Written By: Adam Decide, Affected person Advocate, Creator & Web site FounderMedical Skilled: Kevin Hodges, MD, Cardiac Surgeon, Northwestern MedicinePublished: April 17, 2024
Unbelievable!
Throughout our current affected person webinar, “5 Warning Indicators You Might Want Coronary heart Valve Surgical procedure”, I obtained 43 questions that we didn’t have time to reply in the course of the reside occasion. Think about my shock when Dr. Kevin Hodges, a number one minimally-invasive coronary heart surgeon at Northwestern Drugs and the featured speaker of the webinar, typed up solutions to every affected person query and requested me to submit them right here to assist educate our affected person neighborhood.
Query #1: Deborah asks, “Had an aortic bivalve changed in 2017. Now one other valve is starting to regurgitate…reasonably… Is that this uncommon, once I haven’t had any points with different valves earlier than, or does this occur?
Each affected person, coronary heart, and valve is somewhat bit totally different. We do see that over time sufferers might develop new or worsening regurgitation in a distinct valve. As an example, a affected person with a earlier aortic valve operation might subsequently develop mitral valve regurgitation, which isn’t essentially uncommon. We’d advocate monitoring the opposite valve with common echocardiograms and looking for indicators and signs of coronary heart failure or decreased coronary heart perform. If the regurgitation turns into extreme, it’s attainable you might want a second process. — Dr. Kevin Hodges
Query #2: Chris asks, “If one has each persistent A-Fib AND average Aortic Valve Stenosis, which ought to get mounted first? Secondly, what’s the key figuring out situation for TAVR process?”
For sufferers with atrial fibrillation and vital valvular coronary heart illness, we regularly handle each concurrently throughout a concomitant process. As an example, a affected person may have an aortic valve alternative and a maze process with left atrial appendage ligation in the identical setting. In your case, the strategy could be partly decided by the severity of the aortic valve stenosis (is it barely average or practically extreme) and the symptom burden of your atrial fibrillation. There are a number of therapy choices for each issues, which must be individualized for a selected affected person. Affected person choice for TAVR is predicated on a lot of components, together with the kind of aortic valve illness, anatomy of the valve, and affected person danger components and comorbidities. One situation that favors surgical aortic valve alternative is atrial fibrillation, as a result of that may be addressed with a concomitant maze process on the time of aortic valve alternative. — Dr. Kevin Hodges
Query #3: Robyn asks, “Are you able to repair Afib concurrently the valve in case you are doing an open coronary heart surgical procedure?”
Sure. For sufferers with atrial fibrillation who want coronary heart valve surgical procedure, we carry out a concomitant process referred to as a maze process. It is a sort of ablation process with an 80-90% probability of eliminating atrial fibrillation. We additionally shut of the left atrial appendage with a clip, which reduces the prospect of stroke. — Dr. Kevin Hodges
Query #4: Nader asks, “I’ve been in persistent AFIB for nearly 2 years and been on Calcium blocker and 81 mg aspirin. I’m a 53 12 months previous male and no hypertension or diabetes just a bit excessive LDL. I lately discovered my MVR grew to become extreme. I’m the only bread winner for my household and can’t afford 3 plus months restoration time. What qualifies me for minimally invasive restore with robotics?”
There are a selection of things that decide whether or not a affected person is an effective candidate for a robotic operation. These are based mostly partially on outcomes of an echocardiogram, CT scan, and coronary angiography. For sufferers with vital atrial fibrillation, generally a conventional operation is greatest, as a result of it offers us the most effective probability of fully eliminating the atrial fibrillation and managing the left atrial appendage, which has a major impact on long-term outcomes and even life expectancy. Nevertheless, we all the time weigh a number of components when planning an operation. Additionally it is price noting that the restoration time following a conventional operation for a wholesome 53 12 months previous is more likely to be a lot shorter than 3 months and doubtless nearer to 6-8 weeks. — Dr. Kevin Hodges
Query #5: Georgia asks, “What age is taken into account “TOO YOUNG” for TAVR as preliminary therapy of calcified AVR?”
