45 Patient Questions Answered by Dr. Doug Johnston!
Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Doug Johnston, MD, Chief of Cardiac Surgery, Northwestern Medicine
Page last updated: March 3, 2025
Great news!
During our recent webinar, “6 Expert Tips for Heart Valve Patients”, I received 45 patient questions that we did not have time to answer during the live event.
Imagine my surprise (and thankfulness) when Dr. Doug Johnston, Chief of Cardiac Surgery at Northwestern Medicine and a featured speaker of the webinar, typed up answers to each patient question and asked me to post them to help educate our patient community.
Question #1: Bobby asks, “I have had several TEEs, Echos and Cardiac MRIs over the last 22 months. They all vary from moderate to moderate-severe. Some recommend surgery while others say looks good see you in a year.
Mitral regurgitation can appear different in severity based on loading conditions, meaning how much fluid you have in your body at the time of the study. Sometimes it is best to get a stress echo to see how the valve is performing when you exercise. – Dr. Doug Johnston
Question #2: Anonymous asks, “Is it possible to develop complete heart block eight years after having Mitral Valve repair. I now have a pacemaker.”
It is possible to develop late heart block, but often this occurs because the conduction system of the heart is changing over time, not due to the repair itself. – Dr. Doug Johnston
Question #3: Shari asks, “I am curious to know if doctors are recommending transcatheter valve replacement for patients under 60 years of age?
This is a great question. There is a lot of debate about the role of TAVR in younger patients. In general, whether TAVR or SAVR is a better option depends on what other medical problems the patient has, as well as the size and shape of the valve and condition of the other heart valves. – Dr. Doug Johnston
Question #4: Anonymous asks, “I have a trifecta valve which is deteriorating. Is TAVR an option to replace this valve?”
TAVR can be an option in failing Trifecta valves. It will depend on the size of your aortic root, and the position of the coronary arteries, which can be determined on a TAVR CT scan. –- Dr. Doug Johnston
Question #5: Bobby asks, “Two surgeons were ready to do surgery based off of one Echo. Is that okay?”
It sounds like you have gotten a number of different opinions. It is a good idea for your cardiologist and surgeon to review all the studies and get a consensus they can discuss with you. – Dr. Doug Johnston
Question #6: Kim asks, “What kind of symptoms happen if a mechanical aortic valve is failing?”
Symptoms can include fatigue, shortness of breath, dizziness – all of the symptoms that can occur when a native valve is failing. An echocardiogram is the right first test to look at valve function. – Dr. Doug Johnston
Question #7: Bobby asks, “The LA and LV some say severely dilated and other say normal size?”
Your valve team should take a look at the actual dimensions of the LA. MRI and TEE tend to be the most accurate. – Dr. Doug Johnston
Question 8: Cynthia asks, “Cholesterol medicine if little blockage was present in heart arteries at time of SAVR (20%)?”
Cholesterol medication may be indicated. This will also depend on what the blood tests for cholesterol show. – Dr. Doug Johnston
Question 9: Julie asks, “I have diagnosed with Aortic stenosis, yet too early for surgery, how can I keep my valve healthy and open to avoid surgery?”
The best thing to do is keep your whole heart healthy. Eat well, exercise, keep other cardiovascular risk factors in control. Valve disease tends to progress slowly, and there is not much a patient can do to change the course of aortic stenosis. – Dr. Doug Johnston
Question 10: Cynthia asks, “Can a TAVR replace a 21mm SAVR bovine valve?”
In some cases yes, although TAVR in a 21 mm valve may result in some residual stenosis. – Dr. Doug Johnston
Question 11: Susan asks, “What is the success rate for a third redo for aortic valve replacement?”
Most of the time reoperative aortic valve replacement can be performed with similar risk to a first time operation. – Dr. Doug Johnston
Question 12: William asks, “What is the current status of TAVR HALT treatment?”
