(instrumental music) – Recovery from valve
surgery is dependent on at least three things: what
valve lesion is that we’re repairing or replacing, what
the general condition is of the patient is going in,
and what the access trauma is that’s performed in order to get there. So let’s talk first about the valve. If we have a patient with aortic stenosis, let’s think what that heart’s doing. That heart is trying to
squeeze against the blockage. And when I go in and release
that blockage with a new valve by whatever means,
or repair the old one, I’ve got a good, strong heart banging away saying, phew, let’s go. That’s not always the case. If it’s been neglected
too long, that heart’s gonna have failed. But in general, those people’s
recovery is pretty quick because the heart is instantly better. Let’s compare that to a
mitral valve that’s leaking. That ventricle is
supposed to be pumping out through the aorta, but the
mitral valve’s leaking. So it may pump half of
its volume out into that high pressure system to
the body, and it may say, I’ll just throw the other
half out the back door, ’cause that’s a low pressure system. No sweat, I can sit here
and get fat and lazy and not very strong. That patient has a slower
recovery because their heart has to have some time to strengthen over the course of that. That’s an example of the
lesion, what is the lesion that the patient is having, which valve, was it a leaking valve or a
blocked valve that goes on? The condition of the
patient going in has a great deal to do with that. If someone has been up and
about, walking a mile a day, they’re gonna bounce back pretty quickly. If they’re on dialysis and
weakened and in heart failure, and have been on a ventilator
struggling for a while, you know that that’s a much more difficult recovery for them. It’s going to take them some time. The third thing that influences recovery is the access trauma. Access trauma is what we
refer to as the incisions or alterations we had to
do with the chest wall and the blood vessels to
gain access to the heart to place or repair the valve. Now traditionally, that
was done through a median sternotomy, and people were
restricted because it takes a good six or eight weeks
for that bone to regain its strength. Some valve lesions can be repaired through smaller incisions, and those generally heal faster. There was a technological
revolution going on in valve repair and replacement.. It’s lead the way with
aortic valve replacement and it’s coming with mitral valve repair and replacement. And that is to have
innovative valves with newer manufacturing techniques
that are compressible and can be placed within
a catheter and delivered by going up your own
blood vessel, most usually coming from your femoral
artery at the top of your leg, though there are a
couple other approaches. That usually goes by the name of TAVR. TAVR is a newer technique that
is getting better rapidly. In the beginning, we only gave
it to our riskiest patients, the ones we knew wouldn’t live through a conventional operation. As we gain experience with the technique, as the manufacturing and
the delivery mechanisms have improved, that’s expanding
now, and it’s going to continue to expand as time goes on. The promise of that is
the access trauma is less and that patient will have
a more rapid recovery, and indeed that seems to be the case, as we move forward.