There isn’t any arduous cut-off for TAVR vs surgical AVR (SAVR) by way of age. We weigh a number of components, together with age, danger components for surgical procedure, comorbidities, and valve anatomy (e.g. tricuspid vs bicuspid). This subject can also be evolving quickly as we acquire extra expertise with TAVR and as new know-how turns into obtainable. Typically, I feel most would agree that youthful sufferers (particularly youthful than 60) are nonetheless greatest handled with surgical aortic valve alternative so long as they’re low danger for surgical procedure. The excellent news is most youthful sufferers may be handled with a minimally invasive strategy. In lots of circumstances, this is usually a proper anterior mini thoracotomy that doesn’t require dividing the sternum. — Dr. Kevin Hodges
Query #6: Dixie asks, “Ought to I solely think about a health care provider or hospital that may do the Sentinel process for the TAVR? My mom had a stroke and had AFib.”
The Sentinel machine is a sort of filter that’s designed to forestall particles from the aortic valve from inflicting a stroke throughout a TAVR process. A big examine of this machine didn’t present a statistically vital discount in stroke in sufferers who had this machine in place throughout a TAVR process (https://www.nejm.org/doi/full/10.1056/NEJMoa2204961). Nevertheless, there are various who imagine strongly within the worth of the Sentinel machine and who use it routinely. From the above examine, it additionally appears that there have been few dangers related to use of the Sentinel machine. Primarily based on the obtainable information, I don’t assume it will be honest to say you must solely think about a middle that makes use of Sentinel, however I might encourage you to debate this problem together with your suppliers when deciding the place to have your process. — Dr. Kevin Hodges
Query #7: Pat asks, “Does train assist or hinder valve regurgitation?”
I’m not conscious of any information to counsel that train (or weight loss plan for that matter) impacts the speed of development of valvular coronary heart illness, however a wholesome life-style can definitely assist with the restoration from any potential valve surgical procedure or process. Nevertheless, in sufferers with extreme valve illness, strenuous train can generally be harmful, and I might advocate speaking to your physician about your train plans. — Dr. Kevin Hodges
Query #8: Invoice asks, “My scenario seems just like the left pic however they are saying I’ve extreme leaky mitral valve. I don’t have any signs besides generally I really feel somewhat drained periodically in the course of the day and so when do I have to do the surgical procedure?”
Timing of surgical procedure in your scenario has to do primarily with (1) how probably we’re to get , sturdy restore and (2) how dangerous it will be to carry out surgical procedure based mostly in your comorbidities. For wholesome sufferers with a excessive chance of a sturdy restore, we provide early surgical procedure as a result of that is related to the most effective long-term outcomes. In sufferers with a number of different medical issues or a valve that might not be repairable, we advocate ready till you develop signs or indicators of worsening left ventricular perform. — Dr. Kevin Hodges
Query #9: Peter asks, “Is a prolapsed mitral valve really coronary heart “illness” or is it actually extra of a mechanical malfunction?”
Usually when individuals say “coronary heart illness” within the media we consider coronary artery illness however this time period applies to a broad vary of situations. Mitral valve prolapse is extra on the spectrum of congenital or genetic coronary heart illness that results in a mechanical malfunction of the valve over time. — Dr. Kevin Hodges
Query #10: Nameless Attendee asks, “I’ve extreme tricuspid regurgitation Beforehand I had mitral valve restore (14 years in the past). Now with congestive coronary heart failure my dr has stated he won’t ever have me below open coronary heart surgical procedure and thinks {that a} tricuspid clip is probably going to not assist me with my explicit scenario. I don’t perceive this- would possibly you be capable to speculate why a clip wouldn’t profit me?”
Some sufferers have development of tricuspid regurgitation after a mitral valve restore process. Most often, these sufferers had delicate to average tricuspid regurgitation on the time of their first operation. Reoperation for extreme tricuspid regurgitation is related to elevated surgical danger (at the least 5-10% operative mortality), particularly if sufferers have developed liver or kidney failure from their leaky tricuspid valve. Nevertheless, excessive danger surgical procedure could also be acceptable for sure sufferers and there are a selection of investigational transcatheter restore or alternative choices that might be thought-about. I like to recommend getting a second opinion (that is by no means flawed) from a middle that participates in trials of transcather tricuspid alternative to make sure that you’ve exhausted your whole choices. — Dr. Kevin Hodges
Query #11: Michael asks, “My prognosis is extreme aortic stenosis. I’ve been doing a ton of analysis on latest research for reversal and decalcification. Are you able to share your ideas on this?”
