Key Research Findings

Heart valve diseases are prevalent, affecting an estimated 2.5% of the population in the Western world, and their incidence is increasing due to an aging population. 2 , 1 . Once symptoms appear, heart valve diseases can be life-threatening and significantly impact daily life and quality of life. 2 , 1 . Surgical treatment, including valve replacement or repair, remains the preferred treatment option. 2 , 1 . However, the transition back to daily life after surgery can pose physical, mental, and social challenges. 2 , 1 .

Surgical treatment of combined valve and coronary heart disease in elderly patients reveals that age itself is not a contraindication for cardiac surgery. 4 . While age ranks sixth in the list of risk factors for coronary revascularization, it is important to note that the operative risk for patients over 60 is somewhat higher than for younger individuals. 4 . However, there's no definitive age-based measure for determining suitability or unsuitability for surgery in individual cases. 4 . Elderly patients who have maintained a normal, active lifestyle prior to the onset of symptoms related to underlying valve or coronary heart disease should be considered for surgery. 4 . These patients should be highly motivated to improve their lifestyle postoperatively. The presence of severe additional conditions could potentially lead to the abandonment of surgical intervention. 4 .

Percutaneous balloon valvuloplasty for stenoses has become a widely accepted alternative to valve surgery in specific cases, gaining traction in the late 1970s. 3 . Over the past decade, this technique has evolved into a viable alternative. 3 . Balloon valvuloplasty for isolated mitral stenosis is currently the preferred treatment, producing results comparable to those of surgery. 3 . It may even be superior for valves with only moderate disease. 3 . However, balloon dilatation is not suitable for the most prevalent valve stenosis, which is aortic stenosis in the elderly. 3 . Dilatation of congenital aortic stenosis can be attempted if the valve is bicuspid or tricuspid. 3 . The recurrence rates for valvular stenoses after valvuloplasty are similar to those seen after surgical commissurotomy. 3 .

One study analyzed combined procedures in 124 patients with arteriosclerotic vessel disease. 5 . Patients were divided into two groups for the purpose of evaluating the procedures and outcomes. 5 . In 15 patients (group I), carotid endarterectomy was combined with aorto-coronary bypass surgery. 5 . One patient in this group underwent subclavian artery stenosis resection concurrently. 5 . One patient from this group passed away after 31 days (7%). 5 . Group II involved 108 heart valve operations performed alongside coronary artery revascularization. 5 . Early and late mortality rates were as follows: aortic stenosis (6/44, 14% and 2/44, 5%); aortic insufficiency (1/14, 7% and 0); combined aortic disease (1/8, 13% and 0); mitral stenosis (1/11, 9% and 0); mitral insufficiency (6/26, 23% and 2/26, 8%); combined mitral valve disease (1/2, 50% and 0); and there were no deaths during the replacement of both valves (aorta, mitral) in three instances. 5 . In our view, combined procedures, including resection of supraaortic artery stenosis, cardiac valve operations, and aorto-coronary bypass, are particularly indicated, given the excellent functional long-term outcomes. 5 . However, it is crucial to acknowledge the elevated operative risk in patients with mitral insufficiency and combined mitral valve disease. 5 .

Treatment Summary

Surgical intervention, specifically valve replacement or repair, is the prevailing treatment for heart valve diseases. 2 , 1 . Age can be a risk factor for surgery, potentially leading to a slightly higher operative risk in older individuals. 4 . For patients with mild to moderate mitral stenosis, percutaneous balloon valvuloplasty has shown outcomes comparable to surgery. 3 . Additionally, studies have documented combined surgical procedures for patients with coexisting coronary heart disease and valve disease. 5 . It's important to recognize the elevated surgical risks associated with patients having mitral insufficiency or combined mitral valve disease. 5 .

Benefits and Risks

Benefits Summary

Surgical treatment of heart valve disease can effectively improve symptoms and enhance quality of life. 4 . While the transition to daily life post-surgery can be challenging, rehabilitation programs have the potential to improve physical capacity and mental well-being, potentially reducing hospitalizations and healthcare costs. 2 , 1 . Percutaneous balloon valvuloplasty has demonstrated results similar to surgery, possibly offering an advantage for patients with mild to moderate mitral stenosis. 3 .

Risks Summary

Surgical treatment of heart valve disease carries inherent risks, such as bleeding, infections, and atrial fibrillation. 4 . Older patients might experience a slightly higher risk associated with surgery. 4 . It is crucial to consider the heightened surgical risks associated with patients experiencing mitral insufficiency or combined mitral valve disease. 5 .

Comparison of Research

Research Similarities

Multiple studies confirm the effectiveness of surgical treatment for heart valve disease in improving symptoms and quality of life. 2 , 1 , 4 . Additionally, research consistently highlights the tendency for older patients and those with coexisting conditions to have a greater risk associated with surgery. 4 , 5 .

Research Differences

Some studies suggest that post-surgical cardiac rehabilitation programs can contribute to improved physical fitness and mental health, potentially leading to fewer hospitalizations and reduced healthcare expenditures. 2 , 1 . Other studies explore percutaneous balloon valvuloplasty, highlighting its comparable outcomes to surgery, particularly for patients with mild to moderate mitral stenosis. 3 . Additionally, research has examined combined surgical procedures for patients with coronary heart disease and valve disease. 5 .

Consistency and Discrepancies in Results

While numerous studies support the effectiveness of surgical treatment for heart valve disease, the risks and benefits associated with surgery can vary depending on individual patient circumstances. 4 . Therefore, it is crucial to engage in open communication with your physician to make well-informed decisions. 4 .

Practical Considerations

While surgical treatment for heart valve disease can bring about symptom relief and improved quality of life, it is important to acknowledge the inherent risks. 4 . Elderly individuals and those with coexisting conditions may face an elevated risk associated with surgery. 4 . The decision to undergo surgery should be made in close consultation with a medical professional, ensuring a comprehensive understanding of your individual condition and the potential risks. 4 .

Limitations of Current Research

Current research provides insufficient data regarding the risks and benefits of heart valve surgery. 4 . Further investigation is necessary, particularly regarding the long-term effects of surgery on elderly patients and those with coexisting conditions. 4 .

Future Research Directions

Future research efforts should prioritize the elucidation of long-term outcomes and risks associated with heart valve surgery. 4 . Research focused on validating the efficacy of post-surgical rehabilitation programs is also crucial. 2 , 1 .

Conclusion

Heart valve disease, a condition on the rise in aging populations, can potentially pose a threat to life. 2 , 1 . While surgery is an effective treatment option for symptom management and quality of life improvement, it is not without risks. 4 . The decision to undergo surgery should be made in conjunction with a medical professional, ensuring a thorough understanding of your personal condition and the potential risks. 4 . Future research holds the promise of revealing more insights into the intricacies of heart valve surgery. 4 .

Treatment List

Treatments for heart valve disease include valve replacement, valve repair, percutaneous balloon valvuloplasty, and combined surgical procedures.