OT? Aortic valve replacement

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This post may be on-topic because so many Americans have aortic valve stenosis (narrowing of an important valve in the heart) and also because other METARs may need the information.

I was diagnosed with severe aortic valve stenosis in 2024 as a result of a nurse practitioner listening to my heart when I stopped into the clinic for an unrelated issue. My primary care doctor never bothered to listen to my heart since I worked out almost daily and was physically fit. I was feeling more tired but after all I was over 65. It didn’t occur to me that my heart was failing.

Ultrasound and CT showed that I had a birth defect. My aortic valve had only two leaflets (bicuspid) instead of the normal three leaflets. The valve was like a clam shell shape which couldn’t open fully. Plus it had become heavily calcified and stiff. As a result of a very small opening (1 square cm) the jet of blood was like a garden hose and caused an aneurysm in my ascending aorta over years of vigorous aerobic exercise. The word “severe” in the report definitely got my attention.

When I read about the modern minimally-invasive procedure of TAVR (which is like sliding a stent with a valve through the artery into the heart) it seemed so perfect. Compared with TAVR, open-heart surgery seemed so brutal and old-fashioned.

But my cardiologist said that my fitness showed that I could live another 15 years. The TAVR valve would have to be small to fit inside my calcified aortic valve - maybe 19 mm. In 15 years it would be worn out. The space for a new slide-in valve would be restricted.

Also, research showed that some of the TAVR valves didn’t fit exactly into the calcified valve. Blood leaked around the TAVR valve which is a pressure fit and not sewn in. My stiff clam shell-shaped valve wasn’t round. I was at high risk for outside leakage.

That’s why I opted for the open-heart surgery. Also I needed to have that aneurysm fixed which could only be done surgically.

My new valve is the largest they make - 25 mm. It’s specifically designed to accept a new slide-in valve when that’s needed in maybe 10 to 15 years. The surgery was a bear but it was easier at age 70 than it would be at age 80. Fluid leaked out into the space around my lungs (pleural effusion). My lungs partially collapsed. Measure lung volume was 500 cc. I was in the hospital on oxygen 24/7 for 9 days. Once home, I was so weak that I needed a chair to shower.

I’m just now beginning to feel more like myself again - the recovery took many months, close to a year or maybe even more. Cardiac rehab helped but I was also exercising daily on my own.

An old college friend had TAVR a couple of months before I had SAVR (surgical aortic valve replacement). He was out of the hospital in 2 days and felt fine. A no-brainer, right?

https://www.wsj.com/health/healthcare/heart-valve-tavr-surgery-aorta-1e0eda70?mod=hp_lead_pos7

​A Breakthrough Heart Procedure Comes With Risky Tradeoffs

A minimally invasive alternative to open heart surgery is gaining popularity, but some find ​their new valves don’t work as well or last as long as they hoped

By Betsy McKay, The Wall Street Journal, April 23, 2026

…
Transcatheter aortic valve replacement, or TAVR, is considered one of the biggest innovations in cardiovascular medicine, offering a way to spare patients the physical and emotional trauma of open heart surgery…

Yet there’s limited research on how long the valves might last. And as TAVR has become more widely used among younger and healthier people, some are finding that their valves don’t work as well or last as long as they hoped. The procedure they thought would spare them a complicated surgery leads some to the operating table anyway…

More than 710,000 Americans received a TAVR between 2015 and 2024. The procedure is designed to treat severe aortic stenosis, in which calcium buildup narrows the opening of the aortic valve. Symptoms include fatigue, shortness of breath, chest pain and a fluttering heartbeat. Aortic stenosis affects at least 1.5 million Americans, and if severe and left untreated, can lead to heart failure and death.

TAVR is an appealing option for patients and doctors because it’s a simpler, less invasive procedure than a surgical aortic valve replacement (SAVR), with shorter recovery times…

Doctors are concerned by recent data from another clinical trial in low-risk patients suggesting that some TAVR valves may wear out faster than their surgical counterparts.

Some TAVR patients end up needing an “explant,” a complex surgery to remove the original aortic valve along with the TAVR valve and sew in a new surgical one. While uncommon, the explant is the fastest-growing type of cardiac surgery, by rate, in the U.S. today. It is a riskier operation than regular surgical aortic valve replacement…

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“Almost nobody’s thinking about what’s next,” he said.

Valve makers and many doctors say when a TAVR valve wears out, a new valve can be inserted inside the old one, like Russian nesting dolls. The number of patients undergoing a second TAVR procedure after their valve wears out is also growing. But little is known about how long second TAVR valves last, and the nesting doll procedure doesn’t work for everyone.

