TAVR Procedure

Malka

Hi,

My dad, 94, just got out of the hospital after a bout of pneumonia. Seems the cause pneumonia was the that my dad has aortic stenosis. Going to see the cardiologist on Thursday. My dad's stay in the hospital was very harrowing for me and him as his disease is at the mid to late stages (I don't quiet understand those either). He had bad delusions, so bad, that I talked the doctors into letting him go home a day earlier because I was afraid another night would have cost him his entire mind. I guess the doctor agreed after hearing some of the things my father was saying.

Anyway, the cardiologist mentioned the TAVR procedure. I said my dad wouldn't do a procedure and keeping him in the hospital without anesthesia would be a problem because of the delusions.

Is anyone aware of this procedure and does anyone have any opinions? I would be happy if you would share.

Thanks so much,

Malka

M1

Hi malka, im not a cardiologist but an internist. TAVR is a procedure to try to open up the aortic valve with a balloon that can be blown up in the valve opening, enlarging it. I was actually a resident at one of the Boston hospitals that first developed this in the early 80's. It's similar to an angioplasty for coronary artery blockages, if that helps. But honestly, at 94, i think your gut instinct is spot on, i would not put him through it. It is not going to enhance his quality of life.

Frankly it doesn't make a lot of sense to say that the aortic stenosis caused his pneumonia unless he passed out and aspirated when he passed out. But there's a reason they call pneumonia the old man's friend. If it were my dad, i would be focused on comfort care only. i wouldnt even go to the cardiologist. That's like asking a barber if you need a haircut. If he hurts, you treat it. If he's comfortable, so be it. But that's just my opinion.

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harshedbuzz

My mom (my dad was the parent with dementia) had TAVR 2 years ago; my DH is in watch and wait mode too as he has a bicuspid aortic valve.

Her cardiologist said that without the procedure, she would likely die within 18 months. It has been amazing for her, but the process is not one to which I would subject a PWD beyond perhaps MCI stage. There was extensive testing ahead of the procedure including a cardiac catherization and a 4-5 day hospital stay in the CCU.

YMMV, but the anesthesiologist who took care of my mom explained that she'd be using light anesthesia and that mom might wake up completely naked and restrained in the OR. My mom had some irregular beats immediately after the device was employed which settled quickly. Since it did, her interventionalist sent her home with wearable monitoring for 30 days which was quite high tech and required my assistance. Had the extra beats popped up again, she would have been fitted with an implanted pacemaker. As her POA, this could have potentially put me in the position of having to make a decision someday to deactivate the device.

Had it been my dad, I would have brought in hospice and aim for comfort care.

HB

Malka

Thank you all for your comments. It has reinforced how I feel. I also felt prepared when I went in to talk to the doctor with my father. The doctor was young and vital and he sort of pushed the "procedure", but my dad said no right away and I agreed. I asked how the doctor could just call it a procedure when he would have to stay in the hospital for 5 days? If my dad made it through the procedure, the 5 days in the hospital would certainly take away what is left of his mind.

The doctor also told me that he is strong and his heart is strong, he could last another 18 months. It made me feel better in a weird way to think that there is an end to this torture.

M1

Glad to hear the update Malka, feels like the right decision to me and your dad obviously had an opinion that should be honored. I know the feeling of looking to death as a welcome release, I assure you--I think many of us here know that in our heart of hearts.

harshedbuzz

Malka-

I would see if you can bring in hospice at this point.

HB

Malka

HB,

We are doing "Comfort Care"? This seems to be a combination of palliative care without the regulations (this is according to his primary care doctor). I think they might accept him now that he has AS. We have been turned down before. I have to take a breather from this last hospital stay. They get harder and harder.

Thank you all.

Malka