Dr. Mohankrishnan Sathyamoorthy – Valve in Valve: Know the facts

While other types of heart valve procedures continue to evolve, Dr. Mo said many of these new approaches, such as Valve in Valve, or Transcatheter Aortic Valve Implantation (TAVR), lack long term data on their effectiveness.

I think emerging concepts like Valve in Valve operative techniques are absolutely important to advancing the science and the practice of medicine,” he said. “However, as a practicing heart specialist, I always think of a precautionary tale and relate this back to evidence. Do we have evidence over a long period of time that these types of approaches will in fact deliver the expectation and the promise of that type of less invasive, or more minimally invasive second valve replacement operation? And the answer is we don’t have that data yet. And so, to a certain extent we’re relying on optimism and hope, without evidence – long term evidence.”

“The second thing that I’m always concerned about is just a simple concept of plumbing. If you think about the size of the original valve that was deployed, and as that tissue valve deteriorates necessitating another valve that could be placed using one of these more minimally invasive techniques leading to a Valve in Valve operation, you have to fundamentally ask the question how much space is there left for that second valve, and if the space is not enough or the fit is tight, then what types of additional problems may arise from that? In other words, will the pressures in the heart rise more, and if they do, they can cause significant symptoms for patients. So we end up perhaps eliminating one problem and creating another.”

Dr. Mo said in considering heart surgery it is always important for the patient to understand what the options and benefits are of a surgery or procedure, as well as potential drawbacks and pitfalls, in order to know what lies ahead.

“I think the hope, and the promise, and the expectation of the discussion of cardiac surgery for most patients is, this is my lifetime operation and I’m really hopeful that this won’t ever take place again. I think it’s very reasonable to expect any of our patients to feel great trepidation to go back and have more operative intervention. For all the common sense reasons, it’s a big deal and if it can be done successfully once, I think most patients would appreciate that.”

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