Market expansion

Edwards Lifesciences, Medtronic and other companies have built TAVR into a global business with $7.02 billion in 2025 revenue, estimated to increase to $9.91 billion in 2030… [end quote]

The charts in the article show that the number of TAVR replacements is growing fast. Since TAVR first became widely used in 2015 it’s only been slightly over 10 years for a device which is expected to have an average life of 10 years. Research shows that about 1.5% of the devices fail but it will take longer experience to learn how many fail earlier since the numbers only picked up recently.

I know an 83 year old woman who just got her second TAVR. She’s feeling fine. She never had open heart surgery. But she doesn’t do heavy exercise.

The companies that make the valves are encouraging TAVR in younger, healthier patients with longer life expectancy. It seems like a no-brainer since it’s so fast and easy.

But anyone with an aortic valve problem needs to think carefully and clearly about the risks in their specific case.

My husband pointed the WSJ article out to me. I think he wasn’t truly convinced about my choice of SAVR until he read it.

Wendy

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A timely post @WendyBG and you beat me to my announcement. Dh’s new valve is 7 years old. He had his ultrasound and saw the cardiologist this last Monday. No return of the HALT and a minimal amount of regurgitation. Ejection fraction and everything else surrounding function was great.

However, the visit came with a heads-up…we’re now entering the time when these biovalves start to fail. Cardiologist mentioned that the surgeons are always confident in their predictions for longer…but the average age is made up of those whose valves fail early and those who fail late. He is a bit more introspective as he sees the valves for far longer than the surgeons follow them.

Should that happen, a TAVR option is there.

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Ha! My surgeon didn’t visit me until the third day after surgery and then he only stopped long enough to pat himself on the back, tell me what a great job he did and scrawl a get-well note and the surgical cuts on a heart-shaped pillow. He never asked how I felt or sent a doctor to follow up on my pleural effusion. When I phoned his office with a question a month or so later the receptionist brushed me off as if I had insulted them by calling.

I have ZERO confidence in surgeons following up with patients. They only make money when they are operating.

I plan to see my cardiologist every year for follow up (which is what he asked me to do). I expect he will order an ultrasound. If I felt the slightest problem in my heart I would phone in a heartbeat. But not the surgeon.

I’m glad that your husband is feeling well and has good function. His surgery was more complicated than mine since I didn’t have a Bentall, just valve and aorta replacement.
Wendy

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On the other side of things, I had surgery last month and my surgeon visited me twice a day (once a day on the weekends).

These things vary, just like people.

DB2

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Wow, @DrBob2 that’s great! What kind of surgery did you have (if you don’t mind me asking)? I hope you are healing well.

Wendy

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That is true.

My Dad would fire a fellow doctor before anything got underway if some of the signs discussed here were like writing on the wall.

I have two sisters. I just discovered one has a bone in the top of her mouth. I put two and two together and now know why the orthodontist did not want to put braces in her mouth. She could not wear a retainer. The other two of us had braces as teenagers. The orthodontist never told any of us the truth about this bone.

I am waiting on Apo B results. I also just did a lipid panel while fasting 12 hours. Both within the last 24 hours.

I may be thick on that topic, but I am early to the party, figuring out if my dosage of rosuvastatin is doing the job. I am indebted to VeeEnn.

I just fired a garage mechanic. My brakes are beginning to slightly wear. My mechanic had sold the family business to a new multi-state service group. I went in for what might have been $300 on a single job to hear I needed 5 jobs for $1800.

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Removal of two cancers, one in the colon and one in the liver. The surgeries went well, and the best news was that all regional lymph nodes tested negative for tumors – so, no chemo needed! 35 staples though.

FWIW, the docs said I was healing better than average. I feel lucky that these were caught early (stage 1).

DB2

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Just got my results. I am feeling some stress coming off. Looking at your own guts under the spotlight is always stressful.

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Best wishes for a speedy recovery.

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That’s not quite true. Follow up visits have reimbursable procedure codes. The cardiothoracic surgeon was there when my husband was extubated and did daily rounds with his entourage. First follow up was at 2 weeks then again at 6 weeks, then evey 6 months and via zoom through the Covid lock down. The intervention cardiologist’s appointments were arranged every 6 months too, but staggered so he saw someone and got either an ultrasound or CTangio every 3 months.

