Adam's Heart Valve Surgery Blog – Page 50

I just received a very interesting question from Joseph about the different types of tissue heart valve replacements.

Joseph writes, “Have you ever heard of any surgeon using equine tissue valves for aortic valve replacement? In the 10 months of researching my aortic valve disease, I’ve not heard of EQUINE valves being implanted — not once. Can you provide some insight? Thanks, Joseph”

ATS 3F Bioprosthetic Aortic Valve – Equine Tissue Valve

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Considering our recent discussion about heart valve re-operations, often referred to as “Re-Dos”, I wanted to wish Bob Uecker a very successful surgery today. If you didn’t know, Bob Uecker — who was anointed  “Mr. Baseball” by Johnny Carson — will undergo his second heart valve surgery during the past six months.

Bob Uecker – Heart Valve Surgery Patient

According to reports, a pseudoaneurysm (a tear) happened where his heart valve replacement is located. According to his medical team, it’s believed a skin-related staph infection entered his bloodstream and got into his surgical repair site.

“I’m approaching this with the same optimism that I had the first time,” said Uecker. “I appreciate all of the kind thoughts and well wishes from Brewers fans and everyone who has reached out to me.”

Keep on tickin’ Bob!
Adam

Interest in catheter-based technologies for heart valve repair and heart valve replacement continues to skyrocket.

As you have seen, we recently (i) reviewed new data for the SAPIEN aortic valve replacement and (ii) observed a MitraClip case for mitral valve repair. Recently, I learned that Medtronic, one of the leading heart valve manufacturers, received FDA approval for its investigational device exemption application. That means that Medtronic can conduct a patient trial to determine the safety and efficacy of its percutaneous CoreValve system for aortic valve replacement.

Aortic Stenosis – Narrowed Trileaflet Valve

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I just received an interesting question from Alma about a critical step during heart valve repair and heart valve replacement surgeries. Alma writes, “Adam – I’m going in for surgery next week. Thanks to your book, my anxiety has greatly decreased. I’m curious… I know my heart is going to be cooled and stopped during surgery. But, will my surgeon actually put ice on my bare heart? Alma”

Coincidentally, I just took the picture below while observing a heart valve surgery last week. As you can see, the answer to Alma’s question is typically… Yes.

Ice Chips On Heart During Cooling Process

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When the latest results of the PARTNER trial became available, many in the medical, investment and patient communities quickly analyzed the data specific to the new SAPIEN heart valve replacement. As you may be aware, the SAPIEN (i) requires no trauma to the sternum during aortic valve replacement, (ii) is currently used for high-risk patients suffering from aortic stenosis, and (iii) has yet to receive FDA approval in the United States.

While many physicians and investors took instant favor to the findings published in The New England Journal of Medicine, I was curious to know what cardiologists and heart surgeons thought of the study — after the data was digested.

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Monique just sent me two, very interesting pictures of her mitral valve – before and after surgery. I thought you might like to see these pictures as they illustrate the challenges of heart valve disease and the opportunities of heart valve treatment. The procedure was performed by Dr. David Adams at Mount Sinai Hospital in New York City.

Monique At Mount Sinai Hospital

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A few months ago, I received a very difficult phone call from George Avakian who resides in Northern California.

George’s mother was suffering from severe heart valve disease. He was fearful that he might lose his mother. After speaking with George, he immediately took the steps needed to get the best care for his mother. If you are interested to learn about her surgical result, here is a follow-up email from George about his mom’s heart valve replacement surgery.

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From my own experience and patient research, I know that the physical, social and mental benefits of attending a good cardiac rehabilitation program are overwhelming. Unfortunately, physician referrals of these patient programs are… underwhelming.

 Me Peddling Away On The Bike At Cardiac Rehab

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I just received an extraordinary email about Kirk Rose from his daughter, Angela. If anybody needs inspiration before or after heart valve surgery, I encourage you to read this:

Kirk Rose – Triple Heart Valve Surgery Patient

Adam-

I just came across your website and noted that you mention Team Scar Trek of Oregon. So you know, my father was the organizer of this group and is currently on the comeback from his THIRD heart valve replacement.

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I just received a great email from Mike about heart valve replacements. Mike writes, “Adam – I’ve got a severely leaky valve and need mitral surgery. I’m 55 and never knew about my prolapsed valve. Just curious… If the surgeon can’t repair my leaflets, how much do the replacement devices cost? Thanks, Mike”

Like Mike, I had this same question when I was diagnosed with severe aortic stenosis. I wanted to know just how much this little medical device cost.

As you might imagine, obtaining pricing data on heart valve replacement devices is a bit difficult. You can’t just run down to your local Wal-Mart and order an ATS Open Pivot Valve. And, you definitely can’t purchase a Medtronic Freestyle pig valve from Amazon.com.