The mainstay of HALT treatment is blood thinners. If the HALT is caught early, the clot may dissolve and the valve return to normal function. – Dr. Doug Johnston
Question 13: Cynthia asks, “Is a previous HIT II during SAVR a reason to have a future TAVR when needed?”
Not necessarily. This would be a good discussion to have with your valve team. HIT is often temporary, and later procedures can often be performed safely with a single dose of heparin. – Dr. Doug Johnston
Question 14: Cathy asks, “How many cardioversions can a person have?”
A person can have a lot of cardioversions, but at some point it makes sense to talk to your team about ablation procedures for the Afib, whether surgical or transcatheter. – Dr. Doug Johnston
Question 15: Chris asks, “I’m 66 a former runner (half marathons). I have congenital Bicuspid Aorta Valve. Diagnosed 6 years ago. I went in due to sudden onset of having it hard to breath during runs. went for a stress test echo and they found the issue. the breathing and chest pain seems to be getting more often with less stress. But my annual echo shows just moderate stenosis with slight worsening numbers every time and I keep hearing I’ll need surgery in 3- 5 years. I’m feeling I should maybe have the surgery next year… even though doctors have not suggest it. Thoughts?”
It would be important to look for other reasons for the shortness of breath. Usually moderate stenosis does not result in significant symptoms, but sometimes echo can underestimate the extent of disease. In some cases MRI can be useful to take another look at the valve. – Dr. Doug Johnston
Question 16: Richard asks, “What is the best way to manage aftercare following surgery?”
Early return to activity is important. Most patient can get back to aerobic activity very early after valve surgery, and can be at full activity in 6 weeks. – Dr. Doug Johnston
Question 17: Lew asks, “I have been diagnosed with anemia and 8 months after my aortic valve replacement. Is it possible that my aortic valve is not sealed correctly?”
In some cases a leak around the valve can lead to damage to red blood cells and hemolytic anemia. This can be hard to see on transthoracic echo (TTE). A TEE may be necessary to rule out a leak. There are also many potential causes of anemia not related to the valve. – Dr. Doug Johnston
Question 18: Judy asks, “Please comment on whether robotic mitral valve repair surgery is riskier because it takes longer and has increased risk of stroke. And how often does a mitral valve repair become a replacement?”
Patient selection is very important for robotic surgery. We obtain a very detailed CT scan on all patients considered for any minimally invasive approach including robotics so that we minimize the risk of stroke. Robotic surgery should NOT be riskier than other approaches when patients are selected carefully. As with open surgery, repair is possible in greater than 95% of patients with degenerative mitral valve disease. – Dr. Doug Johnston
Question 19: Marc asks, “Back in October I had “complex mitral valve repair, posterior MAC decalcification that was performed via sternotomy. What causes the calcification and how do I prevent it from returning?”
We don’t have a good understanding of why mitral annular calcification occurs. The good news is it takes a long time to grow and is unlikely to grow back. – Dr. Doug Johnston
Question 20: Dave asks, “2 weeks ago I had 3 valves repaired, mitral, tricuspid, aortic and the ascending aorta replaced. As an active 70 year old how long can I reasonably expect these repairs to hold up, given a good diet and staying active?”
How long valve repairs last depends a lot on what is wrong with the valve in the first place. We expect a well done repair to last at least 10 years, in many cases more like 15-20. The same is true for tissue valve replacements. – Dr. Doug Johnston
Question 21: Allina asks, “Do you expect that TEER will prove to increase life expectancy? Who decides the best regarding risks vs benefits cardiac surgeon/ interventionist who is experienced in performing T TEER or HF cardiologist who knows the patient for a few months, if they disagree- one says safe, the other says very dangerous for 91 y.o? Thank you”
The best way to look at risk and benefit of a procedure is to have a team of experts who understand the data, have a lot of experience with the procedure, and work TOGETHER to help you choose the right therapy. A patient should not be put in the position of deciding between conflicting opinions of two different doctors. – Dr. Doug Johnston
Question 22: Gutha asks, “For a calcified mitral valve, I have been advised to get it replaced. Am 72 and do not have any other co-morbidity. Please explain the differences between open heart Vs Robotic Vs Video assisted thoracotomy. What considerations should I factor in?”
