In Part 1, we discussed the basics of heart valve disease. In Part 2, we will discuss how this disease is treated at Chester County Hospital.
You've been through the tests and you've anxiously waited for the results. And finally, it's official. You've been diagnosed with heart valve disease.
Valve disease is a condition where the flaps that open and close to allow blood to flow in and out of the heart and body do not work correctly.
In many cases, valve disease does not require treatment. In fact, the majority of patients can manage the disease without doing anything but to monitor it to make sure it does not get worse.
However, there are times when valve disease does require treatment -- and that often comes in the form of surgery.
At Chester County Hospital, our heart and vascular specialists treat valve disease in our Heart Valve Center.
Steven Weiss, MD, Physician and Chief of Cardiac Surgery at Chester County Hospital, explains what you need to know about treating valve disease.
Symptomatic Valve Disease Needs to Be Treated
Valve disease does not always cause symptoms. When it does, it may cause lightheadedness, chest pain, or shortness of breath. While asymptomatic valve disease generally does not need to be treated, disease that causes symptoms needs treatment right away.
Dr. Weiss explains that when symptoms develop, it is a message from the heart saying it cannot keep up with the demands of the diseased valve. "This is a critical moment to identify," he says. "If you do not get treatment when symptoms begin, valve disease can become fatal. About 33% of patients with symptomatic aortic stenosis will die within 1 year, and 50% will die within 2 years, if they don't receive treatment."
Dr. Weiss also points out that if you are experiencing symptoms and you are not a candidate for surgery, there are other successful forms of treatment. For example, while there are no medications known to cure mitral regurgitation, there are prescription medications to reduce symptoms.
There Are Multiple Types of Surgery
Don't panic if you hear the word "surgery." Often times, valve disease surgeries do not involve making large incisions or open heart surgery. According to Dr. Weiss, many valve disease surgeries are minimally invasive procedures -- they involve a few small cuts, rather than large incisions. These procedures typically have less pain and scarring, and a quicker recovery time, than open surgeries.
"At Chester County Hospital, we do valve repairs whenever possible. But if necessary, we can insert a brand new valve," says Dr. Weiss.
Many procedures are done via catheter -- a thin, hollow tube that is inserted into the heart. Common catheter-based techniques include:
- Balloon valvuloplasty: A small, expandable balloon is attached to the end of the catheter and threaded into the heart, where it's placed through a tightened valve. The balloon then expands, stretching the valve open and separating the flaps.
- Transcatheter aortic valve replacement (TAVR): This is a valve-within-a-valve approach. We use the catheter to wedge a replacement valve into the aortic valve, without removing the damaged valve. The new valve expands, pushing the flaps of the damaged one out of the way. The tissue in the replacement valve takes over regulating blood flow.
- Transcatheter mitral valve replacement (TMVR): This is very similar to TAVR, except that it replaces the mitral valve, rather than the aortic valve. TMVR is also a much newer treatment model.
- Mitral valve clip (MitraClip): This procedure treats regurgitation (leaking). A small clip is attached to the mitral valve via a catheter. The clip allows the mitral valve to close more completely, which stops leaking and restores normal blood flow.
Dr. Weiss explains the process:
"You will first be seen and evaluated by a surgeon, cardiologist, and a specialist from the Structural Heart Program at the Hospital of the University of Pennsylvania (HUP). This is done locally at the Heart Valve Center at Chester County Hospital. The actual procedure will be performed at HUP's Philadelphia campus, but all follow-up care is provided at Chester County Hospital."
Valve Surgery Is Safe and Effective
It is true -- there are risks with any procedure. But when it comes to valve surgery, those risks are low.
Dr. Weiss says, "Modern valve operations emphasize repair over replacement, including performing these procedures minimally invasively when possible. This, coupled with improved timing of the operation, which tends to be earlier in a patient's life when they are less sick, leads to improved outcomes and enhanced recovery. These operations have only a fraction of the risk of the valve operations of 30 years ago."
Newer techniques and modern equipment have made valve operations highly successful. But success is not measured solely on the results of surgery.
"Excellent surgical results are, of course, our first priority, but they are not our only focus in the treatment of valve disease," Dr. Weiss explains. "Valve disease goes through stages, and an individual's progression over the years isn't always easy to predict."
That's why when you are diagnosed with valve disease at Chester County Hospital, we will assign you a specialized valve disease coordinator to help you navigate the process of getting care from multiple providers as time goes on. The coordinator is like a concierge -- not for the doctor, but for you. They will smooth the process of visits and tests, and make sure that you are comfortable and understand everything.
"It's a team-based approach that meets every patient's unique needs at every stage of the disease. That's part of what makes Chester County Hospital so amazing for valve disease management and treatment."
Choose Your Surgeon Wisely
Choosing your surgeon is one of the most important parts of undergoing valve surgery. Dr. Weiss says, "While nearly all heart surgeons are comfortable doing major procedures, such as coronary artery bypass surgery, they vary considerably in their experience and ability when it comes to fixing heart valves."
Dr. Weiss has two general recommendations for choosing a surgeon:
- Patients requiring mitral valve surgery should ask the surgeon:
- Do you have a 90% or higher success rate at repairing valves that are predicted to be repairable?
- What is your mortality rate (percent of deaths from the procedure) for valve repair? This should be less than 1%.
- Are you experienced with minimally invasive approaches?
- Similarly, if you need aortic valve surgery, find a surgeon who has a track record of performing aortic valve replacement with low mortality and stroke rates. Also, it's important that while evaluating you for surgical aortic valve replacement, the surgeon is additionally checking to see if you are a good candidate for TAVR, as that is a good minimally invasive option for patients at advanced age or higher risk.
Whether you need surgery, non-surgical treatment, or monitoring, the experts at Chester County Hospital's Heart Valve Center are ready to help.
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