In late 2014, Dennis Dobkowski thought a lot about life and death. His heart murmur, which his physician had been monitoring for about 15 years, had progressed to a valve leakage a few years earlier and was now suddenly causing exhaustion and a skipping heart beat. His doctor said he needed surgery to replace the faulty valve right away, but the procedure couldn’t be scheduled for weeks.
“That was quite terrorizing,” says Dobkowski, a 69-year-old federal government worker in Orange County, California. “I was like, ‘Is this [heart] going to last?'”
Despite his fears, Dobkowski’s heart powered him until January 2015, when he underwent an aortic valve replacement, a several-hour procedure that typically involves opening the chest, stopping the heart, putting the patient on a heart-lung machine, removing the failing valve and replacing it with one made of artificial materials or animal tissue. The surgery kept Dobkowski in the hospital for a week and recovering at home for about three months. Today, he continues to build up his stamina and regain the muscle he lost by walking three miles a day and swimming. “Everything’s gone well since then,” he says.
Heart valve replacement surgeries are relatively common treatments for faulty heart valves, which shuttle blood within the heart and between the heart and the rest of the body. For people like Dobkowski, the replacement fixes a leaky valve, most often the aortic (the one that allows blood to flow to the rest of the body); others might undergo procedures to replace a blocked, weakened or deformed valve due to age or illness. About 2.5 percent of the U.S. population has a heart valve problem, but that prevalance increases with age to more than 13 percent among the 75-years-and-older crowd, according to the American Heart Association. Not everyone with a heart valve problem, however, needs surgery, and many of those who do can have it repaired rather than replaced, says Dr. Timothy Gardner, a former president of the American Heart Association and medical director of Christiana Hospital’s Center for Heart & Vascular in Newark, Delaware.
“If we have the option of repairing a valve, we’ll do it,” he says. “We’ll only replace it when it’s essentially unreparable.”
Although some people never experience symptoms, ignoring signs of valve problems, such as shortness of breath, chest pain and syncope (passing out), can lead to heart failure and a 50 percent chance of death within one year, says Dr. Vinod Thourani, a professor of surgery and medicine at Emory University School of Medicine, where he also co-directs the Structural Heart and Valve Center.
But not all valve replacement surgeries are the same, and today there are more options than ever for mending the issues. “Ten years ago, a patient would come into me, and I’d say, ‘Hey, I have two ways of fixing your valve,'” Thourani says. “Now, I’ve got eight ways of fixing your valves.”
While that’s good news, it also means patients have more work to do, including researching which surgical route is best for them to undergo and recover from. Here’s how to start that process:
1. Understand Your Procedural Options
There are two main types of heart valve replacement procedures: surgical, like what Dobkowski underwent, and which can be performed via minimally invasive incisions in the chest, and transcatheter, a minimally invasive process by which a surgeon snakes a catheter into a major artery, usually in the thigh, and weaves a new valve into the damaged one – without removing it.
“Instead of opening the chest, stopping the heart, going to the heart-lung machine, all of that stuff, we’re able to perform the valve replacement … while the heart’s beating the whole time,” says Thourani, whose research has shown the procedure to be effective in patients who have too many health risks to undergo open heart surgery, as well as for patients who are at high risk for the more traditional method, such as those who are especially frail or sick. He’s currently studying the efficacy of this approach in lower-risk patients and is optimistic about the results.
While the short-term recovery is easier for transcatheter patients, Thourani says, “both the surgery and the [transcatheter] patients do similarly excellent at one year.”
2. Consider Your Artificial Valve Options
Meantime, people who undergo a surgical procedure typically have another decision to make: whether their valve will be replaced with one made from plastic, metal or some other material, or if it will be made from an animal’s heart tissue, usually a cow’s. (Patients undergoing the transcather technique don’t have a choice; their replacement is made from a bovine valve attached to a wire-like scaffold.) While tissue valves are generally preferred, since mechanical valves usually require patients to take blood thinners for life, they don’t last forever and may not be the best choice for younger patients, Gardner says. “The surgeon may recommend one or the other based on durability or desirability of avoiding blood thinners,” he says, “but the patient ultimately makes the decision with the doctor.”
What type of surgery and what type of valve you and your surgeon opt for depends on a variety of factors including your health history, current medical conditions, age and even the size of your arteries, since too-small arteries will rule you out for transcatheter techniques, Thourani says. That’s why it’s important undergo a variety of medical tests – such as a pulmonary function test, coronary angiography to look at the heart’s arteries and an ultrasound to look at the blood vessels going to the brain – before making any decisions, he says.
Someone found to have narrowed arteries caused by carotid artery disease, for instance, might need another procedure in addition to the valve replacement to stave off stroke. “It’s really, really rare to have carotid artery disease beforehand, but stroke is such a devastating complication that I commonly do the carotid ultrasound,” Thourani explains. “If you save one person from having a stroke, you feel pretty good about it.”
4. Find the Right Surgeon
Fortunately, good heart surgeons aren’t hard to come by, Gardner says. “You don’t have to go across the country to find a very competent, experienced heart surgeon, and you usually get to the first heart surgeon by referral from your cardiologist,” he says. Still, it’s important to visit with prospective surgeons and ask them about their technique and experience, such as how many of these procedures they have done on patients like you, and be sure you’re comfortable with their approach and communication style before settling, Gardner advises. “The concept of shared decision-making is really important in valve surgery because there are options,” he says.
To find a hospital with qualified surgeons in your area, check out the latest U.S. News Best Hospitals ratings, which for the first time include heart valve replacement surgery as one of the nine common procedures and conditions evaluated.
5. Talk to People Who’ve Been There
Though Dobkowski was relieved when he awoke from surgery and saw his wife’s face, he felt ill-prepared for the difficulty and length of the recovery process that followed. “When you come out of surgery, your body is out of sync totally – going to the bathroom, stuff like that, it doesn’t work,” he says. “You’re sitting there going, ‘What’s going on?'”
That’s why he became an American Heart Association heart valve ambassador, a program through which he can help answer other patients’ questions about what to expect from surgeries and recovery as well as how to tell the difference between normal symptoms and those that deserve an expert eye. Even people who aren’t anticipating heart valve surgery can benefit from learning from patients like Dobkowski, he says.
“Pay attention if you feel your heart skipping or something – don’t think of it as just stress at work; have it checked out,” he advises. “It’s really important because there are too many people who just collapse and don’t have a chance.”