I just received a question about tricuspid valve surgery from Eva. She writes, “Adam – Can tricuspid valves be as easily repaired as mitral valves?”

To help answer Eva’s question, I just found a great video from Dr. Lishan Aklog, chief of cardiovascular surgery and chair of the Cardiovascular Center at the Heart & Lung Institute at St. Joseph’s Hospital and Medical Center.

As Dr. Aklog notes, it is possible for the tricuspid valve to be repaired. However, as each patient case is unique, your surgeon will ultimately make the decision whether or not your valve will be repaired. In many situations, like mine, the valve leaflets are so degenerated — due to calcification, infection, aging, etc. — a repair will not restore valvular function. In those patient cases, a valve replacement is necessary.

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In a very short time, Heart Valve Journals has become an online epicenter of patient-to-patient communication specific to heart valve surgery. Using this free Internet tool, patients can share their experiences while engaging in meaningful discussions with other patients around the world.

Ros Hernmarck – Mitral Valve Repair Patient

Recently, I clicked upon the interesting journal of Ros Hernmarck. Up until a few days ago, Ros suffered from symptoms tied to her severe mitral regurgitation diagnosis.

Considering Ros was placed on an 18-week waiting list in the United Kingdom, she looked for surgical options. One of those options was private treatment in the UK. However, as Ros notes in her journal, “Private treatment in the UK is around 50,000-60,000 pounds.” (That’s about $90,000 United States dollars.)

After watching a video about Robin Steel’s mitral valve repair in India (provided below), Ros became intrigued by the possibility of having her heart valve operation in India.

As she wrote on April 26, 2010, “After a lot of internet research, I have decided to go for Doctor Vivek Jawali at Fortis Hospital in Bangalore, INDIA! He has pioneered minimally invasive, mitral valve operations in India and comes highly recommended at a fraction of the cost of private treatment over here. I am now what they call a Medical Tourist. FYI, Fortis Hospital is one of the 10 top internationally recommended hospitals. About 50% of their patients are Americans.

I am thrilled to report that on May 24, 2010, Ros had a successful mitral valve repair. It appears that Dr. Jawali performed the procedure via thoractomy.

To learn more about Ros and her mitral valve surgery in India, please visit her journal!

Keep on tickin’ Ros!

The treatment of diseased heart valves continues to get more-and-more exciting as new technologies continue to shape the way that valvular disorders are corrected. In the minimally invasive space, Edwards Lifesciences, the largest heart valve replacement manufacturer on the planet, just received a CE Mark for its SAPIEN pulmonic transcatheter heart valve device (shown below).

As you may know, this device was designed as an alternative to surgical valve replacement for patients suffering from congenital heart disease of the pulmonary valve.

This device utilizes Edwards Lifesciences’ transcatheter valve technology — which has already been used in more than 5,000 cases worldwide. Interesting details of the Edwards SAPIEN pulmonic transcatheter heart valve include:

• The valve is a tri-leaflet design;
• The material used is bovine pericardial tissue (from a cow);
• The valve frame is constructed of stainless steel; and
• Prior to delivery, the tissue valve is compressed onto a balloon to the diameter of a pencil. It is then threaded into position, using a delivery system.

Sapien Heart Valve Replacement Device

In the United States, the Sapien Pulmonary Valve Replacement is an investigation device. It is currently being evaluated in the COMPASSION (COngenital Multicenter trial of Pulmonic vAlve regurgitation Studying the SAPIEN InterventIONal THV) clinical trial.

Also… Edwards recently announced clinical findings for Sapien’s use in aortic valve replacement procedures across 32 medical centers in Europe where the device is commercially available:

• Patients treated with the artery approach had a 81.1% one-year survival rate
• Patients treated with the between-the-ribs approach had a lower 72.1% one-year survival rate.

Yes, this data suggests that several patients died within a year of treatment. However, it is critical to remember that these patients were “high-risk” and often too sick to withstand the rigors of regular chest-opening surgery.

