UnityPoint Health - Cedar Rapids Heart and Vascular Institute takes you inside
the heart for an aortic valve replacement surgery at UnityPoint
Health hospital in Cedar Rapids, Iowa our patient is Cory Ranney. He's a 50
year old Marion man with a bicuspid aortic valve condition he was born
with and it was identified 25 years ago by his UnityPoint Clinic family doctor. This
congenital heart condition led to aortic stenosis.
it's an aortic valve and it tends to leak.
It would leak when it pumped so it would have to pump extra when it would pump
which is hard on your heart so it needed to be replaced so it don't leak.
Aortic stenosis is the tightening of the aortic valve. The aortic valve typically
opens and closes each time the heart beats and in people over time the valve
can become calcified. So each time the heart would beat
the valve doesn't want to open properly it puts a lot of extra work on the heart
to pump blood out each time the heart goes to beat through a small
In his situation he was born with what's called a bicuspid valve meaning that
congenitally it was slightly malformed compared to what a normal valve is and
that resulted in earlier onset of aortic stenosis. For him today we're gonna
replace his valve and put in a mechanical aortic valve to take the
pressure of his heart. Dr. Gary Weide, a cardiothoracic surgeon from Physicians'
Clinic of Iowa will be performing today's aortic valve replacement surgery
on Ranney. Joining Dr. Weide in the operating room is an anesthesiologist, a
perfusionist who operates the heart-lung machine, a physician assistant and St.
Luke's highly skilled open-heart team of nurses and surgical techs. Because of
Ranney's young age the decision was made to replace his aortic valve with a
mechanical valve rather than using a tissue valve that has basically a life
long durability to hopefully last the rest of his life. Other valves one can
choose from would be called a tissue valve. The valve is typically produced from
the heart sac of a cow, the downside to that valve is it has a life expectancy
of about 10 to 15 years so when a guy who's young and 50 years of age. You don't want
to go in the direction that would result in another operation at some
point of his life. He's opted to have a mechanical valve hopefully for a
lifelong solution to this problem. This is true open heart surgery. We
open the chest we go on the heart-lung machine. We stop the heart for a period
of time, and take out the valve put in a new valve and then start the heart once
again. Another option for aortic valve
replacement and treating aortic valve stenosis is through non-surgical
treatment called TAVR which stands for transcatheter aortic valve replacement.
St. Luke's started its TAVR program in 2016.
Dr. Weide explains how they decide which procedure is best for patients.
These procedures are relatively common, it's probably the most common
valve procedure that we do. I would say over the last four or five years things
have changed dramatically in how we treat aortic stenosis with the
introduction of TAVR. It has really kind of turned the
number of patients that were once open procedures to more catheter
based valves. The TAVR valve is a
tissue valve so in Corey's situation I think he did have an option for a
TAVR valve but again it would have been a limited durability as far as the valve
goes so we opted for open heart surgery forthe mechanical valve to hopefully never
have to deal with this again. Ranney's open-heart surgery is expected
to last about three hours. Dr/ Weide makes an incision in the
middle of the chest and then cuts through the sternum, cannulas are then
inserted so the cannulas are basically tubes that we use to drain the blood out of the
heart to circulate through the bypass machine and then it goes back into a
separate tube into the aorta. That basically pumps blood throughout
the patient's entire body while the heart stops so it continues to provide
whether the brain and the kidneys and the liver and everywhere else so we can
stop the heart and then work on the heart while it's not
it's more so the cannula is essential to bypass surgery that's essential to the
operation we usually basically goes on bypass and then we we put a clamp
generally on the the aorta and then we deliver was called cardioplegia which is
a high potassium solution that's used to stop the heart and then every 15 or 20
minutes we have to keep giving that solution to keep the heart stopped.
It also protects the heart from injury during that time as well.
Dr. Weide removes Ranney's a aortic valve.
This valve like we talked about was a bicuspid valve. It was calcified in
the sense that it didn't want to open particularly well but in addition to not
wanting to open well, the stiffness of the valve makes it not want to close as well.
either so the valve not only was just a naughty but it relieved and replaces it
with a mechanical a or dick valve
they come in various sizes for various size people of course I mean the goal is
to generally try to put the biggest valve to put in but at the same time
he's you got to be able to accommodate it into the Hartmann to the aorta so
here at the mercy of that so in him you we measured three different sizes and we
came up with a you know 25 Valve's actually a pretty good sized valve for
him everybody is unique in the sense of size and goes and then like I said we we
pass multiple sutures around the annulus like we talked about and they're like I
said they're color-coordinated and they're kind of individually laid out
and it's important to keep track of all those they don't get all tangled
together and then we pass them through the valve sewing ring itself and then
slide the valve down over the sutures and then tile the sutures and that's
what it secures the valve into the heart now so it doesn't pop out or move out
testing just make sure the valve leaflets open it close it means make
sure that there's nothing under the valve that's impinging the valve
leaflets because they pivot back and forth so want to make sure that they
pivot fully they open to their maximum extent and they close they come together
so the valve doesn't leak in general it's that's the only not a problem most
of the time when you clean everything out the valve leaflets will pivot open
and close like problems but it's always good to double check before you close
there's a lot of ways to close the chest I mean the most common way is with you
know six or seven you know a surgical stainless steel wires and it works well
for the more people and that's what we did for him
and and I think you'll do with it just does that thing in the wires will say I
think everything went well I think everything went when asked plan and then
no surprises nothing comes I think the valve the appearance of the valve is
what we expected it functioned the way that we thought it was functioning me we
got it out or nicely we clean everything up and actually got a pretty sizable
loan and there so I would say overall this quite a success in mechanical valve
and to take you our he'll have to be in a blood thinner you have to be on a
blood thinner for the remainder of your life which requires you to get some
blood drawn you be on coumadin or warfarin so you get your blood checked
regularly that's the that's the one advantage to a tissue valve is you don't
need to be on that but it has limited durability so you kind of trade the
durability for the anticoagulation and Cory as it gets it's probably the best
best decision for him but you know long term you know he'll go through cardiac
rehab after he gets out of the hospital for you know two to three months and
then hold on periodically have an echo to make sure the valve is still
functioning fine and make sure that it's doing okay but a mechanical valve in
particular this should it should really last down
years about the rest of his life after his surgery rainy spent a day in st.
Luke's intensive care unit and four days total at st. Luke's I'm doing a lot
better than I anticipated I very thankful for the for the help
that was it was here I see you from that to my departure was was wonderful
surgery I don't know anything about I went in there they put a mask on me and
I was done you gonna wake up and I see you so I
don't remember anything there but from ICU to the time of departure was
wonderful it's been a little over three weeks since his open-heart surgery and
Rainey is participating in st. Luke's cardiac rehab I prepared myself for a
lot worse than I have actually encountered I wouldn't I wouldn't
anticipate where I'm at now that's just over three weeks post-surgery and feel
great I figured that I would feel a lot worse
I planned a big feel a lot worse Rainey will continue attending cardiac rehab
and follow up with his doctor he hopes to put his surgery behind him soon as
his body continues to heal and he looks to return to work in the coming weeks
class act everything went great as anticipated the
post care has been great today I had rehab and that was great
so from from the start to the finish I had very good care unity point health
st. Luke's Hospital is Cedar Rapids Heart Hospital it has been the area's
leader in open heart surgery since 1978 we invite you to learn more about our
program and st. Luke's heart care services today