Adam's Heart Valve Surgery Blog – Page 47

Since launching this blog five years ago, I’ve been very fortunate to attend unique events related to heart valve surgery. Last Friday, I attended a Medtronic “Wet Lab” at the Mitral Conclave in New York City. As the pictures and videos below illustrate, this was a memorable experience.

Dr. Vinay Badhwar Moderates The Heart Valve Repair Wet Lab

During the 90-minute session, led by Dr. David Adams and Dr. Vinay Badhwar, an ordinary conference room in the Sheraton hotel was transformed into a medical laboratory. There, heart valve surgeons — from around the world — exchanged views and opinions about heart valve repair techniques using annuloplasty rings.

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While at the Mitral Conclave, I was fortunate to meet with Dr. Kevin Accola, a leading mitral valve surgeon from Orlando, Florida. During our discussion, I asked Dr. Accola a question submitted by Debby about mitral valve repair. (Click here to learn about mitral valve repair operations.)

Debby asked, “I was diagnosed with a severe mitral regurgitation disorder over 5 years ago. Now, at 42, I have no symptoms or health concerns. Is it possible that I will never need a mitral valve repair? Or, is that wishful thinking?”

Thanks to Debby for her question. And, a special thanks to Dr. Kevin Accola for sharing his clinical expertise with us!

For those of you who are hearing impaired, please find below a transcript of our discussion.

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Since Friday, I’ve received several questions from patients and caregivers in our community about the 2011 Mitral Conclave in New York City. To share more insight about the Mitral Conclave, I asked Dr. David Adams, the program director, to describe the origins of this very unique event. Here is what Dr. Adams shared with me.

So you know, this is Part I of my interview with Doctor Adams. Please stay tuned… In the next few days, I will be posting Dr. Adams’ response to one of your questions about mitral regurgitation disease and mitral valve repair.

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I never imagined I would travel across the country for a mitral valve surgery conference. However, when Dr. David Adams invited me to the inaugural Mitral Conclave in New York City, I had to attend this extraordinary meeting.

To help those members of our community who are hearing impaired, I have provided a video transcript below.

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While the Da Vinci robot is primarily used for mitral valve repair procedures, a handful of clinical cases have leveraged robotic technology for aortic valve replacement.

To get an update on robotic aortic valve replacement, I recently interviewed Dr. Husam Balkhy, the director of minimally invasive and robotic surgery at The Wisconsin Heart Hospital. As you may recall, Dr. Balkhy has performed aortic valve replacement using the Da Vinci robot and the ATS 3f Bioprosthetic valve, a horse valve replacement.

To help those in our patient and caregiver community that are hearing impaired, I have included a transcript of this video interview with Dr. Balkhy below.

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Hi everybody,

I wanted to let you know that the new 2011 edition of my book is now available. For this edition, we are thrilled to feature several contributions from leading heart valve surgeons and cardiologists that focus on valvular care. In total, there are over 50 references from the likes of Dr. Gillinov, Dr. Chitwood, Dr. Adams, Dr. Stewart, Dr. Roselli and many more.

In addition, this fourth revised edition includes several updates specific to heart valve technology, surgical options, patient-recommended surgeons and post-operative care.

Most importantly, the book continues to focus on the patient perspective specific to heart valve surgery. In total, over 135 patient contributions are included in the new book. That said, I’m very hopeful this book will continue to help patients and caregivers around the world.

If you have any interest in reading the 4th revision of “The Patient’s Guide To Heart Valve Surgery”, please click here.

Keep on tickin!
Adam

I just received an interesting email from Judy about adhesions, the pericardium and heart valve re-operations.

