New York, NY (PRWEB) May 16, 2010
Severe aortic valve stenosis (AS) is quite frequent in western society. By the age of 80 we see it in at least 4% of the population. It is, without a question, a common disease of the elderly. The recent announcement that Ms. Barbara Walters needs aortic valve surgery has caused a surge of interest in this topic. We asked Dr. Giovanni B. Ciuffo, assistant professor of cardiothoracic surgery and specialist in Minimally Invasive Heart Surgery at the Mount Sinai Hospital and School of medicine in New York City to give us a real update on the modern treatment of this deadly heart condition.
Most patients are diagnosed because of their symptoms of shortness of breath, chest pain, dizziness, fainting, progressive weakness and fatigue or because of an obvious and loud heart murmur detected by a doctor on physical exam. The current guidelines of the American College of Cardiology are crystal clear about what to do for these patients. Severe symptomatic aortic stenosis is a deadly disease and its only cure is an operation to replace the aortic valve. There is NO medical treatment for this disease. Without surgery three quarters of aortic stenosis patients will die within three years of symptom onset. The first graph shows very eloquently the striking difference in survival between medical and surgical treatment.
Further, there is a real urgency about undertaking an aortic valve replacement once symptoms are present. Several reports of sudden death within three months of onset of symptoms have been published. The second graph clearly shows how most patients have only one or two years to live after symptoms develop. About 25% of symptomatic patients with severe AS who do not undergo their needed valve surgery die a preventable death every year. In other words, each month that this life saving surgery is postponed or delayed carries a mortality risk of about 2%.
In spite of these very well-established statistical data, severe aortic valve stenosis continues to be a grossly “neglected child” in our medical community. A good example is the all-too-common case of the little old lady who complains of worsening shortness of breath and ankle swelling. Her doctor prescribes some diuretics and she gets a little better. Two months later she shows up in the emergency room with worsening symptoms and more diuretics are given. An Echocardiogram is obtained at this time and it shows severe or moderate-to-severe AS (Aortic Valve Area of 1.1 cm2 or less). This elderly patient and her family are reassured that some more diuretic therapy will do the trick and that, after all, no one wants to rock the boat with a “dangerous” open heart operation. Few more months go by and the family will call the office to let the good doctor know that Grandma has passed away and…well… to thank him for the wonderful care he provided.
There is a widespread and wrong perception that surgery would not be a good option in an elderly and otherwise functional patient. There are a great number of octogenarians that are as clear minded and functional as Ms. Walters. If we go back to the mortality rates we discussed, medical therapy is, by far, the most dangerous choice. It is also well known that the life expectancy of AS patients after a successful aortic valve replacement is the same as any healthy patient of the same age. At a recent seminar in New York City, a local internist asked a heart surgeon if he would change his mind about operating on an old lady with multiple medical problems (diabetes, hypertension, history of “ministrokes”). His answer was: “Let’s suppose this hypothetical lady with all her risk factors has mildly symptomatic colon CA (constipation) instead of severe AS….Would you be willing to send her home with a few fleet enemas instead of a referral to a general surgeon to undergo a “dangerous” colon resection? I don’t think so!”
Symptomatic severe AS, we might add, does kill you much faster than early colon CA. That goes to show you that there is a strong and wrong cultural bias in our society about treating this condition. Certain buzz words such as “cancer” or “aneurysm” usually get both doctors and patients up in arms right away, while life threatening heart conditions like severe aortic stenosis are grossly underestimated until it is too late.
What are the surgical options? A well-meaning relative will ask: “Isn’t Grandma too old and frail to withstand open heart surgery?” The answer is: “No. Grandma is too old and frail to withstand severe aortic valve stenosis. Here are the statistics on this condition!” New minimally invasive, “low impact” techniques have dramatically changed the impact of this operation on the overall patient’s experience and on the speed of recovery. Most patients can leave the hospital two – three days after surgery. A few pictures will illustrate this technique better than a thousand words. The surgical incision is about 2-3” in length and is carried out in between two ribs. There is no bone cutting involved and this is a great advantage for wound healing in patients with advanced osteoporosis, a condition present in most elderly patients, especially ladies.
The entire operation and all the necessary connections to the heart-lung machine are carried out through this tiny incision. As you can appreciate on the second surgical picture, the prosthetic valve in its light blue holder is ready to be tied to the heart and it is right at the center of the operative field. The same incision can be currently used for a variety of open heart operations. More details and surgical pictures about this revolutionary minimally invasive approach are available at http://www.bigappleheartsurgery.com
In female patients many of these operations can be performed through an incision hidden in the skin fold underneath the right breast with excellent cosmetic results. Once the aortic valve replacement is completed and prior to the wound closure, a local anesthetic solution is injected in the surgical wound. The end results is a patient who successfully solves his or her heart problem and resumes an active life style quickly and uneventfully instead of facing a crippling heart condition and a premature, definitely preventable death.
Dr. Ciuffo is a “superspecialist” in minimally invasive and bloodless heart surgery. He teaches and practices cardiothoracic surgery at Mount Sinai Hospital in Manhattan, NY. His techniques and patient stories are illustrated in the website http://www.bigappleheartsurgery.com
If you’d like more information about this topic, or to schedule an interview with Dr. Giovanni B. Ciuffo, please call (212) 659-6815 or email giovanni(dot)ciuffo(at)mountsinai(dot)org
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