Ask the Cardiologist: What Should Patients Know About the Valve Management Guidelines?
By Adam Pick on June 16, 2015
Have you ever wondered how your doctor figures out the best treatment for your valvular disorder?
I did. But, I never asked my surgeon before my operation. In fact, it wasn’t until years later that I learned about the Heart Valve Management Guidelines issued the American Heart Association and the American College of Cardiology.
To learn about these special guidelines, I interviewed Dr. Blase Carabello, a leading cardiologist, who has been working on the guidelines since 1998. Here are the highlights from my talk with Dr. Carabello.
I hope this video helped all of us learn more about the 2014 Valve Management Guidelines. Many thanks to Dr. Carabello for taking the time to share his clinical experiences and research with our community.
Keep on tickin!
P.S. How cool is the name Blase? 🙂
P.P.S. For the hearing impaired members of our community, I provided a written transcript of my video interview with Dr. Carabello below.
Dr. Blase Carabello: I am the Chairman of Cardiology at the Mount Sinai Beth Israel Heart Hospital. As a cardiologist, I specialize in cardiac problems in general, but my own specific interest is in valvular heart disease. American College of Cardiology and American Heart Association are two of the leading cardiac associations in America and in the world. They, in turn, are able to appoint cardiologists and others, cardiac surgeons and anesthesiologists, to help develop guidelines that help other physicians practice medicine up to speed.
The guidelines are aimed at the proper practice of medicine. The AHA/ACC has guidelines for I suspect at least 25 disorders. One of those is valvular heart disease. The AHA/ACC guidelines in general have been around at least since 1990. The first guideline that I was involved in was published in 1998 and the last one just this year in 2014.
There are four valves and they either stick or leak and there’s really a guideline for all eight of those. Valves are mechanical structures and when they fail they create mechanical problems. The only real solution for which are mechanical. That is, the valves either need to be repaired or replaced. Medications are a very small part of the guidelines.
The first thing is to assess severity of disease. We do not believe that mild or moderate valvular stenosis, either the valve is leaking or sticking, causes much in the way of problems. If the disease is severe, has it caused the patient any symptoms? Is it slowing them down? Is it causing them to get out of breath or to have chest pain or to feel like they’re going to black out depending on which valve we’re talking about? If symptoms have already occurred, it’s time to get the valve fixed.
The Valve Management Guidelines really address now very directly the difference between replacing and repairing valves. The most reparable and the valve for which we have the most data is the mitral valve. We say as part of the guidelines that people with a leaking mitral valve (regurgitation) should be referred to a center of excellence, a center where they are used to repairing these valves and where they have the skill sets to repair them. If I was a patient and I was referred to a heart surgeon, I’d want to know what his or her track record was. How many of these do they do a year? What’s the response rate? What’s their mortality rate? What’s the long-term outcome of these valves?
I think it is important for the patient to take an integral part in their care. One of the ways they can do that is to learn about the guidelines. It’s easy to go online and look them up. They’re written for physicians so some of the technical language might be difficult, but they’re pretty understandable. I think the guidelines, although written to help the physician care for the patient are also written to help the patient care for himself.