Up to now, there isn’t any convincing information for a method to reverse aortic stenosis or decalcify an aortic valve. Right now, sufferers with extreme aortic stenosis ought to be desirous about a valve alternative process, both surgically or with a TAVR process. The specifics of timing and selection of process are based mostly on the severity of the aortic valve stenosis and affected person comorbidities, together with age and different medical issues. — Dr. Kevin Hodges
Query #12: Nameless Attendee asks, “I developed HFrEF after robotic mitral valve surgical procedure with 37% EF. One 12 months later and after utilizing the 4 pillars of medicines it’s now 56%. Is that this frequent?”
It’s not unusual for a affected person’s ejection fraction to lower after mitral valve restore. It is because ejection fraction, which is a two-dimensional estimate of left ventricular perform, may be overestimated within the setting of extreme mitral regurgitation. After surgical procedure, when the mitral regurgitation has been eradicated, the ejection fraction is usually initially decrease. In lots of circumstances the guts will rework over time and the ejection fraction will return to regular or near-normal over the course of a number of months. — Dr. Kevin Hodges
Query #13: Michael asks, “The place can I get a second opinion?”
You’re all the time greater than welcome to get a second opinion from Northwestern Drugs from anyplace on this planet through telehealth (or in individual, when you choose). In any other case, the Society of Thoracic Surgeons (STS) offers a star rating system for applications based mostly on sure frequent cardiac surgical procedure procedures, which may give you some steering on the standard of applications in your area. There are nationwide rankings, like US Information & World Report, which may be helpful however ought to be taken with a grain of salt. One nice useful resource is Adam Decide and his wonderful affected person advocacy web site, heart-valve-surgery.com. — Dr. Kevin Hodges
Query #14: Trish asks, “What’s the age for TAVR? My physician stated I’m too younger at 59. They’re wanting me to have the older approach with reducing my chest plate open.”
There isn’t any arduous cut-off for TAVR vs surgical AVR (SAVR) by way of age. We weigh a number of components, together with age, danger components for surgical procedure, comorbidities, and valve anatomy (e.g. tricuspid vs bicuspid). This subject can also be evolving quickly as we acquire extra expertise with TAVR and as new know-how turns into obtainable. Typically, I feel most would agree that youthful sufferers (particularly youthful than 60) are nonetheless greatest handled with surgical aortic valve alternative so long as they’re low danger for surgical procedure. The excellent news is most youthful sufferers may be handled with a minimally invasive strategy. In lots of circumstances, this is usually a proper anterior mini thoracotomy that doesn’t require dividing the sternum. — Dr. Kevin Hodges
Query #15: Robyn asks, “When you’ve got been an athlete most of your life, doesn’t that additionally help as your coronary heart muscle is powerful?”
There isn’t any doubt that sufferers who’ve been very energetic are higher capable of tolerate a coronary heart valve drawback as their coronary heart sometimes has extra “reserve”. Wholesome, energetic sufferers additionally sometimes have a neater and quicker restoration once they do want an operation. — Dr. Kevin Hodges
Query #16: Trish asks, “My echo says do it now, the angiogram and TEE say I can wait.”
Timing of coronary heart valve surgical procedure is usually a complicated determination and infrequently requires balancing information from a number of assessments. When there may be competing (and even conflicting) information, that could be a nice time to get a second opinion to make sure that you’re making the proper determination. — Dr. Kevin Hodges
Query #17: Madlyn asks, “I’ve a mitral valve restore with a hoop across the valve. I’m additionally in Afib. Is the ring across the valve failing?”
The event of atrial fibrillation after a mitral valve restore is considerably frequent. Having atrial fibrillation doesn’t essentially imply there’s a drawback with the restore, but when it is a new discovering, it could be a good suggestion to see your heart specialist for an echocardiogram to ensure your valve is functioning appropriately. There are additionally a lot of therapy choices for atrial fibrillation, together with drugs and catheter ablations that don’t require one other open coronary heart operation. — Dr. Kevin Hodges
Query #18: Georgia asks, “Do Surgical overview boards have the ultimate say if SAVR or TAVR can happen?”
