloquis. Aside from peripheral vascular disease, I am doing well and active. Because of balance problems I use a treadmill instead of walking outside. On doctor’s instructions, I have had all Covid shots without any problems except last year when I had the flu shot the same day. That wiped me out the next day. My latest yearly scan and checkup last month found the valve was working just fine.

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EJ, I’ve got a balance issue, too, having developed a vestibular Schwannoma years after radiation to the same area— The very same radiation treatment for Hodgkin’s lymphoma that caused the radiation heart disease and necessitated the valve replacement. Great that you are doing the treadmill workouts at 94! Encouraging to hear from you.

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@alex1962

I have some of the same concerns. And because the natural bovine tissue in the TAVR valve isn’t connected to the circulatory system, I worry that the response of the immune system might be limited there.

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That's an interesting thought I never considered and it opens a can of worms in my mind. Would like to have a scientific answer to that, which I can't do. Just applying some basic deduction from my very limited understanding, I thought of some further questions. My wife first wondered "Do cows get Covid". As I understand tissue valves, I believe the tissue used is made "inert" so it's not recognized as a foreign body that our immune system can attack. So my question would be, "Can bacterial or viral flora, which is commonly in our bodies on a daily basis, recognize valve tissue as infectable? Bacteria and virus can't infect a table top.
So I have more questions for my valve doc....

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@johnbflat

That's an interesting thought I never considered and it opens a can of worms in my mind. Would like to have a scientific answer to that, which I can't do. Just applying some basic deduction from my very limited understanding, I thought of some further questions. My wife first wondered "Do cows get Covid". As I understand tissue valves, I believe the tissue used is made "inert" so it's not recognized as a foreign body that our immune system can attack. So my question would be, "Can bacterial or viral flora, which is commonly in our bodies on a daily basis, recognize valve tissue as infectable? Bacteria and virus can't infect a table top.
So I have more questions for my valve doc....

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I am not a doctor or a biologist, so just sharing this as an individual patient. I’m not sure this says anything about Covid outcomes, but heart valves can get infected in other ways, and my understanding is that the infections are hard to treat because antibiotics can’t do their work as effectively as they can for your own native tissues that have blood flow/vascularity/circulation. I was told to be careful about dental work and subcutaneous skin infections because, if they result in an infection in the heart, an operation might be required to deal with it. For this reason, many of us take antibiotic prophylaxis for certain dental procedures. And my PCP is aggressive about treating anything that looks like a skin infection. Back to the main topic, I would love to know anything more about Covid and bio-prosthetic heart valves, so please do share if you learn anything more. I’m guessing there might not be a lot of organized data on this, but my PCP is definitely cautious about it.

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I'm the same, just a valve patient and not a doc or medical expert (disclaimer).

I still take amoxicillin for dental procedures that result in any bleeding, for the TAVR. Before the valve, I used to take it for my knee joint replacement. They used to be very concerned about proylatics with joint replacements, but after years of up/down controversy on the potential prophylactic benefits verses potential antibiotic resistance risks, now I'm told that premedication for joint replacements is no longer necessary. I wouldn't be entirely surprised one day if this same controversy also extends to some cardiac conditions, but for now I take the premed for blood bearing dental procedures, invasive procedures, and surigcal procedures, as I was told those events potentially could introduce a foreign organism load directly into the blood stream.

With my limited knowledge and experience it just seems to me that a bloody or invasive surgical procedure may be an entirely different matter than catching a cold, or flu, or perhaps Covid, as well. If it isn't, would we potentially need prophylactic antibiotics for every infectous "sniffles" or "cold" or "flu" sick event?

I am very suspectable to sinusitis and minor cuts/abrasions/rashes/blisters/bug bites from hiking, biking, and working on my many manual labor home projects. Being on both Aspirin and Plavix those minor injuries (no sutures) are often bleeding events. It would be difficult to think those injuries are also TAVR infection risk events requiring prophilatic antibiotics in each case. I bleed more in these cases than I do after a dental cleaning. I only hope that TAVR infection risks are actually low, premeds are an over abundance of precaution, and that perhaps TAVR will go the same way as joint replacements one day soon. Again, more good questions for the valve doc, next time.