Which surgical approaches are safe for mitral replacement depend a lot on how much calcium is present and where it is. It is sometimes difficult to deal with severe invasive calcification through a small incision. It is important to talk to your surgeon about exactly how the calcium will be dealt with, for example will it be removed so the largest possible valve can be implanted? – Dr. Doug Johnston
Question 23: Anonymous asks, “I am getting mitral valve repair next month. I have been debating if it is better to get robotic or traditional sternotomy. I am being offered robotic. Is the repair just as good with robotic? I hear you are on the heart lung machine longer with robotic ? Is that a big concern. I am 48yo. I also hear if things go south with robotic surgery and they have to open you up it can cause a lot of complications.”
A robotic approach can be an excellent option provided the patient has good anatomy for a robotic repair, there are no other heart which might complicate the approach, and the surgical team is very experienced with robotic repair. Time on the heart lung machine tends to be slightly longer, but not much compared with sternotomy. It’s important to know the results of the team you are working with, and how they think about robotic vs sternotomy or other minimally invasive approaches. – Dr. Doug Johnston
Question 24: Cathy asks, “Will an enlarged left atrium cause future problems?”
An enlarged left atrium can lead to a higher risk of atrial fibrillation, but what is more important is what caused the enlargement. – Dr. Doug Johnston
Question 25: Richard asks, “Doing my heart valve surgery, I was told I had a minor stroke. Is it common to have a minor stroke during this surgery?”
Fortunately, strokes are not common with valve surgery, but they do occur in a small number of patients. About half of strokes occur during surgery and half in the few days afterwards. – Dr. Doug Johnston
Question 26: Daneen asks, “I just had surgical aortic valve and aorta resection in August of 2024 and just found out my mitral valve regurgitation just worsened to moderate regurgitation. Can I wait until I have to get a reoperation for my aortic porcine valve to then also get a mitral valve replacement/repair?”
In some cases the changes in heart shape and function after aortic valve surgery can affect the mitral valve, but fortunately moderate mitral regurgitation is not usually something that needs intervention. Your team should be following you with regular echocardiograms. – Dr. Doug Johnston
Question 27: David asks, “If you had an AV bioprosthetic valve, and you need a redo at some point in the future and are healthy enough for open heart, is open heart valve replacement give you a better result than transcatheter AV replacement?
There are currently several studies underway to look at outcomes for redo surgery after aortic valve replacement vs valve in valve. There is some evidence that redo surgery may be more durable, but this depends a lot on what valve is in place, the size of the valve, and other factors related to the patient. Stay tuned as I expect we will learn a lot more in the coming year. – Dr. Doug Johnston
Question 28: Sravanthy asks, “When patients as young as 16 yrs old get Ross procedure done where the prosthetic pulmonary valve can last for just 10 to 12 yrs.. can get it replaced through trans catheter procedure for only thrice… What options are left for such patients later?”
A pulmonary homograft can be replaced with surgery if there are no transcatheter options. This is generally a low risk operation. – Dr. Doug Johnston
Question 29: David asks, “Are there any lifestyle, diet, supplements that can make your heart valve last longer or is bioprosthetic valve lifespan a mystery from one patient to the next. I know younger patients bio valves don’t last as long due to immune response? Does someone who likes to exercise wear it out faster?”
Fortunately exercise does not wear out valves faster. The only thing to avoid is taking very high doses of calcium. Otherwise bioprosthetic valve durability is very much independent of lifestyle. While it is true that valves don’t last as long in younger patients, they can still last for more than a decade even in patients under 50. – Dr. Doug Johnston
Question 30: Joni asks, “I got discharged from a congenital heart Dacron graft with untreated pneumonia for 10 months (even with 5 follow-up visits with the cardiologists and chest x-rays all stating such). My aortic valve went bad causing the need for a replacement. My new cardiovascular surgeon told me “I died on the table” and replaced my mitral valve with too small of a cow valve as that was all they had in stock. Did the untreated pneumonia cause the valves to go bad?”
