43 Affected person Questions Answered by Dr. Kevin Hodges

Improbable!

Throughout our current affected person webinar, “5 Warning Indicators You Could Want Coronary heart Valve Surgical procedure”, I obtained 43 questions that we didn’t have time to reply through the dwell occasion. Think about my shock when Dr. Kevin Hodges, a number one minimally-invasive coronary heart surgeon at Northwestern Drugs and the featured speaker of the webinar, typed up solutions to every affected person query and requested me to submit them right here to assist educate our affected person neighborhood.

Query #1: Deborah asks, “Had an aortic bivalve changed in 2017. Now one other valve is starting to regurgitate…reasonably… Is that this uncommon, after I haven’t had any points with different valves earlier than, or does this occur?

Each affected person, coronary heart, and valve is slightly bit totally different. We do see that over time sufferers might develop new or worsening regurgitation in a unique valve. As an example, a affected person with a earlier aortic valve operation might subsequently develop mitral valve regurgitation, which isn’t essentially uncommon. We’d suggest monitoring the opposite valve with common echocardiograms and searching for indicators and signs of coronary heart failure or decreased coronary heart perform. If the regurgitation turns into extreme, it’s attainable you could want a second process. — Dr. Kevin Hodges

Query #2: Chris asks, “If one has each persistent A-Fib AND reasonable Aortic Valve Stenosis, which ought to get mounted first? Secondly, what’s the key figuring out situation for TAVR process?”

For sufferers with atrial fibrillation and important valvular coronary heart illness, we regularly tackle each concurrently throughout a concomitant process. As an example, a affected person may have an aortic valve alternative and a maze process with left atrial appendage ligation in the identical setting. In your case, the strategy can be partly decided by the severity of the aortic valve stenosis (is it barely reasonable or practically extreme) and the symptom burden of your atrial fibrillation. There are a number of therapy choices for each issues, which must be individualized for a selected affected person. Affected person choice for TAVR is predicated on a variety of elements, together with the kind of aortic valve illness, anatomy of the valve, and affected person threat elements and comorbidities. One situation that favors surgical aortic valve alternative is atrial fibrillation, as a result of that may be addressed with a concomitant maze process on the time of aortic valve alternative.  — Dr. Kevin Hodges

Query #3: Robyn asks, “Are you able to repair Afib similtaneously the valve if you’re doing an open coronary heart surgical procedure?”

Sure. For sufferers with atrial fibrillation who want coronary heart valve surgical procedure, we carry out a concomitant process known as a maze process. This can be a kind of ablation process with an 80-90% probability of eliminating atrial fibrillation. We additionally shut of the left atrial appendage with a clip, which reduces the prospect of stroke.  — Dr. Kevin Hodges

Query #4: Nader asks, “I’ve been in persistent AFIB for nearly 2 years and been on Calcium blocker and 81 mg aspirin. I’m a 53 yr previous male and no hypertension or diabetes just a bit excessive LDL. I lately came upon my MVR grew to become extreme. I’m the only real bread winner for my household and can’t afford 3 plus months restoration time. What qualifies me for minimally invasive restore with robotics?”

There are a variety of things that decide whether or not a affected person is an effective candidate for a robotic operation. These are based mostly partly on outcomes of an echocardiogram, CT scan, and coronary angiography. For sufferers with important atrial fibrillation, generally a conventional operation is greatest, as a result of it offers us the very best probability of utterly eliminating the atrial fibrillation and managing the left atrial appendage, which has a big impact on long-term outcomes and even life expectancy. Nonetheless, we at all times weigh a number of elements when planning an operation. It is usually value noting that the restoration time following a conventional operation for a wholesome 53 yr previous is more likely to be a lot shorter than 3 months and possibly nearer to 6-8 weeks.  — Dr. Kevin Hodges

Query #5: Georgia asks, “What age is taken into account “TOO YOUNG” for TAVR as preliminary therapy of calcified AVR?”

