Increasingly common surgery will replace aortic valve to improve blood flow
TUESDAY, May 11 (HealthDay News) -- TV broadcaster Barbara Walters surprised fans of her weekday show "The View" Monday when she announced she was preparing to undergo a heart valve replacement, a procedure that will keep her off the air until the fall.
But doctors say her prognosis is excellent, with heart-valve replacement surgery now considered a routine procedure that typically leads to a full recovery.
"Having an isolated aortic valve replacement nowadays is associated with maybe a 1 or 2 percent mortality," said Dr. Daniel Goldstein, surgical director of the Center for Advanced Cardiac Therapy at Montefiore-Einstein Heart Center in New York City.
Walters, who is 80, told viewers that the faulty valve was discovered during an echocardiogram.
Other high-profile recent recipients of heart valve replacements include former First Lady Barbara Bush and comedian Robin Williams.
Dr. Paul Stelzer, a professor in the department of cardiothoracic surgery at Mount Sinai Medical Center in New York City, said the most likely reason for "someone to have a valve replaced these days is aortic stenosis."
This condition involves the aortic valve, which is located between the left lower chamber of the heart -- the left ventricle -- and the aorta, the largest artery in the body. As the left ventricle contracts, the valve opens, forcing oxygenated blood into the aorta where it is then distributed throughout the body.
"The valve is supposed to be a one-way door that opens completely and doesn't cause any obstruction of blood flow, and then closes completely so the blood only flows in one direction," Stelzer explained.
But as a heart ages, the valve can sometimes stiffen and not open all the way, which forces the heart muscle to do all the work, potentially leading to shortness of breath, fainting, chest pain and heart failure, he said.
The problem is more common than one would expect, Stelzer said. "Probably 5 to 10 percent of the population when they get into their mid-80s will have some degree of aortic stenosis. Women get this about twice as often as men, but we are not sure why that is."
The surgery to correct the problem typically involves replacing the defective valve with a heart valve from a pig or cow, but sometimes a human donor valve or a mechanical valve is used, Stelzer said.
"For someone who is over the age of 70, we almost always use a tissue valve [either pig or cow]," Stelzer said. "In an octogenarian I almost never use a mechanical valve."
"We are pretty sure these are going to last 15 to 20 years," he said. "It's going to exceed the life expectancy of the majority of people we put them into. If you live another 20 years, there's about a 50 percent chance you are going to have to have it done over."
The operation takes about three hours and most patients remain hospitalized for five days, Goldstein said.
However, full recovery takes some time. "Usually what I tell my patients is it's a good six to eight weeks until you are fully back to normal and able to do as much as you like, and the older you are the slower that might be," he said.
Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City, said that "women tend to ignore their symptoms" associated with a faulty valve.
"What women need to understand and pay attention to is if there is any change in how they feel in terms of their exercise capacity, they should call their doctor," she said.
Ignoring these problems is never a good idea, Steinbaum said. "You want to take care of it before heart function suffers or you get sick with chest pain, syncope [fainting] and heart failure," she said.
To learn more about heart valve surgery, visit the American Heart Association.
SOURCES: Paul Stelzer, M.D., professor, department of cardiothoracic surgery, Mount Sinai Medical Center, New York City; Daniel Goldstein, M.D., surgical director, Center for Advanced Cardiac Therapy, Montefiore-Einstein Heart Center, New York City; Suzanne Steinbaum, M.D., director, women and heart disease, Lenox Hill Hospital, New York City
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