“The encouraging outcomes add to the evolving body of clinical evidence that demonstrates transcatheter aortic valve implantation is a viable option for this high-risk patient population. The data provide valuable, real world insights that enable the continued advancement of this important treatment for patients in need of alternative therapies to traditional open-heart surgery,” said Dr. Thomas, director of cardiothoracic services, Guys and St. Thomas’ NHS Foundation Trust in London.

Mike Mussallem – Edwards’ Chief Executive Officer

On the outlook for transcatheter devices, Mike Mussallem, the chief executive officer of Edwards Lifesciences, noted in a recent interview, “[Sapien] has not only big growth potential, but potentially changes the landscape for a very long time.”

Specific to that landscape, it definitely feels as if we are on the cusp of some form of transcather transformation specific to heart valve treatment. While there remains no long-term data on the durability of these devices, it is appropriate to acknowledge that these technologies from Edwards, Abbott Laboratories and Medtronic may initially help a select portion of the patient population suffering from heart valve disease (e.g. aortic stenosis, mitral regurgitation).

That said, I recently had the unique and fortunate opportunity to (i) interview a transcathether valve repair patient and (ii) observe a transcatheter procedure.  In the next few days, I will be sharing those experiences with you.

Keep on tickin!

Over the years, I have received many patient and caregiver requests for paperback copies of my book from countries including Belgium, Canada, Mexico, Brazil, Finland, Germany, Japan, Chile, Singapore, South Africa, New Zealand and more.

Paperback Copies Go Global!

Unfortunately, I faced a few technical and shipping challenges finding an affordable way to send the book to other countries. For that reason, I have traditionally offered international readers an eBook version of The Patient’s Guide To Heart Valve Surgery.

However, that officially changed today!

Thanks to Andy, my programmer, and the United States Postal Service, my book can be sent to over 150 countries using an automated payment and mailing service. All international packages will be sent using Global Priority Mail and should reach most countries within 4-8 days.

If you have any interest in reading a paperback copy of the book, please click here to order your copy. A few books just went out to Canada, England, Ireland, Australia and Kenya.

I hope this helps all the international patients and caregivers out there!

Keep on tickin!

I just received a very interesting question from Nina about robotic heart valve repair and the heart-lung machine (also known as the “pump”).

Heart-Lung Machine Diagram

Nina writes, “Hi Adam – I’ve been reading your blog and patient comments about thoracotomy versus sternotomy for mitral valve repair. But, I have not found a similar post about the robotic procedure. I need a valve repair and I’m leaning towards the da Vinci robot. However, I have heard that patients are on the pump for much longer. Do you have any data on this? Thanks, Nina”

Nina raises a common concern for patients specific to the heart-lung machine for many reasons including the ongoing debate about pumphead.

So… To obtain the best answer to Nina’s question, I contacted Dr. W. Randolph Chitwood. As you may know, Dr. Chitwood is the director of the East Carolina Heart Institute. But, more importantly for this question, Dr. Chitwood pioneered the use of the da Vinci Surgical Robot for mitral valve repair. Dr. Chitwood is also the past-president of The Society of Thoracic Surgeons.

Dr. W. Randolph Chitwood with the da Vinci Surgical Robot

In response to Nina’s question Dr. Chitwood wrote to me, “Adam – For those of us have done many, many, many da Vinci robotic mitral repairs the pump times are typically no more than 15 minutes longer. Today, I did a procedure with less than 90 minutes on the pump. The repair was complete in 45 minutes. Please encourage Nina to select a surgeon who has extensive experience with robotic valve repairs. I can help Nina if she would like to chat. My office phone number is (252) 744-4822. She can ask for Amy Ethridge or myself. Regards, Dr. Chitwood”

I hope that helps helps Nina (and perhaps you) better understand the use of the heart-lung machine during robotic valve repair.

Also, thanks to Dr. Chitwood for answering Nina’s question! To learn more about Dr. Chitwood and the ECHI, please see “Cardiac Clinic Tour: Keeping Up With Dr. Chitwood”.

Keep on tickin!