The choice between SAVR and TAVR is made by a group of cardiologists and coronary heart surgeons at a person medical heart, and most significantly by means of a dialogue with the affected person. Your medical doctors will weigh a lot of components together with valve anatomy, danger components, and age and offer you a suggestion for which process they assume is greatest for you. Nevertheless, it’s finally a joint determination based mostly in your preferences that determines how you can proceed. — Dr. Kevin Hodges
Query #19: Robyn asks, “I felt like I used to be 30 years older at age 58, as my valve was failing. I simply thought it was a part of my illness and being drained and never feeling nice was the “new regular”. Then, I used to be instructed it was time for open coronary heart surgical procedure to switch the aortic valve and my aneurysm.”
Your expertise is quite common. When you’ve got not but had your operation, then know {that a} working valve can assist you are feeling the way in which you must on your age. When you’ve got already had surgical procedure then I hope that you’re doing very nicely and again to feeling your self. — Dr. Kevin Hodges
Query #20: Nameless Attendee asks, “If the left ventricle grows from 6 to six.4 in six months… When ought to the valve get replaced in your opinion?”
Timing of valve surgical procedure based mostly on left ventricular dimension is dependent upon the valve in query and whether or not the dangerous valve is inflicting the ventricle to stretch or vice versa. As an example, a affected person with extreme mitral valve regurgitation from mitral valve prolapse and a beforehand wholesome ventricle in all probability ought to have their valve mounted if the top diastolic diameter (the bigger of two frequent measurement) is above 6cm. Nevertheless, in some circumstances the first drawback is definitely the ventricle itself, which we discuss with as cardiomyopathy. These conditions are extra sophisticated and require a devoted group to determine the proper plan of action. — Dr. Kevin Hodges
Query #21: Mike asks, “Is there any connection between bundle department block and aortic valve stenosis?”
I’ll admit that I have no idea whether or not there’s a causative relationship between aortic stenosis and a bundle department block, however that is definitely believable. Nevertheless, the existence of a bundle department block does have implications for aortic valve alternative (TAVR or SAVR). One of many dangers of both of those process is the necessity for a pacemaker, and sufferers with a bundle department block are at greater danger for requiring a pacemaker after their process. — Dr. Kevin Hodges
Query #22: Patty asks, “I’ve extreme/average aortic stenosis and was lately identified with HFpEF with regular BNP. I’m in a wait and see standing engaged on coronary heart conditioning, every day strolling and so on. I’ve elevated signs, train intolerance, shortness of breath, chest tightness with train, lightheadness no syncope. Are these signs a results of the HFpEF or am I near valve alternative?”
Usually talking, sufferers with vital aortic stenosis and signs of shortness of breath, chest ache, or syncope ought to have an aortic valve alternative. If there may be uncertainty about whether or not these signs are associated to the aortic valve, then a stress echocardiogram may be helpful. — Dr. Kevin Hodges
Query #23: Joni asks, “What else may trigger the stroke? I had a serious one with delayed therapy of TPA, inflicting my left facet to be weak and I maintain falling.”
There are a selection of potential causes of a stroke. In circumstances the place the trigger is unsure, a group of cardiologists and neurologists might use a mixture of the options of the stroke and a affected person’s danger components to find out the most probably trigger. If a preventable trigger is recognized, they’ll advocate therapy to restrict the danger of one other stroke. — Dr. Kevin Hodges
Query #24: Andrew asks, “How frequent is Afib after valve surgical procedure? What’s the distinction between afib and atrial tachycardia?”
Atrial fibrillation and a associated arrhythmia referred to as atrial flutter are quite common after valve surgical procedure. For mitral valve restore, as an example, the speed is greater than 30% in the course of the first 30 days after surgical procedure. This danger is barely decrease with a robotic operation. Usually, post-operative atrial fibrillation may be managed very successfully with drugs and the danger decreases again to baseline after just a few months. Atrial tachycardia is a distinct sort of atrial arrhythmia that’s not as intently associated to coronary heart valve surgical procedure. — Dr. Kevin Hodges
Query #25: Nameless Attendee asks, “What proportion is taken into account excessive surgical danger? Thanks for this wonderful presentation.”
