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Good health begins with a strong heart and healthy blood vessels. Your heart pumps blood throughout your body through your blood vessels, delivering oxygen and other life-sustaining components to every one of your organs, tissues and cells.

When disease damages your blood vessels (vascular system) the vascular specialists at Central Maine Heart & Vascular Institute (CMHVI) can provide the care you need. We have the expertise and the state-of-the-art medical technology needed to manage the many different forms of disease and damage that can affect your body’s complex network of blood vessels.

About Vascular and Endovascular Surgery

The vascular system, also known as the circulatory system, is made up of blood vessels that carry blood throughout your body. Arteries carry oxygenated blood away from your heart; veins carry blood back from the body to your heart. Vascular diseases can damage your arteries or veins, reducing their ability to transport blood.

The vascular surgeons here at CMHVI can repair damage to arteries and veins, either with traditional vascular surgery or with endovascular surgery, which uses minimally invasive treatment procedures.

In addition to surgery, vascular surgeons provide a variety of treatment options, depending on the type and severity of vascular disease. Treatment may include medications and lifestyle changes.

Conditions We Treat

Vascular conditions and diseases can arise for many reasons. Unhealthy behaviors such as smoking, overeating and lack of exercise, as well as genetics, may result in the buildup of plaque and cholesterol, which can cause blockages. (Blockages near the heart are treated by cardiovascular surgeons.) Untreated blockages can cause strokes, loss of a limb or even death.

Your primary healthcare provider will refer you to a vascular surgeon as needed. For example, you might see a vascular surgeon if your primary care provider has diagnosed any of the following:

• Abdominal aortic aneurism (AAA): An aneurism is a bulge (or a ballooning) in the wall of an artery. It can be caused by factors such as atherosclerosis (also known as hardening of the arteries), high blood pressure, genetics, poor diet or smoking. Aneurysms can occur in the chest, abdomen and extremities. Over time, aneurisms can enlarge and rupture. This is especially typical of an abdominal aortic aneurysm; if an AAA ruptures, blood loss can cause death in minutes. In other parts of the body, the aneurysm may cause a clot that can lead to poor circulation to a limb. If left untreated, poor circulation can require amputation.
• Carotid artery disease: Caused by a build-up of plaque within an artery, carotid artery disease causes the artery to narrow, which restricts blood flow. The carotid arteries, which are in the neck, are the main route for blood supply to the brain. If a small piece of plaque breaks off in the carotid artery, it may travel to the brain and cause a stroke or a transient ischemic attack (TIA), known as a mini-stroke.
• Peripheral artery disease: Caused by a build-up of plaque in the leg arteries, peripheral artery disease restricts blood flow to the legs and feet. Patients may suffer muscle pain while walking, a condition known as claudication. In severe cases, PAD can cause severe foot pain or gangrene. Without prompt treatment, amputation may be necessary.
• Varicose veins: In healthy veins, valves help prevent blood from flowing backwards. In patients with a condition known as venous insufficiency, the valves are damaged and no longer work properly. Venous insufficiency causes leg veins to enlarge, twist and appear blue or purple, a condition called varicose veins. Although varicose veins are not necessarily a serious health risk, they can be painful and cause leg ulcers that are resistant to healing. In some cases, however, they can cause more serious issues including leg pain and swelling, as well as serious blood clots known as deep vein thrombosis.

Testing for Vascular Disease

Circulation problems can be difficult to diagnose and may appear to be other medical conditions. Also, some symptoms that mimic circulation problems are actually other physical problems, such as nerve or joint problems. A vascular surgeon is the best person to help you diagnose and treat any circulatory problem you may have.

We provide a full range of diagnostic tests for vascular diseases. Discuss your health with your primary care provider to determine whether you should be screened or examined for vascular diseases. Not all vascular diseases have noticeable symptoms in their early stages, so it’s important to tell your provider about any changes you may be noticing, however slight.

Are You a Candidate for Minimally Invasive Treatments?

