3.165 TAVReport 1

Monday 04/16/2022

Took an abbreviated walk, about 2 miles. Then attended the Events Committee meeting at 10:30, nothing exciting there. Then to FOPAL to tidy up my section after the sale weekend, and do a post-sale count: 58 books sold.

Finally it was time to head to PAMF South, at El Camino and highway 85, to meet with Dr. Rammohan, whose title is Interventional Cardiologist, and Dr. Pei Tsau, a Thoracic Surgeon, to discuss installing a TAVR for me. Here’s an actual TAVR:

The metal basketwork gets squished to a pencil shape, and they run it up your femoral artery, around the aortic arch, and push it between the leaflets of the aortic valve. Then they let it go and it springs out as seen above, pushing the leaflets of the old valve aside and taking over its function.

Dr. Rammohan is middle-aged, very tall, lean, brown and confident. Dr. Tsau is also of middle years. She knows, and often works with, Dr. Vincent Gaudiani who installed my first valve, back in 2000! Dr. Rammohan knows “Vince” well, also. We had a good time talking about what a character he is. The two doctors, Rammohan and Tsau, work together as a team doing TAVR procedures. They seemed to have a very comfortable, chatty working relationship, which was reassuring. It was further reassuring that they knew all about the previous procedure, knew in detail what Dr. Gaudiani had done, what kind of valve he had used, and so on. One of the things I had planned to ask was, “are you aware just how thoroughly my valve has been messed-about with?” And they definitely were aware, better than I am. They’d studied all my CTs and MRIs right back to 2000.

Dr. Rammohan said something Dr. Dibiase had not been explicit about: that just one of the three leaflets in my porcine valve is failing, but that allows nearly half of the blood the heart pushes out, to flow back on each stroke. The heart tries to compensate by enlarging, which mine has done, so as to push more per stroke. Hence the need to replace the valve.

We talked about possible problems. One is that some cardiac arteries spring off the aorta just above the valve, and in some cases the TAVR can partially block these. But in my case, Dr. Gaudiani had relocated those arteries higher when he reconstructed my aorta, so that will not be an issue for me. Another possible side-effect is stroke: less than 1% (but not zero percent) of TAVR procedures result in stroke. However, that is probably more common in cases where the procedure is done because of stenosis, where the valve being replaced is failing due to calcification. That is not the case with me; my valve is not calcified.

Then the two surgeons left, and I got an orientation session with Kathleen Masket, RN. I’m not sure of her job title, but she does the administration and patient orientation for this cardiac group. She pointed out a page in the booklet she gave me, showing the safety numbers for their group compared to national averages. They had helped to pioneer the TAVR technology and consistently have fewer complications (less than 1%) than the national average.

The procedure is often done under partial anesthesia, similar to a colonoscopy. In my case, they want to use a Trans-esophageal echo during the procedure so they can visualize the valve. That’s where an echo transmitter wand is pushed down the throat, and Dr. Rammohan said, “you wouldn’t want to be awake for 25 minutes while that’s in there.” So I will get full anesthesia.

Following the procedure one is moved to a normal ward (not the ICU) and has to lie flat for six hours to ensure full closure of the entry to the femoral artery. (Hey, I can do that.) Then you can sit up, get up and walk around, but you remain in the hospital overnight. Next morning there are a few tests and an echocardiogram and, assuming all is good, normally you can go home by lunchtime.

The actual date for this adventure is TBD, but probably in a week or so.

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