Excessive danger means one thing totally different for each affected person and contains components like probability of mortality, main issues (e.g. stroke, needing dialysis or a tracheostomy, and potential high quality of life). For a reference, the primary trial of TAVR vs surgical aortic valve alternative used a cutoff of 10% predicated danger of mortality to outline “excessive danger”. For any affected person who’s contemplating a excessive danger operation, a very powerful factor is to have an in depth dialogue about dangers and advantages together with your surgical group earlier than selecting a plan. — Dr. Kevin Hodges
Query #26: Robyn asks, “Is there a chart that identifies the danger ranges for surgical choices?”
The Society of Thoracic Surgeons (STS) has a web-based software that predicts the danger of mortality or main issues with sure frequent cardiac operations. These are based mostly on nationwide information and should range considerably between facilities based mostly on quantity and experience. Usually talking, excessive quantity facilities have danger profiles which can be extra favorable than the nationwide common. A few of this variability is captured within the STS star rating system for cardiac surgical procedure applications. — Dr. Kevin Hodges
Query #27: Tina asks, “Many due to Dr. Hodges for sharing his experience! Will please touch upon how “surgical danger” is outlined? Thanks!”
Surgical danger means the chance of an opposed final result, together with loss of life, stroke, dialysis, tracheostomy, wound an infection, or a pacemaker. What is taken into account acceptable danger is totally different for each affected person and each operation. Most operations have a modest danger of great issues, however understanding the danger of surgical procedure requires an in depth dialog together with your surgical group. — Dr. Kevin Hodges
Query #28: Joni asks, “What’s the various check to the stress echo? I recall having one many years in the past.”
There are a selection of assessments that assist us decide the severity of a coronary heart valve drawback. These embrace a stress echocardiogram, cardiac MRI, cardiac catheterization (proper or left coronary heart catheterization), or much more specialised assessments in distinctive circumstances. — Dr. Kevin Hodges
Query #29: Deb asks, “When you’ve already had mitral valve surgical procedure (valve restore) for extreme regurgitation and the surgical procedure reduces the regurgitation to delicate however then (round 7 yrs later) the regurg progresses to average worse once more…. What are the issues or dangers of getting surgical procedure once more to cut back the regurg once more? And in addition what’s the chance of that surgical procedure resolving the problem fully and never having to go through one other surgical procedure once more?”
Usually talking, redo surgical procedure is reserved for sufferers who progress all the way in which again to extreme mitral valve regurgitation. In that scenario a re-repair or a alternative is indicated to deal with the leaky valve. The dangers of redo mitral valve surgical procedure are particular to particular person circumstances however are usually barely greater than the danger of a first-time operation. Nevertheless, normally the danger remains to be low and surgical procedure may be carried out safely and with wonderful outcomes. In sure circumstances, when a re-repair may be carried out with a excessive chance of a sturdy end result, then this is a wonderful possibility. In different circumstances it could be greatest to switch the valve. Redo mitral valve surgical procedure ought to be carried out at a excessive quantity heart with a group that has experience in assessing the appropriateness of re-repair and the chance of success. — Dr. Kevin Hodges
Query #30: Nameless Attendee asks, “Had aortic valve alternative nearly 16 years in the past & I’m in my late 70’s. Apart from that I’ve felt tiredness for a few years, ought to I be involved?”
Tiredness is usually a troublesome symptom to pin down. To know whether or not that is associated to your prosthetic aortic valve, the very first thing to do could be to see you heart specialist and test an echocardiogram. If the valve is working nicely on echocardiogram, it’s not more likely to be the issue. — Dr. Kevin Hodges
Query #31: Salvatore asks, “5 years in the past, I had mitral valve restore. Final overview exhibits delicate regurgitation & LAFB. Ought to I keep away from train for concern that doing so may make my situations worse?”
I might seek the advice of together with your heart specialist earlier than beginning an train program, however delicate mitral regurgitation (this sound like restore) and left anterior fascicular block, by themselves, shouldn’t restrict your train. — Dr. Kevin Hodges
Query #32: Maryanne asks, “My heart specialist does the echocardiogram for the previous 5 years and he stated within the final two years my delicate to average regurg. modified to delicate. How may this be attainable?”
