Hi everybody,

I just received a note from the Patient Education Team at the Cleveland Clinic about a new, online tool for patients with mitral valve regurgitation. The tool is pretty neat for learning about mitral valve regurgitation, the severity of mitral regurgitation, echocardiogram results, ejection fractions, heart dilation and atrial fibrillation.

Ultimately, this new Mitral Regurgitation Tool uses a series of interactive questions to determine whether-or-not you are currently a candidate for surgery. The tool leverages the current guidelines of the American Heart Association and American College of Cardiology in determining your situation.

If you would like to use the Mitral Regurgitation Tool, click here.

Keep on tickin!

Are you ready for another interesting “True / False” trivia question about heart valve surgery? Okay… Is this statement true or false?

One of the first heart-lung machines used in cardiac surgery, the Dewall-Lillehei machine, cost only $15 to manufacture.

For the answer, please scroll below the picture of Richard Dewall and his artificial heart-lung machine (1955).

With about $15 worth of odds and ends from their laboratory — including tubing made for carrying beer — two University of Minnesota medical legends, Richard Dewall and Walt Lillehei, ended the era when a serious heart defect meant a drastically shortened life.

In 1955, Dewall and Lillehei created what became known as the DeWall-Lillehei bubble oxygenator, the very first artificial heart-lung machine. The machine worked by extracting depleted blood from the patient and feeding it with oxygen bubbles shot in through a series of needles. The rejuvenated blood was then mixed with an anti-foaming agent and channeled back into the circulatory system.

The bubble oxygenator replaced two riskier alternatives available to open-heart surgeons at that time.

One was induced hypothermia. When Lillehei and another University surgeon, John Lewis, performed the world’s first open-heart surgery in 1952, they lowered their patient’s body temperature to 80 degrees to slow her metabolism. The surgery was a success, but hypothermia gave doctors only a brief window — about 10 minutes — to operate.

Dr. Walt Lillehei (1918-1999)

The other early alternative was to have a live donor (sometimes a parent of the patient) in the operating room serving as the patient’s heart and lungs during the procedure. But “cross-circulation” was risky to the donor, and finding the right blood-type match could be difficult.

While other heart-lung devices were being tested at the time, the Dewall-Lillehei machine stood out. It was easy to sterilize and, unlike other prototypes, contained no moving parts which could break down. It was the prototype of equipment still in use today. It has allowed trained cardiac surgeons in any modern, well-equipped hospital to perform open-heart surgery.

According to the American Heart Association, about 700,000 open-heart surgeries were performed in the United States in 2005.

Also, if you are curious, $15 in 1955 is worth about $120 in 2010 (adjusted at an annual inflation rate of 3.9%). Still, pretty cheap for a heart-lung machine, right?

Keep on tickin!

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!

I was just reading The Washington Post when I came across an interesting story about aortic valve replacement. In addition to discussing the recent heart valve replacements of Barbara Bush and Robin Williams, the article posted its “Top 5 Facts About Aortic Valve Replacement”.

Tissue Valve Replacement Sewn In Aortic Position

I thought you might like to see some of the highlights from this article. So, here they are:

1. There is not much you can do to prevent or protect against aortic valve failure, which occurs when either the valve hardens or simply wears out, often as a function of age. (Bush was 83 and Williams was 57 at the time of their aortic valve surgeries.)

Read the rest of this entry »

I just received an email from Bob about cardiac care centers. He writes, “Adam – Do you happen to know what is the number one hospital in heart valve replacements? I have a mitral valve prolapse and I need a mitral valve replacement. I would like to know which are the best hospitals in the United States.”

Unfortunately, I don’t know which hospital is number 1 for heart valve replacement surgery. However, I do have one reference point for Bob regarding the top ten hospitals for heart surgery. Each year, U.S. News And World Report issues a “top 10 ranking” of the best hospitals for heart surgery. While this ranking does not indicate the quantity of heart valve replacements performed each year, it does (in some sense) indicate the quality of heart surgery which I believe is most important.

That said, this list might help you get started with your hospital and, more importantly, your surgeon selection process. Here is the link, Best Hospital For Heart Care And Heart Surgery – US News And World Report.

However, you should know that some people feel that these rankings are not properly developed and reported. For an interesting read, please see NPR’s article, Heart Hospital Rankings Don’t Reveal Picture.

ANOTHER POINT TO CONSIDER: So you know, I had my aortic valve replacement surgery at USC Medical Center in Los Angeles, California. You will note that this facility is not listed on the above-referenced ranking. Personally, I was more focused on finding the right surgeon than finding the right hospital. That said, I think I was incredibly lucky to find Doctor Starnes (my surgeon). Again, it’s just another point to consider.

I hope that helps you learn a little more about the number 1 hospital for heart valve replacement. Click here to leave a reply, thought or comment for Bob.

Keep on tickin!