Early open heart surgery could save Britons from deadly strokes

21/11/2021

Should we all be given open heart surgery at the first sign of ticker trouble to help prevent strokes and other life-changing illnesses?

The American Heart Association are considering treatment for aortic stenosis
400,000 Britons are affected by the condition which leads to severe illness
Early intervention could save patients from having heart attacks and strokes

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.

The American Heart Association Scientific Sessions conference yesterday heard that the lives of people with aortic stenosis, which affects more than 400,000 Britons, could be extended if they have open-heart surgery within months of diagnosis.

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.

But doctors showed that symptom-free patients who underwent the surgery immediately after diagnosis were twice as likely to avoid heart attacks and strokes years later compared with those who went without.

Aortic stenosis happens when the opening of the main valve, which takes freshly oxygenated blood from the heart to the rest of the body, narrows, reducing the blood flow

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 happens when the opening of the main valve, which takes freshly oxygenated blood from the heart to the rest of the body, narrows, reducing the blood flow.

The disease is usually caused by a build-up of calcium – a mineral in the blood – on the valve. This increases naturally with age but smoking, high blood pressure and obesity can accelerate it. The heart must then work harder to pump blood around the body, which in turn receives less oxygenated blood.

Often the first signs of damage to the aortic valve go unnoticed. Sufferers usually live unaffected for several years before symptoms start and they seek help for treatment.

But by this time it is often too late, and most develop deadly heart failure.

Once symptoms begin, only 50 per cent of patients survive longer than two years without having the valve replaced via open-heart surgery. But with patients already ill, the procedure is sometimes considered too risky and is usually performed only when lives are at immediate risk.

The new research suggests that acting preventatively could be a far safer option.

Researchers at the University of Belgrade Medical School in Serbia recruited 157 adults across seven countries with symptom-free aortic stenosis. Half underwent early surgery, while the other half were monitored by doctors.

Retired nurse Julie Morgan, 65, from Doncaster, pictured, would have benefited from early treatment. She underwent emergency surgery in September having been diagnosed with midl aortic stenosis in 2013

After two-and-a-half years, participants who had undergone early surgery had half the number of heart attacks, strokes, unplanned hospitalisations and deaths than the untreated group.

Dr Marko Banovic, cardiologist and lead investigator of the trial, said that while the immediate risk of death for asymptomatic patients was low, the damage caused by aortic stenosis increased the risk of heart disease later in life.

Heart attack rate cut by lockdown

Lower air pollution during lockdown may have helped slash the number of heart attacks.

University of California researchers investigating the effect of the stay-at-home order during the first wave of the pandemic found the number of hospital admissions and paramedic call-outs related to heart attacks fell dramatically in the first two months of lockdown, compared with the same period the year before.

The scientists also looked at levels of common particle found in air pollution, particulate matter 2.5, which dropped as fewer cars were on the road.

With each ten micrograms per cubic metre fall in the particle, the number of heart attacks decreased by six per cent. This translated to 374 fewer heart attacks per 10,000 people in the period studied.

But experts caution that the study has its limitations, as it doesn’t account for other factors such as those who quit smoking over Covid fears.

There may also be patients who avoided calling for an ambulance, for fear of bothering the health service as it tackled the pandemic.

Despite this consultant cardiologist Dr Malcolm Finlay said: ‘This study suggests that if we make our cities cleaner and greener, we will see a clear health benefit.’

The American Heart Association has recognised air pollution as a significant contributor to heart disease and death. Polluted air carries harmful materials such as nitrogen dioxide, carbon monoxide and sulphur dioxide which damage the inside walls of blood vessels, ultimately adding strain on the heart.

‘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.’

During the three-hour procedure, surgeons make an incision in the chest to access the heart. It is then stopped and the patient is hooked up to a machine which takes over the function of the heart and lungs.

The diseased aortic valve is removed and replaced with a new one, usually made of metal. The heart is then restarted and the opening in the chest closed.

Mr Kulvinder Lall, a heart surgeon at Barts Health NHS Trust, believes early surgery is a good idea. ‘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.

One who could have benefited from an earlier operation is 65-year-old Julie Morgan, a retired nurse from Doncaster.

However, she was given no choice but to have an emergency aortic valve replacement in September, after doctors said she had less than two years to live. She had been diagnosed with mild aortic stenosis in 2013 after suffering shortness of breath and dizzy spells. Scans revealed the condition had caused an irregular heartbeat. She was given drugs to tackle this, and told to return for check-ups every year.