Our providers have expertise in all types of heart valve surgeries. If you have mitral valve or aortic valve hardening (stenosis) or leakage (regurgitation), you may be a candidate for minimally invasive surgical treatment, using specialized surgical equipment, miniature cameras and hybrid techniques. The primary benefit of these procedures compared to open-chest procedures is that they eliminate the need for a large incision through the breastbone, resulting in fewer surgical risks and faster recuperation.

We perform minimally invasive valve surgeries in our surgical suites, which feature sophisticated diagnostics, leading-edge technologies and state-of-the-art imaging capabilities. This environment combines the capabilities of an operating room and cardiac catheterization lab. If required, we also offer conventional open chest surgery. Our treatment offerings include:

Aortic Valve Replacement (AVR)

Traditional AVR is considered the gold standard for severe aortic stenosis and other valve disorders. During this open-heart procedure, the damaged valve is replaced with an artificial one.

Transcatheter Aortic Replacement (TAVR)

Transcatheter aortic valve replacement (TAVR) offers an alternative to open-heart surgery. In this minimally invasive procedure, our specialized surgeons use a catheter through a small incision to replace your faulty valve with a new valve while your heart beats. TAVR often provides immediate relief of debilitating symptoms and helps patients live longer, more active lives.

Valve Repair

Depending on your specific condition, your cardiologist might recommend valve repair, rather than replacement. Advantages include decreased risk of infection, maximum heart function and reduced need for blood thinners. Not all valves are repairable, and repair is often more difficult than replacement. Your care team will work with you to decide the best option for your needs.

Cardiac Rehabilitation Offers Individualized Recovery

If you have structural heart disease or any other heart conditions, we offer cardiac rehabilitation as part of our Cardiopulmonary Rehabilitation Program. Our cardiac rehabilitation is a medically supervised program that helps you recover with an individualized plan that provides evaluation and instruction on physical activity, nutrition, stress management and other health-related areas as needed. Cardiac rehabilitation can make a significant difference in the lives of heart patients.

• Coronary artery disease
• Angina
• Coronary artery angioplasty or stents
• Open heart surgery such as coronary bypass or valve surgery
• Heart failure
• Heart transplantation

You will also be invited to join Mended Hearts™, a patient-run support group affiliated with the American Heart Association that offers support and encouragement through its visiting program, monthly meetings and educational forums. To learn more, call 207-795-8230.

The mitral valve is one of the four valves in your heart. It regulates blood flow between the two chambers on the left side of your heart. When your mitral valve doesn’t work correctly, problems with blood flow can damage your heart.

The heart surgery specialists at Central Maine Heart & Vascular Institute have expertise in all types of heart valve surgery, including mitral valve surgery. Patients with mitral valve hardening (stenosis) or leakage (regurgitation) are candidates our for minimally invasive surgical treatment.

About the Mitral Valve

The mitral valve is a valve in the heart located between the left atrium and the left ventricle. It allows blood to flow from the left atrium into the left ventricle, but not in the reverse direction. The mitral valve has two flaps (cusps). It is also known as the bicuspid valve.

There are two types of mitral valve disease:

• Mitral valve stenosis: This occurs when the flaps of the mitral valve stiffen, thicken or stick together. When this happens, the valve opening gets smaller and less blood can flow from the left atrium to the left ventricle. 
• Mitral valve regurgitation: This occurs when the flaps of the mitral valve can no longer close completely and tightly. When this happens, blood leaks back into the left atrium from the left ventricle. Over time, this leakage, or regurgitation, can damage your heart muscle.

Symptoms of Mitral Valve Disease

Mitral valve disease may have no symptoms, or it could cause the following:

• Anxiety 
• Chest pain or discomfort
• Dizziness
• Fatigue
• Heart palpitations or irregular heartbeat
• Shortness of breath

Over time, mitral valve disease can lead to dangerous complications such as blood clots, stroke, heart failure, irregular heartbeat (atrial fibrillation) and pulmonary hypertension (high blood pressure that affects the blood vessels in the lungs).

Minimally Invasive Mitral Valve Surgery

Open-chest valve surgery has been used successfully in the surgical treatment of various heart-circulatory problems for decades. However, minimally invasive surgical treatment is now a preferable option for many patients. These surgeries are performed with high-tech thin instruments, miniature cameras and hybrid techniques.

