ROBIN WILLIAMS: The comedian is scheduled to have aortic valve replacement surgery.
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Comedian and actor Robin Williams, 57, last week postponed a planned 80-city tour of his one-man show, "Weapons of Self-Destruction" to undergo aortic valve replacement surgery. His announcement came just days after 83-year-old former first lady Barbara Bush left a Houston hospital after undergoing the same procedure.
The aortic valve is what keeps oxygenated blood flowing from our heart into the aorta, the largest artery in our body, and prevents it from washing back into the heart with each pump cycle. But as we age, the tricuspid (three-leafed) valve tends harden and thicken, forcing the heart work harder to keep blood flowing smoothly. Open-heart surgery is typically required to replace the valve if it thickens so much that it causes aortic stenosis, an abnormal narrowing and stiffening of the valve.
Although Williams is 26 years younger than Bush, the procedure is not particularly unusual for someone in his or her late 50s. Factors such as obesity and genetics can play role in hastening the decline of the valve's function, but heart infections, typically caused by rheumatic fever or drug use, can also lead to a form of sclerosis. Williams is well-known for his cocaine-infused youth.
To find out more we spoke with Rajendra Makkar, co-director of the Cedars–Sinai Medical Center Heart Institute's Cardiovascular Intervention Center in Los Angeles.
[An edited transcript of the interview follows.]
What is the aortic valve?
The aortic valve is the valve between the left ventricle—one of the heart's four chambers—and the aorta which provides oxygenated blood to the entire body. The heart pumps blood by contracting, and if this one-way valve was not present then when the heart relaxes then most of the blood it just pumped from the ventricle would leak back in, making the heart very inefficient.
Why would someone need a replacement?
The procedure is most commonly performed in the U.S. for a condition called aortic stenosis, where the valve fails to open properly. This is a fairly common condition in the aging population.
It begins as aortic sclerosis, a thickening of the aortic valve by calcification. About 10 to 15 percent of the population above 55 has this, and about 25 percent of the population over 65 has it. That does not produce much of a problem unless it progresses to stenosis. Over 10 years, roughly 15 percent of patients with sclerosis will progress to stenosis, and not all of those cases will be severe enough to lead to treatment.
About 2 percent of the population also has[is born with?] a bicuspid valve rather than a tricuspid valve, and this tends to wear out the heart much earlier, leading to stenosis. In the developing world, stenosis can be a consequence of rheumatic fever (caused by untreated strep infection) during childhood. Drug use can also lead to endocarditis, an infection of the heart. Anything that causes an infection of the valves can lead to stenosis.
The most common symptoms of aortic stenosis are related to the fact that the heart has to work much harder to pump blood out. These include chest pain and shortness of breath as well as fainting, known as syncope.
What does the surgery involve?
In the early days, surgeons would open up the entire sternum, put the person on a heart–lung machine, open up the aorta, and stitch in a new valve. These days the surgeons will make a smaller incision, but it is still open-heart surgery, which requires a whole team of people and lasts two to three hours.
Now, there is a technique we are testing, which involves changing the valve percutaneously (without opening the chest). We go from the femoral artery in the groin and work our way back almost 100 centimeters [40 inches] to the aortic valve. The whole procedure takes an hour and a half and is the way the whole field is going. We've done about 100 procedures as part of a clinical trial.
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16 Comments
Add CommentMany heart surgeons are not trained to do the minimally invasive heart surgery, so if you elect to do that they lose the operation. If the only heart surgery you require is replacement of the aortic valve then you should be able to have the minimally invasive operation done.
Reply | Report Abuse | Link to thisIt is not correct that the recovery times are the same for both procedures, particularly in older patients. The recovery for minimally invasive surgery is much faster normally.
You need to see another surgeon that is trained in the minimally invasive procedure and get his opinion.
I HAD THE SURGERY AND KEEP HAVING PROBLEMS THE LATEST MY ARMS HURT AND MY HEAD WITH MY SIGHT BEING EFFECTED I WAS CRYING IS THIS THE NORM FOR RECUPERATING I HAVE BEEN CHECKED OUT REPEATEDLY WITH THE SAME RESULTS NORMAL EKG AND TO REST I AM AFRAID SOMETHING IS WRONG PLZ RESPOND TY
Reply | Report Abuse | Link to thisHere is a site worth checking out. It may provide some answers.
Reply | Report Abuse | Link to thishttp://bicuspidfoundation.com/
my grandma is 76 yrs she is needing this surgery but were waiting to see if she is a even able to have it. But the doctor said with out the surgery she would only live 6 months to 1 yr.
Reply | Report Abuse | Link to thisThey put her on oxygen in the hospital but that day they did the dye test and found out the info the sent her home w/out. They told her to call in a month to find out more about if she can have the surgery... Pls HELP i need to be refered to the best in tx any in DFW area.. what do i do!
my grandma is 76 yrs she is needing this surgery but were waiting to see if she is a even able to have it. But the doctor said with out the surgery she would only live 6 months to 1 yr.
