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.
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
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.
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 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.
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.