Heart and Vascular Institute – Structural and Valvular Heart Disease
For the latest diagnostic and treatment options, turn to Penn State Health Heart and Vascular Institute.
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The Medical Center offers state of the art cutting edge treatment options for patients with wide variety of heart valve disease. The multidisciplinary team of experts works in a collaborative fashion to discuss and treat each patient with the goal of providing individualized care, to achieve the best possible outcome while keeping patient’s values in mind.
Our heart team
Aortic valve disease
Aortic stenosis refers to narrowing of the heart valve that commonly causes shortness of breath, fatigue, chest pain, heart failure and ultimately death if left untreated. It is a mechanical problem that requires a new valve replacement either by conventional open-heart surgery or by minimal invasive catheter based techniques (TAVR).
This is the conventional standard method, in which a surgeon makes an incision through the center of the chest bone, cuts out the old diseased valve and sutures in a new valve. Sometimes a lesser invasive surgery could also be performed. To learn more about surgical aortic valve replacement, please visit our cardiac surgery page.
TAVR – Transcatheter Aortic Valve Replacement
Coexistence of multiple medical problems somewhat increase the operative risk of a traditional surgical aortic valve replacement. For such patients, TAVR is an excellent alternative to achieve a less invasive and faster recovery valve replacement. Since its approval by the Food and Drug Administration in 2011, more than 50,000 patients have undergone TAVR in the United States alone.
In TAVR, the physicians insert a small tube commonly through an artery in the groin and through this tube, a collapsed new heart valve is advanced up to the heart. Once in appropriate position, the new valve is expanded and starts functioning immediately. The old aortic valve is pushed to the side and does not need to be removed from the body. In fact the old valve helps anchor this new valve. At the end of the procedure, all tubes are removed and a small dressing is applied to the groin. There are no major incisions and therefore patients are able to walk after a few hours of bed rest and commonly discharged within one to three days.
There are two TAVR valves that are approved by the Food and Drug Administration for commercial use in the United States; Penn State Heart and Vascular Institute has expertise in using both valves.
Stu discusses his experience with the TAVR procedure
Mitral valve disease
The mitral valve can either leak (mitral regurgitation) or get narrowed (mitral stenosis). Mitral regurgitation is the most frequent heart valve disease in the United States. Nearly one in 10 people over the age of 75 years have moderate or severe mitral regurgitation. Severe mitral regurgitation commonly causes shortness of breath, swelling and weight gain due to water retention and ultimately heart enlargement and death if left untreated. While medicines treat early disease, mechanical correction is needed as the disease advances.
Mitral Valve Surgery
This is the gold standard technique in which a surgeon makes an incision through the center of the chest bone and manually repairs the damaged valve. In some instances the damaged valve is removed and a new valve is sewn in place. To know more about the mitral valve surgery, please visit our cardiac surgery page.
Coexistence of multiple medical problems increase the risk associated with open heart surgery and therefore the surgery is not recommended for approximately half of the patients who need a mitral valve repair. Above the age of 80, only 15 percent of the patients undergo surgery. Minimally invasive and fully percutaneous mitral valve repair using the MitraClip system has emerged as an excellent option. The biggest advantage is faster recovery as the entire procedure is done via a vein in the leg in the cardiac catheterization laboratory. Since there is no incision involved, the patient is able to walk in a few hours and typically discharged in the next one or two days. MitraClip has been extensively studied across the world and has been proven to improve symptoms, quality-of-life and reduced hospitalizations for heart failure.
As depicted in the animation below, through a vein in the groin, a tube is advanced to the right top chamber of the heart. A tiny hole is made in the wall separating the top two chambers of the heart to cross over to the left side. The MitraClip system is then maneuvered across the mitral valve. On a beating heart, the leaflets of the mitral valve are carefully grasped at the site of leak, thus reducing the regurgitation. The delivery system is then removed out of the body leaving behind a small metallic clip. This entire procedure is done through a vein in the groin therefore allowing a fast recovery.