Leading Medicine Guide: Professor Schäfers, heart valve operations are among the most common treatments at your clinic. We have the impression that younger patients are increasingly requiring aortic valve replacement. Are we mistaken?
Prof. Hans-Joachim Schäfers, MD: You are mistaken, because aortic valve replacement does not occur any more frequently in younger patients. Your observation is based on the fact that heart valve operations are being monitored and discussed with increasing attention, particularly in younger patients.
Leading Medicine Guide: And why is that?
Prof. Hans-Joachim Schäfers, MD: It is because younger people today are less willing than in the past to live with medication such as Marcumar on a long-term basis. Marcumar is a potent blood-thinning medication which, while preventing blood clotting, also causes side effects such as bruising or nosebleeds. In addition, alternatives such as reconstruction and the Ross procedure are increasingly being used today, and young people need not fear these as much as they did traditional heart surgery ten or twenty years ago.
Leading Medicine Guide: What exactly is a Ross procedure?
Prof. Hans-Joachim Schäfers: The Ross procedure involves, for example, replacing the diseased aortic valve with the body’s own healthy pulmonary valve. This is the heart valve between the right ventricle and the pulmonary artery. At our clinic, the Ross procedure is a routine operation.
Valve open, valve closed: high-performance valves
Leading Medicine Guide: And how do you proceed with the reconstruction of the patient’s own heart valves?
Prof. Hans-Joachim Schäfers: Reconstruction as an alternative to aortic valve replacement is still a relatively new procedure. It is always necessary to assess which changes in the aorta and aortic valve are causing the leak. For example, in the case of an aortic aneurysm, the affected section is replaced with a section of synthetic tube. The aortic valve is then adapted to the new shape. For specific congenital malformations, we develop strategies to achieve a configuration that is as close to normal as possible. In recent years, reconstructive procedures have been gradually developed that also enable the treatment of other causes of leakage. The exact procedure to be followed is discussed with the patient in advance. Even though the final decision is always made in the operating theater.
Leading Medicine Guide: It is now possible to insert artificial heart valves into the heart via a catheter, isn’t it?
Prof. Hans-Joachim Schäfers: Exactly. And as this is less invasive than open surgery, this surgical method can be used particularly in older patients. However, the durability of catheter valves is, unfortunately, still unclear even today. I therefore recommend conventional replacement if the patient is expected to have a life expectancy of at least another ten years. There is no need to be afraid of the surgical implantation of artificial heart valves: this almost routine procedure has been established for decades. The catheter-based procedure is gentler, particularly for older patients, and does not require general anesthesia. In such cases, cardiology and cardiac surgery work together to decide what is best for the individual patient.
Leading Medicine Guide: And how do you proceed in cases of congenital heart valve defects?
Prof. Hans-Joachim Schäfers: A distinction is made between congenital and acquired heart valve defects. Approximately one in a hundred newborns is born with a heart valve defect, which can significantly reduce life expectancy. Aortic valve insufficiency also occurs in younger people; this is usually the result of a faulty valve structure. The young heart continues to grow over the years.
Leading Medicine Guide: What happens to the implanted heart valve? Will the young patient need to go under the knife again in a few years’ time?
Prof. Hans-Joachim Schäfers: Standard prosthetic valves do not grow with the body. This means that as the body grows, they become too small and must then be replaced. This operation is not always straightforward. The situation is different with the Ross procedure and reconstruction mentioned earlier: after these, the valves grow with the patient. If a child needs to have a heart valve implanted at a young age, it is important to keep an eye on the various growth phases. Body height doubles in the first three years, followed by an increase of around six centimeters per year until puberty, when another significant growth spurt begins. However, heart valves made from the body’s own cells are currently still at the experimental stage. It is not yet clear whether they really do grow with the patient and last long enough. If this were the case, these heart valves would be good options for avoiding permanent surgical procedures. They do have one advantage in any case: they are not rejected.
Professor Dr Schäfers, thank you for the in-depth insights into the amazing world of heart surgery and for the fascinating conversation!
Do you have any further questions on this topic? Then visit Prof. Schäfers on the Leading Medicine Guide! Here you also have the opportunity to contact the heart valve specialist directly.
You can also find more information on heart valve reconstruction here.
Image sources: fotolia.com; psdesign1, me² medical and media private institute, University of Homburg/Saar