There isn’t any laborious cut-off for TAVR vs surgical AVR (SAVR) when it comes to age. We weigh a number of elements, together with age, threat elements for surgical procedure, comorbidities, and valve anatomy (e.g. tricuspid vs bicuspid). This subject can also be evolving quickly as we achieve extra expertise with TAVR and as new know-how turns into obtainable. Generally, I feel most would agree that youthful sufferers (particularly youthful than 60) are nonetheless greatest handled with surgical aortic valve alternative so long as they’re low threat for surgical procedure. The excellent news is most youthful sufferers may be handled with a minimally invasive strategy. In lots of instances, this is usually a proper anterior mini thoracotomy that doesn’t require dividing the sternum.  — Dr. Kevin Hodges

Query #6: Dixie asks, “Ought to I solely take into account a physician or hospital that can do the Sentinel process for the TAVR? My mom had a stroke and had AFib.”

The Sentinel gadget is a kind of filter that’s designed to stop particles from the aortic valve from inflicting a stroke throughout a TAVR process. A big research of this gadget didn’t present a statistically important discount in stroke in sufferers who had this gadget in place throughout a TAVR process (https://www.nejm.org/doi/full/10.1056/NEJMoa2204961). Nonetheless, there are a lot of who consider strongly within the worth of the Sentinel gadget and who use it routinely. From the above research, it additionally appears that there have been few dangers related to use of the Sentinel gadget. Primarily based on the obtainable knowledge, I don’t assume it will be honest to say it’s best to solely take into account a middle that makes use of Sentinel, however I might encourage you to debate this concern along with your suppliers when deciding the place to have your process.  — Dr. Kevin Hodges

Query #7: Pat asks, “Does train assist or hinder valve regurgitation?”

I’m not conscious of any knowledge to counsel that train (or food plan for that matter) impacts the speed of development of valvular coronary heart illness, however a wholesome life-style can actually assist with the restoration from any potential valve surgical procedure or process. Nonetheless, in sufferers with extreme valve illness, strenuous train can generally be harmful, and I might suggest speaking to your physician about your train plans.  — Dr. Kevin Hodges

Query #8: Invoice asks, “My state of affairs appears just like the left pic however they are saying I’ve extreme leaky mitral valve. I don’t have any signs besides generally I really feel slightly drained periodically through the day and so when do I must do the surgical procedure?”

Timing of surgical procedure in your state of affairs has to do primarily with (1) how doubtless we’re to get an excellent, sturdy restore and (2) how dangerous it will be to carry out surgical procedure based mostly in your comorbidities. For wholesome sufferers with a excessive chance of a sturdy restore, we provide early surgical procedure as a result of that is related to the very best long-term outcomes. In sufferers with a number of different medical issues or a valve that might not be repairable, we suggest ready till you develop signs or indicators of worsening left ventricular perform.  — Dr. Kevin Hodges

Query #9: Peter asks, “Is a prolapsed mitral valve really coronary heart “illness” or is it actually extra of a mechanical malfunction?”

Usually when individuals say “coronary heart illness” within the media we consider coronary artery illness however this time period applies to a broad vary of situations. Mitral valve prolapse is extra on the spectrum of congenital or genetic coronary heart illness that results in a mechanical malfunction of the valve over time.  — Dr. Kevin Hodges

Query #10: Nameless Attendee asks, “I’ve extreme tricuspid regurgitation Beforehand I had mitral valve restore (14 years in the past). Now with congestive coronary heart failure my dr has mentioned he won’t ever have me below open coronary heart surgical procedure and thinks {that a} tricuspid clip is probably going to not assist me with my specific state of affairs. I don’t perceive this- would possibly you have the ability to speculate why a clip wouldn’t profit me?”

Some sufferers have development of tricuspid regurgitation after a mitral valve restore process. Normally, these sufferers had gentle to reasonable tricuspid regurgitation on the time of their first operation. Reoperation for extreme tricuspid regurgitation is related to elevated surgical threat (at the least 5-10% operative mortality), particularly if sufferers have developed liver or kidney failure from their leaky tricuspid valve. Nonetheless, excessive threat surgical procedure could also be acceptable for sure sufferers and there are a variety of investigational transcatheter restore or alternative choices that may very well be thought-about. I like to recommend getting a second opinion (that is by no means incorrect) from a middle that participates in trials of transcather tricuspid alternative to make sure that you’ve gotten exhausted all your choices.  — Dr. Kevin Hodges

Query #11: Michael asks, “My analysis is extreme aortic stenosis. I’ve been doing a ton of analysis on latest research for reversal and decalcification. Are you able to share your ideas on this?”

