Stationary Cycling Test Could be Leading to Unnecessary Open Heart Operations

Aortic stenosis (AS), which is the narrowing of the aortic heart valve, affects predominantly older people and affects up to 3% of people over 75 years of age. Symptoms, such as chest pain, breathlessness and feeling faint, can take years to develop. However, when they do, it means the person is seriously ill and could die from heart failure or sudden death.

The exercise test, which involves cycling on a stationary bike, is used to determine whether surgery is needed for people with the condition.

First Canine Open Heart Surgery Performed in the UK
A three-year-old dog suffering from heart failure and breathing difficulties has successfully undergone an open heart surgery in the UK.

‘The exercise test, an approved international test to check whether people need open heart surgery could be sending twice as many people under the knife unnecessarily, at a cost of nearly £75m. ’

Tweet it Now

If exercise test participants become breathless, they are recommended to have valve replacement therapy. About 10,000 aortic valve replacements are performed every year at a cost of up to £15,000. Hospital recuperation then takes between seven and 10 days.

However, a study, led by Gerry McCann, Professor of Cardiac Imaging and Honorary Consultant Cardiologist from the University of Leicester Department of Cardiovascular Sciences, who conducted the research as part of a NIHR Fellowship, has shown the current approach is "highly inaccurate" and if followed may send thousands of patients to surgery before it is needed.

The exercise test is only has a 60% accuracy rate, the study found.

Echo Imaging Allows Correction of Residual Holes During Child Open Heart Surgery
Using transesophageal echocardiography (TEE) during heart surgery may improve outcomes for children with congenital heart disease.

Professor McCann, who is also a consultant cardiologist from the NIHR Leicester Cardiovascular Biomedical Research Unit (BRU), said: "There is no doubt that valve replacement therapy is highly effective for patients with symptoms, however there are risks involved. It’s a major operation and there’s a one per cent chance of people dying or having a stroke during or after. There’s also the chance they could develop an infection."

"It can often take six months to recover, but if they survive they tend to do very well afterwards. However, if we know a patient has AS and no symptoms and we do nothing there’s also a one per cent chance they will die so there’s a fine line between whether we should intervene or not."

Indian Doctors Conduct Open Heart Surgery on 18-hour-old Baby in Delhi
The baby from Mathura was born with a rare condition — veins were attached to his heart in abnormal positions. Mortality rates are high in such cases.

"Our findings showed that this exercise test, which has been approved by the American Heart Association/American College of Cardiology and the European Society of Cardiology, was highly inaccurate as almost twice the number of people who became breathless during the test did not develop symptoms within a year."

The findings have been published in the world-leading European Heart Journal, which showcases work often considered in future guidelines.

Stenting of Carotid Artery Prior to Open Heart Surgery Linked With Best Outcomes Among Severe Carotid and Coronary Disease Patients
Researchers at Cleveland Clinic have found that undergoing stenting of the carotid artery before a open heart surgery leads to best outcomes.

Professor McCann now wants to conduct further research to find a more accurate way to determine whether doctors should wait for symptoms to develop or to intervene beforehand. Ultimately a clinical study comparing early surgery versus waiting for symptoms to develop is needed.

Source-Eurekalert