Saturday, January 28, 2023

Surgery For Leaky Heart Valve

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When Is Surgical Repair Of A Mitral Valve Advisable

Cardiologists repair leaky heart valves without open-heart surgery

Your mitral valve is two little flaps of tissue that control the flow of blood from the upper chamber to the lower chamber on your heart’s left side. If it’s seriously damaged, especially if it’s leaky, it is strongly advisable to consider surgical repair.

If you are diagnosed with a damaged mitral valve, your surgeon will evaluate the specifics of your situationespecially whether your valve is leaky or blocked . Then it will be possible to weigh the risks of surgery against the risks of managing the disorder with medication and other nonsurgical treatments. Sometimes, if your symptoms are not serious, they can be managed with lifestyle changes and/or medication. But often it will be advisable, especially for a leaky valve, to consider surgery to address the deficiency.

If your valve is severely leakyas long as it hasn’t been damaged by rheumatic fever and hasn’t become calcified, or hardenedit is usually a good idea to repair the valve before it either results in significant damage to your heart or becomes so defective that it can’t be repaired and must be replaced.

New Clip Helps People Too Old Too Sick For Open

One of the best aspects of my career as an interventional cardiologist is that I get to see an immediate improvement in patients I treat.

As Medical Director of UT Southwesterns Cardiac Catheterization Lab, I perform percutaneous procedures on patients with various types of heart disease. Percutaneous pronounced per-cue-TAY-ne-us literally means through skin. During the procedures, we can access the hearts of patients by means of a catheter that is inserted in an artery and then is guided to the problem area of the heart.

Since there is no surgical wound, patients recover from these minimally invasive procedures quickly.

My specialty is the repair of diseased heart valves through percutaneous procedures. In 2014, we added a new mitral valve repair procedure to our repertoire. The mitral valve is a two-leaflet valve between two chambers of the heart the left atrium and the left ventricle. Sometimes, this valve doesnt seal effectively, and when the mitral valve doesnt close as it should, blood can leak backward into the left atrium and even into the lungs, causing serious breathing problems for the patient.

A new medical device called a MitraClip can be used to clip the two leaflets of the mitral valve together, reducing the amount of backward leakage of blood.

Does Mitral Valve Repair Shorten Your Life

Mitral valve repair can help you live a longer and healthier life. Like all heart surgeries, it carries risks. Most people survive the surgery. But some people dont.

The operative mortality, or the number of people who dont survive an isolated mitral valve repair procedure, is less than 1 in 1,000 at experienced centers.

If your provider recommends mitral valve repair, they believe the benefits of the surgery outweigh the risks. Its important to talk with your provider about your specific risks for having surgery and your chances of survival. Also, ask your provider what you may expect if you dont have the surgery.

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Why Its Better To Have Your Mitral Valve Repaired Than Replaced

Having your mitral valve repaired before symptoms become severe can increase your longevity. Heres one patients story.

When Thomas Kimble discovered he would need to have his mitral valve repaired, he was happy to get a recommendation from his Florida cardiologist for a surgeon highly skilled in minimally invasive procedures.

This eased the decision for the Florida resident to move forward, even though, like many individuals, he wasnt experiencing symptoms of his mitral valve regurgitation, which may include fatigue, shortness of breath, chest pain and an irregular heartbeat.

In fact, just prior to his November 2020 surgery with Michigan Medicine Frankel Cardiovascular Center surgeon Gorav Ailawadi, M.D., the 68-year-old was hiking at 11,000 feet in Breckinridge, Colorado. I may have felt a little fatigued, but I attributed it to my age, he says.

Good News For Af Patients With Leaky Heart Valves

Aortic valve replacement
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Journal Wrap | Atrial fibrillation patients who received cardiac ablation to correct a leaky heart valve during surgery were less likely to experience additional AF episodes after one year, according to a study published in the New England Journal of Medicine.

