On November 8th, 2013, @ColumbiaSurgery and @HeartValveCntr encouraged followers to ask NYP/Columbia Heart Valve Center’s doctors, Isaac George, MD, Attending Cardiac Surgeon, and Tamim M. Nazif, MD, Attending Interventional Cardiologist, about their questions and concerns during a Twitter chat, “Hybrid Cardiac Surgery: A Minimally Invasive Approach to Coronary and Valve Disease.”
As promised here are Dr. George’s and Dr. Nazif’s answers below.
I have Tetralogy of Fallot & received full repair but will need my pulmonary valve replaced in the near future. Can I be considered for a Hybrid Cardiac Surgery?
Yes, depending on the individual anatomy the pulmonic valve can be replaced through a fully minimally invasive approach.
Is this procedure for adults with a congenital heart defect?
Yes, this type of approach can be applied to certain congenital heart defects. For example, percutaneous, transcatheter closure can be performed for various “holes” in the heart, including ventricular septal defects (VSD) and atrial septal defects (ASD). In addition, replacement of pulmonic valves and aortic valves after a Ross procedure or homograft can be performed using a minimally invasive, hybrid or fully percutaneous procedure.
I’m 77 & in good health other than a “faulty” aorta heart valve. Can the replacement/repair be made without open heart surgery?
Currently transcatheter aortic valve replacement (TAVR) is only approved for patients who are considered inoperable or high risk for surgical aortic valve replacement. TAVR is being studied in ongoing clinical trials in patients who are at intermediate risk for surgery. The Columbia Heart Valve Center is playing a leadership role in these studies, and, we are excited to offer this new technology to our patients. TAVR has not yet been studied in patients who are low risk for surgical valve replacement.
When will minimally invasive aortic valve replacement for men who otherwise healthy and in good shape be available?
As mentioned, TAVR is currently being studied clinical trials for intermediate risk patients. However, the procedure is not yet being studied in patients who are low risk for surgery. The standard of care for an otherwise healthy individual remains open heart surgery.
Who would not be a candidate for minimally invasive aortic valve repair/replacement and must have open heart surgery?
Patients who are considered low risk for open heart surgery are currently not candidates for transcatheter aortic valve replacement, and the gold standard therapy remains open heart surgery for these patients. In addition, patients with certain anatomic features, such as bicuspid aortic valve or severe coronary disease may be better served by surgical valve replacement.
Can this minimally invasive approach to valve disease be used on a patient with a blood clotting Factor XI (eleven) deficiency?
Yes, we can safely treat patients with clotting factor deficiencies. In such a case, we work with our Hematology colleagues to develop an optimal strategy for anticoagulation during the procedure and recovery period.
What cardioplegic agent will you be using?
We sometimes need to stop the heart to perform open-heart surgery and we use a solution called cardioplegia to “stop” the heart temporarily. At Columbia, we use a solution called Del Nido solution. One important advantage of hybrid cardiac surgery is that we can often avoid the need to stop the heart through the use of hybrid techniques.
What options are available to me for aorta valve replacement if I won’t undergo open heart surgery, and am not “sick” enough for the minimally invasive procedure?
As mentioned, transcatheter aortic valve replacement is only approved in the United States for patients who are inoperable or at high-risk for surgical aortic valve replacement. Intermediate risk patients may access this technology through ongoing clinical trials. In general, it would not be appropriate to perform this procedure in low-risk surgical candidates given the absence of data to support the approach in this patient population. We would suggest that you make an appointment with a cardiologist or cardiac surgeon for formal risk assessment in order to explore your therapeutic options.
To view the entire #heartmeded Twitter chat transcript, please visit: Hybrid Cardiac Surgery: A Minimally Invasive Approach to Coronary and Valve Disease