Minimally invasive valve surgery techniques offer several advantages compared to open-chest procedures.   They include:

• Faster recovery. Patients can usually return to work or other activities within two or three weeks, which is much quicker than open-chest heart valve surgery. 
• Shorter hospital stays. Hospitalization time can be reduced by as much at 50%. 
• Fewer complications. Because the breastbone (sternum) is not cut during minimally invasive surgery, chances for post-surgical complications and infection go down. 
• Less pain. Decreased trauma to tissue and muscle results in less pain than open-heart procedures. 
• Less blood loss. Because incisions are smaller, patients lose less blood and are less likely to require a transfusion. 
• Less scarring. Only a few tiny scars and/or a two-inch scar remains after minimally invasive valve surgery. 

If you have minimally invasive mitral valve surgery, your surgeon will make four or five dime-size incisions in your upper chest between our fourth and fifth ribs or through a two-inch incision on the side of your chest. Using specialized surgical equipment and cameras, your surgeon performs the surgery much as they would through a far larger incision through the breastbone (sternum).

During valve surgery, your surgical team stops your heart with medication and uses a heart-lung machine to oxygenate and circulate your blood. Your surgeon removes the damaged valve and sews a new valve in place. The replacement valve may come from an organ donor, but it is more likely to be a mechanical valve made of plastic and metal. Sometimes diseased valves can be repaired – for example, if calcium deposits on the valve can be removed, the valve may be surgically reshaped, allowing it to close more effectively. If the valve opening is too big, it sometimes can be tightened with stitches.

If you are not a candidate for minimally invasive mitral valve surgery, CMHVI also offers conventional open chest surgery.

Mitra Clips

In the past, open-heart surgery was the only option for patients with damaged heart valves. Now transcatheter mitral valve replacement with MitraClip® therapy offers a minimally invasive alternative for patients who don’t qualify for traditional surgery.

Why Do You Need a MitraClip?

Every heart has four chambers that collect blood and circulate it throughout the body. Heart valves play an important role in this process — they open to allow blood to empty through a chamber and close so blood cannot flow the wrong way.
Mitral regurgitation is a common heart valve problem that occurs when blood leaks backward when the left ventricle contracts. Blood flow in both directions causes increased blood volume and pressure, which can lead to the following symptoms:

• Chest pain
• Loss of consciousness
• Shortness of breath
• Swelling in the lower body

Although symptoms can range from mild to more severe, regurgitation could cause serious complications and eventually lead to heart failure. If you have severe mitral regurgitation and have not responded to other medical therapy, a MitraClip procedure could help repair the damaged heart valve and improve your quality of life.

Getting Ready for a MitraClip

Speaking with your surgeon and medical team before receiving a MitraClip procedure can help you feel confident before surgery. They will provide you with preparation instructions to follow for up to a week before surgery. Those instructions could include the following:

• Keep the area to be operated on clean to prevent infection.
• Do not consume any food or liquids the night before surgery.
• Pick up any prescribed pain medications or antibiotics.
• Stop certain medications temporarily. Your provider will advise you about medications that need to be discontinued.

Preparing your home in advance will also make coming home after surgery easier. Having premade meals, a well-stocked pantry and a clean house can help you relax after your operation and focus on healing.

What to Expect During a MitraClip Procedure

During a MitraClip procedure, the surgeon guides a catheter from a vein in the leg to reach the heart. A small, metal clip is inserted onto the flaps of the mitral valve to hold it together. The clip stays inside the body to keep the valve together and stop blood leakage backwards toward the lungs.

Recovering From MitraClip

Because MitraClip placement is a minimally invasive procedure, most patients have a faster recovery time, less pain and not as much blood loss as conventional surgery.

Patients usually stay in the hospital for three days or fewer. When you are ready to return home, you will be given instructions about taking care of the incision and what medications you should take for pain. To reduce swelling, it may be recommended that you keep your legs elevated or wear elastic stockings. Your provider will give you detailed guidelines about when to resume normal activities.