Researchers conducted a randomized 1:1 trial to assess the benefits of ablation in AF patients with a leaky valve undergoing mitral valve surgery. Author A. Marc Gillinov, MD, and his colleagues studied 260 persistent or long-standing persistent AF patients from the Cardiothoracic Surgical Trials Network. Participants received either mitral valve surgery with surgical ablation or mitral valve surgery alone.

Results showed that 63% of patients who received mitral valve surgery plus ablation were free from AF 1 year after surgery, versus 29% of patients who received surgery alone. Patients who received ablation were more likely to require a pacemaker than those who had valve surgery alone. However, those who had surgery alone described a lower quality of life, as they still experienced daily AF.

Gillinov AM, Gelijns AC, Parides MK, et al. N Engl J Med. 2015 10.1056/NEJMoa1500528.

Keywords:CardioSource WorldNews Interventions, ACC Publications, Atrial Fibrillation, Cardiac Surgical Procedures, Catheter Ablation, Mitral Valve, Pacemaker, Artificial, Surgeons

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How To Fix A Leaky Heart Valve Without Surgery

Several options are available for treating a leaky heart valve without surgery. Some options are less invasive than surgery, such as a transcatheter mitral valve repair or aortic valve replacement . You can learn more about these procedures by reading this article. The procedure is performed through a small incision in the center of the chest. The sternum will be separated into two halves and spread apart, exposing the heart. Your surgeon will stop the heart to repair or replace the valve and then insert tubes to circulate blood through your body.

Track Your Symptom Progression

Its important to ask yourself about symptoms.. When doing so, donât simply think in terms of yes or no, but consider the degree to which you experience symptoms.

What causes you to become short of breath? Is it walking 3 miles? Or has that walk gotten shorter and shorter over time, and do you now feel breathless after going to the mailbox?

Do you ever feel lightheaded? Do you ever notice a sudden urge to lie down until you feel steady? How often do you have this sensation?

What about chest pain or unusual swelling in the feet or ankles? Its important to track your symptoms and remind yourself to review them every 6 months or at least annually. Because most valvular heart problems progress slowly, with good notes youâll probably be able to see evidence of your condition if it begins to worsen.

What if Im just out of shape?

It can be hard to separate habits from the mechanics of the heart, which is one important reason you need a health care professional to monitor your progress regularly. Your health care provider will rely on your reportsto help them make treatment decisions. The better you are at noticing whatâs going on, the better you can advocate and participate in building a longer and healthier life.

) and makean appointment with yourself every six months to review and repeat the exercise. You never know when being attentive may save a life.

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What Are The Benefits And Considerations For A Tavi Or Other Minimally Invasive Procedure

Benefits of minimally invasive treatment options may include:

  • Lower risk of infection
  • Less trauma to the chest and heart muscle tissue
  • Reduced length of hospital stay

Of course, everyone wants less pain and a shorter recovery time. But everyone also wants the best possible outcome and the longest, healthiest life as a result. Those factors along with a persons age, health history, type and severity of the valve problem and overall health will factor into selecting the best surgical option for any patient.

Diagnosis Of Heart Valve Disease

Leaky Heart Valve After Surgery to Repair Tetralogy of Fallot (TOF) – CHOP

Our multidisciplinary team of experts at the Heart Valve Program at the Mass General Corrigan Minehan Heart Center manages complex and common valve diseases. Specialists in valvular heart disease, cardiac imaging, interventional cardiology, cardiac surgery and cardiac anesthesia work together to diagnose and understand a patient’s heart valve condition. From there, personalized and comprehensive care will determine the best treatment approach.

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What Else Should I Ask My Healthcare Provider

To learn more about how a leaky heart valve is affecting you, consider asking your healthcare provider:

  • Which valve is affected?
  • What is causing the leaky valve?
  • What lifestyle changes might help?
  • Should I have a procedure to repair or replace the heart valve?
  • Can I still do all of my normal activities?
  • What is my prognosis?

