Innovations in Treating Heart Valve Disease
As minimally invasive surgical techniques continue to advance, surgeons are becoming more adept and more creative in applying them. For patients with heart valve disease and coronary artery disease, this means new and better options and for many, the chance to avoid more traumatic surgeries.
The heart has four valves that control the flow of blood into and out of the heart. Most commonly, valvular disease affects the aortic valve. If the aortic valve becomes narrowed (stenotic), the heart must work harder to push blood into the aorta and to the rest of the body.
According to Mathew R. Williams, MD, Surgical Director of Cardiovascular Transcatheter Therapies and Co-Director of the Heart Valve Program, severe aortic stenosis usually requires replacement of the aortic valve. In some cases, patients who have had valve replacements will also need to have additional procedures to correct blocked arteries. Until recently, these procedures were traditionally both done through open surgery.
But open surgery may be too risky for certain patients, and may be particularly problematic for patients who have coronary artery disease, or who had prior heart surgery and need re-operation. If they were not able to withstand open bypass surgery, such patients previously had no choice but to endure their symptoms as their hearts grew weaker. Now, the advent of hybrid surgerieswhich combine catheter-based procedures with minimally invasive surgical techniquesare providing a broader and better range of treatment options.
As Dr. Williams explains, "Hybrid procedures are done in order to minimize risk and simplify surgery in instances where combining two procedures into one would be simpler, safer, and more durable." Dr. Williams is one of the only surgeons in the nation dually trained in both catheter-based (interventional) procedures as well as traditional cardiac surgery.
He says that hybrid valve procedures are most appropriate for older patients who need a valve replacement and who also have coronary artery disease (hardening of the arteries). Rather than performing a bypass operation to address the arteries and then a separate valve operation later, the hybrid procedure allows both problems to be corrected using minimally invasive incisions and catheter-based instruments. A valve can be surgically replaced through minimally invasive incisions in the chest, while the blocked arteries are fixed via the groin using catheter-based techniques and stents. Patients can recover more quickly after such hybrid procedures than after open surgery, and they do not need to return for multiple procedures. According to Susheel Kodali, MD, Assistant Professor of Clinical Medicine and Co-Director of the Heart Valve Program, "Valve replacement and bypass surgery require a full sternotomy (large chest incision). If the patient has had any prior cardiac surgery, this can be very complicated. Minimally invasive hybrid surgery can lower the risk in these patients by simplifying the procedure."
Hybrid surgery is gaining traction throughout the nation, but at this time remains available only in select institutions because of the need for specialized operating rooms and multidisciplinary expertise. Hybrid procedures require close collaboration between interventionalists and surgeons, a type of cooperation not usually found in institutions with traditional departmental divisions. At NewYork-Presbyterian/Columbia, such cooperation underpins the newly established Heart Valve Program, where a multidisciplinary team from the Department of Surgery and the Center for Interventional Vascular Therapy collaborates to determine the best course for each patient. "Instead of having to go to separate appointments to see a cardiologist, surgeon, or other physicians," says Dr. Kodali, "patients can come to our clinic for a full evaluation including catheterization, echocardiography, and physical evaluation in one visit."
The Heart Valve Program at NewYork-Presbyteria/Columbia consists of a team of specialists who evaluate, treat and provide long-term care for patients with heart valve conditions. Learn more at www.columbiaheart.org or by calling 212.342.0444.