AVR with new Ispiris Valve

[KRod1]

Hi All, New here and just wanted to say that I am scheduled to go into Kings tomorrow under the care of Prof Wendler to have my bicuspid aortic valve replaced with the new Edwards Inspiris Resilia valve. I’ll let you know how it goes. I’m 37 so hoping it will give me a good stretch without a reoperation.

[skid112 Heart Star]

Hello and welcome to the forum. Good luck, I'm sure you will be fine let us know how you get on

Mark

[KazSumm]

Hi KRod 1

Good luck for tomorrow, I had AVR surgery 13 wks ago, I’m 20 yrs older than you so I had a Peppa Pig Value 😂 I was wondering if this is the new type of value I read about?

Wishing you a speedy recovery, and keep us updated. Kaz 💕❤️❣️

[Funky_Uk]

Good luck, hope all goes well

[laura_dropstitch Heart Star]

Welcome and all the best with your procedure. Let us know how you are getting on when you are able to.

[Fredders]

Good luck tomorrow. I'm due to go into Glenfields tomorrow for my second AVR (6th attempt) but I'm having a mechanical valve this time as I can't risk more surgeries following a splenectomy last year.

Wendy

[KRod1 in reply to Fredders]

Good luck to you too Wendy. Sure you’ll be right as rain soon

[Mary_Janet]

Welcome good luck with your operation. I had what was described as a new generation aortic valve at end of May this year not sure if that is the same one. Hope all goes well and you have a s.booth recovery. I joined this site recently and have found it very helpful..

[KRod1]

Thanks for the well wishes all. Fingers crossed and I’ll update you next week. In the words of Monty Python’s Black Knight; ‘‘tis but a scratch!” 😉

[Mirador19]

Good luck for tomorrow ♥️

[Hidden]

Hi and welcome, wishing you well with the op, keep us all posted, take care char xx

[KRod1]

Morning All, I’m pleased to say the op was a success and I’m currently stalking the wards of Kings in London. Was fairly routine with only the odd wobble including a moment when I first sat up and Bp and Hr crashed. That’s why they put the pace wires in through, so I was paced for a morning and then off in the pm. Think it was a combination of first sitting up and the meds that did it.

I also had rather odd muscle spasms on the second day post op which caused a lot of pain but the right meds nipped that in the bud as well.

Other than that, it’s been good and have got lots of rest punctuated with walks and sitting up.

I read a lot about this before having the op and I’m pleased to say that to date it’s been as per the leaflets from the NHS rather than as per some of the horror stories you read.

I’m sure there will be many more bumps in the road as I recover but if the 98 year old lady in the corner of my ward can do it then I sure can.

Thanks again for your support

Kevin

[laura_dropstitch Heart Star in reply to KRod1]

Great news, all the best with the rest of your recovery

[skid112 Heart Star]

Good to hear Kevin get well soon

[KRod1]

Hi All, little update for you. I’m still in hospital as have had some atrial fibrillation. Nothing major but 2 bouts which they are trying to control with drugs for blood pressure, heart rhythm and with magnesium and potassium which were both a bit off.

So, although I’m disappointed it’s delaying discharge for a while, I am very glad that it’s showing up now rather than at home!

From what I read it’s fairly common to have afib post surgery (1:4 to 1:3) and most cases rectify over time so I’m still optimistic I’ll be okay soon 😬

[ecmas in reply to KRod1]

Hi KRod1, just wondering how you are getting on with the Inspiris Resilia valve? I'm 38 and due to have my BAV replaced with the Resilia valve on 5th Feb. Any info/advice you could give me would be greatly appreciated!

[KRod1 in reply to ecmas]

Hey, that’s roughly the age I was too and the valve has been great. Where are you having it done?

In terms of what to do, check out my previous posts as it’s been a while and I will prob forget details. There’s some great leaflets available online which will tell you about heart surgery. I went to Kings College Hospital in London and the leaflet they have was good.

Is there anything inparticular that you’re worried about?

I would stress that it’s not too bad. Honestly. it’s not painful, you WILL wake up and be alive and you WILL feel better after a few weeks. I think a natural talent for being a bit lazy in the recovery helps as you really can’t push it. I had a touch of afib in the days after surgery and it would happen if I exerted myself slightly. You do have to rest and take it easy. But the afib went and I run and do anything I want to now. At our age, assuming you’ve not got other health issues, this isn’t a big deal. Don’t worry about it (as much as that’s possible) and you’ll be fine.