A note from Cleveland Clinic

A leaky heart valve doesnt close properly when the heart beats. Heart valve leakage can place extra strain on the heart and cause symptoms or even heart failure. If you have symptoms of a leaking heart valve, talk to your healthcare provider. There are many ways to repair or replace a valve, and lifestyle changes may help.

Last reviewed by a Cleveland Clinic medical professional on 03/09/2021.

References

Leaking Heart Valves Life Expectancy

  • Although a leaky heart valve can have fatal effects, it is usually diagnosed accidentally as it does not have specific signs and symptoms.
  • Nearly every person has a small amount of valvular regurgitation which can be effectively managed with the help of suitable diet and exercise
  • In some patients, a leaky heart valve remains in the same condition lifelong, not causing any trouble while in some it may develop rapidly leading to heart failure.

Therefore, it can be said that life expectancy with leaking heart valves is quite relative and can vary from person to person.If you are diagnosed with a leaky valve, irrespective of how minor the leak is, it is advisable to keep a regular follow-up with your doctor to be updated about your leaky valve.

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Can A Heart Valve Be Repaired Without Surgery

If you are experiencing a medical emergency, please call 911 or seek care at an emergency room.

Heart valve disease, a malfunction of one or more of the valves that allow blood to flow through the heart, affects roughly 2.5 percent of the U.S. population. More than 6 million people live in the Washington area, which means we can expect more than 152,000 people in our community to have some form of heart valve disease. Fifteen percent of people 75 and older have some problem with their heart valves function.

Symptoms of heart valve disease often build over time and can vary depending on the valve thats affected:

  • Aortic valve: chest pain, shortness of breath and fainting
  • Mitral valve: shortness of breath and swelling of the extremities
  • Tricuspid valve: swollen feet and liver congestion

Too many people suffer for years with these symptoms, but they shouldnt. We offer advanced treatment options, ranging from medication alone to minimally invasive procedures that dont require opening up the chest at all.

How Is Keyhole Mitral Valve Repair Surgery Performed

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Keyhole Mitral valve repair or replacement is performed through a small incision over the right side of the chest between the ribs and does not require the need to cut any bone. The wound heals within 7 to 10 days and is cosmetically very appealing. This is the preferred technique for mitral valve repair keyhole surgery at The Keyhole Heart Clinic and our preferred location is at The London Clinic venue.

We do not use the Da Vinci Robot since we have become highly skilled in the use of specialised designed surgical instruments to perform the surgery with extreme accuracy. Using these instruments, and a 4K television monitor, we can achieve perfect results very quickly with the resulting time on the heart lung machine being significantly shorter than with robotic surgery. We believe that this leads to a far superior recovery because of the reduction in heart lung bypass related dysfunction.

We also avoid spreading the ribs apart which means that the pain associated with surgery is minimal. Patients who undergo keyhole mitral valve surgery experience:

  • Less Risk Of Wound Infection
  • Healing In Days Rather Than Months
  • Quicker Recover

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Surgical Replacement Of Aortic Valves Offers Good Long

This is a plain English summary of an original research article

People undergoing surgery to replace a narrowed aortic heart valve have only slightly lower life expectancy than people without the condition. Surgery was also associated with a low rate of stroke.

This review gathered data from 93 observational studies that followed long term outcomes for people with severe aortic stenosis who had the valve replaced with a biological or tissue valve.

Following surgery, survival ranged from 16 years on average for people aged 65 or less, to six or seven years for those over 75. Fewer than one in 100 developed a stroke each year.

Ten years after surgery most people still had a good functioning valve. By 20 years the rate of valve deterioration had risen to 48%.

Bioprosthetic valves appear safe and are linked to average lifespan for this population, but there may be a need for monitoring and possible replacement after the first ten years.

