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.

Key Takeaways: Heart Valve Surgery

• Valve choice is personalized, not one-size-fits-all. The choice between mechanical valves and tissue valves depends on the individual’s age, lifestyle and medical history. While mechanical valves are durable and last a lifetime, tissue valves (bioprosthetics) reduce the long-term need for powerful blood thinners.
• Atrial fibrillation (AFib) must not be ignored. Patients often believe "a little AFib" isn't a serious concern during valve surgery. However, untreated AFib can significantly drop life expectancy and increase the risk of stroke. Franciscan Health experts emphasize that AFib should be addressed simultaneously during heart surgery whenever possible.
• Heart valve surgery can improve (not just maintain) life expectancy. Modern surgical techniques—including minimally invasive options—are designed to restore heart function, prevent further damage and can lead to a longer, more active life.
• With advancements and minimally invasive approaches to heart valve surgery, many patients experience less pain and a quicker return to their normal daily activities than in the past.

Myth: Mechanical Valves Are Not As Good As Tissue Valves

The truth: Not so, said Manesh Parikshak, MD, cardiothoracic surgeon at Franciscan Health Indianapolis.

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

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. Parikshak.

“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, “and we have these discussions before surgery with all of our patients.”

“Several studies have demonstrated no difference between mechanical and tissue valves in a patient's survival,” Dr. Parikshak said. “Both valve options are on the shelf and can readily be placed in any patient. We just need to decide, 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. Parikshak. “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. Parikshak. Several medical studies came to this conclusion, estimating that the life expectancy of a patient having valve surgery would be shortened by one to four years. But in comparison, without surgery at all, a patient’s survival rate is only a few years.

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

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

“Every replacement poses some risk for the patient because it introduces a foreign object into the body. But when we are able to repair a valve, we eliminate that risk and restore life expectancy to normal,” said Dr. Parikshak.

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 (TAVR) or Transcatheter Edge to Edge Repair (TEER). These techniques deliver therapy via a catheter and don’t require open-heart surgery. It remains an excellent choice for patients who are not good candidates for more invasive surgery, especially if they have 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.”

"At Franciscan Health Indianapolis we utilize a team approach including cardiologists and surgeons to decide the best option for each individual patient to provide the best possible and most durable outcome," added Dr. Parikshak.