Judy writes, “Hi Adam, I am a 66-year old female preparing for aortic valve replacement. I have calcification at the sinotubular junction. Reoperation would be tricky in my case as I have an anomalous circumflex artery. I wondered what can be done to minimize the chances of adhesions? Could not closing the pericardium contribute to adhesions? What are the pros and cons of leaving the pericardium open? Thanks, Judy”

Post-Operative Adhesion

To answer Judy’s questions, I contacted Dr. Craig Smith, the chairman of surgery at NewYork-Presbyterian Hospital / Columbia University Medical Center. If you did not know, Dr. Smith recently performed aortic valve replacement on Barbara Walters. Doctor Smith has also operated on Former President Bill Clinton and several members of our patient community including Gary Poltorak.

Dr. Craig Smith – Heart Surgeon of Former President Bill Clinton
and Barbara Walters (NewYork-Presbyterian Hospital)

In his response to Judy, Dr. Smith noted…

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Alice just sent me a great question about the use of heart-shaped pillows after heart valve surgery. She writes, “Hi Adam,  I’m 61-years old and preparing for a mitral valve repair due to mitral regurgitation disease. I can’t help but notice the huge pillows clutched by patients in several photos across your website. What are those used for? Thanks, Alice”

In case you have yet to see them, here are four pictures of heart valve surgery patients (David Swendson, Anita Devine, Carla Hansen and John Turan) which feature these unique, heart-shaped pillows.

Heart Valve Surgery Patients – David Swendson,
Anita Devine, Carla Hansen & John Turan

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I’ve received several questions about the use of Pradaxa as a potential Coumadin-substitute for patients with atrial fibrillation, valve disease and/or mechanical heart valve replacements. I am a “better safe than sorry” type guy, so I wanted to make sure our patient community was on the same page specific to this new anticoagulant.

For those of you unfamiliar with Pradaxa, it was approved by the FDA in October, 2010. Following the results of its RE-LY study, Pradaxa is now considered by some to be an alternative to Coumadin — an established anticoagulant (blood thinner) for preventing strokes in patients with atrial fibrillation. During the RE-LY trial, patients with atrial fibrillation taking Pradaxa had fewer strokes compared to those using Coumadin.

In light of this news, patients in our community – including Gene – sent me questions about Pradaxa. I contacted Dr. Niv Ad, a leading cardiac surgeon at White Oak Medical Center in Takoma Park, Maryland, to learn more about this drug and its potential utility for patients with mechanical heart valve replacements.

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A common consideration among patients preparing for valvular treatment is whether or not they will get a heart valve repair or a heart valve replacement.

Recently, Dr. Lars Svensson and I discussed the clinical indicators for aortic valve repair due to aortic regurgitation. Relative to the mitral valve, here is an educational video in which Dr. Jeffrey Swanson answers Barbara’s question, “From a surgeon’s perspective, what differentiates the need for mitral valve repair versus mitral valve replacement due to mitral regurgitation?”

Also, for the hearing impaired, I have provided a video transcript below.

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Carole recently sent me an interesting email about Ian, her sixteen-year old son who suffers from aortic valve disease.

She writes, “Hi Adam, My son needs to have his aortic valve replaced. His surgery is scheduled for August. We are struggling with the decision of which valve replacement to have implanted. Ian is leaning towards the On-X mechanical valve but is hesitant because of the Coumadin factor. Do you know any other patients in Ian’s age group? What do you think is the best valve replacement for Ian? Thanks so much for your wonderful and informative heart valve book. Carole”

This is a great and complex question. As we have discussed before, if a valve repair is not possible, a key consideration for the patient will be, “Which type of heart valve replacement is best for me?” The answer to that question is dependent upon several factors – including age, active lifestyle, risk factors, etc.

I wanted to provide Carole an expert opinion. So, I contacted Dr. Lucas Collazo.

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Yesterday, I spoke with Denise, a 44 year-old patient suffering from severe mitral regurgitation disorder. She asked me, “Adam – The first surgeon I met with has yet to request a cardiac catheterization. Is that normal? I thought all patients got heart caths before surgery?”

First… Great question Denise!