Up to now, there isn’t any convincing knowledge for a technique to reverse aortic stenosis or decalcify an aortic valve. Right now, sufferers with extreme aortic stenosis ought to be eager about a valve alternative process, both surgically or with a TAVR process. The specifics of timing and selection of process are based mostly on the severity of the aortic valve stenosis and affected person comorbidities, together with age and different medical issues.  — Dr. Kevin Hodges

Query #12: Nameless Attendee asks, “I developed HFrEF after robotic mitral valve surgical procedure with 37% EF. One yr later and after utilizing the 4 pillars of medicines it’s now 56%. Is that this frequent?”

It isn’t unusual for a affected person’s ejection fraction to lower after mitral valve restore. It’s because ejection fraction, which is a two-dimensional estimate of left ventricular perform, may be overestimated within the setting of extreme mitral regurgitation. After surgical procedure, when the mitral regurgitation has been eradicated, the ejection fraction is commonly initially decrease. In lots of instances the guts will transform over time and the ejection fraction will return to regular or near-normal over the course of a number of months.  — Dr. Kevin Hodges

Query #13: Michael asks, “The place can I get a second opinion?”

You might be at all times greater than welcome to get a second opinion from Northwestern Drugs from wherever on this planet by way of telehealth (or in particular person, in the event you want). In any other case, the Society of Thoracic Surgeons (STS) offers a star rating system for applications based mostly on sure frequent cardiac surgical procedure procedures, which can provide you some steering on the standard of applications in your area. There are nationwide rankings, like US Information & World Report, which may be helpful however ought to be taken with a grain of salt. One nice useful resource is Adam Decide and his wonderful affected person advocacy web site, heart-valve-surgery.com. — Dr. Kevin Hodges

Query #14: Trish asks, “What’s the age for TAVR? My physician mentioned I’m too younger at 59. They’re wanting me to have the older method with reducing my chest plate open.”

There isn’t any laborious cut-off for TAVR vs surgical AVR (SAVR) when it comes to age. We weigh a number of elements, together with age, threat elements for surgical procedure, comorbidities, and valve anatomy (e.g. tricuspid vs bicuspid). This subject can also be evolving quickly as we achieve extra expertise with TAVR and as new know-how turns into obtainable. Generally, I feel most would agree that youthful sufferers (particularly youthful than 60) are nonetheless greatest handled with surgical aortic valve alternative so long as they’re low threat for surgical procedure. The excellent news is most youthful sufferers may be handled with a minimally invasive strategy. In lots of instances, this is usually a proper anterior mini thoracotomy that doesn’t require dividing the sternum.  — Dr. Kevin Hodges

Query #15: Robyn asks, “You probably have been an athlete most of your life, doesn’t that additionally help as your coronary heart muscle is robust?”

There isn’t any doubt that sufferers who’ve been very lively are higher in a position to tolerate a coronary heart valve drawback as their coronary heart usually has extra “reserve”. Wholesome, lively sufferers additionally usually have a neater and sooner restoration once they do want an operation.  — Dr. Kevin Hodges

Query #16: Trish asks, “My echo says do it now, the angiogram and TEE say I can wait.”

Timing of coronary heart valve surgical procedure is usually a advanced choice and infrequently requires balancing knowledge from a number of exams. When there’s competing (and even conflicting) knowledge, that could be a nice time to get a second opinion to make sure that you’re making the suitable choice.  — Dr. Kevin Hodges

Query #17: Madlyn asks, “I’ve a mitral valve restore with a hoop across the valve. I’m additionally in Afib. Is the ring across the valve failing?”

The event of atrial fibrillation after a mitral valve restore is considerably frequent. Having atrial fibrillation doesn’t essentially imply there’s a drawback with the restore, but when it is a new discovering, it could be a good suggestion to see your heart specialist for an echocardiogram to ensure your valve is functioning appropriately. There are additionally a variety of therapy choices for atrial fibrillation, together with medicines and catheter ablations that don’t require one other open coronary heart operation.  — Dr. Kevin Hodges

Query #18: Georgia asks, “Do Surgical evaluate boards have the ultimate say if SAVR or TAVR can happen?”

