Ask Adam Anything LIVE at the Heart Valve Summit!!!

Here is my question –

There seems to be a range of opinion on the timing of mitral valve
surgery. I am a patient with (almost)severe mitral regurgitation and a
moderate/severe enlarged left atrium. I have received two contradictory
opinions from both cardiologists and surgeons, one advising immediate
surgery to prevent more heart damage and the other advising no need for
surgery now. As a patient, I find this distressing and feel that it’s up
to me to do research and decide the right course of action. Why isn’t
there a consensus or clear guidelines about timing of mitral valve
surgery in the medical community?

There does not seem to be much information on failed Ross Procedures on the web. I had OHS in September 2016 for AVR using the Ross. My new Aortic Valve (my old Pulmonary Valve) is doing fantastic, yet the cadaver Pulmonic Valve they implanted became severely stenotic very rapidly; within a year. I was just recently treated using a Edwards SAPIEN XT Transcatheter Heart Valve in the Pulmonary position. My question that I can’t seem to find the answer to is How did it happen so fast? and Is this something that has happened often or am I just one of a kind?

Thanks Adam!

I had a bovine valve replacing my tricuspid valve in 2009 thru my sternum. What would be the next procedure if I needed to replace this valve in the future?

Before I had my BAV replaced in August 2016 I was experiencing shortness of breath. More than a year later, I still get short of breath. The last echo I had showed that my valve looks great, my mitral valve has a slight leak and I have a dilated ascending aorta (4.3). My question is, what could be causing my shortness of breath? Thank you for your response.

After a heart echo in 2013 that preceded a pacemaker implant, I was told I had 2+ mitral valve regurgitation. I was told it wasn’t a matter of if it failed, but when it would fail. I had the same result from an echo in 2014, but in 2015 & 2016 the echos showed 1+ regurgitation, and my cardiologist told me we didn’t need to check it this year. I don’t feel comfortable with that. Should I seek another answer elsewhere, or does improvement in mitral regurgitation frequently occur?

Is TAVR for aortic valve regurgitation as good as open heart surgery for long term (>10 yrs). What is the success rates for both methods for otherwise fit males over 70 yo?

I had mitral valve regurgitation repair in April of this year. After a follow up echo in July, my cardiologist related that my aorta valve was dilated at 4.5 cm and surgery might be necessary at 5.0 to 5.5 cm. At the time of surgery, the aorta valve was dilated at 4.1 cm. COULD THE VALVE REPAIR IN APRIL AND/OR STRENUOUS, PROLONGED EXERCISE CAUSE THE AORTA TO GROW SO RAPIDLY? THE AORTA VALVE LEAFLETS WERE OBSERVED AS NORMAL. I have no other health issues nor am I on any medication as a 61 year old male.
Thanks

On my 47th birthday I was given the choice of a pig valve or a Mechanical valve in the mitral location. I was given about 10 minutes to make a decision. Needless to say I’d like a little more time to do SOME dudellgence next time around. Knock on wood….. I’m using a Medtronic model 310C31 in the Mitral position. I’m doing wonderful my cardiologist thinks I’m a long way out from my next event 10+ years.
Knock on some more wood… So I’m working on my 52nd b-day in February. What should I be looking ahead for?? I’m not exactly pumped about a “sternum”access event again. But is this the only way for a guy of my I’m going to say young age..
By this time could a valve be made using my own genetic material? What do I have to look forward to?? As always thank you for all you do.. 😎

I had my mitral valve replaced with a bovine valve 1 July, but I am still tired and short of breath when I do anything. How long will I be this way?

Hi Adam,
I had a aortic valve replacement at age 58 (pig valve) and now at age 60 , I am already wondering what my “next valve” could be, when this one wears out. What are my options 10 to 12 years from now? I am currently very healthy. (run marathons….)

Hi Adam, I am 71 years of age and I have have a Stenosis Aortic Valve that is considered to be at a moderate stage now, I also have Mitral Valve Regurgitation that is considered severe. My Cardiologist says I will most likly need my Aortic Valve replace within a year or two along with my Mitral Valve either being repaired or replaced during the same surgical procedure… My question is, Should I have the surgery done sooner do to the fact that I have severe Mitral Valve Regurgitation?

