I just received a great question from Taylor about heart valve replacement and heart valve repair options. Specifically, Taylor is curious to learn more about the Port Access System for the surgical treatment of aortic stenosis.

Taylor writes, “Hi Adam – I’m 62 years old and my cardiologist thinks I need heart valve replacement surgery due to stenosis in the aortic valve. The valve is narrow (.8 cm) and I’m starting to feel the symptoms – especially shortness of breath and fatigue. The docs have referenced the Port Access technique to replace the aortic valve. What do you know about the Port Access system? Thanks Taylor”

Diagram Of The Port Access Technique

Taylor raises an insightful question which focuses on the different options by which surgeons perform heart valve replacement and heart valve repair surgery.

My research suggests there are really three core categories for aortic valve replacement – median sternotomy (a cut through the breastbone), minimally invasive (robotics, mini-sternotomy) and catheter-based (no bone or sternum incisions). In my opinion, the Port Access System belongs in the minimally invasive category.

During an aortic valve replacement using the Port Access technique, the following steps occur:

• The patient goes on the heart-lung machine. You will have your blood flow diverted from its path through the heart to an artificial heart-lung machine which will continue to provide your body with the oxygenated blood it needs. A small cut will be made in your thigh through which the tube will be fed which will put you on the heart-lung machine (see diagram above).
• Another incision will be made in your neck. This is where the surgeon will put a tube into your blood vessel and follow it to the heart. Through this tube, drugs to stop your heart will be given.
• To allow the doctor to see and to operate, surgical tools and a camera are fed through a cut under your armpit.
• The surgeon removes the malfunctioning valve. The surgeon will then insert and attach either a mechanical or a biological valve replacement. If you are given a mechanical valve, you will need to take medications (e.g. Coumadin) for the rest of your life to prevent blood clots around the new valve.

Tools Used In The Port Access System

Below you will see two pictures which illustrate the different incision sizes between (i) a Port Access approach using a right mini-thoracotomy and (ii) a median sternotomy. The first picture shows a patient’s chest scar after a median sternotomy. FYI, that’s me one week after surgery.

The second picture shows a patient, Jim Engelmann, after an aortic valve replacement using the Port Access system.

Jim’s Mini-Thoracotomy Scar After Valve Replacement

So you know, the Port Access approach can also be used to treat the mitral valve. In fact, Edwards Lifesciences, the device manufacturer of the Port Access system, recently issued clinical results which showed that:

• Patients undergoing mitral valve repair with the Port Access System had hospital stays approximately 1.5 days less than sternotomy patients;
• The number of patients requiring post-operative ventilation was reduced from 75.6 percent in the sternotomy group to 50.3 percent in the Port Access group.

Although the information provided above is very encouraging, please, please, please remember that each patient case is unique. You should discuss, at length, with your surgeon if the Port Access system via right mini-thoracotomy is appropriate for you.

I hope this helps you learn more about the Port Access system for heart valve replacement and heart valve repair.

Keep on tickin!

I was walking up to my house earlier today… When this super, scary spider tried to attack me!!!

Instead of biting me, the spider started kissing and hugging me. Then, I realized it wasn’t a spider at all. It was Ethan, my six-month old son, enjoying his first Halloween.

Happy Halloween Everybody!!!

Ethan, Robyn and Adam

P.S. To leave a comment, please click here.

I really, really, really encourage patients to attend a cardiac rehabilitation program after heart valve surgery.

As I personally learned during my early recovery, cardiac rehab can greatly enhance the physical and mental well-being of patients while minimizing post-operative issues like cardiac depression.

New medical studies and patient stories (e.g. Charles Harrall) continue to illustrate the positive effects of cardiac rehab programs for patients following a cardiac event – heart attack, CABG or valve surgery. Still, research suggests that cardiac rehabilitation is under-utilized by the patient community.

As another source of encouragement for patients to enroll in cardiac rehab, I just found this interesting video which discusses the benefits of these programs. Simply click the “play” button in the video above and please make sure the sound on your computer is on.

I hope this helps you further understand the benefits of cardiac rehab.

Keep on tickin!

Considering the recent Swine Flu outbreak, I’ve received several emails about flu shots and heart valve surgery.

I just opened a note from Jackie that reads, “Hi Adam – I recently had mitral valve replacement with a pig valve due to severe regurgitation. I’m curious to know if there is any reason I should not get a flu shot or an H1N1 vaccine? Thanks! Jackie”

As I really do not like being sick, I’ve always been a flu shot fan. However, after my heart valve replacement surgery, I found myself wondering, “Could a flu shot cause some form of complication after open heart surgery?”

To answer that question, I contacted my surgeon. In discussing this topic with Doctor Starnes’ office, I learned there were no apparent issues for patients getting flu shots after heart valve surgery.

However, with the new Swine Flu vaccine, I found myself thinking, “Is it safe to get the H1N1 vaccine?”

This time, I decided to contact Dr. Eric Roselli, M.D., staff surgeon at The Cleveland Clinic, to learn more about swine flu and heart surgery patients. In response, Dr. Roselli noted, “According to our infectious disease specialist, the vaccine should be fine.”

As of Friday, 16.1 million doses of swine flu vaccine were ready for shipping, and over 11 million doses had been sent out to state health authorities.

You should know that the symptoms of swine flu and seasonal flu are very similar. According to MedicineNet, the symptoms are virtually the same — fever, cough, sore throat, runny or stuffy nose, body aches, headache, and chills. Yet, experts say that swine flu is more contagious, and seems to affects a younger age group.

I hope this helps you learn more about flu shots, the swine flu vaccine and heart valve surgery.

Keep on tickin!

I just received a great patient story from Connie Batich. Considering that Connie’s note touches on so many elements of heart valve surgery – diagnosis, symptoms, second opinions, angiograms, vent tubes, a-fib, recovery – I thought you might appreciate reading about her experience. Here is what Connie wrote to me:

Adam,

We both had heart valve surgery. Only difference.. You were 33 and I am 85!

I’ve had a heart murmur all my life. But, in 1996, I felt palpitations and went to a cardiologist who diagnosed stenosis of the aortic valve. Since then, I’ve seen a cardiologist yearly for an echocardiogram and stress test. Then, about two years ago, my cardiologist called me all excited that my stenosis was severe and I should have the valve replaced right then-and-there!

Connie Batich, Heart Valve Surgery Patient

Well, my family wanted a second opinion… So, I went to another cardiologist who said, “Well, let’s wait until you get symptoms.”

Read the rest of this entry »