New surgical solutions for old heart problems

Created date

February 12th, 2018
Photo of a man using his hands to form a heart image.

Photo of a man using his hands to form a heart image.

Since 1921, heart disease has been the No. 1 killer of men and women in the U.S., according to the Centers for Disease Control and Prevention (CDC). Today, heart disease kills one in four (about 610,000) people every year. The most common heart problem is coronary heart disease (CHD), and there have been many advancements to treat it, so the prevalence is trending down.

But there are other common heart problems that affect seniors, and medical technology has been somewhat slower in catching up. Now that is changing.

Problem: Atrial fibrillation

The most common type of arrhythmia (abnormal heart rhythm) in the U.S. is atrial fibrillation (AFib). It affects about five million people, including 9% of people over age 65, according to the CDC.

“AFib is an irregular beating of the upper heart chambers [atria], which causes clots to form within those chambers,” says Ali Tabrizchi, D.O., board-certified clinical interventional cardiologist at LifeBridge Health Cardiovascular Institute in Baltimore, Md. “The clots can leave the heart and become lodged anywhere in the body, but the primary risk is to the brain, which results in ischemic strokes.”

Ischemic strokes account for about 87% of cases, according to the American Heart Association. 

People with AFib are usually treated with anticoagulants (blood thinners), to prevent clots. Blood thinners, however, can be risky. “Some patients tend to have significant bleeding as an adverse effect of these medicines to the point where they require blood transfusions,” Tabrizchi says. “People with severe arthritis who have to take anti-inflammatory medication, for example, are at a very high risk for bleeding.”

Bleeding can occur throughout the body, but when it happens in the brain, it causes another type of stroke called hemorrhagic strokes. 

Solution: The WATCHMAN device

A safe alternative that has been shown in clinical trials to reduce strokes is called the WATCHMAN device. 

The WATCHMAN is so small it can be threaded through a catheter and placed in the heart. “It looks like a tiny umbrella,” Tabrizchi says. “It sits in the left atrial appendage, which is a pouch within the atrium where clots tend to form.”  The procedure itself is called left atrial appendage closure (LAAC). First, doctors insert a catheter in your upper leg under general anesthesia. It takes about an hour, and requires a one-day hospital stay. Patients need to remain on anticoagulants for a period of time. “After about six months, most patients can be tapered off anticoagulants,” Tabrizchi says.

Not everyone with AFib can have this procedure. “The WATCHMAN is very expensive,” Tabrizchi says. “There are strict criteria in place regarding which patients are candidates for this procedure.”

Tabrizchi explains that in addition to patients who have adverse events while taking anticoagulants, people with a history of falling may qualify for LAAC. “People who fall may hit their head or cause serious injury to other parts of the body that results in bleeding,” he explains.  

Problem: Mitral valve regurgitation 

Diseases of the heart valves are considered by some experts to be the next epidemic of heart disease because of the overall rise in life expectancy and the aging of the population. In the U.S., about 13% of people age 75 and up have some sort of heart valve disease, according to a 2011 research study.

Mitral valve regurgitation (MVR) is a condition in which the heart’s mitral valve doesn’t close tightly, which allows blood to flow backward in the heart. Symptoms include shortness of breath; fatigue; lightheadedness; and a rapid, fluttering heartbeat.

Your doctor may prescribe medicines to treat complications or treat the heart problem that caused the mitral regurgitation.

Solution: Nonsurgical placement of a mitral valve clip

In more severe cases of MVR, replacing the valve or placing a clip to close it might be necessary. Mitral valve clipping is not new, but this procedure traditionally had to be performed under general anesthesia in the operating room. “A better quality of life is possible for high surgical risk degenerative MVR patients,” Tabrizchi says. 

Now a new type of clip can be placed through a catheter. “This procedure is appropriate for high-surgical-risk MVR patients,” Tabrizchi says. “It may involve a short hospital stay to assess the effectiveness of the procedure. Patients tend to feel better right away and have an improved quality of life.”

Problem: Aortic valve disease

Common forms of aortic valve disease in seniors are regurgitation, when the valves do not operate properly and allow blood to flow backward into the left lower heart chamber (ventricle), and stenosis, when the valve stiffens because of deposits or narrows. Symptoms are similar to MVR, but complications of aortic valve disease can be serious, including heart failure, stroke, and blood clots.

Some people need the valve repaired, but in more severe instances, it must be replaced entirely.

Solution: Transcatheter aortic valve replacement

Surgical treatment for aortic valve replacement used to involve heart surgery in the operating room, but now one of the newest valve procedures is called transcatheter aortic valve replacement (TAVR). 

TAVR is done in a similar fashion as mitral valve repair. “Patients have a lower risk of complications, such as infection, and they tend to have shorter hospital stays,” Tabrizchi says.  

Post-procedure care

After any heart procedure, you should take especially good care of your heart. Eat well and exercise, but follow your doctor’s advice about how much and what type of exercises are safe after any heart procedure.