There are a selection of things that decide the severity of valve regurgitation and it’s not unusual for severity to fluctuate considerably over time. The excellent news is that neither delicate or mild-moderate regurgitation wants an intervention, so you possibly can proceed to comply with this with periodic echocardiograms. — Dr. Kevin Hodges
Query #33: Invoice asks, “I need revised my query. I’ve AFib and lately I used to be identified I’ve extreme mitral valve regurgitation. I don’t have any signs. What process and when ought to I’ve it achieved?”
The choice to proceed with an operation is predicated on the severity of mitral regurgitation (yours is extreme), chance of a sturdy end result based mostly on overview of your echocardiogram, and your particular person danger of present process cardiac surgical procedure, based mostly in your total well being. The presence of atrial fibrillation favors earlier surgical procedure, even within the absence of signs, as a result of it signifies vital mitral regurgitation, is related to poor outcomes if left untreated, and may be handled with a concomitant maze process with left atrial appendage ligation on the time of surgical procedure. For an in any other case wholesome affected person with this mixture of issues (and assuming that your valve is repairable), I might advocate that you just proceed with a mitral valve restore and a maze process with left atrial appendage ligation. This doesn’t sound like an pressing scenario, however one which you must consider addressing in the course of the subsequent few months. — Dr. Kevin Hodges
Query #34: Nameless Attendee asks, “I used to be identified in 2013 with mitral valve regurgitation which was delicate on the time, it has progressed to average. Why do sufferers have to attend till it turns into extreme which at that time might make for a tougher restoration? Why do it’s important to practically die to get restore and at what stage would you counsel a restore?”
The grading system of valvular coronary heart illness is predicated partially on the chance of the valve illness resulting in signs or coronary heart failure. Usually talking, lower than extreme mitral regurgitation just isn’t ample to trigger vital issues, and plenty of sufferers with delicate or average regurgitation won’t ever progress to extreme. The opposite factor to contemplate is that any operation carries some danger of great issues and even loss of life, even when that danger may be very low. We don’t wish to supply an operation that would result in severe complication if we’re not positive that the mitral regurgitation will finally grow to be an essential drawback. — Dr. Kevin Hodges
Query #35: Jennifer asks, “Is there a relationship between MR, Hypertension, A-fib and Hypertrophic Cardiomyopathy?”
Completely. Sufferers with hypertrophic cardiomyopathy (HOCM) are susceptible to creating mitral valve regurgitation resulting from a phenomenon name systolic anterior movement (SAM) of the mitral valve. Sufferers with HOCM may develop mitral valve regurgitation for different extra typical causes (i.e. mitral valve prolapse). HOCM can also be related to greater charges of atrial fibrillation. In sufferers with this mixture of issues, who require surgical procedure, we will sometimes handle all three on the identical time with a septal myectomy, probably a mitral valve restore if myectomy alone is inadequate, and a maze process with left atrial appendage ligation.
Query #36: Nameless Attendee asks, “How prevalent is Thoracic ascending aortic aneurysm surgical procedure utilizing robotics/minimally invasive?”
I’m not personally conscious of any robotic ascending aneurysm surgical procedure. There are surgeons who’ve described repairing an ascending aneurysm by means of a proper anterior mini thoracotomy. In my observe, I supply sufferers with remoted ascending aortic aneurysms the choice of an higher hemisternotomy, which I really feel affords the most effective mixture of publicity, security, and restricted invasiveness. — Dr. Kevin Hodges
Query #37: Daneen asks, “Is getting a second opinion getting an opinion out of your heart specialist and a surgeon?”
Getting a second opinion usually means getting one other opinion from a heart specialist and/or surgeon at one other heart, which can have totally different observe patterns or assets. Cardiologists and surgeons that work collectively frequently are inclined to share the identical opinions about that are the most effective therapy methods. Typically we’re all responsible of presenting our opinions as the one possibility and it may be very useful to listen to one other perspective. Many facilities, like Northwestern Drugs, supply a digital second opinion possibility and can overview your information and meet with you just about. Getting a second opinion doesn’t have to imply fully establishing care with a brand new set of medical doctors. — Dr. Kevin Hodges
Query #38: Mike asks, “The place can sufferers discover the requirements like Dr. Hodges confirmed for suggestions for having surgical procedure?”