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In the past, we’ve talked about the risks of valvular disorders and enlarged hearts. Recently, a study was released which further examined whether or not dilated hearts return to normal size after heart valve surgery. Interestingly, the study considered this post-operative objective from a male and female perspective.

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One of the ongoing themes in this blog focuses on patient advocacy — before, during and after surgery. Specific to this point, I just received an interesting letter from Anne about second opinions, patient research, chest incisions and surgeon selection. In her note, Anne writes to me:

Anne Shannon – Heart Valve Surgery Patient (Evergreen, Colorado)

Dear Adam,

When I had my yearly echo in May, I learned it was time to start thinking about aortic valve replacement due to stenosis. My cardiologist strongly recommended two local surgeons at the new heart center in Denver. After doing some research, I asked about minimally invasive surgery.

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I just received a very interesting email from Marc about heart valve surgery re-operations. He writes, “Adam, I’m an active 47 year-old just diagnosed with severe mitral regurgitation. I can’t help but think that I’ll need a 2nd surgery if I get a repair or a tissue valve. Do you know what percent of valve surgeries are re-operations? Are they primarily from surgical error or degenerative reasons? Thanks, Marc”

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As I remember… Once diagnosed with severe heart valve disease, many patients begin researching surgical options immediately.

During that process, we quickly realize that different approaches for open heart surgery exist. One approach, the mini-thoracotomy, deploys a surgical technique unlike a median sternotomy, robotic surgery or transcatheter procedure.

In the past, we have discussed mini-thoracotomy for aortic valve replacement and mitral valve repair. That said, I thought you might like to see a video which shows a mini-thoracotomy being performed. While this video is a bit graphic, I found it very educational.

To learn more about mini-thoracotomy (also referred to as port access), you might want to consider the following:

• Scarless Heart Valve Surgery For Women by Dr. Ciuffo
• “What About Port Access For Heart Valve Replacement?” Asks Taylor
• Jim’s Successful Aortic Valve Replacement Via Mini-Thoracotomy

I hope the video and information provided above helps us all learn more about mini-thoracotomy for heart valve surgery.

Keep on tickin!
Adam

Hi everybody,

I just realized that this website reached a fun milestone in its ongoing development. Earlier today, I posted the 1,000th blog about heart valve surgery.

Thanks to you – the patients, the caregivers, the cardiologists and the surgeons – for your ongoing contributions (questions, answers, guest blogs, comments, etc.) to this online resource.

Great job everybody!
Adam

Kerrigan just sent me a very interesting update about his heart valve surgery recovery. As his email touched on many patient issues — fatigue, blood pressure, beta blockers and patient advocacy — I thought you might enjoy his perspective and positive results.

Kerrigan Gray – Heart Valve Replacement Patient

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I just received a great question from Kate about heart valve replacement surgery.

Kate writes, “Hi Adam, I’m going in for surgery next week and I have a quick, follow-up question about the size of a heart valve replacement. It might sound silly, but… During the operation, how will the surgeon measure my valve? Do they have some kind of sterile tape measure? Thanks, Kate”

While we might think that a “surgical tape measure” would determine the diameter of the mechanical or bioprosthetic replacement valve, the reality is a bit different.

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Within minutes of posting “CoreValve Technology Get E.U. Approval”, I received two excellent questions from Jim and Mark. Their questions were, “Can the CoreValve system treat aortic regurgitation?” and “Can the CoreValve technology replace my bicuspid aortic valve?”

To provide Jim, Mark and everybody else a thoughtful response, I contacted Dr. Eric Roselli, MD, a heart surgeon from The Cleveland Clinic, and Dr. Allan Stewart, a heart surgeon from Miami. Here are their responses:

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As difficult as the memories of today can be, I always end up smiling in Scotty’s memory – his bubbly laugh, constant high fives and ability to see the good in everything around him.

There will be a tomorrow that exists without me. And I know that. When that day arrives, I want this world to have seen greater beauty because I existed. I want my life to have meant something. I want this world to be brighter. I want this world to be happier. I want people to have smiled more and to have laughed more because I’ve spent time here. I want others to have seen and felt the uniqueness of my spirit. And if I accomplish that, when my soul does move on and my gift stays here and makes just one ripple, I will look down and I will smile. I will smile wide.

To learn more about my friend, please visit the Scott Weingard memorial.

Thinking of you Scottie!
Adam

As technology for heart valve treatment rapidly advances, we continue to learn more about the roll-out of percutaneous devices for both heart valve repair and heart valve replacement. On Tuesday, Medtronic announced that regulators in the European Union have approved the latest version of its CoreValve heart system.

The CoreValve delivery system is designed to help surgeons replace a diseased aortic valve without removing the original valve and without open heart surgery. Instead, they put a new valve into a catheter and guide the catheter to the heart from an artery in the leg.

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