Second… For those of you unfamiliar with this diagnostic test, I have posted a video below which describe a cardiac catheterization, commonly referred to as heart maths.\

 
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With all the exciting possibilities of transcatheter heart valve therapy, my inbox is overflowing with questions about the CoreValve, the Sapien and the MitraClip. For example, Dorothy sent me a question that reads, “Given all the advancements in certain treatments… Can you estimate a time when open heart valve replacement surgery will be part of a bygone era?”

I wanted to get Dorothy the best possible answer to this question. So, I met with Dr. Eric Roselli, staff surgeon from The Cleveland Clinic, to obtain his clinical opinions. Dr. Roselli is actively using transcatheter heart valves replacement therapies in his practice. In fact, Dr. Roselli is so knowledgeable with the percutaneous technologies shaping heart valve treatment, he was named the TechCon Co-Chairman at the annual Society of Thoracic Surgeons meeting.

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For those of you following the story of 5-year old Sarah Weir… I have great news to share!!!

Sarah’s mitral valve repair surgery was completed by Dr. Pedro Del Nido at Children’s Hospital Boston on Wednesday. After some minor post-operative issues (blood pressure, swelling), Dr. Pedro Del Nido is very happy with the results!

Sarah Weir – Two Days After Mitral Valve Repair Surgery

As for Sarah… Pam, her mother, writes, “Sarah is mad as hell – but doing GREAT!!! She wants to go home! I ask New York??? She says NO – HOME – THE FOUR SEASONS.”

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One of the most visited sections at Heart Valve Journals, our social network, is the patient’s guestbook. It’s pretty amazing to see all the support, care, advice and love exchanged among patients, caregivers, friends and family members. For example, Judy Fridono has 775+ comments in her Guestbook following her recent heart valve surgery at USC.

To enhance the Guestbook, we just a launched a great new feature.

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I don’t know about you… But, I’ve always been a huuuuuge Bill Cosby fan. That said, I’m hopeful this video — taken from a 1992 airing of “You Bet Your Life” — should start your weekend with a giggle.

 
Have a great weekend,
Adam

Recently, I received a great question from John Myers about asymptomatic patients with mitral regurgitation. John wrote to me, “Hi Adam, I’m 76 and in good shape. In 1999, I was  diagnosed with moderate-to-severe regurgitation even though I have NO physical symptoms. I’ve read that some surgeons believe having mitral valve repair sooner than later is preferable. Should I be worried? Should I get a second opinion? Thanks, John”

Luckily, during the 47th annual Society of Thoracic Surgeons meeting, I had the chance to ask John’s question directly to Dr. David H. Adams, chairman of cardiothoracic surgery at The Mount Sinai Medical Center in New York. Considering Dr. Adams’ clinical focus on mitral valve treatment, I thought you might like to see his response.

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Wendy just sent me an interesting question about heart valve replacement surgery and atrial fibrillation. She writes, “Adam – At 68, I’m confused and nervous. I’ve been dealing with atrial fibrillation for some time. But, I was just diagnosed with a severely leaking mitral valve. Can a surgeon fix both problems during one operation? Or, will I need two separate procedures? Thanks, Wendy”

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When we started HeartValveJournals.com, our social network, I didn’t know what to expect. But now, 15 months later, I am constantly touched, moved and inspired by the patients and the caregivers who openly share their hearts in this special community.

Just now, I was surfing through the website when I came across the journal of Sarah Weir from New York, New York.

Sarah Weir – Heart Valve Repair Patient

As you can read in her story, Sarah was recently diagnosed with severe mitral valve regurgitation. Her surgery is scheduled for March 16th — next Wednesday. Doctor Pedro Del Nido at Children’s Hospital Boston will be performing the mitral valve repair. As you may recall, Dr. Del Nido was Baby Gabe’s surgeon.

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Great news everybody!

If you are interested in learning more about heart valve disease and treatment options, this is a fantastic opportunity to access two heart valve specialists — Dr. Marc Gillinov and Dr. Brian Griffin from The Cleveland Clinic.

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