Sources: fda.gov, heart.org, heart.org, heart.org, heart.org, medlineplus.gov, medlineplus.gov, medlineplus.gov, nih.gov, nih.gov, sts.org

Your heart has four valves, which are thin membranes that open and close to allow blood to flow properly. In a healthy heart, these valves work seamlessly. But in people with heart valve disease, heart valves may leak or allow too much or too little blood to flow. If you have a diseased heart valve and your provider recommends valve surgery, your heart is in good hands at Central Maine Heart & Vascular Institute.  In addition to traditional open surgery, we offer three minimally invasive procedures for the treatment of valvular disorders.

About Heart Valve Surgery: Your heart’s four valves (tricuspid valve, pulmonary valve, mitral valve and aortic valve) manage the flow of blood through your heart. A diseased heart valve may allow regurgitation, which means it allows blood to leak back through the valve in the wrong direction. Or it may be afflicted with stenosis, which means the valve doesn’t open as well as it should, blocking blood flow. And when the mitral valve prolapses, that means it doesn’t close tightly.

If you have a diseased heart valve, your cardiologist may recommend heart valve replacement or repair. During valve surgery, your surgical team stops your heart with medication and uses a heart-lung machine to oxygenate and circulate your blood. Your surgeon removes the damaged valve and sews a new valve in place. The replacement valve may come from an organ donor, but more often a mechanical valve, made of plastic and metal, is used.

Sometimes diseased valves can be repaired – for example, if calcium deposits on the valve can be removed, the valve may be surgically reshaped, allowing it to close more effectively. If the valve opening is too big, it sometimes can be tightened with stitches. We offer both open-chest valve surgery, which requires a large incision through the breastbone, and minimally invasive surgery, which can be accomplished through small incisions in the chest.

Benefits of Minimally Invasive Surgery: Open-chest valve surgery has been used successfully in the surgical treatment of various heart-circulatory problems for decades. However, minimally invasive surgical treatment is now a preferable option for many patients. These surgeries are performed with high-tech thin instruments, miniature cameras and hybrid techniques.

Minimally invasive valve surgeries for adults are performed in surgical suites featuring sophisticated diagnostics, leading-edge technologies and state-of-the-art imaging capabilities. This environment combines the capabilities of an operating room and cardiac catheterization lab. Minimally invasive valve surgery techniques offer several advantages compared to open-chest procedures. They include:

• Faster recovery – Patients can usually return to work or other activities within two or three weeks, which is much quicker than open-chest heart valve surgery. 
• Shorter hospital stay – Hospitalization time can be reduced by as much at 50%. 
• Fewer complications – Because the breastbone (sternum) is not cut during minimally invasive surgery, chances for post-surgical complications and infection go down. 
• Less pain – Decreased trauma to tissue and muscle results in less pain than open-heart procedures. 
• Less blood loss – Because incisions are smaller, patients lose less blood and are less likely to require a transfusion. 
• Less scarring – Only a few tiny scars and/or a two-inch scar remain after minimally invasive valve surgery. 

CMH offers conventional open chest surgery for patients requiring such procedures.

CMHVI offers three types of minimally invasive valve surgery

Minimally Invasive Aortic Valve Surgery: Aortic valve surgery is approached from the right upper chest through an incision between the second and third rib near the breastbone (sternum). Using specialized surgical equipment and cameras, the surgeon performs the surgery much as they would through a much larger incision through the breastbone (sternum). During valve surgery, your surgical team stops your heart with medication and uses a heart-lung machine to oxygenate and circulate your blood. Your surgeon may repair the valve or replace it, depending on the type of valve disease you have. In an aortic valve replacement procedure, your aortic valve is removed and replaced with a mechanical valve or a valve from a cow or pig.