The difference might be that this unit is part of an academic center and is also multidisciplinary…so, given that my husband’s Aortic Incompetence was secondary to an aorta that was rapidly developing an aneurysm, he was also followed up with genetic testing for some underlying syndrome associated with his aortopathy…a connective tissue disorder like Ehlers Danloss or Marfan’s (nothing about appearance to suggest either one) In addition, my daughter was evaluated and she too is a member of the Big Aorta Club.

One other departure from the stereotypical cardiothoracic surgeon, he went to great lengths pre op to emphasize the quality of the whole team

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@DrBob2 wishing you complete healing and no return of the cancer!
Wendy

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Another difference might be that the surgeon actually cared.

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On the topic of ASCVD and CT angiography mentioned upstream, here’s an article on just that…

Coronary CT Angiography: Is it Time to View Your Coronary Arteries Cleerly? – The Skeptical Cardiologist https://share.google/wLleu6jMIGmT58TmA

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…and more on why LDL-C shouldn’t be ignored. And why, if cholesterol denialism/statin phobia arguments are attractive, it’s important to dig a bit deeper. And why Apo-b levels might be the decision maker if lipid management is a concern.

It’s a long read, but for a simple message, the title says it all…

There is no safe gamble with high LDL cholesterol - Peter Attia There is no safe gamble with high LDL cholesterol - Peter Attia

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With any other doctor that matters more. With surgeons, you do not want someone cutting who cares about you on any sort of personal level. S/he should care about their work, which means taking time with the patient, offering an honest diagnosis, making decisions for the course of treatment, and understanding the prognosis. Care, though, is a tricky word with surgeons. They must remain emotionally unavailable for the most part.

Psychiatrists must remain separate. Meaning work with the patient’s problems, but the moment the session is over it is over. The doctor can not bring those problems home as their own.

Doctors can not delve into caring as lovers might define it. With surgeons, I would take focus and time.

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I didn’t want my surgeon to love me. I just wanted him to care enough about my physical well-being to send a hospital physician who would treat my pleural effusion.

Wendy

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Many surgeons are like that. It’s not just money, it’s also the “God complex” that they’ve had drilled into their psyche.

But my shoulder surgeon (orthopedic) was a gem. He checked up on me, then checked up again, and even popped into one of my Physical Therapy sessions a few months later to watch how I was progressing. I’ve recommended him repeatedly over the ensuing years.

My Hematologist (I also have a blood disorder) is also a gem. She is delightful and funny, and I truly look forward to seeing her each year. She actually looks at the bloodwork WITH ME, and is not shy about giving me direct feedback. Last time (in December) she told me straight out that I’m getting too fat and that if I want she can get someone to prescribe a GLP drug for me! As usual, I told her that I don’t take drugs at all - no aspirin, no tylenol, no advil, no prescriptions, nothing ever.

My Cardiologist is so-so. In my opinion, he’s using those online tools too much, and spending too little time with the patient (me). Each visit he throws numbers at me based on cholesterol numbers (like “9% chance of a heart issue over next 10 years”, blah blah blah). And he KEEPS TRYING to put me on a statin drug. I don’t want to take any drugs at all unless absolutely necessary, so he ran the numbers again online and said “chance goes down to 7%” with a low dose statin. Is 2% lower risk worth taking a statin? Maybe. Maybe not. Anyway, I asked for a reprieve and have modified my diet since January in an attempt to lower the cholesterol and avoid the statin. Basically, I reduced carbohydrate intake to a very low number. So far my weight dropped from 194 to 171. I’m now away from home for another 6 weeks so I don’t have access to my usual scale (the one in my gym locker room) so I won’t be weighing in again until June. I hope it works, but unfortunately, LDL is still at 144, and the calculator that the Cardiologist uses weighs that number more than any other.

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As I said, I’d want time and focus out of a surgeon. Ignoring you is a reason never to use him.

Others mentioned caring. That is not so simple.

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Most of that is very good to read, but dump this guy.

I have had a cardiologist tell me what he wants to bill for he can, the insurance won’t reject the claim. There is no excuse not to get time and care as in treatment from a cardiologist.

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Well, there’s a reason for that, as you’ve had many opportunities to read…including, but not limited to, a post on the very topic upstream from this. LDL-C particles are recognised…with a wealth of evidence that can’t be refuted intelligently…as the underlying driver of ASCVD.

Why bother even making and attending an appointment when you know a priori that you’re not even going to follow the advice you’re given? Seems to me that it’s a bit like conferring repeatedly with a financial advisor knowing before you go that you’ll ignore any explanations of the value of compound interest, and that you’ll continue living above your means

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