By Laura Freeman
Some heart valve problems are present at birth. Others may develop suddenly during illnesses or gradually through the years, adding an extra layer of complexity in managing a patient’s overall health. In making decisions about the broad range of health challenges that can accumulate over a lifetime, a valve that isn’t performing as it should has to be considered in the equation.
What can be heard through a stethoscope or seen on an echo may suggest the need for follow-up, but the question of what to do about a valve issue, when and how, can be more nuanced. To help patients and their physicians get a clearer understanding of their valve health status and options for treatment, Baptist Health recently opened a heart valve clinic. Based at Baptist Health Brookwood with outreach locations around Alabama, the clinic is led by interventional and structural cardiologists Drs. Matthew Sample and Stephen Bakir of Baptist Health Cardiovascular Associates.
“With an aging population, we’re seeing more aortic valve cases,” Sample said. “While statins help slow plaque damage in arteries, we’re not seeing the same protective effect in the aortic valve so we have more older patients coming in at the same time we’re doing more evaluations for other valve disorders.”
Bakir concurs. “Now that we’re able to do so much more for tricuspid issues, we’re also working with more of these cases. Advances in both percutaneous procedures and minimally invasive surgery have expanded what is possible. But the unfortunate fact is that there are far too many people with valve issues who never get an evaluation and never get the treatment that could make a difference in their lives.”
According to recent estimates, around eight percent of the population will be experiencing at least some valve issues by the time they are in the 65 to 85 age group, and by the time they reach 80 to 85, that number will have risen to 15 percent with two percent of those showing severe symptoms.
Recommendations for the type of intervention vary by age and by the severity of the problems, which tend to get worse over time. When a patient is evaluated and the disorder hasn’t progressed to the point that a repair procedure is warranted, the heart clinic can provide a comprehensive baseline and help the referring physician plan a roadmap for follow up.
“Medications aren’t a substitute for valve repair, but sometimes they can be prescribed to help with symptoms,” Sample said. “When it’s time to schedule a procedure, age and comorbidities are taken into account. For patients over 65 or in fragile health, we’re likely to suggest a transcatheter approach. Advances in clip technologies can often simplify and speed repairs for mitral and tricuspid valves, and in most cases we can also replace aortic valves with TAVR without the need for open heart surgery.”
Bakir said, “In younger patients in otherwise good health, we’re likely to recommend surgical repairs, since they tend to hold up better for patients who are going to need reliable performance over more years. We’ll work with a heart surgeon from our team, usually someone experienced in minimally invasive techniques or robotic surgery which can usually make surgical repairs with a smaller incision and faster recovery.”
Valve disorders can cause fatigue, shortness of breath, edema, chest pain and palpitations. Repairs are recommended when they have a strong possibility for improving these symptoms and overall quality of life. In some cases that have progressed to heart failure, they may even extend survival.
“A big advantage of the Heart Valve Clinic is that we can bring in the entire heart team when we have a difficult case. It helps to have extra sets of eyes looking at a problem, and having cardiologists in a whole range of heart subspecialties helps us take into account the many other things that can be going on with a heart and circulatory system. We can also call on the entire range of specialties on the Baptist Health campus when we have complex comorbidities to consider,” Sample said.
Bakir said, “When we began working with Orlando Health, they were very open and encouraged us to bring in our ideas for improving care. The Heart Valve Clinic was one of those ideas, and in the months since launching it, we’ve been very pleased with how it’s working. It has been well received by both patients and their referring physicians.”
Health professionals who would like to schedule an evaluation for a patient can contact the Baptist Health Valve Clinic directly at their Brookwood offices at 205 877-2901, or contact Baptist Health Cardiovascular Associates.