Heart Specialists Say Procedure Is Common, Outlook Good
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Reviewed By Laura J. Martin, MD
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May 11, 2010 -- Broadcast journalist Barbara Walters, famous for asking probing interview questions and getting politicians and celebrities to spill juicy details, gave little information Monday to her co-hosts on The View and her viewers about her upcoming heart surgery.
The 80-year-old TV personality simply said she needed heart valve replacement to repair a valve that had become "tighter and smaller." She didn't mention which heart valve, although an ABC news story pinpoints the aortic valve as the faulty one.
WebMD turned to two cardiac specialists for more information on heart valve surgery. Neither has treated Walters, and they emphasize they are speaking in general about heart valve replacement surgery.
In 2007, nearly 18,000 aortic valve replacement surgeries were done in the U.S., according to the Society of Thoracic Surgeons. The figure includes only "isolated" valve replacements, not procedures in which the aortic valve was replaced and other heart procedures also done.
Heart Valve Surgery: The Options
The heart has four valves (pulmonary, aortic, mitral, and tricuspid), but the aortic and mitral are most commonly in need of surgery, says Joseph DeRose, MD, chief of adult cardiac surgery at the Albert Einstein College of Medicine and director of minimally invasive and robotic cardiac surgery at Montefiore -Einstein Heart Center in New York.
The aortic valve lets blood out from the left ventricle, the heart's main pump, into the aorta, the main artery bringing blood to the body.
The mitral valve is located between the heart's upper, holding chamber (left atrium) and the lower, pumping chamber (left ventricle) and allows blood to flow between them.
The mitral and aortic valves could be leaky -- letting blood escape at inappropriate times -- or they could be narrowed, what doctors call a stenosis, not letting enough blood through.
Heart valve problems can be the result of diseases that scar or destroy a valve, or the result of birth defects. Aging can take a toll on valves, too.
"Some thickening of the aortic valve is present in almost a quarter of people above age 65," says Raj Makkar, MD, director of interventional cardiology and the cardiac catheterization laboratory, Cedars-Sinai Medical Center, Los Angeles.
The thickening can lead to narrowing, or stenosis, he says.
Heart Valve Problems: How They're Detected
Walters told her viewers that her heart valve problem had been detected during an echocardiogram, the use of sound waves to create a moving picture of the heart.
Why would a doctor order an echo? "If the doctor heard a murmur during a physical exam, an echo would be the next logical step," Makkar says.
Heart Valve Surgery: The Options
Heart valve replacement surgery can be done in the conventional way, in which the physician makes an incision, divides the breastbone to get to the heart, and puts the patient on a bypass machine while the heart is stopped and the valve replaced, DeRose tells WebMD.
"In general, most isolated valve operations [involving one valve and no other procedure] lasts four to six hours," DeRose says. Makkar says it could be less, perhaps two to four hours.
"The operation can also be done minimally invasive," DeRose says. This approach does not include dividing the breastbone, but making tiny incisions and inserting a telescope-like device between the ribs to insert the new valve.
"Both [approaches] require stopping the heart," DeRose says.
Another minimally invasive approach, still under investigation, involves inserting a stent with a valve inside, eliminating the need to stop the heart, says Makkar, who is studying this approach. The stent, once in place, pushes aside the native valve and the new valve starts to function.
The replacement valves can be mechanical (also called synthetic), or tissue, obtained from pigs or cows. With tissue valves, Makkar says, the patient does not need to be on blood thinners long-term.
"But if you put in a completely artificial, or mechanical, valve, you have to be on Coumadin for a lifetime," Makkar says.
The plus of mechanical valves, however, is that they last a lifetime, while tissue valves generally have a life expectancy of up to about 15 years, Makkar tells WebMD.
Heart Valve Surgery: The Recovery
After heart valve surgery, most patients stay in the hospital for about five days, recovering from the surgery and the general anesthesia, the doctors say.
"Most people will get back on their feet with routine activities in two to four weeks," Makkar says.
"There is a significant amount of fatigue after surgery," DeRose says.
Walters did say she will take time off over the summer to recuperate. What's a reasonable period to allow for return to work? That's individual, Makkar says, noting that "most 80-year-olds aren't working full-time."
SOURCES: Joseph DeRose, MD, chief of adult cardiac surgery, Albert Einstein College of Medicine; director of minimally invasive and robotic cardiac surgery, Montefiore-Einstein Heart Center, New York.
Raj Makkar, MD, director of interventional cardiology and the cardiac catheterization laboratory, Cedars-Sinai Medical Center, Los Angeles.
American Heart Association: "Heart Valve Surgery," "Aortic Valve Stenosis and Regurgitation," Mitral Valve and Mitral Valve Prolapse."
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