Wow I am very sorry to hear about your experience. That sounds like a complicated situation. It is possible for bacteria from pneumonia to get into the bloodstream and cause an infection of the valves. That is something that usually can be determined at the time of surgery, or by looking at the pathology report to see if the valves were infected. – Dr. Doug Johnston
Question 31: Bernadine asks, “Good evening! I had my aorta valve replaced in Jan. 2024 with a Bovine valve-how will I know if the valve start failing?”
Congratulations on your new valve. The good news is that these valves typically last a very long time. Your team will likely schedule you for a yearly echocardiogram, which will show when the valve starts to narrow or leak. Hopefully it will be many years in the future. – Dr. Doug Johnston
Question 32: Sher asks, “Can robotics (minimally invasive) now be used for Aortic aneurysm grafts and valve repair?”
Minimally invasive approaches are possible for many patients needing aortic valve and ascending aortic aneurysm repair. While robotic approaches are very useful for mitral valve operations, and are slowly gaining traction for the aortic valve, minimally invasive aneurysm repairs are usually performed through a small incision in the upper part of the sternum without using the robot. – Dr. Doug Johnston
Question 33: Grace asks, “What can I do to prevent calcification of a new replacement valve? Do I need to avoid phosphorus or foods?”
Other than avoiding very high doses of calcium supplements, there is nothing you need to avoid in terms of lifestyle or foods. – Dr. Doug Johnston
Question 34: Anonymous asks, “At my first annual post TAVR procedure I asked my cardio if I needed to have a Echo and he said no my heart will let me know when one is needed. Should I change doctors?”
At Northwestern we believe every patient with a replacement valve, TAVR or otherwise, should have an annual echocardiogram to evaluate the valve function, especially since valves usually start to show signs of failure by echo long before patients get symptoms. – Dr. Doug Johnston
Question 35: Alan asks, “I had a TAVR recently for bicuspid aortic valve and after the surgery had several episodes of V-tach including an episode that my implanted defibrillator shocked me. I was told that the new valve needs to epithelialize. Have you heard of this and how long does it take to recover.”
Ventricular tachycardia is an uncommon rhythm after valve surgery. While newly implanted valves do develop an ingrowth of tissue including endothelial cells, I’m not sure how that will impact the risk of recurrent V-Tach. That sounds like a good question for an electrophysiologist. – Dr. Doug Johnston
Question 36: Susan asks, “I understand the trifecta valve was recalled. I’ve had mine for 10 years and still ok. Is there any risk to still have this in me.”
Though the Trifecta valve is no longer being sold, many Trifecta valves have very good durability. The most important thing is to monitor the pressure gradients through the valve, and any evidence of leakage, with regular echocardiograms. As long as it is functioning well it should be no riskier to you than any other valve. – Dr. Doug Johnston
Question 37: Matthew asks, “Hi Doctors, I am 53 I’ve been diagnosed with bicuspid valve. Is there anything that can be done – other than surgery – to help the valve or to otherwise put off the surgery, e.g., pharmaceutical, diet, exercise, aspirin, etc… Or is this just waiting until I become symptomatic.”
The good and bad news, depending on how you look at it, is there is nothing we know of that will alter the course of the valve if it is becoming narrow or leaky. That said you should not wait until you develop symptoms! Healthy patients often develop symptoms very late. Be sure you and your team are following the valve with regular echocardiograms. – Dr. Doug Johnston
Question 38: Robert asks, “I had my aortic valve replaced with a bovine valve in November 2024 along with repairs to both mitral and tricuspid. Things were great until mid January and they now suspect paravalvular leak of my replacement valve. My hematologist now has diagnosed me with hemolysis and hemolytic anemia from blood loss and he suspects this is a result of the open heart surgery. What are possible options to repair the leaking replacement valve?”