[IanGordon]

How's it going KROD1? Guess you should be leading a pretty much normal life with your new, longlife valve. Interested to hear the anticipated lifespan and any lifestyle or medication concessions you have had to make?

[KRod1 in reply to IanGordon]

Hi ian,

Sorry I missed this post. But, to answer your question, all is good. Anticipated lifespan of the valve is 20+ years (they don’t know how long exactly until some of us make it that far). Lifespan for me, who knows as I’m enjoying a few glasses of wine right now. I’m on no medication and am running 5k a few times a week. I feel well and no issues. All is good.

[ecmas in reply to KRod1]

Many thanks for reply KRod1, was just curious really as to how the valve was settling down, and thankfully all seems good. Also I was wondering if you were required to take any long-term meds with the tissue valve and you have also answered this (no meds!). Glad to hear you are managing to run again ok, triathlon a big part of my life so am hoping to get back in to it post-op! I also like a beer or 6 so nice to hear you are still hitting the wine Thanks again, Marc.

[ecmas in reply to ecmas]

Sorry KRod1, forgot to mention i'm getting op done at Blackpool, i've got pre-op assessment tomorrow. Apparently my surgeon has had to put my case across to the hospital big wigs in an attempt to secure funding for the Inspiris Resilia valve, so hopefully will get news tomorrow that they will be able to get it in time for my op?! Cheers, Marc.

[KRod1 in reply to ecmas]

Hey Marc,

No, I’m not on any meds although I was on a hat full post op - thinners, statins, heart rate, all sorts but was off them all within 3 months. That’s the big benefit of tissue valve and in most cases people don’t need meds. My blood pressure is up a bit but usual threats after a night out and running helps keep it down.

In terms of funding, I am under St thomas in London but went to Kings for surgery so I could get the Inspiris. I picked my surgeon because he was one of the first fitting the valve and was great when I met him. I could have got it done at St thomas’ in the end as they were using the valve shortly after I spoke to Kings. There was no issue with funding as far as I know. You can choose where to go so make sure the hospital does these things regularly and you have a good surgeon.

[ecmas in reply to KRod1]

Hi pal, good to know that you aren't requiring any long-term meds, but i suppose it's on a case-by-case basis, hopefully i will be like you and not need any! Just got back from my pre-op assessment, surgeon is pretty confident that he should be able to get his hands on the valve by my surgery date (05/02), apparently this particular valve is on the expensive side, hence the hesitation from the money men at the hospital in approving funding! All set to go next Tuesday then.....will let you know how things go, and thanks for your comments and advice, much appreciated 👍!!

[KRod1]

That’s good news and sure it will be fine. It’s the latest valve so can imagine it’s pricey. But then doing one every 30 years is cheaper than doing one every 15 years isn’t it.

Best of luck with it mate and sure you’ll be fighting fit in no time. 👍👊🏻

[JJL15]

Hi, how’s the new valve working out for you? I had a calves valve put in nearly 7yrs ago when I was 28 but now waiting for the nod for the next valve. Is the lifespan longer with the i ispiris valve? I don’t want to take warfarin if I can help it, like u I’m still quite young so rather not- presuming your one isn’t mechanical and not taking meds? How did you come out finding out you needed AVR? If you don’t mind me asking? Was it a shock? Interested to hear in others experiences (nosey I think they call it ) lol 😂

[KRod1 in reply to JJL15]

Hey,

Not nosey at all, just doing your homework.

Important stuff first - yes, Inspiris should last longer. Sheep trials have indicated up to 30 years but it’s new so no human clinical data yet. It’s tissue so shouldn’t require meds.

Less important stuff about me: I’ve known about having a BAV since I can remember and found out about the need for a replacement after my mum protected me from it but an insensitive consultant at University Hospital Cardiff decided to show off in front of his interns and say ‘I may snuff it if I don’t have a replacement’. Not great but that’s how I found out! Was a shock and it definitely affected me. I didn’t like the sound of my own heartbeat and was always a bit apprehensive to push myself in exercise.