The choice between SAVR and TAVR is made by a group of cardiologists and coronary heart surgeons at a person medical heart, and most significantly by a dialogue with the affected person. Your medical doctors will weigh a variety of elements together with valve anatomy, threat elements, and age and offer you a suggestion for which process they assume is greatest for you. Nonetheless, it’s finally a joint choice based mostly in your preferences that determines learn how to proceed.  — Dr. Kevin Hodges

Query #19: Robyn asks, “I felt like I used to be 30 years older at age 58, as my valve was failing. I simply thought it was a part of my illness and being drained and never feeling nice was the “new regular”. Then, I used to be informed it was time for open coronary heart surgical procedure to switch the aortic valve and my aneurysm.”

Your expertise is quite common. You probably have not but had your operation, then know {that a} working valve may help you’re feeling the way in which it’s best to in your age. You probably have already had surgical procedure then I hope that you’re doing very effectively and again to feeling your self.  — Dr. Kevin Hodges

Query #20: Nameless Attendee asks, “If the left ventricle grows from 6 to six.4 in six months… When ought to the valve get replaced in your opinion?”

Timing of valve surgical procedure based mostly on left ventricular measurement is determined by the valve in query and whether or not the dangerous valve is inflicting the ventricle to stretch or vice versa. As an example, a affected person with extreme mitral valve regurgitation from mitral valve prolapse and a beforehand wholesome ventricle most likely ought to have their valve mounted if the tip diastolic diameter (the bigger of two frequent measurement) is above 6cm. Nonetheless, in some instances the first drawback is definitely the ventricle itself, which we seek advice from as cardiomyopathy. These conditions are extra difficult and require a devoted group to resolve the suitable plan of action.  — Dr. Kevin Hodges

Query #21: Mike asks, “Is there any connection between bundle department block and aortic valve stenosis?”

I’ll admit that I have no idea whether or not there’s a causative relationship between aortic stenosis and a bundle department block, however that is actually believable. Nonetheless, the existence of a bundle department block does have implications for aortic valve alternative (TAVR or SAVR). One of many dangers of both of those process is the necessity for a pacemaker, and sufferers with a bundle department block are at larger threat for requiring a pacemaker after their process.  — Dr. Kevin Hodges

Query #22: Patty asks, “I’ve extreme/reasonable aortic stenosis and was lately recognized with HFpEF with regular BNP. I’m in a wait and see standing engaged on coronary heart conditioning, every day strolling and so on. I’ve elevated signs, train intolerance, shortness of breath, chest tightness with train, lightheadness no syncope. Are these signs a results of the HFpEF or am I near valve alternative?”

Usually talking, sufferers with important aortic stenosis and signs of shortness of breath, chest ache, or syncope ought to have an aortic valve alternative. If there’s uncertainty about whether or not these signs are associated to the aortic valve, then a stress echocardiogram may be helpful.  — Dr. Kevin Hodges

Query #23: Joni asks, “What else may trigger the stroke? I had a serious one with delayed therapy of TPA, inflicting my left aspect to be weak and I maintain falling.”

There are a variety of potential causes of a stroke. In instances the place the trigger is unsure, a group of cardiologists and neurologists might use a mix of the options of the stroke and a affected person’s threat elements to find out the most certainly trigger. If a preventable trigger is recognized, they are going to suggest therapy to restrict the danger of one other stroke.  — Dr. Kevin Hodges

Query #24: Andrew asks, “How frequent is Afib after valve surgical procedure? What’s the distinction between afib and atrial tachycardia?”

Atrial fibrillation and a associated arrhythmia known as atrial flutter are quite common after valve surgical procedure. For mitral valve restore, as an example, the speed is greater than 30% through the first 30 days after surgical procedure. This threat is barely decrease with a robotic operation. Usually, post-operative atrial fibrillation may be managed very successfully with medicines and the danger decreases again to baseline after a number of months. Atrial tachycardia is a unique kind of atrial arrhythmia that isn’t as carefully associated to coronary heart valve surgical procedure.  — Dr. Kevin Hodges

Query #25: Nameless Attendee asks, “What proportion is taken into account excessive surgical threat? Thanks for this wonderful presentation.”