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Aortic stenosis - yes l have been told l have this. Not really sure what it signifies. However, am about to find out. I had a Double bypass Feb 2017 but still having episodes of PTSD. Am 82 and have other health issues and a hidden disability, am caring for my 83 year old husband who is rather frail. We live in the UK and enjoy superb health care MOST of the time. I tend to get a bit political with regard to health!
I also take a hefty dose of amoxicillin before any dental treatment especially my last extraction and recent filling,

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@alex1962

I am not a doctor or a biologist, so just sharing this as an individual patient. I’m not sure this says anything about Covid outcomes, but heart valves can get infected in other ways, and my understanding is that the infections are hard to treat because antibiotics can’t do their work as effectively as they can for your own native tissues that have blood flow/vascularity/circulation. I was told to be careful about dental work and subcutaneous skin infections because, if they result in an infection in the heart, an operation might be required to deal with it. For this reason, many of us take antibiotic prophylaxis for certain dental procedures. And my PCP is aggressive about treating anything that looks like a skin infection. Back to the main topic, I would love to know anything more about Covid and bio-prosthetic heart valves, so please do share if you learn anything more. I’m guessing there might not be a lot of organized data on this, but my PCP is definitely cautious about it.

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Yes @alex1962. I whole-heartedly (pardon the pun) agree. First and foremost, I'd like some answers about what happens when post TAVR individuals catch Covid.
What does the data show?
What are the outcomes?
Are there any TAVR valve implications?
Do we need to continue very high levels of precautions or can we relax precautions after full Covid vacination and getting all the available boosters?
Why is it still difficult to get any of this information?

I assume there are cases now and perhaps someone can report some data or point us to a source, perhaps?

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@johnbflat

Yes @alex1962. I whole-heartedly (pardon the pun) agree. First and foremost, I'd like some answers about what happens when post TAVR individuals catch Covid.
What does the data show?
What are the outcomes?
Are there any TAVR valve implications?
Do we need to continue very high levels of precautions or can we relax precautions after full Covid vacination and getting all the available boosters?
Why is it still difficult to get any of this information?

I assume there are cases now and perhaps someone can report some data or point us to a source, perhaps?

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Maybe ask your surgeon or cardiologist?

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Did that....reply was, "there is not much useful reported data currently". Both practice in a large city medical center at the university professor/director of department levels.
Hard to imagine they don't have some cases of TAVR and Covid after a couple of years have passed, but perhaps the cases they have are unvacinated cases or perhaps many of their cases have added, serious, cardiac comorbities as in the more advanced age cohorts.
My case is the more recently approved, generally healthy, younger TAVR cohort.
What do your's have to say?

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My husband had his aortic valve replaced with an Edwards Lifesciences cow valve in 2004.
In 2015, he had aortic stenosis. He had a valve-in-valve TAVR procedure (a cow valve placed within his cow valve). The second valve was also an Edwards Lifesciences cow valve.
On Dec. 7, 2021, he had LVAD (left ventricular assist device) surgery. Prior to his surgery, he had the first 2 Covid vaccines and one booster.
While in the hospital, he contracted Covid on Dec. 29. His symptoms included a cough and fatigue. He was cleared from Covid on Jan. 8, 2022.
Considering his major surgery 3 weeks earlier and the fact that he has two cow valves in his body, he did remarkably well. He was 70 years old when he got Covid.

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@johnbflat

Did that....reply was, "there is not much useful reported data currently". Both practice in a large city medical center at the university professor/director of department levels.
Hard to imagine they don't have some cases of TAVR and Covid after a couple of years have passed, but perhaps the cases they have are unvacinated cases or perhaps many of their cases have added, serious, cardiac comorbities as in the more advanced age cohorts.
My case is the more recently approved, generally healthy, younger TAVR cohort.
What do your's have to say?

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I have gotten similar responses, “we don’t have data.” I am sure you are right that the varied co-morbidities make it hard to generalize.

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