When it started to show signs of stenosis and get worse, I started researching lots - the operation, valves, post op etc. There were a lot of valves in development but Inspiris was the one that came through and I was lucky that I needed the op just after it was released. So I found a surgeon who was pioneering it, paid to see him then got the op scheduled and done on the nhs. All went well (a few post op bumps in the road but nothing major) and I’m feeling great.

Advice I would give is research surgeons and hospitals and speak to people to get comfortable with them and the procedure.

You’ll be fine though. Don’t worry.

[headorheart in reply to KRod1]

Hi. I've been reading your posts - and they're really inspirational. I am 48, female and love hiking up to 15km sometimes or swimming long distance. I have 2 teenage kids. I have to have AVR on Friday as was born with bicuspid valve. Found out about it when a GP picked up a murmur a few years back. Its been watched since then but now the stenosis is severe and I have no option but surgery despite fact I'm largely non-symptomatic. I hummed and haa'd over mechanical/tissue option and sought opinions from a couple of cardiologists and surgeons in London. All were v pro mechanical but it just didn't sit comfortably with me. I like a drink and I hate the idea of something mechanical ticking in me. Also hate the idea of warfarin possibly interacting with other stuff. So I've opted for tissue and I am happy with that option even though my surgeon says at worst it might only last 5 years. I think that's the worst case scenario. I'd rather take my chance with new technology although it's likely I'm going to need resurgery down the line. Because of the posts on here, I asked him about the new Inspiria Valve, his reaction was a bit negative, but said he is happy to fit it for me although it would be his first use of this valve (This is at The Cromwell and he also operates out of Hammersmith). He says its the same surgery so thats not his issue but he does say he is conservative and prefers to use valves that have clinical data (ie many years of use behind them). I've been told he's an excellent aortic surgeon and feel in good hands. I know you can't make the decision for me (nor would I ask you to) but do you know what actual data there is on the Inspiria to date!?

[KRod1 in reply to headorheart]

Hi there. Thanks for the nice comments and glad my ramblings have been useful.

So, I’m not a doctor but I have read a fair bit and also made the decisions myself so I can tell you what I know. Put simply, there’s a few reasons I chose the valve:

1. Favourable early studies with logical science

2. The valve is based on Edwards perimount which is the leading tissue valve so this de-risked things for me

3. I met with a conservative surgeon who didn’t go in for new valves as well and I kind of thought ‘well, if we were all like that, we wouldn’t progress would we’.

I’ll explain points 1 and 2 a bit more. Point 3 is just how I felt.

1. As I said, there’s limited human studies as the valve is new. longest is 3 years and available here edwardsprod.blob.core.windo...

The accepted model for heart valves is to use juvenile sheep for clinical trials because (I think) their body reacts similiarly to our own in its reaction to foreign valves. You’ll see that the data from these is favarable and that calcium cannot bond to the resilia tissue. Calcification is the biggest cause of prosthetic valve failure so stopping it should mean longer lasting valves and this is what the studies have shown. You can read more here but realise it’s the company promoting their product. That said, it’s been passed for use in Europe and the US so is relatively sound.

2. The Edwards valves are widely used and industry standard. If they fail, they tend to fail slowly. Which I’m sure you’ll agree is better than the opposite! These new inspiris valves also allow for valve in valve future surgery meaning they can potentially fit a valve transcather rather than through open heart surgery.

All these factors led me to decide that the inspiris valve was best for me at this stage of my life. The way I see it, if it’s not as good as people hoped then, given its based on a sound platform, the most likely ‘worst case’ is that it last as long as a normal tissue valve. Therefore, why not go for it!

Hope this helps and good luck with the surgery. It’s not too bad and you’ll be back hiking in a couple of months I’m sure.

[headorheart in reply to KRod1]

Hi KRod1. Really grateful for your insight. Can you explain the table on the link to me (in idiot language? What does POD <30 and POD>30 mean? Is the mortality figure during surgery or at end point? How do these figures compare to standard valve. I'm now freaking I have a 2.6% chance of death during surgery with the new valve as opposed to what everyone has said is 1% with old valve

If I go for the other valve - I think Edwards Magna valve is it sheep, cow, pig? (I should've asked my surgeon this). One cardiologist I saw was very interested in my annulus (who knew?!) which is 25mm. I have no aorta issues luckily or arterial issues but this is my natural annulus which he said might affect what kind of valve I should choose. Mean anything to you? He did explain if it had been larger I might have been a candidate for a larger valve but everything goes to mush once I leave the doctors room. What does bioprosthetic mean? Is it only the Inspiria valve that's bioprosthetic.

