Feb 09, 2017 12:00 AM

Author: Libby Mitchell


Broadcaster Charlie Rose will be off the air for the next few weeks – recovering after undergoing an aortic valve replacement. But while every minute he is off the air may feel like an eternity to his fans they can take comfort in the fact that just fifteen years ago Rose’s recovery time would have been much, much longer. “It used to be that patients undergoing a valve replacement could expect to stay in the hospital at least a week with a few days in the ICU,” says Jason Glotzbach, MD, a cardiothoracic surgeon with University of Utah Health Care. “They would then recover at home for a couple of months. It was a big surgery.”

The impacts of aortic valve replacement are still big – but what has gotten smaller is the procedure. Previously patients getting a replacement valve would undergone an invasive operation involving the opening of the chest, the stopping of the heart, and the use of a heart lung bypass machine while the old valve was removed and the new valve was put in place. That has changed with the introduction of transcatheter aortic valve replacement (TAVR). “Now we deploy the new valve via catheter through an artery in the leg,” says Glotzbach. “Once it is in the heart the new valve expands inside the old valve, functionally replacing it. It’s a minimally invasive valve replacement.  This procedure can also be used after previous surgical aortic valve replacement.  In that scenario the new TAVR valve is deployed within the existing surgically replaced valve.”

Part of the impetus to make valve replacement less invasive likely came from the fact that this is a surgery that many patients have to undergo more than once. The expected life of a replacement valve varies depending on the type. Replacement valves made of tissue usually have to be replaced roughly between ten and fifteen years as they break down. Mechanical valves last longer but may also need to be replaced if they stop functioning. Other factors also play a factor in how soon valves have to be replaced. “Age certainly plays a part, replacement tissue valves do not last as long in younger patients,” says Glotzbach. “In addition, certain health conditions such as renal disease can also decrease the life of a valve.”

The fact a valve replacement is now less invasive has opened up the surgery to those who previously wouldn’t have qualified. When looking at their health doctors would have decided that asking them to undergo a sternotomy (the opening of the chest) was too high of a risk. Patients would have been monitored but their valves would not have been replaced. “That’s now pretty rare in this day and age,” says Glotzbach. “Almost all patients are candidates and it’s a relatively safe procedure.”

 

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