Featured Speaker Heart Failure Now
Dr. Guy Fradet
He graduated from medical school at Laval University in Quebec in 1979 and attended both Montreal’s McGill University and UBC during his training as a surgeon. His specialties are adult cardiac surgery and general thoracic surgery.
( Dr. Guy Fradet, Cardiothoracic Surgeon, Kelowna, BC ) is in good standing with the College of Physicians and Surgeons.
When we replace an aortic valve, we actually have to stop the heart and open and get access within the heart.
That’s usually done by cutting this blood pipe here and getting access to it. To do it with a catheter there’s two to options. We don’t open the heart, we don’t stop the heart, and a catheter is inserted, most commonly into your leg, in the artery of the leg and brought backward to the heart.
And to that blood pipe, and at the end of that catheter there’s a balloon, and then there’s a valve that has been crimped on a stent or a mesh of metal if you want. So the catheter’s coming up this blood pipe, turning around, and going back toward the heart. And then the valve is deployed this way.
Now let’s say that the arteries are too diseased you cannot access that, so we have the heart in your chest like that here. So what can be done is surgeons can go in between your ribs there and then open that, so without breaking the ribs.
So it’s a small incision, and then they make little sutures there to control. And then the catheter is brought into the heart this way, from the apex of the heart and now the valve is going to be deployed this way as opposed to backward.
And when all that is done and the ribs are closed and – similar, it’s the same – it’s usually a short stay procedure, one or two days. The advantages to doing that procedure as opposed to an open heart surgery, surgical replacement of the valve, one is you avoid the cutting of the chest.
Two is the recovery is usually much faster, maybe one day before you’re discharged home, the risk of bleeding is less. The risk of infection is less because the chest is not open. But there’s other risks like stroke, and also not knowing how long those valves last, that’s what’s being studied.
So it’s a compromise, right now within the study, it’s offered to people who are too high risk for surgery, or people that are at higher risk for surgery where then they’re given the options of the two basically.
So again if you have a valve problem it will be a discussion that will be initiated with your cardiologist and surgeons. It might be in your best interest rather than to have surgery, to have the transcatheter implantation.
Those physicians will then initiate a referral to a specialized centre because not all centres do that procedure. And then see if you could be a successful candidate for that.
Local Practitioners: Cardiothoracic Surgeon
Dr. Guy Fradet, MD, FACS, FRCSC, Cardiothoracic Surgeon, discusses heart valve replacement surgery.
So valve surgery or valve replacement surgery in cardiac surgery is a very common procedure.
Almost as equal but if not pretty close to coronary artery bypass surgery. So the other most common type of valve that will be used for replacement is what we call tissue or valve prosthesis. The most common tissues are cow tissue, made of the heart sac of the cow, or pig valve, and sometimes a combination of both.
Now there’s other options where we can use a cadaver valve or we can actually use a valve in another part of your heart and transfer it there. But those are the specific indications for that and it’s usually not the most common procedure.
So if we restrict ourselves to mechanical and the tissue valve that’s usually the discussion you’ll have with your heart surgeons. We already mentioned that the mechanical valve you will have to go on blood thinners because they tend to clot.
There are some risks associated with that for the rest of your life the other option is to take the tissue valve, you don’t necessarily need the blood thinner. You can just be on aspirin, but they wear out with time.
And the younger you are when you get them, the faster they wear. So there’s specific indications again, but if you’re an elderly, probably a good option. So the most common valve that usually gets replaced is the aortic valve, and the most common reason is because it wears out.
This is the aorta there where the red blood comes out of the heart, and the valve is right there. The role of the valve is to prevent the blood when the heart ejects or pumps. When it relaxes, the valve closes and it prevents the blood going back into the heart.
Typically the way we replace that valve is we make a cut in that pipe, and already by that time you’re on cardiopulmonary bypass so you’re connected to a machine that takes the blood away from your heart and your lungs.
The machine does the work, and we stop the heart, and it allows us to open, do our work so through that pipe here we go and take that valve out. And we’ll put either a tissue valve or a mechanical valve and then we close and we fill the heart back with blood, and then we restart the heart, and we’re done.
If you think that you need valve replacement surgery or valve interventions, the first step again is discuss this with your family doctor. He can then refer you to the appropriate person typically the cardiologist or the surgical team.
Most commonly it would a team that’s assessing you, your options will be reviewed, and recommendation based on your lifestyle and your comorbidities.
Local Practitioners: Cardiothoracic Surgeon