Bet you wish I'd never messaged!

[KRod1 in reply to headorheart]

Not at all. I’ll answer what I can but prob worth talking to your surgeon tomorrow if you’re worried.

- I’d say don’t worry about the mortality rate at all. I’d bet my house that it’s nothing to do with valve being fitted as it’s the same procedure as fitting any other tissue valve just like your surgeon said. The risk of mortality during surgery is quoted as around 1% regardless of valve so don’t worry about that. If you’re worried, phone or email the consultant though. My guess that the higher mortality rate for the study would be because the group were slightly more at risk hence agreeing to be in a trial.

- Remember that this 1% will include a disproportionate amount of older patients because they’re more likely to need the surgery. For you, the risks are lower as you’re younger. All surgery carries risks but you’ll be in good hands and fine

- bioprostetic is another name for tissue valve

- most tissue valves are cow or pig I believe. Inspiris is cow as are most other Edwards valves

- I think annulus would be referring to the diameter for your aorta at the point where the valve sits (the aortic root). 2.5cm is within the normal range. Above 5cm and they tend to replace it during the surgery but you’re fine. There’s also a link between bicuspid valve and a tissue issue which can mean the aorta can dilate hence them checking that. Doesn’t sound like you have that so all good and the valves come in all these sizes so shouldn’t be an issue - youd get a bigger valve if you had a larger diameter. The only down side is that a smaller diameter means less blood flow but as I say, you’re in normal range so no issues. I was high at 4.5 but still in range so no replacentment.

As I say, I hope this helps but do speak to your surgeon if you’re worried as they know much much more than me and can address your specific issues

[headorheart in reply to KRod1]

Thacks so much. I’m so grateful. And you seem to know your stuff. . At the end of the day it’s my choice and I guess I’m lucky to have it. With choice though comes the burden of responsibility. My surgeon said no choice is the wrong one but I can’t decide what to have for breakfast let alone this. I’ll post hopefully when I’m feeling a bit better.

[KRod1 in reply to KRod1]

Regarding the table, the 2 columns refer to less than 30 days post op and more than 30 days post op (up to 3 years).

My interpretation of the table is that the valve performs well. No degeneration and no regurgitation. Looking at the issues that people had, they are mostly post 30 days and not related to the valve. Coupled with the mean age of 67+ , I think the group were at a higher risk of issues and that’s the reason for the issues you see in the table and for the higher mortality rate.

Id not be worried about this data. Indeed, it says the valve performs well.

Again, talk to your surgeon if you’re worried though.

[ecmas in reply to headorheart]

Hello thought i would stick my two-penneth in!....I had AVR for bicuspid valve 6 weeks ago, and went with the Inspiris Resilia valve (Also had a graft to replace section of my aorta because it was dilated). Apart from few bouts of AFib post-surgery I have recovered really well, now back at work and back to gentle jogging, and taking only a baby aspirin daily. Pre-surgery I was competitive triathlete and really wanted to get back to being able to compete some day, that was my main justification for choosing a tissue valve (also high risk of cuts etc. doing my job, and like a good drink!). Looks like KRod has been very helpful in explaining the technicalities of the valve! As he says, when it fails there is potential opportunity for valve-in-valve taken through the groin, and even if push comes to shove and I need full OHS again in 10/15/20 years I will be fairly young (38 at the moment) and fit enough to recover well again, and by then who knows what options will be available! As KRod says, if nobody was willing to take a chance on new technology then we would all be in a much sorrier state! I am not attempting to sway your choice in any way, I am simply giving you a brief account of my story, and I can say that so far so good! I had 25mm diameter valve fitted (think you mentioned your annulus 25mm?) which should hopefully be big enough to give good haemodynamic performance (flow of blood over/through the valve), particularly important if I wanna get good at triathlon again! All the best

[headorheart in reply to ecmas]

Thanks so much ecmas. Glad you put your two pennies in. Is the AFib due to the new valve or can that happen with the conventional valve. Its a difficult choice because neither my cardiologist or surgeon will actually recommend the valve as there is no clinical data. My cardiologist won't even find the time to chat it through with me in person despite fact I have to make decision on Friday morning. Just got a message via her PA. Think it's a bit crap! so I guess the decision is mine and all of your input is really helpful. I guess there is an argument to say go conventional now and then potentially have the newer valve put in when there is more data on it. I won't be wanting to do triathlons but I love open water swimming over long distances. Would hate to give that up in the medium term.

