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Repairing or Replacing Heart Valves: What's the Latest Minimally Invasive Technique
Dr. Wade Fisher explains why someone would need to replace or repair a heart valve, and the newest minimally invasive treatment option available.
Featuring:
Wade Fischer, MD
Wade Fischer, MD is a Cardiothoracic Surgeon at Florida Heart and Lung Institute of Osceola. Transcription:
Prakash Chandran (Host): When we think about heart surgery, it’s easy to imagine a lengthy and invasive procedure, but did you know there are new minimally invasive options that are available to treat serious heart conditions? We’re going to talk about it today with Dr. Wade Fischer, a cardiothoracic surgeon at Florida Heart and Lung Institute of Osceola.
This is Helmet of Health, the podcast from Osceola Regional Medical Center. I’m Prakash Chandran. So, first of all Dr. Fischer, can you tell us about the heart valves and the role they play in keeping blood flowing throughout our bodies?
Wade Fischer, MD (Guest): The heart is a remarkable machine, and it runs in two separate cycles. One is to pump blood to the lungs and then the oxygenated blood returning from the lungs goes to the left side of the heart which then pumps blood to the body. In between each of those chambers, or sections, lie heart valves. So, there are four heart valves that are in the heart, and they make sure that blood is moving forward efficiently and not having any of it leak backward or be regurgitant—is the medical term.
Host: Okay. So, I’m curious as to what happens if our heart valves aren’t functioning correctly, and what is this condition called?
Dr. Fischer: Well, there are two ways that a heart valve can malfunction. One is it could not open properly and that would be stenosis. The other is if the heart valve doesn’t seal properly and then that would be leaking or regurgitation, and if the aortic valve, for instance, is stenotic, that’s a common finding in older patients, then the heart has to work extra hard to push blood past that valve, and what sometimes happens is you can have both situations where the heart valve is both stenotic and leaking because the leaflets get fixed in a partially open position. So, blood doesn’t easily get pumped by them and blood, because they don’t close properly, falls back into the ventricle.
Host: I got it. So, whether it be that stenosis or regurgitation that you’re talking about, is that really—when people say heart disease or heart valve disease—is that what they’re talking about?
Dr. Fischer: Usually, that’s the most common in the United States is what we’re referring to with heart disease. Now, there are other forms. There used to be quite a bit of valvular disease from rheumatic infection or rheumatic heart disease, but we don’t see that with the advent of antibiotics and the good care that children get now. It’s unusual to see very much rheumatic valve disease except in people who immigrate here from other countries. Another cause—common causes that we see more frequently now is an infection of the valve, or endocarditis, which can happen when patients have been using illegal drugs and non-sterile needles to inject themselves.
Host: Okay. I understand. So, if someone has one of these issues that you’re talking about, what signs or symptoms might they experience to let them know that they might need a valve replacement?
Dr. Fischer: Well, one of the most common symptoms is heart failure because when the valves aren’t opening and closing properly, then the heart’s not working efficiently, and blood can back up in the lungs and cause shortness of breath.
Host: I see. So, when there’s complete heart failure, it’ll cause shortness of breath. Is there also pain in the chest or anything like that?
Dr. Fischer: There can be. Let’s talk about aortic valve stenosis, and as that valve becomes more stenotic and the heart struggles to push blood past it, then you can have situations where the heart begins to fail from the extra work. Also, the heart not being able to push the blood past that valve prevents the coronary arteries from getting filled so that it could cause chest pain from ischemic heart disease or the heart not getting enough blood. Another symptom that you sometimes see is if a patient suddenly stands up from a lying position, and the heart is struggling to push blood past that valve. The brain may not get enough blood and then the patient may have what we call syncope, or pass out, or go briefly, temporarily unconscious.
Host: When we think about operating on the valves, I think a lot of people think about open heart surgery, but I understand that there are minimally invasive options for heart valve replacement. Can you maybe talk a little bit about them and what the procedure’s like?
Dr. Fischer: Absolutely. There are some remarkable technologies that have come about in the last 5 to 10 years that are being used more and more commonly. One of the more common ones being done now is called TAVR, transcatheter aortic valve replacement, and that involves placing a catheter through the femoral artery, or the artery in the patient’s groin, and threading a catheter up into the heart where the aortic valve lies and inflating a—there are two types—there’s one type that is a balloon inflatable valve that can be deployed. The other type is a self-expanding valve made of a material called nitinol that also you can deploy, and it pushes the old valve leaflets out of the way and leaves the new valve in place.
Host: Huh. That is truly incredible that you’re able to just do that without making really any incision and, you know, whenever I hear minimally invasive, I also assume that the recovery time is much faster, is that correct?
Dr. Fischer: That is correct, and it’s remarkable with this technology, which originally we first used on patients who were not candidates at all for heart surgery, and one of the more common groups of patients were the very, very elderly, you know, those in the 90’s with multiple—what we call—comorbidities, or other significant medical problems, such as kidney failure or poor lungs, and they did so remarkably well that we started offering it to less sick patients.