Types Of Replacement Valves

Mechanical and biologic valves are used to replace faulty valves. Mechanical valves are artificial components that have the same purpose as a natural heart valve. Theyre created from carbon and polyester materials that the human body tolerates well. They can last between 10 and 20 years. However, one of the risks associated with mechanical valves is blood clots. If you receive a mechanical heart valve, youll need to take blood thinners for the rest of your life to reduce your risk of stroke.

Biologic valves, also called bioprosthetic valves, are created from human or animal tissue. There are three types of biologic heart valves:

  • An Allograft or homograft is made of tissue taken from a human donors heart.
  • A porcine valve is made from pig tissue. This valve can be implanted with or without a frame called a stent.
  • A bovine valve is made from cow tissue. It connects to your heart with silicone rubber.

Biologic valves dont increase your risk of developing blood clots. This means you most likely wont need to commit to a lifetime of anti-clotting medication. A bioprosthetic doesnt last as long as a mechanical valve and may require replacement at a future date.

Your doctor will recommend which type of heart valve you get based on:

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What Does Current Guidance Say On This Issue

2014 NICE guidelines on management of heart failure recommend surgical aortic valve replacement for people with heart failure due to severe aortic stenosis, who are assessed as suitable for surgery.

NICE recommend transcatheter aortic valve implantation for people who are unsuitable for surgery. This involves accessing the aorta via a catheter inserted into an artery in the groin or chest. However, the risks involved with this procedure mean that it is currently not recommended as an alternative for people otherwise suitable for surgery. This guidance is under review.

How Can I Reduce My Risk Of Heart Valve Leakage

Cardiologist Q& A: Do Leaking Heart Valves Require Surgery?

You can’t prevent most causes of heart valve regurgitation. But you can reduce the chance of all heart conditions by taking good care of yourself:

  • Eat a well-balanced, nutritious diet.
  • Exercise regularly.
  • Get enough rest.
  • Limit or eliminate unhealthy things such as alcohol, illegal drugs, smoking, and foods high in fat or salt.
  • Maintain a healthy weight.

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What Causes Leaking Heart Valves

The condition of leaky heart valves is called valvular insufficiency or valvular regurgitation. In case of a leaky heart valve, the heart valve does not close completely after blood has passed through. This condition can affect one or more heart valves.

Leaking Heart Valves can be of The Following Types:

  • Congenital Valve Disease it is an abnormality which develops before birth. It can be due to irregular size or malformed leaflets. Congenital leaky valves can be of two types:
  • Bicuspid aortic valve disease this condition affects the aortic valve.This condition affects nearly 2% of the entire population.
  • Mitral valve prolapse this condition occurs due to abnormal growth of connective tissues of the mitral valve. MVP causes tissues of leaflets to become stretchy causing the valve to leak.MVP is seen in about 1-2% of population. MVP is frequently seen among athletes.
  • Acquired Valve Disease these are conditions which affect previously normal valves commonly as a result of the following:
  • Infective endocarditisbacterial infection of the heart valves and its lining . It can cause scarring, growths or holes in the heart valves causing them to leak.
  • Rheumatic heart disease occurs as a result of untreated streptococcal infection.
  • Structural changes such as:
  • Degeneration related to advancing age.
  • Calcification seen in people over 6 years of age. Advancing age, high blood pressure and being overweight are some risk factors.
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    Encouraging Inspiris Resilia Valve Results For Patients

    Dr. Svensson, the Co-Principal Investigator for the COMMENCE trial that evaluated the RESILIA tissue technology had this to say about the INSPIRIS RESILIA valve results*. Almost 700 patients were enrolled in the FDA trial, known as the COMMENCE aortic trial, which supported the approval of the INSPIRIS valve, Dr. Svensson stated. There have been no structural failures of the study valve during the trial out to 3 years which we reported at the recent American Association for Thoracic Surgery Conference, and hence we did not have any re-operations due to structural valve failures. This is obviously an encouraging result for a breakthrough technology.

    Reference:

    *RESILIA tissue tested against commercially-available bovine pericardial tissue from Edwards in a juvenile sheep model.

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