Heart valve repair at Piedmont

We talked with Piedmont Heart Institute cardiovascular surgeons W. Morris Brown, M.D., John Gott, M.D., and James R. Kauten, M.D., to learn more about heart valve repair at Piedmont.

Heart valves make sure that when blood flows either through the heart or out of the heart, it only flows in one direction. The valve opens when blood goes through and shuts to prevent the flow of blood either back into the heart or into the chamber where it came from.

W. Morris Brown, M.D., says patients with heart valve disease  should seek treatment at Piedmont because of the high-quality team of professionals we have “under the same roof.”

“We’re a multi-specialist group that has both cardiologists and cardiac surgeons,” says Dr. Brown. “We offer the full range of valve repairs, replacement and trans-arterial valve replacement.”

Think of the heart as a muscular pump. There are four valves in the heart, each with its own personality – pulmonary, tricuspid, aortic and mitral. The pulmonary valve is the least likely to be involved with disease processes. The tricuspid valve is commonly involved with disease states, but many times it can be repaired.

“The mitral valve and aortic valve are most commonly involved with illness, and they have a bit of a different personality,” says John Parker Gott, M.D. “The mitral valve quite often lends itself to reparative techniques, especially when the abnormality is a leak. When it is a narrowing, or stenosis, there are some patients with rheumatic disease that can have reparative techniques.”

James R. Kauten, M.D., says Piedmont Heart Institute has a high success rate with mitral repair.

“We are in the high 90 percent range for repair, meaning if we intend to repair a patient’s valve, then 98 percent of the time or better, we are able to do that,” he says.

Dr. Morris says the aortic valve can either leak, not close fully or tear from some other degenerative process or infection. Then, when the heart beats, instead of blood going back out to the body where it can be used, a large percentage  of it will run back into the ventricle only to be pumped out again, so the heart has to work a lot harder.

If it becomes calcified, which is the main way valves become narrowed, then the valve doesn’t open fully. Instead of pushing the blood through a tube the size of a 50-cent piece, it may be the size of a pencil. The heart then has to work a lot harder to squeeze the blood through an opening that’s much smaller than it should be.

“The patient has the feeling that they’re running up a hill all the time because their heart is working so hard,” he says.

The outcomes after replacement are quite good, Dr. Morris adds.

“Now that we have the trans-arterial valve replacement as an option, patients who were not candidates for a valve replacement by conventional means are candidates for minimally-invasive trans-arterial valve replacement. And they do extremely well. Most patients are out of the hospital in a few days.”

He says because it’s a mechanical problem with the heart, many patients wake up in the ICU after surgery and immediately feel better.

“They can tell a difference on day one,” he says.

In addition to Piedmont Hospital being named Best in Atlanta for Overall Cardiac Care, Cardiac Surgery and Coronary Intervention by HealthGrades®,  a leading healthcare ratings company, Piedmont Heart Institute Physicians are leaders in many areas of heart care. Among many accomplishments, Piedmont heart specialists:

• Provide patients with access to the Medtronic CoreValve clinical trial, which involves implanting valves through a catheter versus open heart surgery, which is often not an option for older patients. Piedmont Hospital is one of 40 hospitals in the United States participating in the CoreValve trial.
• Lead the nation in the treatment of chronic total occlusions of the coronary arteries. They host renowned cardiologists from around the world for onsite training in this technique on a regular basis.
• Offer the most experienced and successful adult ECMO program in Atlanta. ECMO (extracorporeal membrane oxygenation) is a life-saving procedure that gives failing hearts and lungs time to heal without harming critical internal organs.
• Give people with heart failure a better quality of life through the latest heart assist devices and heart transplants.
• Serve as one of the leading centers in the country for the treatment of atrial fibrillation, particularly catheter-based ablation therapies. This common arrhythmia frequently affects patients with heart valve disease.

For more information on heart valve repair, visit Piedmont Heart Institute.