Schwarzenegger's Heart Valve Replacement Surgery: What We Know

Actor, former body-building champion and ex-governor of California, Arnold Schwarzenegger, 70, is recovering from heart surgery after complications during a minimally invasive procedure to replace a heart valve.

Mr. Schwarzenegger is in stable condition at Cedars-Sinai Medical Center in Los Angeles. He had been scheduled for a “less-invasive catheter valve replacement” that was initiated Thursday, but complications led to emergency surgery, Mr. Schwarzenegger’s spokesman Daniel Ketchell said in a statement.

Emergency valve replacement requires an “open heart” procedure with a “sternotomy,” in which the chest is surgically opened. Mr. Schwarzenegger required replacement of the pulmonary valve, which directs blood flow from the heart to the lungs. He was scheduled for a TPVR (transcatheter pulmonary valve replacement.) His pulmonary valve was previously replaced in 1997 due to a congenital heart defect, his spokesman said in the statement.

“Patients with previous heart valve interventions may be more prone to complications, which can include bleeding, displacement of the new valve or arrhythmias (heart rhythm abnormalities),” said Ramon Quesada, M.D., medical director of the Structural Heart and Complex Percutaneous Coronary Intervention Programs at Miami Cardiac & Vascular Institute at Baptist Hospital.

The more widely performed minimally invasive procedure to replace a heart valve is called TAVR (transcatheter aortic valve replacement). TAVR is most often performed on people with a condition called aortic stenosis, a narrowing of the aortic heart valve, which allows bloods to leave the heart from the left ventricle to the aorta — and on to the rest of the body. Miami Cardiac & Vascular Institute has been performing TAVRs since 2012, says Dr. Quesada.

Pulmonary valve replacements in adults are rare, Dr. Quesada said. “It’s more frequently done in children with congenital heart disease,” he added.

Both TPVR and TAVR usually involve small incisions. Most commonly the catheter is inserted through an artery or vein in the groin and passed up through the blood vessels to the heart to deliver a replacement valve.

Through his Twitter account, Mr. Schwarzenegger said Monday that he is recovering well and grateful. “It’s true: I’m back!” he said in his Tweet. “I went to sleep expecting to wake up with a small incision and woke up with a big one – but guess what? I woke up, and that’s something to be thankful for. Thank you to the doctors & nurses. And I’m truly filled with gratitude for all of the kind messages.”

The pulmonary valve is one of the heart’s four valves. It closes off the lower right chamber, or right ventricle, and opens to allow blood to be pumped from the heart to the lungs — through the pulmonary artery — where it will receive oxygen. Mr. Schwarzenegger’s “1997 replacement valve was never meant to be permanent, and has outlived its life expectancy, so he chose to replace it …,” the actor’s spokesman said in the statement.

Over the last few years, the U.S. Food and Drug Administration has approved transcatheter pulmonary valves to facilitate TPVRs. Minimally invasive procedures to replace either the aortic or pulmonary valves are done without removing the old, damaged valve. Instead, the procedures involve wedging the replacement valve into the damaged valve’s place.  The TAVR procedure has been performed in the U.S. for more than 10 years.

Similar to a stent placed in an artery, the transcatheter approach delivers a fully collapsible replacement valve to the valve site through a catheter. These minimally invasive procedures are usually for patients with symptomatic stenosis (narrowing of the arteries) and who are considered an intermediate or high risk patient for standard valve replacement, or “open heart” surgery.

“All procedures are done with a multiple-disciplinary team approach,” Dr. Quesada emphasizes. “Surgical teams are always available to end the procedure or if complications arise.”