Excessive threat means one thing totally different for each affected person and consists of elements like probability of mortality, main issues (e.g. stroke, needing dialysis or a tracheostomy, and potential high quality of life). For a reference, the primary trial of TAVR vs surgical aortic valve alternative used a cutoff of 10% predicated threat of mortality to outline “excessive threat”. For any affected person who’s contemplating a excessive threat operation, an important factor is to have an in depth dialogue about dangers and advantages along with your surgical group earlier than deciding on a plan.  — Dr. Kevin Hodges

Query #26: Robyn asks, “Is there a chart that identifies the danger ranges for surgical choices?”

The Society of Thoracic Surgeons (STS) has a web based device that predicts the danger of mortality or main issues with sure frequent cardiac operations. These are based mostly on nationwide knowledge and should fluctuate considerably between facilities based mostly on quantity and experience. Usually talking, excessive quantity facilities have threat profiles which can be extra favorable than the nationwide common. A few of this variability is captured within the STS star rating system for cardiac surgical procedure applications.  — Dr. Kevin Hodges

Query #27: Tina asks, “Many because of Dr. Hodges for sharing his experience! Will please touch upon how “surgical threat” is outlined? Thanks!”

Surgical threat means the chance of an antagonistic consequence, together with dying, stroke, dialysis, tracheostomy, wound an infection, or a pacemaker. What is taken into account acceptable threat is totally different for each affected person and each operation. Most operations have a modest threat of great issues, however understanding the danger of surgical procedure requires an in depth dialog along with your surgical group.  — Dr. Kevin Hodges

Query #28: Joni asks, “What’s the various check to the stress echo? I recall having one a long time in the past.”

There are a variety of exams that assist us decide the severity of a coronary heart valve drawback. These embrace a stress echocardiogram, cardiac MRI, cardiac catheterization (proper or left coronary heart catheterization), or much more specialised exams in distinctive circumstances.  — Dr. Kevin Hodges

Query #29: Deb asks, “In the event you’ve already had mitral valve surgical procedure (valve restore) for extreme regurgitation and the surgical procedure reduces the regurgitation to gentle however then (round 7 yrs later) the regurg progresses to reasonable worse once more…. What are the issues or dangers of getting surgical procedure once more to scale back the regurg once more? And likewise what’s the likelihood of that surgical procedure resolving the difficulty utterly and never having to go through one other surgical procedure once more?”

Usually talking, redo surgical procedure is reserved for sufferers who progress all the way in which again to extreme mitral valve regurgitation. In that state of affairs a re-repair or a alternative is indicated to deal with the leaky valve. The dangers of redo mitral valve surgical procedure are particular to particular person instances however are usually barely larger than the danger of a first-time operation. Nonetheless, most often the danger continues to be low and surgical procedure may be carried out safely and with wonderful outcomes. In sure instances, when a re-repair may be carried out with a excessive chance of a sturdy end result, then this is a wonderful choice. In different instances it could be greatest to switch the valve. Redo mitral valve surgical procedure ought to be carried out at a excessive quantity heart with a group that has experience in assessing the appropriateness of re-repair and the chance of success.  — Dr. Kevin Hodges

Query #30: Nameless Attendee asks, “Had aortic valve alternative nearly 16 years in the past & I’m in my late 70’s. Aside from that I’ve felt tiredness for a few years, ought to I be involved?”

Tiredness is typically a troublesome symptom to pin down. To know whether or not that is associated to your prosthetic aortic valve, the very first thing to do can be to see you heart specialist and verify an echocardiogram. If the valve is working effectively on echocardiogram, it’s not more likely to be the issue.  — Dr. Kevin Hodges

Query #31: Salvatore asks, “5 years in the past, I had mitral valve restore. Final evaluate reveals gentle regurgitation & LAFB. Ought to I keep away from train for concern that doing so may make my situations worse?”

I might seek the advice of along with your heart specialist earlier than beginning an train program, however gentle mitral regurgitation (this sound like an excellent restore) and left anterior fascicular block, by themselves, shouldn’t restrict your train.  — Dr. Kevin Hodges

Query #32: Maryanne asks, “My heart specialist does the echocardiogram for the previous 5 years and he mentioned within the final two years my gentle to reasonable regurg. modified to gentle. How may this be attainable?”

