Getting To The Heart Of Valve Problems
John Richardson, MD (far left end) with cardiovascular team
When heart valves aren’t working as well as they should be, simply getting through the medical maze can be exhausting. From appointments with cardiologists, to multiple outpatient testing procedures, to an evaluation by a cardiovascular surgeon, getting answers and a treatment plan can take weeks and feel like a marathon.
To expedite the process and make it easier for patients, Alabama’s first comprehensive heart valve clinic opened this summer at St. Vincent’s Birmingham campus.
“We’ve brought everything together in one easily accessible location on the first floor near the entrance of Professional Building One,” Director of Cardiovascular Services James Story said. “Another advantage, especially for patients who drive in from out of town, is that they don’t have to make multiple trips or wait to schedule a series of appointments. The heart valve clinic gives them direct access to an experienced multidisciplinary team including cardiologists and cardiovascular surgeons plus a complete range of diagnostic facilities.”
One of the physicians patients may see is cardio-thoracic surgeon John Richardson, MD, who is noted for his work in robotic and minimally invasive heart surgery.
“Our nurses work with the patient’s primary physician to gather copies of echoes, arteriograms and other tests so we can determine whether additional studies need to be done when the patient arrives,” Richardson said. “A cardiologist and cardiovascular surgeon both see the patient before we make our recommendations.
“If a case hasn’t progressed to the point where surgery is indicated, then we discuss the type of follow up needed and send a copy of our treatment plan to the patient’s physician,” Richardson said. “When surgery is needed, we determine the type of surgery likely to be most beneficial in that particular case and explain the options.
“Is the patient a candidate for robotic surgery or another minimally invasive technique? Are there other factors such as blockages that should be addressed that would make conventional surgery a better choice?”
Robotic surgery and other minimally invasive surgical techniques used to repair or replace valves offer the advantages of faster recovery and less pain with smaller incisions that don’t have to go through the breastbone. Where previous surgeries make those choices more difficult, or where the chest will need to be opened to bypass a blockage, conventional surgery is likely to be a better option.
“Whatever technique is chosen, the biggest influence in successful valve surgery is experience,” Richardson said. “There are many surgeons who do a lot of surgery, including other types of heart surgery, but they may only do a few valve surgeries a year. At the valve clinic, patients see surgeons who specialize in valves and do hundreds of valve surgeries a year.”
Soon a new option will be available at St. Vincent’s that will make treatment possible to patients who may now have no option at all.
“We have been approved to begin offering percutaneous valve repair, and one of the prerequisites for that approval is a comprehensive valve clinic, which we already have in place,” Story said. “In the past, when we’ve seen patients too ill to risk surgery, we’ve had to send them home with only medication and little hope of improving a poor prognosis. With percutaneous repair, we will be able to implant a valve in much the same way as we put in a stent.”
Richardson is one of the surgeons training to perform the procedure and says he hopes to begin offering it to his patients by early next year.
“To meet criteria to qualify for Trans-Aortic Valve Replacement (TAVR), patients must be inoperable using other surgical techniques,” Richardson said. ‘These are usually the sickest patients who are at high risk. The procedure is not without risks itself, but it does offer the possibility of improving quality of life and perhaps the overall prognosis as well,”
The Heart Valve Clinic at St.Vincent’s treats disorders in all valves of the heart, and it’s beginning to see some patients before their valve problems become symptomatic.
“There is a growing body of evidence suggesting that correcting valve problems earlier can help patients avoid heart failure and damage to other organs.” Richardson said. “Another area of concern is how many people with serious valve problems are not getting the treatment they need. Half the people with critical aortic stenosis never get referred by their family doctor. Often the thought may be that patients are “too old” to benefit, but age is not a limiting factor. Some of my patients are in their 90s and have seen a real improvement in their quality of life. So if anyone says you’re too old, I’d say ask for a second opinion.”