Minimally Invasive Mitral Valve Surgery: The mitral valve is a valve in the heart located between the left atrium and the left ventricle. It allows blood to flow from the left atrium into the left ventricle, but not in the reverse direction. The mitral valve has two flaps (cusps). It is also known as the bicuspid valve. Mitral valve surgery can replace or repair mitral valve damage due to two types of mitral valve disease:

• Mitral valve stenosis: This occurs when the flaps of the mitral valve stiffen, thicken or stick together. When this happens, the valve opening gets smaller and less blood can flow from the left atrium to the left ventricle. 
• Mitral valve regurgitation: This occurs when the flaps of the mitral valve can no longer close completely and tightly. When this happens, blood leaks back into the left atrium from the left ventricle. Over time, this leakage, or regurgitation, can damage your heart muscle.

TAVR: When your aortic valve doesn’t work properly because of aortic stenosis, having surgery to repair or replace it may reduce symptoms and lower your risk of potentially fatal complications. Aortic valve replacement – done either through an open chest procedure or minimally invasive surgery – offer you an opportunity to feel better and live longer. However, the least invasive type of procedure currently available is TAVR. During TAVR, your surgeons insert a replacement valve into your own aortic valve without removing your damaged valve. Because the replacement valve is wedged into place – and because TAVR is less invasive than other repair or replacement procedures – TAVR offers a variety of advantages, including shorter recuperation time and a quick improvement in aortic stenosis symptoms.

About Aortic Stenosis: Aortic stenosis is one of the most common and serious valve disease problems. The aorta is the main artery carrying blood out of the heart. When blood leaves your heart, it flows through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart. As the aortic valve becomes narrower, the left ventricle must increase pressure to pump blood out through the valve. To do this extra work, the muscles in the ventricle walls become thicker, which can lead to chest pain. As the pressure continues to rise, blood may back up into the lungs. Severe forms of aortic stenosis prevent enough blood from reaching the brain and the rest of the body. Aortic stenosis may be present from birth (congenital), but it more commonly develops during aging as calcium or scarring damages the valve and restricts the amount of blood flowing through it.

Aortic Valve Repair or Replacement: When your aortic valve doesn’t work properly, having surgery to repair or replace it may reduce symptoms and lower your risk of potentially fatal complications. Aortic valve replacement – done either through an open chest procedure or minimally invasive surgery – offer you an opportunity to feel better and live longer. However, the least invasive type of procedure currently available is TAVR.

Benefits of TAVR: With traditional aortic valve replacement surgery, surgeons remove your valve and replace it with a mechanical aortic valve or an aortic valve from an animal. However, with TAVR, your surgeons insert a replacement valve into your own aortic valve without removing your damaged valve. Because the replacement valve is wedged into place, it is a less complicated procedure that can be done through a catheter inserted through an incision in your thigh, rather than through incisions in your chest.

TAVR offers a major advantage: With traditional valve replacement, your surgeons must stop your heart with medication and use a heart-lung machine to oxygenate and circulate your blood during surgery. But because TAVR is done via catheterization and does not require the removal of your existing heart valve, your surgeon can allow your heart to continue beating throughout the procedure. TAVR requires no heart stopping. This makes aortic valve repair a viable option for more patients, especially those at high-risk, either due to age, history of heart disease, frailty or other health issues.

TAVR often provides immediate relief of debilitating symptoms and helps patients live longer, more active lives. It can also allow for quicker recovery than traditional aortic valve replacement surgery. Other benefits of TAVR may include:

• Improvement in common symptoms of aortic stenosis, such as shortness of breath, chest pain and fatigue
• Less pain
• Less blood loss
• Lower risk of cardiac and respiratory complications
• Fewer days in the ICU
• Shorter hospital stays
• Faster return to normal activities

Our Team: CMHVI cardiac surgeons have expertise in all types of heart valve surgeries. They have extensive training and experience in performing valve repair and replacement surgery and are certified by the American Board of Surgery and the American Board of Thoracic Surgery. An experienced, dedicated technical-professional team supports them in their work. Our cardiac surgery program has been recognized by the Society of Thoracic Surgeons as one of the top cardiac programs in the United States.

For a referral to CMHVI’s cardiac surgery program, including minimally invasive valve surgery, speak with your primary care provider. CMHVIS’s cardiac surgeons can provide patients with an in-depth consultation about their cardiac issue.