Valvular Heart Surgery (Repair And Replacement)
Valvular Heart Surgery Repair And Replacement
Heart valve surgery and procedures are performed to repair or replace a valve in the heart that is not working properly because of valvular heart disease (also called heart valve disease). Heart valve surgery is open-heart surgery through the breastbone, into the chest. It is a major operation that can last two hours or longer and recovery often takes several weeks. There are newer, less invasive procedures suitable for some types of valvular heart diseases.
Why is it done?
In a healthy heart, valves control the flow of blood by making it move in one direction through the heart and the body. The valve can either become stenotic ,which means it is narrowed and thus does not allow the blood to flow smoothly from one chamber to another or it it starts leaking which hampers the forward flow of blood.
If your valve problem is minor, your doctor may monitor your symptoms or treat you with medication. If your condition is more serious, surgery is usually required to repair or replace the valve to prevent any lasting damage to your heart valve and your heart.
What is done?
Depending on the problem, there are a several different procedures for repairing or replacing valves.
1. Surgical valve repair
Surgical procedures are generally used for problems with the mitral or tricuspid valves.
Commissurotomy
It is a treatment for a tight valve. The valve flaps (leaflets) are cut to loosen the valve slightly, allowing blood to pass easily.
Annuloplasty
It is done for a leaky valve. There is a ring of fibrous tissue at the base of the heart valve called the annulus. To repair an enlarged annulus, sutures are sewn around the ring to make the opening smaller. Or, a ring-like device is attached around the outside of the valve opening to support the valve so it can close more tightly.
Valvulotomy
It is a procedure to enlarge narrowed heart valves. It can also be done with the help of a balloon.
Non-surgical valve repair
Percutaneous or catheter-based procedures are done without any incisions in the chest or stopping the heart. Instead, a thin flexible tube called a catheter is inserted into a blood vessel in your groin or arm and then threaded through the blood vessels into your heart. Percutaneous or balloon valvuloplasty/valvotomy is used for stiffened or narrowed (stenosed) pulmonary, mitral or aortic valves. A balloon tip on the end of the catheter is positioned in the narrowed valve and inflated to enlarge the opening. Percutaneous mitral valve repair methods – such as edge-to-edge repair – can fix a leaky mitral valve in a patient who is considered high risk for surgery. A catheter holding a clip is inserted into the groin and up into the left side of the heart. The open clip is positioned beyond the leaky valve and then pulled back so it catches the flaps (leaflets) of the mitral valve. Once closed, the clip holds the leaflets together and stops the valve from leaking
Heart valve replacement
If your heart valve is too badly damaged to be repaired, surgery may be needed to replace it with a new mechanical or biological valve. Age is generally a factor in deciding which type to use – biological valves are generally preferred for older people. You and your doctor will discuss the options and decide which is best for you and your circumstances. Mechanical valves made of long-lasting metals, carbon, ceramics and plastic were the first to be used in valve replacement surgery. They have been refined and improved since being introduced in the 1960s. The major advantage of a mechanical valve is durability – they can last a long time. A fabric ring is used to sew the valve to heart tissue. Mechanical valves can lead to blood clots which may in turn cause a heart attack or stroke. To prevent clots, people with mechanical valves must take blood-thinning medications (anticoagulants) every day for the rest of their lives. This can have implications for women of childbearing age or for people who have a history of major bleeding. Depending on the type of blood thinners, you may require routine blood-testing to monitor your INR (international normalized ratio) to measure your blood’s tendency to clot. A mechanical valve makes a soft clicking sound when it closes. This can bother some people. Biological (also called bioprosthetic) or tissue valves are specially prepared natural valves that come from human donors or animals. Animal source valves (a xenograph) – usually cows or pigs – are similar to valves in the human heart. They are tolerated well and are less likely to form blood clots than mechanical valves. People with biological valves need to take blood thinners in the short term. Biological valves are not as durable as mechanical valves. They are more durable in the aortic position and in older patients.
Minimally invasive valve repair and replacement
Unlike conventional surgery, minimally invasive surgery does not involve sawing through the breastbone and opening the chest. It doesn’t require stopping your heart or using a heart-lung machine. The surgeon watches your heart on a video screen and operates using long-handled surgical tools inserted through small incisions. In some cases, robotic arms are used. Minimally invasive valve repair and replacement is suitable for some types of valvular heart disease, but is only available in some hospitals. It may also be called endoscopic or robotic heart surgery.Transcatheter aortic valve implantation (TAVI) is also called transcatheter aortic valve replacement (TAVR). TAVI is a minimally invasive surgical valve replacement procedure that is used to treat symptomatic aortic valve stenosis, with two key differences from traditional valve replacement surgery. Rather than opening up the chest, TAVI is done through small incisions in the groin or chest. Instead of repairing, or removing and replacing the damaged aortic valve, a new aortic valve is implanted directly on top of the damaged one. The surgeon inserts a catheter containing a new, collapsible aortic valve through small incisions in the groin or chest.Using ultrasound and chest x-rays, the catheter is guided to the correct position in the heart and the new valve is implanted and expanded.Once the new valve is in place, it starts to control blood flow immediately. People who undergo TAVI tend to recover faster and have shorter hospital stays (average three to five days) than people who have open-heart valve surgery. TAVI is usually considered for people who are at high risk for complications from open-heart surgery. Your healthcare team will assess your symptoms and overall health to determine if TAVI is an option for you.
