Actor-Comedian Set to Undergo Aortic Valve Replacement Surgery
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Reviewed By Louise Chang, MD
March 6, 2009 -- Comedian and actor Robin Williams abruptly postponed upcoming performances of his one-man show, "Weapons of Self-Destruction," announcing on his web site that he needs to undergo surgery for an aortic valve replacement.
The brief announcement said that Williams, who began the 80-city tour in September 2008, hopes to pick it up again in the fall. Williams, 57, is known not only for comedy but for his role in the TV show Mork and Mindy and the 1997 movie Good Will Hunting.
The aortic valve replacement surgery that Williams needs, termed "routine" by cardiac surgeons, is the same procedure that former first lady Barbara Bush underwent earlier this week.
WebMD contacted two cardiac surgeons -- neither involved in the care of Williams -- to get more information on the valve condition and what can be done.
Where is the aortic valve and what does it do?
The aortic valve sits between the main "pipe" coming out of the heart -- the aorta -- and the left ventricle, the pumping chamber, says John Robertson, MD, director of thoracic and cardiac surgery at St. John's Health Center, Santa Monica, Calif. "It helps maintain the forward flow of blood out of the heart into the body," he says.
Why would the aortic valve need replacing?
The valve might have become thick and narrowed, a condition called stenosis, says Abe DeAnda, MD, a cardiac surgeon and director of aortic surgery at Montefiore -- Einstein Heart Center at Montefiore Medical Center/Albert Einstein College of Medicine, New York.
Or, the valve might have become leaky, a condition known as aortic valve insufficiency. Sometimes, the valve has both problems, DeAnda says.
"Aortic stenosis is becoming more common as the population ages," Robertson says. In some cases, people may have a congenital abnormality of the valve and it then becomes leaky or narrowed.
In 2007, 17,592 aortic valve replacement surgeries were done in the U.S., according to the Society of Thoracic Surgeons. That figure includes only "isolated" valve replacements, not procedures in which the aortic valve was replaced and other heart procedures were also done.
Which of these conditions might Robin Williams have?
It is difficult to say without information about symptoms and medical history, Robertson and DeAnda say. Stenosis is more commonly the reason for valve replacement, in Robertson's experience.
Stenosis usually comes on more gradually than a leakage problem, DeAnda says.
Isn't Williams, at 57, relatively young to have this condition?
Not really. The average age for symptoms associated with aortic valve stenosis is the early 60s, Robertson says.
Many of the patients that DeAnda performs aortic valve replacement on are in their 50s and 60s. But others, like Barbara Bush, are in their 80s. Some teenagers need the procedure, often because of a congenital abnormality of the valves.
How are these faulty valves detected?
A patient may report symptoms, such as sudden shortness of breath, DeAnda says. According to news reports, Williams complained of shortness of breath.
Or, a physician may detect a murmur -- an unusual or extra heart sound heard -- during a routine exam. The doctor may then refer the patient for an echocardiogram, a test that uses sound waves to create a detailed, moving picture of the heart and how it is functioning.
"Sometimes murmurs are innocent and remain innocent for years," Robertson says. "Just because you have a murmur doesn't mean you have a problem that will affect you long term." But these patients should be followed up with echocardiograms [sonogram of the heart] to monitor the condition, he says.
Are the causes of aortic valve problems genetic or due to lifestyle, or both?
"Probably genetics more than anything else," Robertson says, and DeAnda agrees. In some cases, lifestyle can be a factor, Robertson says. One example: a drug addict who injects drugs may develop a valve infection, damaging it, and making it necessary to replace it.
What is the aortic valve replaced with?
There are several options. Two of the most common approaches are to replace the damaged valve with a mechanical valve, or with a biological one, from human or animal tissue (pigs or cows).
"The younger patients are, the more likely they will have a mechanical valve," Robertson says. They last longer than the biological valves. The downside: patients with mechanical valves must be on blood thinners for the rest of their lives to reduce the risk of clots, Robertson says, although "there are [mechanical] valves being studied now that may not require ongoing blood thinners."
Patients given biological valves are typically put on blood thinners only for about three months, if at all, and then can go off the medicines. But the biological valves do not last as long as the mechanical ones.
Those with mechanical valves can sometimes hear the valve clicking, Robertson says. "When you are sitting in a room with them," he says, if it's very quiet you may hear it.
Yet another valve replacement option, called the Ross procedure, is more complicated, say DeAnda and Robertson. The aortic valve is removed and replaced by the patient's own pulmonary valve. Then the patient's pulmonary valve is replaced with a biological pulmonary valve (donor valve).
Will Williams get a mechanical or a biological valve?
"Either choice would be reasonable for him," DeAnda says.
What is the prognosis after aortic valve replacement?
"You can live a normal life," DeAnda says. "That's the whole point."
"You can return [the patient] to a normal life expectancy," Robertson says.
Typically patients are back to work in about six weeks, DeAnda says. After that, if they are doing well, DeAnda tells them they can travel, go through metal detectors without difficulty, and resume a normal sex life.
For those on blood thinners, there are some restrictions, Robertson says. "No contact sports or black diamond skiing," he says, because the risk of injury -- and potential blood loss from it -- is considered too great.
SOURCES: Abe DeAnda Jr., MD, cardiac surgeon, director of aortic surgery, Montefiore-Einstein Heart Center, Montefiore Medical Center/Albert Einstein College of Medicine, N.Y. John Robertson, MD, cardiac surgeon, director of thoracic and cardiac surgery, St. John's Health Center, Santa Monica, Calif. Robin Williams' web site. American Heart Association: "Aortic Valve Stenosis and Insufficiency." Society of Thoracic Surgeons: "Aortic Valve."
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