Patients diagnosed with a common but deadly heart condition should get major surgery as early as possible – even if they feel perfectly healthy – a study has concluded.
At the American Heart Association Scientific Sessions yesterday, it was revealed that people who have aorticstenosis, which has affected more than 400,000 Britons in total, may live for longer periods of time if they undergo open-heart surgeries within six months.
The operation to replace a damaged aortic valve – the opening of the main blood vessels to the heart – is usually performed only when the condition is critical and patients have just a few years to live.
Doctors found that patients with no symptoms who had surgery performed within a few hours of diagnosis were two times more likely to have a stroke or heart attack in the future than those without.
Yesterday’s American Heart Association Scientific Sessions Conference heard that people suffering from aortic Stenosis (which affects over 400,000 Britons) could live longer if open-heart surgery is performed within a few months.
Aortic Stenosis is a condition where the main valve that takes oxygenated blood from heart to rest of body narrows.
Currently, when the first signs of valve damage are spotted, usually via a routine heart scan, patients are placed on a ‘watch and wait’ system, and treated only when they begin to suffer symptoms such as chest pain, breathlessness and dizziness.
Aortic Stenosis is a condition where the opening to the main valve (which takes oxygenated blood from heart to rest of body) narrows. This reduces blood flow.
The disease is usually caused by a build-up of calcium – a mineral in the blood – on the valve. It is a natural process that increases with age, but obesity and high blood pressure can speed it up. In order to circulate blood more efficiently, the heart has to work harder. The body then receives less oxygenated blood.
Many times, the symptoms that indicate damage to the Aortic Valve are not noticed. Patients who suffer from this condition often live for many years without experiencing any symptoms. They then seek treatment.
However, it’s often too late and many people die from heart disease.
Patients who develop symptoms within the first two years of their illness will not live more than 50 percent of their lives without having to have an open-heart procedure. The procedure can be dangerous for patients who are already seriously ill and should only be performed if there is a risk to their lives.
New research shows that preventing problems is a safer alternative.
Researchers at University of Belgrade Medical School (Serbia) recruited 157 patients from seven countries suffering from symptom-free ortic stenosis. The majority of the patients underwent surgery early, and half received ongoing monitoring from doctors.
Only 50% of patients who have symptoms will survive for more than 2 years. This is despite the fact that only half of them need to have their valves replaced by open-heart surgery. The procedure can be dangerous for patients who are already seriously ill and should only be performed if there is a risk to their lives.
Retired nurse Julie Morgan, 65, from Doncaster, pictured, would have benefited from early treatment. After being diagnosed in 2013, she underwent emergency surgery on September 5.
Two-and-a half years later, the participants who received early surgery saw half their number of strokes, heart attacks, and unplanned hospitalisations as compared to the group that had not.
The trial’s lead investigator, Dr Marko Bovic (cardiologist), stated that while there was no immediate danger of death for patients who are symptomatic, the potential damage from aorticstenosis could increase the likelihood of developing heart disease later in their lives.
‘Without treatment, these impairments may progress and become irreversible by the time valve-replacement surgery is done,’ he said. ‘There may be more serious complications, including heart attack, stroke and death.’
The three-hour operation involves a surgeon making an incision on the chest in order to reach the heart. After the procedure is completed, the machine is stopped. The heart and lungs are then taken over by the machine.
It is possible to remove the damaged aortic valve and replace it with one made usually of metal. Once the heart is restarted it’s closed and the chest opening is sealed.
Barts Health NHS Trust Heart Surgeon Mr Kulvinder Lall says that it is best to have surgery as soon as possible. ‘Over time, stenosis can cause lasting damage to the heart because it’s having to work extra hard. Even after a replacement, patients can still encounter dangerous heart complications.’
Replacement valves typically do not need to be replaced, meaning that most patients won’t see their condition worsen after surgery.
Julie Morgan, 65 years old and a former nurse from Doncaster, could have been benefited by an earlier operation.
After doctors told her she would not live for more than 2 years, however, it was necessary to undergo an urgent aortic valve repair in September. After suffering from dizziness and shortness of breath, she was diagnosed in 2013 with mild aorticstenosis. A scan revealed that the condition was causing an irregular heartbeat. The doctor prescribed drugs for her to treat the condition and advised that she return every year to have check-ups.
‘But things just got worse and worse,’ she says. ‘Within a few years I was struggling to get out of bed in the morning. I couldn’t sing along to music in the car because I couldn’t get the breath out.’
Julie learned in November her situation was critical. She says: ‘The doctor said I had a life expectancy of two years unless I had major surgery. I put the phone down and cried my heart out.’
The surgery was successful and she is now experiencing few side effects. She will soon begin an exercise program to help her recovery.
Would she still have undergone such an invasive procedure if offered the option?
‘I’m not sure,’ she says. ‘Part of me thought I could outrun the disease, even if eventually I realised I was kidding myself.’
Mr Lall adds: ‘It’s tough to convince healthy patients to have an operation. But if you tell them that if they do it now they’ll live longer, the message is hard to ignore.’
Indulge boozing can lead to irregular heartbeats
According to some, one night of binge-drinking can trigger an irregular, dangerous heartbeat.
American researchers found that more people were admitted to hospital with atrial fibrillation, as the condition is known medically, at times when large quantities of alcohol are usually consumed, such as New Year’s Eve and the Super Bowl final.
Around 1.4 million Britons suffer from atrial fibrillation. This is caused by nerves malfunctioning in the heart. It causes an abnormally rapid or irregular heartbeat, dizziness, or even shortness of breath. The heart can become clot-prone over time, and this could lead to a stroke.
A study by the University of California San Francisco found that there was an average of 1,757 higher hospital admissions for the first episode of atrial fibrillation in America on days when these types of events were associated with binging.
American researchers found that more people were admitted to hospital with atrial fibrillation, as the condition is known medically, at times when large quantities of alcohol are usually consumed, such as New Year’s Eve and the Super Bowl final
Studies have shown that excessive alcohol intake is linked to atrial fibrillation. Although doctors don’t know why alcohol can cause the condition, they believe that it fuels nerve activity, which increases the chance of misfiring.
Doctors claimed that one drinking session can cause the condition for those already at-risk.
Consultant cardiologist Dr Malcolm Finlay said: ‘Anyone with underlying conditions like high blood pressure and diabetes, which make them predisposed to atrial fibrillation, should avoid big swigs of booze.’