Surgeon Q&A: Scar Tissue and Minimally Invasive Heart Valve Reoperations

With advances in heart valve surgery techniques and longer life expectancies, some patients with one open-heart procedure may require a second or even third reoperation. For example, children with congenital heart valve disease may need several surgeries into adulthood. Additionally, some adults with a tissue or mechanical valve replacement may require a re-replacement due to leaflet failure or infection. Regardless of the situation, the presence of scar tissue during a reoperation can make the procedure complicated.

We received a great patient question about scar tissue and reoperations from Lynn, who asked, “If a person has had two open-heart surgeries to replace the aortic valve and has significant scar tissue, can they have a third, less invasive replacement surgery?”

To answer Lynn’s question, we met with Dr. Patrick McCarthy, the Executive Director of the Bluhm Cardiovascular Institute at Northwestern Medicine in Chicago. Having performed over 10,000 cardiac surgeries, Dr. McCarthy has extensive background with reoperative patients. He is also a celebrated surgeon among the HeartValveSurgery.com community, with over 200 patient recommendations.

Facts About Scar Tissue and Minimally Invasive Heart Valve Reoperations

Here are the key insights shared by Dr. McCarthy:

• Scar tissue complicates reoperations. “It’s a tricky problem when patients form scar tissue. It slows down the operation,” said Dr. McCarthy. “We have to be really careful because we can’t see exactly where the ‘plane’ is. We call it the difference between scar tissue and the aortic wall or parts of the heart. So, we have to slow down.”
• Less invasive options may be possible for patients needing a reoperation. Dr. McCarthy said, “You can certainly do less invasive, as in transcatheter aortic valve replacement (TAVR). In many of those patients, the preferred option may be to avoid another open-heart operation. We can sometimes do the less invasive small incision with another open-heart operation. But again, it needs to be a very careful, controlled procedure. So, it can be done in some situations but isn’t done all that often.”

Transcatheter Aortic Valve Replacement (Medtronic)

• How does the scar tissue slow down the surgery? “The scar tissue makes it difficult because it’s like you put glue in there, and things get stuck together that aren’t normally stuck together,” explained Dr. McCarthy. “As you know, we need to have them separated as we’re doing the surgery, and so we have to slow down and then we have to use an electrocautery or scissors to separate things and put them back to the way they’re supposed to be. That adds time and can also add to the risks for bleeding. So, the second, third, fourth, fifth operations can be trickier, slower, and higher risk for bleeding.”
• Patients should find a surgeon who specializes in reoperation techniques. “There are surgeons that do a lot of these types of operations,” said Dr. McCarthy. “This is our routine at Northwestern and many of the big programs. But others may not see it all that often and many times will refer the patient out.”

 Thanks Dr. McCarthy and the Northwestern Medicine!

On behalf of all the patients in our community, many thanks to Dr. Patrick McCarthy for sharing his clinical experience and research with us. And, a special thanks to Northwestern Medicine for taking such great care of heart surgery patients.

Related links:

• Surgeon Spotlight: Dr. Patrick McCarthy
• Dr. Patrick McCarthy Gets His 200th Patient Review at HeartValveSurgery.com
• Dr. McCarthy Q&A: Why is Mitral Annular Calcification Difficult to Treat?

Keep on tickin,
Adam

P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of our interview with Dr. McCarthy below.