There are a variety of things that decide the severity of valve regurgitation and it’s not unusual for severity to fluctuate considerably over time. The excellent news is that neither gentle or mild-moderate regurgitation wants an intervention, so you possibly can proceed to comply with this with periodic echocardiograms.  — Dr. Kevin Hodges

Query #33: Invoice asks, “I need revised my query. I’ve AFib and lately I used to be recognized I’ve extreme mitral valve regurgitation. I don’t have any signs. What process and when ought to I’ve it performed?”

The choice to proceed with an operation is predicated on the severity of mitral regurgitation (yours is extreme), chance of a sturdy end result based mostly on evaluate of your echocardiogram, and your particular person threat of present process cardiac surgical procedure, based mostly in your general well being. The presence of atrial fibrillation favors earlier surgical procedure, even within the absence of signs, as a result of it signifies important mitral regurgitation, is related to poor outcomes if left untreated, and may be handled with a concomitant maze process with left atrial appendage ligation on the time of surgical procedure. For an in any other case wholesome affected person with this mixture of issues (and assuming that your valve is repairable), I might suggest that you just proceed with a mitral valve restore and a maze process with left atrial appendage ligation. This doesn’t sound like an pressing state of affairs, however one which it’s best to consider addressing through the subsequent few months.  — Dr. Kevin Hodges

Query #34: Nameless Attendee asks, “I used to be recognized in 2013 with mitral valve regurgitation which was gentle on the time, it has progressed to reasonable. Why do sufferers have to attend till it turns into extreme which at that time might make for a more durable restoration? Why do it’s important to practically die to get restore and at what stage would you counsel a restore?”

The grading system of valvular coronary heart illness is predicated partly on the chance of the valve illness resulting in signs or coronary heart failure. Usually talking, lower than extreme mitral regurgitation just isn’t ample to trigger important issues, and plenty of sufferers with gentle or reasonable regurgitation won’t ever progress to extreme. The opposite factor to think about is that any operation carries some threat of great issues and even dying, even when that threat could be very low. We don’t need to supply an operation that might result in severe complication if we aren’t positive that the mitral regurgitation will finally change into an necessary drawback. — Dr. Kevin Hodges

Query #35: Jennifer asks, “Is there a relationship between MR, Hypertension, A-fib and Hypertrophic Cardiomyopathy?”

Completely. Sufferers with hypertrophic cardiomyopathy (HOCM) are vulnerable to creating mitral valve regurgitation resulting from a phenomenon name systolic anterior movement (SAM) of the mitral valve. Sufferers with HOCM can also develop mitral valve regurgitation for different extra typical causes (i.e. mitral valve prolapse). HOCM can also be related to larger charges of atrial fibrillation. In sufferers with this mixture of issues, who require surgical procedure, we will usually tackle all three on the similar time with a septal myectomy, probably a mitral valve restore if myectomy alone is inadequate, and a maze process with left atrial appendage ligation.

Query #36: Nameless Attendee asks, “How prevalent is Thoracic ascending aortic aneurysm surgical procedure utilizing robotics/minimally invasive?”

I’m not personally conscious of any robotic ascending aneurysm surgical procedure. There are surgeons who’ve described repairing an ascending aneurysm by a proper anterior mini thoracotomy. In my follow, I supply sufferers with remoted ascending aortic aneurysms the choice of an higher hemisternotomy, which I really feel affords the very best mixture of publicity, security, and restricted invasiveness. — Dr. Kevin Hodges

Query #37: Daneen asks, “Is getting a second opinion getting an opinion out of your heart specialist and a surgeon?”

Getting a second opinion usually means getting one other opinion from a heart specialist and/or surgeon at one other heart, which can have totally different follow patterns or assets. Cardiologists and surgeons that work collectively regularly are likely to share the identical opinions about that are the very best therapy methods. Generally we’re all responsible of presenting our opinions as the one choice and it may be very useful to listen to one other perspective. Many facilities, like Northwestern Drugs, supply a digital second opinion choice and can evaluate your data and meet with you nearly. Getting a second opinion doesn’t must imply utterly establishing care with a brand new set of medical doctors. — Dr. Kevin Hodges

Query #38: Mike asks, “The place can sufferers discover the requirements like Dr. Hodges confirmed for suggestions for having surgical procedure?”

