**1. Introduction**

Recently, I corresponded with a 71-year-old physician who had just received a replacement aortic valve using a Transaortic Valve Replacement (TAVR) procedure. Instead of being happy for a successful procedure, the physician complained about the procedure. First, he complained about the cost – that he estimated at about \$140,000, even though his procedure was fully covered by his insurance. He said that \$140 K could treat a lot of people in a third world country for a lot of different medical conditions. He added, "I feel guilty having the money spent on me when so many others are going without medical attention." A part of me admires his desire to help others. However, another part of me feels his reasoning was a little like my mother telling me when I was a child to "Eat your peas. There are children starving in China." Even as a child, I reasoned to myself that eating my peas, or not eating my peas, would not affect starving children in China. My older brother and I finally confronted our mother on her peas-exhortation, and she soon quit with the message. Had the complaining physician declined the TAVR procedure, I doubt it would have resulted in any more patients being treated in a third world country: at least not directly.

Second, the complaining physician said, "I do not expect that a new valve will extend my life more than three to six months." He made this inaccurate and rather startling statement even though he had no other underlying health concerns or conditions. Obviously, the cardiovascular system was not his specialty. A recent aortic valve durability study showed valves doing well after 8 years in younger patients (under 65 years of age), regardless of whether the valve was a surgical aortic valve replacement (SAVR) or a Transaortic Valve Implantation (TAVI – also referred to as a TAVR) [1]. This is an important finding for older folk because replacement valves tend to last longer in older patients than in younger patients.

I was corresponding with this physician because I, also, had been evaluated for an aortic heart valve replacement using a TAVR procedure. I wrote about my aortic valve experience in a popular medical journal, and as a result of that article, I have corresponded with several TAVR recipients or prospective recipients. All of us seem to have some concern about how long we might live with a replacement valve. The good news is that TAVR aortic valves are made from the same biological tissue as surgically replaced valves and should last about as long as a Surgical Aortic Valve Replacement (SAVR). Just this past week I talked with a 90-year-old retired physician whose 94-year-old sister had been living with a SAVR for 25 years – the same valve for all 25 years, and she still was having no issues with her valve.

A few months ago, I corresponded via email with a retired military officer who was soon to have a replacement aortic valve at age 69. He, too, was worried about how long his valve would last. He was scheduled to have a TAVR procedure, and he asked me about how long a replacement valve would last. He was hoping to live into his 90s. He had been reading on the internet and had come to believe that replacement valves do not last too long. He asked me about what might happen if he needed a new valve in about 10 years. I reminded him that I was not a physician but that I had been reading about new procedures involving "re-valving" or "valve in valve" procedures. He then wanted to know what would be done if he had a valve-in-valve procedure around age 80 but then needed a third replacement valve at around age 90. I discussed the durability of today's valves, and that is where our correspondence ended. However, I was impressed with his optimism and zeal for a longer life.

About a year ago, I corresponded via email with a psychologist whose 59-year-old brother was scheduled for an aortic valve replacement using the TAVR procedure. Primarily, she was concerned about the safety of the procedure, and her brother primarily was concerned about how much shorter his life would be with a replacement aortic valve. I explained to her the process a TAVR patient would go through as I understood it, and that seemed to put her mind at ease. In follow-up correspondence, she described how well her brother was doing and that he was back at work full-time following his procedure.

I have come to believe physicians should avoid discussing the length of time someone might live when talking with patients about a valve replacement. Instead, I believe it is better to discuss how much improved valves are and how durable they are. For example, I was 80 years old when I was being evaluated to determine if I was a viable candidate for a replacement valve. Since the average longevity for males in the U.S. is about 78 years of age (or less), why discuss with me how much longer I might live with or without the need for a replacement valve? I had already passed the average age for longevity. The good news is that there have been tremendous advances over the past 50 years in the treatment of diseased aortic heart valves. That's the story I believe prospective heart valve recipients need to hear. If patients are *not* reassured about the high quality of today's valves, then we may tend to start looking for ourselves on the

#### *Perspective Chapter: Complication Using TAVR – A Patient DOI: http://dx.doi.org/10.5772/intechopen.112120*

internet about longevity with replacement valves, and we may be subject to gaining a lot of misinformation and outdated information. Bad information can lead to poor decisions regarding our health and cause us unnecessary stress. Additionally, it stands to reason that physicians will be better at their treatment of patients if they have a better understanding of what the patient is going through. We've all heard stories about physicians who were ill and reported they were better at their profession after their illness and recovery – after they had gone through the experience of being a patient. Physicians are used to being in control, and you lose most of your control when you are a patient for a replacement heart valve. My intent in writing this chapter is to show a little bit about what it means to be a patient based on what I went through with my aortic heart valve. In Section 2, I share my early experiences with my congenital heart valve defect. In section three, I share my experiences with pacemakers and my evaluation for a valve replacement. Also, I share the possible kinds of issues facing any heart valve recipient.

The process of replacing someone's aortic heart valve always will have worries and possible complications. My story about the complications I went through with my aortic heart valve follows.