I currently have bicuspid aortic valve disease with severe aortic stenosis, and will be needing my aortic valve replaced most likely within the year. I live in northern New England, but was hoping to have the surgery done in the Midwest, at a facility known worldwide for their expertise. I also am interested in going there due to the option of having a mini-thoracotomy vs. a sternotomy. My new cardiologist said he always recommends having surgery done locally because if complications arise post op, no surgeon is going to want to touch another surgeon’s work. WHAT PERCENTAGE OF PATIENTS EXPERIENCE COMPLICATIONS ( AFTER HAVING A BIOLOGICAL VALVE PUT IN) THAT REQUIRE A REOPERATION SHORTLY AFTERWARDS? What is the timeframe within which post op issues would become apparent? Or will I just ALWAYS bear that risk? Would it be better to have it done locally for these reasons?

Hi Diane, I’ll do my best to get this answered!

Hey John, Great questions. I’ll add it to the list. Thanks!

Thanks Greg! Have you heard much about “Valve-In-Valve” procedures? Here’s some info for you – http://www.heart-valve-surgery.com/heart-surgery-blog/2017/06/15/valve-in-valve-fda-approval/.

Thanks Wilma! Here’s some info about fatigue that might be helpful. http://www.heart-valve-surgery.com/heart-surgery-blog/2012/08/22/tired-after-heart-surgery/

Wow! Only 10 minutes to pick a valve! Geez! Great to hear it’s working out for you. Also, great question about the future of valve replacement approaches and materials John!

Got it Joseph! Thanks!

Hi, I don’t know if TAVR is being used for aortic regurgitation. I know it’s being used for aortic stenosis. I’ll do my best to get this answered!

Mike, I think I can answer this one now. If you are not comfortable with the echo, please, please, please, please get a second opinion. This seems very peculiar that the regurgitation would decrease. Anything is possible, but it seems unlikely that a structural heart issue would improve over time. Usually, it’s the other way around.

Interesting question Tim. Thanks!

Got it Jessica!

Thanks Nupur!

Thank you Adam. Can’t say enough about what your doing to help.
Your my modern day rock star. 😎

How long before mitral valve replacement without opening the chest now have pig valve ( know they use correct name but I forget right now)

In this case stenosis is not a factor. If TAVR is not appropriate is there a less invasive method that has comparable results as open heart surgery available?

Is there anything more in the pipeline for pediatric patients which artificial valves in the mitral position. Any hope to not be saddled with multiple open heart surgeries to replace valves they outgrow?

Here is my question for the surgeons:

Sternal instability with friction between the sternal halves has been reported to promote inflammation, effusion and infection. Publications have also revealed that 50 to 80% of sternal infections are discovered after discharge, and that cardiac patients have the highest readmission rates.
Since the sternal wires are the only force holding sternum together after surgery, why is it that external chest supports are not a standard adjunctive and precautionary procedure after surgery?

Hi Adam, Two questions please: 1) could you please ask the surgeons about annuloplasty rings and which styles (and brands if they are allowed to say) have the best track record for long-term effectiveness following mitral valve repair surgery (for regurgitation)? If certain styles are good for different reasons (leaks in different sections of valve: A1, P1, etc) please see if they can include this data. I understand that there are different shapes and that when tested, some were much more effective than others. 2) could you please ask about how surgeons make the “line of coaptation” the best as possible; this is one of the characteristics that helps ensure the success and longevity of a mitral valve repair. Thank you.

Adam I think I may be to late for my questions but I’ll ask just in case it’s not. I have been diagnosed with Severe Mitral Valve Regurgitation and as per my pre-surgery consult I have broken cords on my posterior leaflet. I am between 2 surgeons 1 in Indiana (Heimansohn) and 1 in Cleveland (Gillinov). The Indiana doctor does not perform robotic surgery so he would perform a mini-MVR in my side and I’m guessing Cleveland would perform robotic surgery (can’t tell because I am not able to have consult until all operative test done). Question 1: Does Mini-MVR or Robotic repair result in a better more durable repair?
2: The Indiana surgeon said I need no Heart Cath since I’m 34 and extremely healthy, said it is a unnessecary risk. Is this safe?

Thank you,
Dave

I was hoping to see a reply to my question I posted about the replacement of my bovine valve done less than 3 years ago. Thank you.