‘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.’

In November, Julie was told her condition had become 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.’

But the surgery went according to plan and today she suffers few symptoms and is about to begin an exercise plan to boost recovery.

But would she have had such invasive surgery years ago, if given a choice?

‘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.’

Binge boozing link to irregular heartbeats

One night of binge-drinking is enough to trigger a dangerous, irregular heartbeat, it is claimed.

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.

Atrial fibrillation, which affects roughly 1.4 million Britons, happens when the nerves in the heart misfire, triggering an irregular or abnormally fast heartbeat that causes dizziness or shortness of breath. Over time this can cause blood to pool and clot inside the heart, which can trigger a life-threatening stroke.

According to a study presented by doctors from the University of California, San Francisco, there were on average 1,757 more hospital admissions in the US related to a first episode of atrial fibrillation on these sorts of days, compared with days which were not associated with binge drinking.

Previous studies have linked excessive alcohol consumption to atrial fibrillation. While doctors are still not certain why it can trigger the condition, it is thought that alcohol fuels nerve activity in the organ, increasing the risk of misfiring.

The doctors claimed this research shows that for patients already at risk of developing the condition, a single drinking binge can be enough to trigger it.

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.’

Adrenaline key to cardiac survival

A shot of adrenaline to the heart as soon as possible after a cardiac arrest could double a patient’s survival chances.

Adrenaline is carried by UK paramedics, but under current guidelines a shot of the natural hormone – which increases blood flow to the heart – is given only in a last-ditch attempt to save a life when all other treatments have failed.

Typically, in a bid to kick-start a patient’s heart, paramedics will first carry out CPR, or chest compressions, followed by at least three defibrillator shocks, before giving adrenaline.

Researchers from Rush University Medical Center in Chicago analysed the records of nearly 6,500 American adults who suffered cardiac arrest and found that those who received an injection of adrenaline within four minutes of a heart attack were twice as likely to survive as those who did not. They also found that those who received the adrenaline shot and survived were twice as likely to see their heartbeat and blood flow return to healthy levels afterwards.

Doctors say the findings are significant, given the current lengthy waits for ambulances in the UK.

Latest NHS figures show that those suffering from life-threatening conditions such as cardiac arrest are now waiting nearly ten minutes for a paramedic to arrive. If no treatment is given, just 12 per cent of those will survive.

Dr Fozia Ahmed, consultant cardiologist at the Manchester Heart Centre, told The Mail on Sunday: ‘Defibrillators can now be found in football stadiums and in shopping malls for members of the public to use in case of a cardiac arrest. Perhaps in the future we’ll store adrenaline pens alongside them.’

Surprise good news for butter and cheese lovers

Eating too many steaks can increase the risk of stroke but cheese and butter are no more harmful than vegetable fats, research suggests.

Scientists tracked the type and quantity of fat in the diet of 117,000 US nurses over the course of nearly 30 years.

Those with the highest intake of animal fat – from red meat such as steaks and sausages – were 16 per cent more likely to suffer a stroke than those who ate average amounts. Those with the highest intake of healthier vegetable fat were 12 per cent less likely than the average participant to suffer a stroke.

The study found that dairy fat, found in cheese, cream, ice cream and butter, was not associated with stroke risk.

The researchers, from Harvard University, noted that people who ate lots of animal fat got their fill from red meat such as beef, pork or lamb, as well as processed red meats such as bacon and sausage.

Previous studies have found that diets high in processed red meat can increase the risk of bowel cancer, due to a harmful type of salt called nitrates.

Every year roughly 38,000 Britons lose their lives to a stroke, which happens when the blood supply to part of the brain is cut off. This is usually caused by either a blood clot or a burst blood vessel in the brain. Fatty diets have been linked to an increased risk of blood clots because, over time, deposits of fat build up in the walls of an artery, forming inflamed areas called plaques. These plaques can rupture, and a blood clot then develops.

Dr Fozia Ahmed, consultant cardiologist at the Manchester Heart Centre, said: ‘This is good news for people who like lots of butter on their toast, but it’s important to note this is just looking at the risk of stroke.

‘We don’t yet know if eating vegetable fat instead of animal fat could reduce the risk of heart attacks, too. Although it is likely, as the onset of a heart attack involves a similar mechanism to that of a stroke.

‘Overall calories are also important, as being obese increases the risk of all sorts of conditions, including stroke.

‘Unfortunately it’s not a case of eating as much cheese as you like and thinking it’s good for your heart.’

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