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Do I Need Heart Surgery?

By    |   Thursday, 02 Apr 2015 04:28 PM

Question: I have congestive heart failure, plus a valve problem. What are my chances of avoiding heart surgery? I’m 62.

Dr. Hibberd's answer:

Fortunately your chances of avoiding open heart surgery are better now than they have ever been. We are now able to perform heart valve-replacement surgery without opening the chest as was done in the past.

Valve replacement can now be done through a catheter inserted into the artery in your groin, under sedation, without the pain or complications seen with open heart procedures that used to always involve opening of the chest wall.

This procedure is offered by larger cardiac centers. If your bad valve is the cause of your heart failure, you need to be contacting your doctor for referral.

Unfortunately, not all heart failure cases are as simple as that, especially if the valve failure has caused other changes that may complicate your situation. Sometimes untreated heart valve failures may cause pressure changes in the lungs. Exposing the delicate tissues of the lung to extraordinarily high pressures for an extended time can cause permanent lung changes that may make valve replacement not a viable option.

Also, remember that our heart muscles need a reliable blood supply, and many cases of heart failure result from damage to the blood vessels that supply the heart. The larger vessels are amenable to bypass procedures, balloon angioplasty, and stenting. Bypass can now also be performed with minimally invasive techniques without requiring an open chest procedure.

The smaller vessels can also be diseased, usually related to underlying disorders such as uncontrolled diabetes or hypertension. These vessels are essential for the heart muscle to function normally. You can visualize small vessel disease like a city with an intact super-highway network without workable smaller connecting roadway networks.

So we have solutions for fixing the larger vessels, but the smaller vessels (when diseased) cause us great concern, because the solutions tie in to controlling heart disease risks so that these delicate vessels can continue to supply tissue with essential nutrients.

Simple measures — such as stopping smoking, controlling hypertension, controlling diabetes, managing weight, control blood fat disorders, following a sensible diet, and regular exercise — will go a long way to prevent acceleration of small vessel disease. You should discuss your heart failure situation with your physician to assess your options.

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Fortunately the chances of avoiding open heart surgery are better now than they have ever been.
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2015-28-02
Thursday, 02 Apr 2015 04:28 PM
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