I’m sorry to hear about your paravalvular leak. There are basically two options to deal with this if your team has decided the leak is too severe, or is causing too much hemolysis, to manage medically. In some cases a plug can be placed in the leak using a catheter going from the groin. This is not possible in all cases due to the size and location of the leak. If a pluch is not possible then redo surgery may be necessary. – Dr. Doug Johnston
Question 39: Anne asks, “I am 53 and have an Edward’s Resila biological tissue valve, replaced 3 years ago. What factors contribute to the tissue valve deterioration that would lead to either a TAVR need or a second SAVR to replace it. Bench tests suggested the valve would last 10-15 years. My intervention cardiologist suggests maybe even 20. If a TAVR was suggested for me at about age 65, what would the likely durability be? Would I potentially need another SAVR?”
Most tissue valves fail very slowly because of deposition of calcium on the leaflets causing narrowing. You are right that there is a good chance for the valve to last 15 years based on studies of older tissue valves. We don’t know as much about how long a valve in valve TAVR will last, but there is some data to suggest these won’t last as long as a SAVR. It’s possible that you might need another SAVR, but we will know a lot more about the durability of these valves in the coming years. – Dr. Doug Johnston
Question 40: Cathy asks, “My husband has had 2 mitral valve surgeries, the first was 23 years ago and he had a tissue valve put in. This valve lasted about 17 years and he has since received an On-x mechanical valve. He has an enlarged left atrium which we think happened in between valves. He has had a little trouble with afib but had an ablation which seems to have worked. He has only had one afib episode since October. What do you think the future is for this mechanical valve?”
The On-X valve is a very well proven mechanical valve and should have very long durability assuming the Warfarin is well managed. – Dr. Doug Johnston
Question 41: Kathryn asks, “I had prolapsed mitral valve repaired with Cosgrove Annuloplasty Band and Atricure Atriclip. Chest was closed with SS rings. The Surgeon said that I should never have an MRI, but both companies state that their product does not preclude an MRI. Are the SS rings an issue or should I be eligible for an MRI (knee, hip etc)?”
If what you are referring to are stainless steel wires, then MRI should be possible. – Dr. Doug Johnston
Question 42: Jim asks, “I have been on amiodarone, 100 mg, for the past two years. What are the risks factors for the medication? This medication is for control of Arrythmia. I am also taking Eliquis.”
Risks for long term amiodarone in general have to do with lung function. Your doctor may want to talk to you about risks of lung disease and possibly obtain lung function tests. – Dr. Doug Johnston
Question 43: Alina asks, “Tricuspid severe regurgitation, anteroposterior annulus 4.2 cm, 91 y o, annulus dilatation, a candidate anatomically. Vina contracta 0.55 cm. Do risks overweight benefits?”
This sounds like a great question for a second opinion consultation. We would need to know more about you and your valve to answer the question. – Dr. Doug Johnston
Question 44: Mark asks, “Doctors, i am 70 and had open heart surgery to repair my mitral regurgitation by installing a ring at the vale. I now have developed aorta regurgitation and the efficiency has gone from 65% efficiency to 55% in the last year. 3 months ago I collapsed from VT and had to be shocked, leading to a defibrillator implant. At what point would you recommend take action? My aorta is a little odd shaped causing the leakage, but the leaflets are calcium fee. Thank You.”
Sorry to hear about your collapse. It would be important to know some more about how bad the leak is and how big your heart is to understand if the aortic valve needs to be replaced. – Dr. Doug Johnston
Question 45: Kellee asks, “What do you think of surgeon curing an enlarged heart to make I smaller before trying to fix continuous afib?”
Would need to know more about what chambers are enlarged to help with this question. – Dr. Doug Johnston
Many Thanks Dr. Doug Johnston!!!
I have to extend a mighty “THANK YOU” to Dr. Doug Johnston for taking the time to answer the patient questions submitted during our special webinar.
Keep on tickin!
Adam
Written by Adam Pick
- Patient & Website Founder
