I just received an interesting email from Judy about adhesions, the pericardium and heart valve re-operations.

Judy writes, “Hi Adam, I am a 66-year old female preparing for aortic valve replacement. I have calcification at the sinotubular junction. Reoperation would be tricky in my case as I have an anomalous circumflex artery. I wondered what can be done to minimize the chances of adhesions? Could not closing the pericardium contribute to adhesions? What are the pros and cons of leaving the pericardium open? Thanks, Judy”

Post-Operative Adhesion

To answer Judy’s questions, I contacted Dr. Craig Smith, the chairman of surgery at NewYork-Presbyterian Hospital / Columbia University Medical Center. If you did not know, Dr. Smith recently performed aortic valve replacement on Barbara Walters. Doctor Smith has also operated on Former President Bill Clinton and several members of our patient community including Gary Poltorak.

Dr. Craig Smith – Heart Surgeon of Former President Bill Clinton
and Barbara Walters (NewYork-Presbyterian Hospital)

In his response to Judy, Dr. Smith noted…

Read the rest of this entry »

On the heels of our recent discussion about the Sapien, a new transcatheter aortic valve replacement technology, additional data about the MitraClip recently surfaced. Similar to the Sapien, the MitraClip is a non-invasive treatment for heart valve disease. Unlike the Sapien, however, the MitraClip is designed to repair the mitral valve of patients suffering from severe mitral regurgitation.

The MitraClip

In this study, the MitraClip’s performance was compared against traditional surgical approaches including median sternotomy. According to reports, 184 patients received the MitraClip procedure while 95 patients had open heart surgery. The key findings of the EVEREST II study were:

Read the rest of this entry »

Recently, new trial data was released for a next generation, catheter-based technology for aortic valve replacement.

At the 2011 American College of Cardiology meeting in New Orleans, patient results for the transcatheter aortic valve implantation (TAVI) solution offered by Edwards Lifesciences suggested that use of its Sapien device was as good as conventional open-heart surgery. However, the risk of stroke continues to be an issue for the technology, researchers reported.

In this part of the experimental trial, the Sapien device went head-to-head with traditional aortic valve replacement techniques including median sternotomy.

Read the rest of this entry »

Alice just sent me a great question about the use of heart-shaped pillows after heart valve surgery. She writes, “Hi Adam,  I’m 61-years old and preparing for a mitral valve repair due to severe mitral regurgitation. I can’t help but notice the huge pillows clutched by patients in several photos across your website. What are those used for? Thanks, Alice”

In case you have yet to see them, here are four pictures of heart valve surgery patients (David Swendson, Anita Devine, Carla Hansen and John Turan) which feature these unique, heart-shaped pillows.

Heart Valve Surgery Patients – David Swendson,
Anita Devine, Carla Hansen & John Turan

To answer Alice’s question… These pillows are typically offered to patients for sternum support while coughing after surgery. As you may know, during most heart valve procedures, select breathing and circulatory functions are simulated using a ventilator and a heart-lung machine. Unfortunately, vapor can settle in the patient’s lungs.

Read the rest of this entry »

I’ve received several questions about the use of Pradaxa as a potential Coumadin-substitute for patients with atrial fibrillation, valve disease and/or mechanical heart valve replacements. I am a “better safe than sorry” type guy, so I wanted to make sure our patient community was on the same page specific to this new anticoagulant.

For those of you unfamiliar with Pradaxa, it was approved by the FDA in October, 2010. Following the results of its RE-LY study, Pradaxa is now considered by some to be an alternative to Coumadin — an established anticoagulant (blood thinner) for preventing strokes in patients with atrial fibrillation. During the RE-LY trial, patients with atrial fibrillation taking Pradaxa had fewer strokes compared to those using Coumadin.

In light of this news, patients in our community – including Gene – sent me questions about Pradaxa. I contacted Dr. Niv Ad, chief of cardiothoracic surgery at Inova Heart & Vascular Institute in Virginia, to learn more about this drug and its potential utility for patients with mechanical heart valve replacements.

Read the rest of this entry »