The latest American society pointers for valvular coronary heart illness (2020 ACC/AHA Guideline for the Administration of Sufferers With Valvular Coronary heart Illness: A Report of the American School of Cardiology/American Coronary heart Affiliation Joint Committee on Medical Observe Tips) may be discovered at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923. — Dr. Kevin Hodges
Query #39: Nameless Attendee asks, “What may be achieved to attenuate stroke throughout aortic valve alternative?”
The chance of stroke is expounded to a lot of components, together with valve anatomy, diploma of calcification, and different patient-specific danger components (i.e. carotid artery stenosis, intensive calcification of the aorta, historical past of earlier stroke). One of the best ways to attenuate danger is thorough pre-operative work-up and meticulous consideration to element in the course of the operation. — Dr. Kevin Hodges
Query #40: Karen asks, “What about early surgical procedure for tricuspid valve? Is that really useful for a leaky tricuspid valve?”
Timing of surgical procedure for tricuspid valve surgical procedure is somewhat bit extra sophisticated than aortic or mitral valve surgical procedure. Traditionally, sufferers have been referred for tricuspid surgical procedure solely when the develop signs of coronary heart failure due to the assumption that (1) sufferers stay asymptomatic with extreme tricuspid regurgitation for a very long time and (2) tricuspid valve surgical procedure is excessive danger. The issue is that by the point sufferers develop signs from their tricuspid valve illness they usually have vital proper ventricular dysfunction and injury to their liver and kidneys, which in all probability explains why tricuspid valve surgical procedure has a better mortality price (5-10%). Not too long ago their has been a push for extra proactive surgical procedure, particularly in in any other case wholesome sufferers with preserved proper ventricular perform. We consider these sufferers on a case by case foundation, however usually supply early surgical procedure when sufferers are good candidates for early restore. — Dr. Kevin Hodges
Query #41: Stefani asks, “What can an EKGs present for vlave illness? It seems most medical doctors solely actually take a look at or care about {that a} regular sinus rhythm is happening and don’t actually use the ECG/EKG to assist inform the story.”
EKGs can inform us whether or not sufferers are in a standard sinus rhythm or if they’ve sure irregular coronary heart rhythms (i.e. atrial fibrillation, PVCs). EKGs also can counsel whether or not sure coronary heart chambers (i.e. the left atrium or left ventricle) are enlarged, however these items are higher seen with different imaging modalities like echocardiogram, CT scan, or cardiac MRI. — Dr. Kevin Hodges
Query #42: Jims asks, “Is there any analysis on the causation of calcification on the mitral valve?”
Sure causes of mitral valve calcification, like rheumatic coronary heart illness, are pretty nicely understood. Others, significantly mitral annular calcification, are extra of a thriller. We all know that mitral annular calcification is extra frequent in older sufferers, girls, sufferers with persistent kidney illness, and in sure subsets of sufferers with mitral valve prolapse. Nevertheless, we don’t absolutely perceive the mechanism for the calcification course of. — Dr. Kevin Hodges
Query #43: Chad asks, “I discovered a really fascinating examine I assumed you would possibly discover fascinating. It’s from 2019, and exhibits that repeatedly taking beta blockers helps stop structural valve deterioration, vs not taking them, for these with bioproshethic mitral valves. Curious if any of your consultants have seen any related research for bioprosthetic aortic valve replacements, TAVRs, and so on?”
Thanks for sharing. It is a small, single heart, retrospective evaluation so I might warning in opposition to taking it as very robust proof, however it’s definitely thought upsetting. There have been a lot of research components that have an effect on prosthetic valve degeneration (and native valve calcification, for that matter) however the course of stays incompletely understood. It is a huge problem for valve producers who put an excessive amount of effort into anti-calcification applied sciences for bioprosthetic valves. As we get extra expertise with every new technology of bioprosthetic valve, we’ll get a way of how efficient these processes are. — Dr. Kevin Hodges
Many Thanks Dr. Kevin Hodges!
I’ve to increase a mighty “THANK YOU” to Dr. Kevin Hodges for taking the time to reply the affected person questions submitted throughout our particular webinar, “5 Warning Indicators You Might Want Coronary heart Valve Surgical procedure”.
Carry on tickin!Adam