Thu. Dec 3rd, 2020

In late 2014, Denise Dobkowski thought highly of life and death. His heart murmur, which his physician had been monitoring for nearly 15 years, had progressed to a valve leak a few years earlier and was now causing sudden exhaustion and skipping. Heartbeat. His doctor said he needed immediate surgery to replace the defective valve, but the procedure could not be scheduled for weeks.

“It was quite terrorizing,” says Dobkowski, a 69-year-old federal government worker in Orange County, California. “I was like, ‘This is it [heart] After all? “”

Despite his apprehensions, Dobkowski’s heart operated on him until January 2015, when he underwent aortic valve replacement, a several-hour procedure that usually involved opening the chest, stopping the heart, placing the patient on a heart-lung machine , Included removing the failed valve. And it is made of artificial materials or animal tissues. Surgery kept Dobkowski in the hospital for a week and healed at home for about three months. Today, he continues to build his stamina Regain the muscle he lost Walk and swim three miles a day. “Everything has gone well since then,” he says.

Heart valve replacement surgeries are relatively common treatments for defective heart valves, which carry blood within the heart and into the heart and the rest of the body. For people like Dobkowski, replacement fixes a leaky valve, most often the aorta (one that allows blood to flow to the rest of the body); Others may undergo procedures to replace blocked, weakened or deformed valves due to age or disease. Approximately 2.5 percent of the US population has heart valve problems, but that prevalence increases with age to more than 13 percent among the crowd over the age of 75, American Heart Institute. However, not everyone with a heart valve problem needs surgery, and many of those who can get it replaced, rather than replace it, are former presidents of the American Heart Association, Dr. Says Timothy Gardner and the medical director of the Center for Heart of Christiana Hospital. And conduit in Newark, Delaware.

“If we have the option to repair the valve, we’ll do it,” he says. “We will replace it only when it is essentially inaccessible.”

Although some people never experience symptoms, such as ignoring symptoms of valve problems, such as shortness of breath, chest pain, and Syncope (Pass out), can Lead to heart failure Professor of Surgery and Medicine at Emory University School of Medicine, Drs. He also co-directs the Structural Heart and Valve Center, says Vinod Thorani, where there is a 50 percent chance of death within a year.

But not all valve replacement surgeries are the same, and today there are more options than ever to address this issue. “Thorani says,” Ten years ago, a patient came to me, and I used to say, ‘Hey, I have two ways to fix your valve. “” Now, I’ve got eight ways to fix your valves. ”

While this is good news, it also means that patients have more work to do, including which surgical route to go through and overcome. How to start that process:

1. Understand your procedural options

There are two main types of heart valve replacement procedures: surgical, such as what Dobkowski did, and which can be done through minimally invasive incisions in the chest, and transcatheter, a minimally invasive procedure by which a surgeon inserts a catheter. Takes into a major artery, usually in the thigh, and weaves a new valve into the damaged valve – without removing it.

Thorani says, “Instead of opening the chest, stopping the heart, going to the heart-lung machine, all of that stuff we’re able to do valve replacement … while the heartbeat stays on all the time.” The procedure to be effective in patients who have many health risks undergo open heart surgery, as well as for patients who are at high risk for the more traditional method, such as those who are particularly vulnerable or ill. Huh. He is currently studying the efficacy of this approach in low-risk patients and is optimistic about the results.

While short-term recovery is easier for transcatheter patients, Thorani says, “surgery and a [transcatheter] The patients perform equally well in a year. “

2. Consider Your Artificial Valve Options

Meanwhile, for those who undergo the surgical procedure, there is usually another decision: whether their valve will be replaced with one made of plastic, metal or any other material, or if it is the heart tissue of an animal Usually made of cow. (Patients undergoing the transcutter technique have no choice; they are replaced by bovine valves attached to a wire-like scaffold.) While tissue valves are usually preferred, mechanical valves are usually given to patients. Blood thinners are required for life, Gardner says, that they do not last forever and may not be the best option for younger patients. “The surgeon may recommend one or the other depending on the durability or desirability of avoiding blood thinning,” he says, “but the patient ultimately decides with the doctor.”

Which type of surgery and which type of valve and your surgeon you choose depends on many factors, including your health history, current medical conditions, age, and even the size of your arteries, because very small arteries will give you a transcatheter. Techniques will rule out for, says Thorani. It is therefore important that a variety of medical tests be performed – such as a pulmonary function test, coronary angiography to look for the arteries of the heart Ultrasound To see the blood vessels going to the brain – before making any decision, he says.

For example, someone has had narrowed arteries due to carotid artery disease, which may require another procedure other than valve replacement. To shock. Thorani explains, “It’s actually rare for carotid artery disease, but stroke is such a devastating complication that I usually do carotid ultrasound.” “If you save a person from having a stroke, you feel great about it.”

4. Find the right surgeon

Luckily, Good heart surgeon Are not hard to come by, Gardner says. “You don’t have to find a very competent, experienced heart surgeon to go around the country, and you usually get to the first heart surgeon by referral from your cardiologist,” he says. Nevertheless, it is important to travel with prospective surgeons and ask them about their technology and experience, such as how many procedures they have performed on patients like you, and make sure you are sure of their approach and communication style before making sure Are comfortable, Gardner advises. “The concept of shared decision making is really important in valve surgery because there are alternatives,” he says.

To find a hospital with qualified surgeons in your area, check the latest America’s News Best Hospital Ratings, including heart valve replacement surgery for the first time, out of which nine common procedures and conditions have been evaluated.

5. Talk to the people who have been there

Although Dokowski was relieved when he woke up from surgery and saw his wife’s face, he felt ill for the difficulty and length of the procedure that followed. “When you come out of surgery, your body is completely out of sync – going to the bathroom, stuff like that, it doesn’t work,” he says. “You’re going there, ‘What’s going on?”

That’s why it became the American Heart Association Heart valve ambassadorA program through which he can help answer other patients’ questions about what to expect from surgery and recovery as well as how to tell the difference between common symptoms and those that deserve a specialist eye. Even those who are not anticipating heart valve surgery can benefit from learning from patients like Dobkowski, he says.

“Note if you feel your heart skipping or something – don’t think of it as work stress; has it been checked,” he advises. “This is really important because there are a lot of people who just collapse and have no chance.”

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