Stroke is one of the most devastating potential complications of heart surgery.
Cryptogenic strokes have no known cause and are responsible for about 1 in 4 stroke events.
Dr. Brandon Jones of the Providence Valve Center offers insight on the advanced techniques and latest clinical trials aimed at protecting against stroke during heart procedures.
[3 MIN READ]
Heart surgery is often a life-saving procedure. Advances in surgical techniques and ever-evolving technology are making it possible to repair structural defects, correct irregular heartbeats and change the prognosis for thousands of heart disease patients every year. Despite the daily occurrence of medical miracles, successful surgery doesn’t always mean it’s time to take a victory lap.
What is perioperative stroke?
A stroke occurs when one of the blood vessels that carry nutrients and oxygen to your brain ruptures or becomes blocked by a blood clot. Strokes that happen during or shortly after surgery are called perioperative strokes.
Fortunately, perioperative strokes are uncommon. However, when they do occur, it can lead to catastrophic results, according to the American Heart Association.
Perioperative stroke may increase your:
- Risk of death
- Length of hospital stay
- Cognitive decline
Providence is at the forefront of advanced heart care that also reduces the risk of stroke. Heart specialists use the latest techniques and participate in clinical research to ensure the greatest likelihood of a successful outcome.
We take every precaution to reduce the risk of perioperative stroke during heart procedures, from extensive pre-surgery screening to constant assessment before, during, and after all heart procedures.
“Strokes are among the most devastating potential complications from heart surgery,” says Brandon Jones, MD, FACC, Interventional Cardiologist at Providence St. Vincent Heart Clinic and the Providence Valve Center. "We take every precaution to reduce the risk of perioperative stroke during heart procedures, from extensive pre-surgery screening to constant assessment before, during, and after all heart procedures."
Protecting patients who have TAVR
Transcatheter Aortic Valve Replacement (TAVR) replaces a too-narrow heart valve that doesn’t open properly, called aortic stenosis. The condition happens when your heart’s aortic valve thickens and calcifies, limiting blood flow throughout your body. If left untreated, the condition causes fatigue, shortness of breath, rapid or irregular heart rate, fainting, heart failure and ultimately death.
“TAVR has been shown to improve symptoms, prolong life, and usually requires minimal recovery time in the hospital. It can relieve your pain, reduce anxiety about your health and improve your quality of life significantly,” says Dr. Jones.
Although the procedure is less invasive than traditional open-heart surgery, it is not completely without risk, according to Dr. Jones.
“During a TAVR procedure small pieces of calcified heart valve or tissue, called embolic debris, can sometimes break free and travel to your brain. If any of the pieces reach their destination and cause a blockage, it can lead to a stroke. We take extra precautions to make sure that doesn’t happen,” he says.
SENTINEL Cerebral Protection System
The SENTINEL™ Cerebral Protection System (CPS) captures loose embolic debris before it can reach your brain. Two tiny filters are inserted into the main arteries going to the brain through a small incision in your wrist. Once the procedure is over, the filters are removed – taking the collected debris with them. The results so far have been exceptional, according to Dr. Jones.
We started using cerebral protective devices during TAVR in 2018 and we were excited to report only one stroke in more than 300 subsequent procedures that year.
“Fortunately, strokes during TAVR procedures have become quite rare, occurring now in less than 2% of procedures in national registries,” he says. “That said, we started using cerebral protective devices during TAVR in 2018 and we were excited to report only one stroke in more than 300 subsequent procedures that year.”
Cryptogenic stroke and congenital heart defects
The foramen ovale is a small doorway in the wall between the two upper chambers of your heart. Before a baby is born, blood normally moves from the veins through the foramen ovale and circulates through the heart. After birth, the door typically closes on its own.
In about 25% of adults, the foramen ovale doesn’t close completely resulting in a congenital heart defect called a patent foramen ovale (PFO). When this happens, the opening can allow small amounts of blood to go directly from the right side of the heart to the left, bypassing the lungs. In rare cases, if a blood clot passes through the opening it can lead to a stroke.
The cause of most strokes can usually be identified. However, in about 25% of strokes, the cause remains unknown despite testing. This is called a cryptogenic stroke.
“Patients with cryptogenic stroke who are found to have a PFO may be at elevated risk of future blood clots passing through the heart,” according to Dr. Jones. “Fortunately, there is now a minimally invasive procedure to close the PFO which can reduce the risk of a future stroke.”
PFO Occluder devices protect against stroke
Providence heart specialists use two FDA-approved devices for PFO closure:
- Abbott AMPLATZER® PFO Occluder device
- GORE® CARDIOFORM Septal Occluder device
“We go in through a vein in your leg until we reach your heart,” says Dr. Jones. “The device is pushed out through a small plastic catheter, has two discs that sit on either side of the heart and close the PFO, preventing blood or blood clots from traveling through the opening. The procedure usually takes less than an hour to complete and patients typically go home the same day.”
Stroke is the fifth most common cause of death and a leading cause of disability in the United States, according to the American Heart Association. Studies show using an occluder device can significantly reduce the likelihood of future events. “We’ve found that for appropriate patients, it can cut the risk of a subsequent stroke in half,” says Dr. Jones.
We always try and employ the most advanced technology to help protect you from stroke so you can feel confident in treating your heart condition at Providence.
“We know that having a heart condition or needing a procedure can be scary. Our team of cardiac surgeons and interventional cardiologists at the Providence Valve Center is committed to making sure we get patients through these life-saving procedures as safely as possible. As the largest valve program in Oregon, and with a strong commitment to cardiovascular research, we always try and employ the most advanced technology to help protect you from stroke so you can feel confident in treating your heart condition at Providence,” says Dr. Jones.
Find a doctor
The heart specialists at Providence combine advanced expertise and the latest techniques to protect your health. The Providence Valve Center is the largest and longest-running structural heart program in the state of Oregon. With Providence Express Care Virtual, you can access a full range of healthcare services. If you need to find a doctor, you can use our provider directory.
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This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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