3 Myths About Heart Valve Surgery

The surgical options available to people with faulty or diseased heart valves have expanded during the last decade. That means it’s more important than ever to learn as much as possible about treatment options, especially if heart disease runs in your family.

Heart valves regulate the flow of blood through the heart chambers by opening and closing with every heartbeat. When valves become obstructed, is leaking or not closing properly, it becomes difficult for the heart to send blood to other parts of the body.

Heart valve disease sometimes starts as a heart murmur not requiring immediate treatment, but it can worsen over time or sometime very quickly. Treatment usually involves heart valve repair or replacement.

Cardiologists and cardiovascular surgeons at Franciscan Health Heart Center in Indianapolis discuss three popular myths about heart valve disease and surgery:

Myth: Mechanical Valves Are Not As Good As Tissue Valves

The truth: Not so, says Marc Gerdisch, MD, medical director of cardiothoracic surgery at Franciscan Health Indianapolis.

Tissue or bioprosthetic valves, usually made with porcine products, have made a lot of news in recent years. Benefits include less dependency on powerful blood thinners than mechanical valves, which makes them a good choice if a patient has issues with these medications. On the other hand, mechanical valves have been around a long time, and tissue valves can deteriorate due to calcium buildup or advancing heart disease and eventually need replacing.

Still, the final choice on whether to use mechanical or tissue valves to replace heart valves should take into account several factors, according to Dr. Gerdisch.

“The choice of tissue or mechanical valve should be tailored to the individual patient, based on age, lifestyle, other medical conditions and the patient’s expectations,” he said.

“Several studies have demonstrated no difference between mechanical and tissue valves in patient survival,” Dr. Gerdisch said. “All the valves are on the shelf—I can put in a mechanical valve; I can put in a tissue valve. We just need to decide, through several individual factors, which choice will be right for each patient.”

Myth: Not All Atrial Fibrillation Is Important To Treat

The truth: Atrial fibrillation, or AFib, is caused by a misfiring of the electrical pathways in the heart muscle, interrupting the heart’s ability to pump blood effectively. Individuals with heart disease often have AFib as well.

Sometimes, patients have symptoms such as dizziness or shortness of breath, but not necessarily. In either case, untreated, AFib can worsen valve disease and increase a patient’s risk of stroke and death.

That is why AFib should be addressed when valve disease is present.

“Today, we have a vast range of therapy options for AFib,” said Shivang Shah, MD, cardiologist at Franciscan Physician Network Indiana Heart Physicians in Indianapolis. “These options include managing stroke risk and the symptoms associated with Afib. These options can be tailored to the individual patient using the shared decision-making principle at our office visits.”

“As far as I’m concerned, there is no such thing as ‘a little atrial fibrillation,’” said Dr. Gerdisch. “When a patient is first admitted to a hospital with AFib, their five-year life expectancy drops 50 percent lower than their predicted lifespan. That’s why every major medical society recommends that AFib be addressed, when possible, during heart surgery.”

Myth: Heart Valve Surgery Decreases Patient Life Expectancy

The truth: Not necessarily, said Dr. Gerdisch. Several medical studies came to this conclusion, estimating that the life expectancy a patient having valve surgery would be shortened by one to four years. Without surgery at all, however, a patient’s survival rate is only a few years.

“The most important determinant of how heart valve surgery affects life expectancy is the time of surgery. It is most important that heart disease is monitored well before there is irreparable damage to the heart,” said Dr. Gerdisch.

What’s more, if a patient’s valve can be repaired instead of replaced, the concern about a shortened life expectancy disappears.

“Every replacement poses some risk for the patient because introduces a foreign object into the body. But when we repair a valve with the patient’s own tissue, we eliminate that risk of rejection and restore life expectancy to normal,” said Dr. Gerdisch.

In addition to expanded surgery options for heart valve replacement and repair, heart specialists now have interventional choices to treat heart valve disease, including transcatheter aortic valve replacement, or TAVR. This valve replacement can be delivered via a catheter and doesn’t require open-heart surgery. When first used, it was an excellent choice for patients who were not good candidates for more invasive surgery, especially if they had symptoms of heart failure.

“TAVR has dramatically expanded the access to aortic valve replacement. We started out by performing TAVR in patients that were too high risk for surgery. Nowadays, it is a possibility for most patients if their anatomy is suitable,” said Saeed Shaikh, MD, director of the structural heart program at Franciscan Health Indianapolis and a cardiologist with Franciscan Physician Network Indiana Heart Physicians in Indianapolis. “In the United States, more TAVR valves are placed in patients annually than valves replaced surgically. TAVR has a short recovery time and it really makes a difference in the patient’s quality of life.”