Host: Alright, Dr. Fischer, well I really appreciate your time today. That’s Dr. Wade Fischer, a cardiothoracic surgeon at Florida Heart and Lung Institute of Osceola. Thanks for checking out this episode of Helmet of Health, and you can check out our website at osceolaheartandlung.com. If you found this podcast helpful, please share it on your social channels, and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we’ll talk next time.
Prakash Chandran (Host): When we think about heart surgery, it’s easy to imagine a lengthy and invasive procedure, but did you know there are new minimally invasive options that are available to treat serious heart conditions? We’re going to talk about it today with Dr. Wade Fischer, a cardiothoracic surgeon at Florida Heart and Lung Institute of Osceola.
This is Helmet of Health, the podcast from Osceola Regional Medical Center. I’m Prakash Chandran. So, first of all Dr. Fischer, can you tell us about the heart valves and the role they play in keeping blood flowing throughout our bodies?
Wade Fischer, MD (Guest): The heart is a remarkable machine, and it runs in two separate cycles. One is to pump blood to the lungs and then the oxygenated blood returning from the lungs goes to the left side of the heart which then pumps blood to the body. In between each of those chambers, or sections, lie heart valves. So, there are four heart valves that are in the heart, and they make sure that blood is moving forward efficiently and not having any of it leak backward or be regurgitant—is the medical term.
Host: Okay. So, I’m curious as to what happens if our heart valves aren’t functioning correctly, and what is this condition called?
Dr. Fischer: Well, there are two ways that a heart valve can malfunction. One is it could not open properly and that would be stenosis. The other is if the heart valve doesn’t seal properly and then that would be leaking or regurgitation, and if the aortic valve, for instance, is stenotic, that’s a common finding in older patients, then the heart has to work extra hard to push blood past that valve, and what sometimes happens is you can have both situations where the heart valve is both stenotic and leaking because the leaflets get fixed in a partially open position. So, blood doesn’t easily get pumped by them and blood, because they don’t close properly, falls back into the ventricle.
Host: I got it. So, whether it be that stenosis or regurgitation that you’re talking about, is that really—when people say heart disease or heart valve disease—is that what they’re talking about?
Dr. Fischer: Usually, that’s the most common in the United States is what we’re referring to with heart disease. Now, there are other forms. There used to be quite a bit of valvular disease from rheumatic infection or rheumatic heart disease, but we don’t see that with the advent of antibiotics and the good care that children get now. It’s unusual to see very much rheumatic valve disease except in people who immigrate here from other countries. Another cause—common causes that we see more frequently now is an infection of the valve, or endocarditis, which can happen when patients have been using illegal drugs and non-sterile needles to inject themselves.
Host: Okay. I understand. So, if someone has one of these issues that you’re talking about, what signs or symptoms might they experience to let them know that they might need a valve replacement?
Dr. Fischer: Well, one of the most common symptoms is heart failure because when the valves aren’t opening and closing properly, then the heart’s not working efficiently, and blood can back up in the lungs and cause shortness of breath.
Host: I see. So, when there’s complete heart failure, it’ll cause shortness of breath. Is there also pain in the chest or anything like that?
Dr. Fischer: There can be. Let’s talk about aortic valve stenosis, and as that valve becomes more stenotic and the heart struggles to push blood past it, then you can have situations where the heart begins to fail from the extra work. Also, the heart not being able to push the blood past that valve prevents the coronary arteries from getting filled so that it could cause chest pain from ischemic heart disease or the heart not getting enough blood. Another symptom that you sometimes see is if a patient suddenly stands up from a lying position, and the heart is struggling to push blood past that valve. The brain may not get enough blood and then the patient may have what we call syncope, or pass out, or go briefly, temporarily unconscious.
Host: When we think about operating on the valves, I think a lot of people think about open heart surgery, but I understand that there are minimally invasive options for heart valve replacement. Can you maybe talk a little bit about them and what the procedure’s like?
Dr. Fischer: Absolutely. There are some remarkable technologies that have come about in the last 5 to 10 years that are being used more and more commonly. One of the more common ones being done now is called TAVR, transcatheter aortic valve replacement, and that involves placing a catheter through the femoral artery, or the artery in the patient’s groin, and threading a catheter up into the heart where the aortic valve lies and inflating a—there are two types—there’s one type that is a balloon inflatable valve that can be deployed. The other type is a self-expanding valve made of a material called nitinol that also you can deploy, and it pushes the old valve leaflets out of the way and leaves the new valve in place.
Host: Huh. That is truly incredible that you’re able to just do that without making really any incision and, you know, whenever I hear minimally invasive, I also assume that the recovery time is much faster, is that correct?
Dr. Fischer: That is correct, and it’s remarkable with this technology, which originally we first used on patients who were not candidates at all for heart surgery, and one of the more common groups of patients were the very, very elderly, you know, those in the 90’s with multiple—what we call—comorbidities, or other significant medical problems, such as kidney failure or poor lungs, and they did so remarkably well that we started offering it to less sick patients.
Host: Alright, Dr. Fischer, well I really appreciate your time today. That’s Dr. Wade Fischer, a cardiothoracic surgeon at Florida Heart and Lung Institute of Osceola. Thanks for checking out this episode of Helmet of Health, and you can check out our website at osceolaheartandlung.com. If you found this podcast helpful, please share it on your social channels, and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we’ll talk next time.