[KRod1 in reply to headorheart]

Glad that ecmas has offered another view here and given another real life example.

Afib is common in all aortic valve replacement but 99% settles down within 6 weeks. I had some and I'm fine now. Theory is that the stitches are close to the electrical signal paths so whilst healing it can affect rhythm and also, as my surgeon said, 'the heart doesn't like to be touched'.

It's extremely poor that your cardiologist won't talk to you at this critical time. Post op, I'd look for someone else. I've been with St Thomas' in London who are excellent and went to Kings to get the surgery because Prof. Wendler there was excellent. There are some great heart centres in the UK and you can pick and choose where you go.

I can't make your decision for you but all valves will work well for you and you have to go with what you feel comfortable with. If you're worried about Inspiris, don't have it as it's not something you can change your mind on. Personally, I think I'd still go for Inspiris as it gives more chance of greater time between ops. And it is being increasingly used so many leading surgeons are happy to back it.

[ecmas in reply to headorheart]

I think atrial fibrillation is quite common after all types of heart surgery (30-40%?), not just valve surgery, and I'm sure you are not more susceptible due to using one particular valve. Shame that your surgeon doesn't seemed interested in entertaining the idea, my surgeon on the other hand was very supportive, even though he had never implanted the valve before, and even though he had to jump through hoops to obtain funding to get the valve! I think you mentioned that were an indecisive person by nature, I too am, but in the end I had to make a decision and so I made one based on my lifestyle and desire to continue that lifestyle, my willingness to accept risk of new valve (lack of data) v potential benefits of improved longevity, and my willingness to accept re-operation further down the line. Obviously weigh up the pros and cons of things, but don't get ate up and worried. I took the view of making a decision, having confidence in and sticking by that decision, and accepting whatever comes. Que sera, sera

Take care.

[headorheart in reply to ecmas]

So incredibly helpful. Yes I will be changing my cardiologist. She's always been good/thorough but her PA is like a Rottweiler. She hung up on me the other day when I said I wanted a follow-up appointment. I'm paying for it for gods sake. Met another through the process, and whilst he wasn't too positive either about Inspiris valve he was just incredibly personable and more local. So assuming I come out of this (having serious doom thoughts), I'll move to him. What does Afibfeel like - just so I know not to panic if it happens.

[KRod1 in reply to headorheart]

Mine felt like a fluttering in my throat but some is more subtle and can go unnoticed. You’ll be wired up to monitors so they’ll know about it before you do and will manage it so don’t worry.

[ecmas in reply to headorheart]

As KRod says, AFib can feel different from person to person and bout to bout, I knew I was going to get a bout because heart rate would initially drop and I would get deep palpitations in throat, then followed by phase of faster irregular beats. Sometimes though the beats wouldn't be that fast, just irregular flutters/quivers/palps. Few potassium supplements and beta blockers sorted mine out fairly quickly. Don't get hung up on this issue though, chances are you will avoid, and if you do get a touch of AF it can usually be sorted quick sharp, so stay positive 👍 let us know how you get on

[kentishbunny1]

Hello,

Good luck with it all, keep posting on your recovery, am also going to Kings for new valve so will follow with interest. Hope all goes well.

[thetidders]

Hi, I also had atrial fibrillation after my triple bypass op last year but it only lasted a few days. To my knowledge it has never occurred again but I didn’t know I had it at the time, I never felt anything.