Reply | Report Abuse | Link to thisThey put her on oxygen in the hospital but that day they did the dye test and found out the info the sent her home w/out. They told her to call in a month to find out more about if she can have the surgery... Pls HELP i need to be refered to the best in tx any in DFW area.. what do i do!
my grandma is 76 yrs she is needing this surgery but were waiting to see if she is a even able to have it. But the doctor said with out the surgery she would only live 6 months to 1 yr.
Reply | Report Abuse | Link to thisThey put her on oxygen in the hospital but that day they did the dye test and found out the info the sent her home w/out. They told her to call in a month to find out more about if she can have the surgery... Pls HELP i need to be refered to the best in tx any in DFW area.. what do i do!
my grandma is 76 yrs she is needing this surgery but were waiting to see if she is a even able to have it. But the doctor said with out the surgery she would only live 6 months to 1 yr.
Reply | Report Abuse | Link to thisThey put her on oxygen in the hospital but that day they did the dye test and found out the info the sent her home w/out. They told her to call in a month to find out more about if she can have the surgery... Pls HELP i need to be refered to the best in tx any in DFW area.. what do i do!
Hy I am a 20 years old man who will need an aortic valve surgery after 10 years as the doctor say . If you please provide with an extra information about the surgery done without the open heart process , and if it is effective or not .
Reply | Report Abuse | Link to thisHy I am a 20 years old man who suffers from aortic stenosis . My doctors say that I have to undergo a surgery after 10 years or so . What I am warrying about is the sexual activity after the surgery would still be effective or not . Also I need you to inform me whether the surgery done for aortic valve replacement is accurate and effective or not . please I am waiting your reply... thanck you.
Reply | Report Abuse | Link to thisIf only we all could be lucky enough to live to be 90 years old.. God bless you. Write back in 10 years when you turn 100! ;)
Reply | Report Abuse | Link to thisAortic valve surgery is an "open heart" procedure performed by heart surgeons, also known as cardiothoracic surgeons. Traditional aortic valve replacement surgeries require the breast bone (sternum) to be split down the middle using a procedure known as a median sternotomy. This provides the surgeon with full access to the patient's heart and chest cavity. However, new minimally invasive procedures are being developed and used with patients including mini-sternotomy, mini-thoracotomy and cathether-based approaches. These newer procedures for aortic valve replacements are designed to reduce the trauma to the body and accelerate patient recovery.
Reply | Report Abuse | Link to thisOne additional option for patients to consider is the Ross Procedure. In this unique form of aortic valve replacement surgery, the patient's own pulmonary valve is used to replace the defective aortic valve. Then, the surgeon uses a homograft valve and inserts it into the pulmonary position.
http://www.insideheart.com/
Aortic valve surgery is an "open heart" procedure performed by heart surgeons, also known as cardiothoracic surgeons. Traditional aortic valve replacement surgeries require the breast bone (sternum) to be split down the middle using a procedure known as a median sternotomy. This provides the surgeon with full access to the patient's heart and chest cavity. However, new minimally invasive procedures are being developed and used with patients including mini-sternotomy, mini-thoracotomy and cathether-based approaches. These newer procedures for aortic valve replacements are designed to reduce the trauma to the body and accelerate patient recovery.
Reply | Report Abuse | Link to thisOne additional option for patients to consider is the Ross Procedure. In this unique form of aortic valve replacement surgery, the patient's own pulmonary valve is used to replace the defective aortic valve. Then, the surgeon uses a homograft valve (from a human donor) and inserts it into the pulmonary position.
http://www.insideheart.com/aortic-valve-replacement-surgery.html
You may need heart valve surgery for these reasons: Changes in your heart valve causes severe cardiac symptoms such as chest pain, shortness of breath, fainting or cardiac failure. Studies show that changes in your heart valve began to seriously affect your heart function. The doctor wants to replace or repair heart valves at the same time you have an open heart surgery for another reason. The heart valve has been damaged by an infection of the heart valves. You have received a new heart in the past, and it is not working well or if you have other problems like blood clots, infections or bleeding.
Reply | Report Abuse | Link to thishttp://www.insideheart.com/aortic-valve-replacement.html
My mother, who is 84, is up to have her aorta valve replaced. It would sure be nice for her to have the less invasive surgery going up the femoral artery. We were told that this surgery is in the experimental stage, not approved by FDA, or whoever does that, and that her insurance will not cover it. There is no way she can afford to pay for it without the help of insurance. Does anyone know if this is indeed true? And where are these less invasive surgeries done? I would appreciate any accurate info I can get.
Reply | Report Abuse | Link to thisi had an aortic valve replacement last year. scary times, for sure. funny that robin williams had to have it to. before i went under the knife, i did some research at <a href='http://www.heart-valve-surgery.com">www.heart-valve-surgery.com</a>. very helpful. lots of great journals from others who have had the procedure done.
Reply | Report Abuse | Link to thisDuring school we had some interesting lectures on aortic valvular abnormalities. This website was used for training medical students to recognize and understand such abnormalities: www.practicalclinicalskills.com
Reply | Report Abuse | Link to this