The latest American society tips for valvular coronary heart illness (2020 ACC/AHA Guideline for the Administration of Sufferers With Valvular Coronary heart Illness: A Report of the American Faculty of Cardiology/American Coronary heart Affiliation Joint Committee on Medical Apply Pointers) may be discovered at: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000923. — Dr. Kevin Hodges

Query #39: Nameless Attendee asks, “What may be performed to attenuate stroke throughout aortic valve alternative?”

The danger of stroke is expounded to a variety of elements, together with valve anatomy, diploma of calcification, and different patient-specific threat elements (i.e. carotid artery stenosis, intensive calcification of the aorta, historical past of earlier stroke). The easiest way to attenuate threat is thorough pre-operative work-up and meticulous consideration to element through the operation. — Dr. Kevin Hodges

Query #40: Karen asks, “What about early surgical procedure for tricuspid valve? Is that beneficial for a leaky tricuspid valve?”

Timing of surgical procedure for tricuspid valve surgical procedure is slightly bit extra difficult than aortic or mitral valve surgical procedure. Traditionally, sufferers have been referred for tricuspid surgical procedure solely when the develop signs of coronary heart failure due to the idea that (1) sufferers stay asymptomatic with extreme tricuspid regurgitation for a very long time and (2) tricuspid valve surgical procedure is excessive threat. The issue is that by the point sufferers develop signs from their tricuspid valve illness they typically have important proper ventricular dysfunction and injury to their liver and kidneys, which most likely explains why tricuspid valve surgical procedure has the next mortality price (5-10%). Just lately their has been a push for extra proactive surgical procedure, particularly in in any other case wholesome sufferers with preserved proper ventricular perform. We consider these sufferers on a case by case foundation, however typically supply early surgical procedure when sufferers are good candidates for early restore. — Dr. Kevin Hodges

Query #41: Stefani asks, “What can an EKGs present for vlave illness? It seems most medical doctors solely actually have a look at or care about {that a} regular sinus rhythm is happening and don’t actually use the ECG/EKG to assist inform the story.”

EKGs can inform us whether or not sufferers are in a standard sinus rhythm or if they’ve sure irregular coronary heart rhythms (i.e. atrial fibrillation, PVCs). EKGs may counsel whether or not sure coronary heart chambers (i.e. the left atrium or left ventricle) are enlarged, however these items are higher seen with different imaging modalities like echocardiogram, CT scan, or cardiac MRI. — Dr. Kevin Hodges

Query #42: Jims asks, “Is there any analysis on the causation of calcification on the mitral valve?”

Sure causes of mitral valve calcification, like rheumatic coronary heart illness, are pretty effectively understood. Others, significantly mitral annular calcification, are extra of a thriller. We all know that mitral annular calcification is extra frequent in older sufferers, ladies, sufferers with continual kidney illness, and in sure subsets of sufferers with mitral valve prolapse. Nonetheless, we don’t totally perceive the mechanism for the calcification course of.  — Dr. Kevin Hodges

Query #43: Chad asks, “I discovered a really attention-grabbing research I assumed you would possibly discover attention-grabbing. It’s from 2019, and reveals that constantly taking beta blockers helps stop structural valve deterioration, vs not taking them, for these with bioproshethic mitral valves. Curious if any of your consultants have seen any comparable research for bioprosthetic aortic valve replacements, TAVRs, and so on?”

Thanks for sharing. This can be a small, single heart, retrospective evaluation so I might warning in opposition to taking it as very robust proof, however it’s actually thought upsetting. There have been a variety of research taking a look at elements that have an effect on prosthetic valve degeneration (and native valve calcification, for that matter) however the course of stays incompletely understood. This can be a huge concern for valve producers who put a substantial amount of effort into anti-calcification applied sciences for bioprosthetic valves. As we get extra expertise with every new technology of bioprosthetic valve, we’ll get a way of how efficient these processes are.  — Dr. Kevin Hodges

Many Thanks Dr. Kevin Hodges!

I’ve to increase a mighty “THANK YOU” to Dr. Kevin Hodges for taking the time to reply the affected person questions submitted throughout our particular webinar, “5 Warning Indicators You Could Want Coronary heart Valve Surgical procedure”.

Carry on tickin!
Adam