Jean

[headorheart]

So here I am in hospital. Surgery at 8am. Surgeon says he’s happy to do Inspiris valve. Says neither decision is the wrong one and can decide in morning. He hasn’t used before but says the process is exactly the same for fitting as the external fitting is identical. Still undecided. This is ridiculous. I kinda feel I need to go with my surgeons advice in my head (conventional valve) but my heart says Inspiris. I told you I was indecisive. But this is crazy. Perhaps I’ll wake up and just know

[KRod1]

Go with what you feel comfortable with. No wrong decision. How often can you say that in life hey.

And try to get some sleep. Will all be sorted very soon and you can stop worrying 👍

[headorheart in reply to KRod1]

Hi there KRod1. Hope you're good and hope you don't mind me messaging. You're my valve guru! So had the Inspiris Resilia valve 3 weeks ago today. Surgery went fine (they say), only 4 days in hospital and have been doing well every since. Up and walking an hour twice a day and no major pain apart from drainage sites. On bisoprolol 1.25mg and aspirin and paracetamol. Due to see cardio surgeon after Easter. Too good to be true. Went out on Wed night and had a few glasses of wine (oops) with hubby to celebrate how I was feeling. Since then had obvious feeling of palpitations. Horrible feeling. Went to GP today who was brilliant and did ECG that confirmed atrial fibrillation. Never had this pre surgery as far as I know. ECG's always normal. She's told me not to panic. Increased the bisoprolol and spoke to cardiac team at George's who said no need to come in as an urgent case but to try and weather the storm. I know you mentioned you had a few bout of a fib. Do you mind me asking at what point and whether they resolved. i'm terrified this may be due to the surgery or a new problem or a sign the valve is failing. My cardio surgeon is off the weekend so not being much help at all.

Most upsetting if this is caused by alcohol will I ever be able to drink again?

[Nic25 in reply to headorheart]

Hey headorheart. Just caught up with your decision to go Inspriris. Well done! I'd of course second that! Hope all's going well with your recovery. Personally I've never had any issues with alcohol and my new valve (but then I am only on aspirin) - sitting here with a glass of red in fact! - but I guess everyone is different. Hope it all gets sorted for you one way or another. Keep getting stronger and look after yourself. Nic x

[headorheart in reply to Nic25]

Hi Nic

Thanks for response. I'm hoping this A Fib goes away of its own accord but it's so horrible. Was going so well. Did you have no palpitations at all?

[Nic25 in reply to headorheart]

Hi. No I've been lucky. Had one episode of "flutter" a few days after discharge (on Christmas Eve in fact) but went to GP who did an ECG and underlying heart rate was still stable. And other than that have had no issues at all, though I know it's not uncommon and hear it often will clear up by itself as you say. But isn't pleasant so feel for you and fingers crossed. Good luck x

[headorheart in reply to Nic25]

Thanks so much. These things always happen at weekends, don't they. I suppose I shouldn't complain. All been so good so far!

[KRod1 in reply to headorheart]

Hey, Sorry to hear that. I had bouts of afib whilst in hospital recovering and they just seemed to happen with no obvious trigger. When I was out and recovering at home I had them for around 6 weeks post surgery. They usually came on when I was walking so prob due to raised heart rate. They would last for a few hours at first then gradually came down to minutes and disappeared. Drink still gives me palpitations if I over do it but not afib thankfully. Hopefully it’ll settle for you. It’s not usually anything to do with the valve itself as far as i know / have read.

There’s lots published on afib post avr and it’s very common (somewhere between 20-50% of people get it). I had bouts for a good 6 weeks post op and was worried it wouldn’t settle but my cardiologist was very sure it would and said it’s common and not to worry.

I can’t really give you much more info as I’m not a Dr and don’t know the medical side of this but I found this very reassuring when I was going through it. heart-valve-surgery.com/hea...

[KRod1 in reply to KRod1]

Also, might be worth asking if you need to go on an anticoagulant for a period if you still have the afib as that can help reduce any associated risks. I was on rivaroxaban for a good 2 months post op due to the afib.

[headorheart in reply to KRod1]

Thanks so much - so grateful. You are pretty much a doctor I think. Seeing cardiologist on Monday so will know more then. Do have a few flutters today but does feel a whole lot better than yesterday. Keep on tickin"!

[headorheart]

Hi. All done. Went for Inspiris valve. Happy with decision so far. Don’t feel too bad at all. Bit of vomiting but pain v manageable. Thank you all for your support!