Even rock stars have to pause for their health. Rolling Stones frontman, Mick Jagger, underwent heart valve replacement surgery in New York last week, postponing the band’s upcoming U.S. tour.
Thank you everyone for all your messages of support, I’m feeling much better now and on the mend – and also a huge thank you to all the hospital staff for doing a superb job.
— Mick Jagger (@MickJagger) April 5, 2019
Although it is unclear at this time which valve Jagger had operated on, the aortic valve is the most common valve to be replaced, according to the U.S. National Library of Medicine.
Roughly 2.5 million people in the United States over the age of 75, Jagger’s age, have been diagnosed with aortic stenosis, which can lead to aortic heart valve disease.
Dr. Jennifer Hanna, a cardiothoracic surgeon at HCA Healthcare/HealthONE’s The Medical Center of Aurora sheds light on heart valve disease, traditional surgery options and a minimally-invasive procedure that the medical community is buzzing about.
TAVR, which stands for Transcatheter Aortic Valve Replacement, “is an amazing technology. It’s really changed our traditional approach to aortic valve disease.”
“This treatment is an approach to aortic valve disease that can be done without having to open up a patient’s chest or place them on the heart-lung machine,” said Dr. Hanna. “It’s a big deal because there was a subset of patients that were not eligible for surgery before. But now, they have a viable treatment option.”
So, what exactly is valve replacement? What is minimally invasive treatment? Let’s break it down.
Heart valve replacement – why is it done?
A healthy heart has four valves that keep blood flowing in the right direction:
- Pulmonary valve
- Mitral valve
- Tricuspid valve
- Aortic valve
Each valve has flaps that open and close during a heartbeat. When just one of these little flaps malfunctions, it can disrupt the flow of blood throughout the heart and body, leading to heart valve disease.
Symptoms of heart valve disease can include:
- Shortness of breath
- Palpitations or a pounding chest sensation
- Chest tightness
- Fainting or light-headedness
Heart valve symptoms can be managed with medications, but if the condition is severe, more intensive treatment may be required, like valve replacement surgery.
The positive news: modern medicine has a few really effective surgical techniques to improve the quality of life for those living with heart valve disease.
Traditional, standard aortic valve replacement
Standard aortic valve replacement was a huge victory for medicine when it debuted almost 60 years ago. The technique is still in steady use today in operating rooms worldwide.
In standard valve replacement, surgeons “open up the breastbone and connect patients to a heart-lung machine,” explains Dr. Hanna. “Surgeons cut out the old calcified valve, debride the annulus and sew in a new valve. A patient’s chest is then closed with stainless steel wires. Patients spend about four to seven days in the hospital and one to two nights in the intensive care unit.”
Patients that undergo standard surgical aortic valve replacement are typically barred from heavy lifting, pushing and pulling with the arms for several weeks.
Not all patients are good candidates for standard aortic valve replacement.
The Society of Thoracic Surgeons has developed a risk calculator, calculating factors for determining if patients are good candidates for certain types of heart surgeries. “If the risk is above three percent, patients are considered intermediate risk,” said Dr. Hanna. “If the risk is above eight percent, then patients are deemed high risk.”
The physical stress of having your chest cut open with standard valve replacement can be challenging for intermediate and high-risk patients, especially those that are elderly and have co-morbidities.
TAVR for intermediate and high-risk patients
But now, there is a valve replacement option for intermediate and high-risk patients: TAVR.
The cardiothoracic community is excited about TAVR because it means a less physically-demanding procedure for their patients. The minimally-invasive procedure repairs the old, damaged valve without having to remove it through an open-chest procedure. With less physiologic stress, those that are frailer can safely undergo this treatment.
With TAVR, a fully-collapsible replacement valve is threaded to the valve site through a catheter that is most commonly guided up the femoral artery (a large artery located in the groin). Doctors may sometimes use other approaches through tiny incisions to access the heart. Once the replacement valve is positioned, it is expanded within the old aortic valve, pushing it out of the way. Once the new valve is expanded, the catheter is withdrawn.
“Patients do not have to get over a big chest operation, general anesthesia, and being on the heart-lung machine with TAVR,” said Dr. Hanna. “We use moderate sedation and patients are going home in significantly less time because they heal faster. On average, patients go home two to three days after their procedure.”
Is TAVR superior to surgery for all patients?
TAVR was first introduced as an alternative to open heart surgery for those who were too sick to undergo the invasive procedure. Recently, big news was shared about TAVR at the American College of Cardiology Conference held in New Orleans.
Open-chest surgery may become the exception rather than the norm. The U.S. Food and Drug Administration (FDA) is expected to approve TAVR devices for low-risk patients.
“While the news of TAVR for all patients is exciting, we need to be cautious,” says Dr. Hanna. “The technology is not that old. The first one was implanted in 2002, so we really don’t know what the long-term durability of the TAVR valves will be.”
“It’s really important that all patients understand that there are some risks associated with TAVR, too,” adds Dr. Hanna. “Just because the technology is revolutionary, does not mean that the risk of complications goes to zero. The risk of stroke from surgery is actually the same as the risk of stroke from TAVR.”
At The Medical Center of Aurora, Dr. Hanna and her colleagues use a multi-pronged approach for determining the best treatment option for all heart patients. “TAVR has pushed us to hold multi-disciplinary meetings as an approach to managing patients with cardiac disease. It really does take a village.”
“From the cardiologist to the heart failure team to blood pressure management, we are discussing the best ways to care for our heart patients, in general, to give them the best quality of life.”
The Rolling Stones have posted on their Twitter account, “The doctors have advised Mick that he is expected to make a complete recovery so that he can get on stage as soon as possible.”
From all of us at HCA Healthcare, we wish him a speedy recovery.
With six campuses in Aurora and Centennial, Colo., The Medical Center of Aurora is part of the HCA Healthcare/HealthONE family. HealthONE is the largest healthcare system in the metro Denver area with more than 10,000 employees.