Kelly just sent me this very interesting story which touches on several critical factors specific to heart valve surgery from the patient perspective. That said, I thought you might want to learn about Kelly and her surgeon, Dr. Kevin Miller. Here is what she wrote to me:

Kelly Gaul – Heart Valve Replacement Patient

Hi Adam,

It’s been about 7 or 8 months since I first found your web site, ordered your book and touched base with you.  I am a 56-year old woman who leads a very active lifestyle – hiking, backpacking, and cross-country skiing.  I knew I had a heart murmur since I was 25 years old, but didn’t realize it was a bicuspid valve accompanied by aortic stenosis until about 7 years ago (mild-moderate at the time).

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I just received a great question from Heidi about heart valve disease, surgery and seniors.

She writes, “Adam – My mom, Betty, has recently been diagnosed with severe aortic stenosis. Although her murmur was detected years ago, I never thought she would need open heart surgery. She’s 68 but acts like she’s 38. No symptoms at all. I’m curious… How common is valve disease and surgery among seniors? Thanks, Heidi”

Considering the aging of the population, I imagine Heidi’s question will be on the minds of many sons and daughters in the near future. Interestingly enough, I was just reading a market research report summary by GlobalData which suggests that:

• The incidence of valve disease in people over the age of 65 is 29%
• The incidence of valve disease in people over the age of 75 is 37%

According to the report, valve calcification and degeneration have become the leading causes of valvular disease (e.g. aortic stenosis) instead of congenital bicuspid disease.

Calcified Heart Valve Leaflets

Please note that this research report did not differentiate between “incidence of valve disease” and “incidence of valvular surgery”. That said, I think it is very safe to assume that the actual rate of surgery among the senior population is much, much, much less… for now.

As you may have seen, recent research from the University of Michigan suggests that up to 50% of patients diagnosed with conditions including aortic stenosis and mitral regurgitation were not referred for treatment.

In review of these datapoints, it is appropriate to say that valve disease is fairly common among seniors and that the rate of surgery is likely to increase in the future – especially considering minimally invasive approaches to heart valve surgery.

Calcium Deposits On Bicuspid Aortic Valve (Aortic Stenosis)

Thanks to medical advances, we are living longer lives. However, it appears that human heart valves may need to evolve faster to counter the degenerative forces (calcium build-up) which cause valve disease. That said, I believe this is one more reason to consider heart valve surgery a “medical miracle”.

I hope this helped Heidi (and perhaps you) learn more about heart valve disease and seniors.

Keep on tickin!

Here is some great patient advice from David about (i) treating heart valve disorders in a timely fashion and (ii) being your own, best patient advocate. David wrote to me:

Hi Adam,

I’m a 55-year old man living in Maine. I just underwent aortic valve and ascending aorta replacement surgery on November 10, 2009.

David Belisle – Heart Valve Replacement Patient

I’m writing you for a very important reason… To encourage other patients with serious valve disorders (e.g. aortic stenosis, mitral regurgitation) to get surgery. So you know, I waited too long.

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In 2009, many public figures, including Barbara Bush and Robin Williams, needed aortic valve replacement due to heart valve diseases including aortic stenosis. One might think that their successful results and the improvement in mortality rates would inspire patients and the medical community to view heart valve surgery as a blessing.

However, fear about the risk of surgery is among the reasons half of eligible patients are not getting aortic valve replacement surgery, according to a study by physicians at the University of Michigan Health System.

The study, published in Circulation: Cardiovascular Quality and Outcomes, found that 66% of patients who did not have aortic valve replacement were suffering symptoms such as shortness of breath that would have improved if they had the surgery.

“Aortic valve replacement not only treats the symptoms, but also saves lives,” says lead author David S. Bach, M.D., professor of internal medicine at the U-M Medical School and cardiologist at the U-M Cardiovascular Center.

Aortic stenosis, a narrowing of the aortic valve opening, is common among older adults. In those age 75 and older, as many as 5 percent have the heart condition. Over time, the heart thickens as it tries to pump blood through the small valve opening which can lead to heart failure.

David S. Bach – Professor Of Internal Medicine, Michigan

The study also suggests that more than a handful of patients were denied surgery. Researchers identified 369 patients from three Michigan hospitals who had aortic stenosis. They had been screened by electrocardiogram. Among them, 191 did not have their aortic valve replaced.

The lack of referrals for surgery occurred in a variety of settings – whether patients saw a community physician or one affiliated with a university or veterans hospital – which suggests a widespread lack of awareness about the benefits of surgery, or overestimation of the risks associated with the surgery.

A review of patient charts showed the most common reasons for not referring for surgery was surgical risk and presence of other major health problems. But surgical risk scores for patients who did not have surgery were lower than doctors had predicted, according to surgical risk guidelines created by the Society of Thoracic Surgery.

Surgery is considered the best treatment for aortic stenosis and the consequences of waiting or passing up surgery are substantial. According to the report, only 66 percent of the patients who did not undergo surgery survived 12 months later.

Keep on tickin!

I don’t know about you, but I am a very visual person. For some reason, diagrams, pictures, illustrations always help me better understand concepts. As a result, I could really relate to Wendy’s question about heart valve replacement diagrams.

Wendy writes, “Hi Adam – I’m 59 and preparing for mitral valve replacement. Everybody keeps talking to me about what is going to happen but I still don’t understand it completely. Do you have a picture that could help me understand where the valve will go in my heart? Thank you, Wendy”

No problem Wendy! To support you and others, I just came across this great diagram which illustrates where the heart valve replacement device will be positioned in your heart.

As you can see above, this diagram shows two valvular disorders – aortic valve regurgitation and mitral valve regurgitation. The picture also shows the two types of valve replacement devices that can be used within your heart (mechanical valves and biological valves).

I hope this helps!

Keep on tickin!