Advanced Treatments for Cardiac Disease

For many patients, heart disease can be traced to a structural defect or damage, often in the valves of the heart. Our cardiovascular surgeons and cardiologists work together to provide a complete approach to valvular and structural heart disease, using both medication and the most advanced minimally invasive, catheter-based and surgical technologies to help repair or replace damaged areas of the heart. From diagnosis to treatment, our team of experts can help explain available options and find the right one to fit your unique needs.

For valvular and structural heart disease treatment options range from minimally invasive therapies to surgical repair and replacement.

Coronary Artery Bypass

Your heart is a muscle and like all muscles, it needs a good supply of blood in order to work properly. It receives blood, as well as oxygen, from the coronary arteries, which run on the surface of the heart. Sometimes these arteries narrow due to a build-up of a fatty substance in the artery walls. A partial blockage can result in symptoms of:

• Chest pain (angina)
• Shortness of breath
• Abnormal heart rhythms
• Fatigue
• Palpitations

If you have these symptoms, you may be a candidate for surgery to reestablish normal blood supply to your heart.

Coronary Artery Bypass Surgery is a procedure in which the arteries are bypassed using the internal mammary artery from your chest wall, the radial artery from your arm, or the saphenous vein from your leg. The grafts are sewn on to the heart and then to the aorta for inflow.

Valve Repair/Replacement

Your heart has four valves that ensure blood flows in the right direction through the heart chambers. These valves act like one-way doors allowing blood to flow forward into the next chamber and then closing to stop it from flowing backwards. The valves most often affected are the mitral valve and the aortic valve. An abnormal valve may be too narrow (stenosis) or it may leak (regurgitation). If you have heart valve disease, the extra strain on your heart can cause:

• Shortness of breath
• Trouble breathing when lying down
• Abnormal heart rhythms
• Dizzy spells
• General tiredness

Tissue Valve

Tissue valves, also called biological or bioprosthetic valves, are made from animal tissue. The tissue may be bovine (cow) or porcine (pig) and constructed from the pericardium (the Protective sac that Surrounds the heart) or heart valve leaflet tissue. Both types of tissue valves work well and have similar defining characteristics. Tissue valves do not require lifelong blood thinners, such as warfarin (Coumadin) or some of the newer medicines. The disadvantage of tissue valves is that they wear out after approximately 12 to 15 years, some can last much longer. If you receive a tissue valve, you will be prescribed Aspirin or another anti-platelet medication that reduces the risk of blood clots.

Mechanical Valve

These are usually made from metal or carbon, and should last a lifetime. If you have a mechanical valve, you may be aware of the “clicking” sound, which is perfectly normal. You will be required to take blood thinners for life, such as Coumadin (Warfarin). If the blood thinners are not taken properly, blood clotsmay form and potentially lead to strokes or prevent the valves from functioning properly.

Factors to consider when making your decision:

Age is one of the most important factors when making the decision between a mechanical and tissue valve. In general, patients older than age 65 tend to receive tissue valves, while patients under age 60 tend to receive mechanical valves. However, valve durability and individual patient survival are both unpredictable.

In addition to valve durability, other factors to consider include the use of blood thinners and noise. If you need blood thinners for medical reasons (such as blood clots), then a mechanical valve may make sense. On the other hand, if you have a condition that prevents the use of blood thinners, such as gastrointestinal bleeding or conditions that are associated with easy or frequent bleeding, you may prefer a tissue valve. Lifestyles choices, including playing contact sports, planning to have children, or having a job that prohibits blood thinners (i.e., active duty military) may result in your doctor recommending a tissue valve.

Heart Valve Replacement

Transcatheter Aortic Valve Replacement (TAVR)

The function of your natural valve is replaced with a transcatheter valve during an operation without open heart surgery. A small tube is used to insert a valve inside your diseased valve through an incision in your leg or other location. This procedure may shorten your recovery time allowing you to resume normal activities sooner. Not everyone is a candidate for TAVR. Your doctor will evaluate your symptoms to determine the best treatment option for you.

Surgical Aortic Valve Replacement (SAVR)

Performed by a cardiothoracic surgeon, SAVR involves making an incision in the chest in order to get to the heart and aortic valve. The heart is stopped, during which time the blood pressure and oxygen levels are maintained with a heart-lung machine (cardiopulmonary bypass). The aorta is opened and the diseased valve removed. It is then replaced with an artificial valve (prosthesis), which will be a tissue or mechanical valve.