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Heart Valve Repair Surgery
Relevant information about Heart Valve Repair Surgery.
Blood is pumped through your heart in only one direction. Heart valves play a key role in this one-way blood flow, opening and closing with each heartbeat. Pressure changes on either side of the valves cause them to open their flap-like "doors" (called cusps or leaflets) at just the right time, and then close tightly to prevent a backflow of blood. There are four valves in the heart: Tricuspid valve, pulmonary valve, Mitral valve and Aortic valve. The tricuspid valve is between the right atrium and right ventricle. The pulmonary or pulmonic valve is between the right ventricle and the pulmonary artery. The mitral valve is between the left atrium and left ventricle. The aortic valve is between the left ventricle and the aorta. Each valve has a set of flaps. When working properly, the heart valves open and close fully ensuring a proper blood circulation.
- Causes of heart valve defects
Heart valves don't always work as they should. A person can be born with an abnormal heart valve, a type of congenital heart defect. Also, a valve can become damaged by: Calcium deposits (calcification), Infections such as rheumatic fever or Medications. Defective valves may cause congestive heart failure and infections (infective endocarditis). Heart valve defects can cause three different phenomenons: blood can leak back through the valve itself, which is called regurgitation; one of the valves, the mitral valve, sometimes has flexible flaps and does not close properly. This is called mitral valve prolapse and is one of the most common heart disease. Sometimes there is regurgitation; when the valve does not open enough and prevents blood flow is called stenosis.
In the United States, surgeons perform about 99,000 heart valve operations each year. The majority of heart valve operations involve repair or replacement of mitral or aortic valves. These valves are on the left side of the heart, which is the harder working one of the two sides because it pumps blood throughout the body. They control the flow of oxygen-rich blood from the lungs to the rest of the body. A defective heart valve is one that fails to fully open or close: a stenotic heart valve can't open completely, so blood is pumped through a smaller-than-normal opening or a valve also may not be able to close completely. This leads to regurgitation (blood leaking back through the valve when it should be closed). In this case, there are two ways to treat the defective heart valve: repair or replacement. The gravity of the medical case determines the option to follow. Both repair and replacement involve a surgery as procedure.
- How is the surgery performed
Heart valve surgery is open-heart surgery that is done while you are under general anesthesia. The surgeon will make a cut, about 25cm (10 inches) long, down the middle of your breastbone (sternum) and will open your ribcage to reach your heart. Your blood is routed away from your heart to a heart-lung bypass machine. This machine keeps the blood circulating while your heart is being operated on. During heart valve surgery, one or more valves are repaired or replaced. Repair means that the valve is mended to help it work better. Replacement means your diseased valve is removed and a new valve is inserted in its place. Whether a valve will be repaired or replaced can only be decided once surgery has begun.
During the procedure, a ring may be sewn around the opening of the valve to tighten it. Other parts of the valve may be cut, shortened, separated, or made stronger to help the valve open and close right. To reach the valve, an incision is made in your heart or aorta. If the valve can be mended, the needed repairs are done. If the valve must be replaced, part or all of the damaged valve and its supportive structures may be removed. The right-sized replacement valve is selected, positioned in the valve opening, and sewn firmly into place. The incision in your heart or aorta is closed. Your heart is then started so it beats on its own again. The surgery can take anywhere from 2 to 4 hours or more, depending on the number of valves that need to be repaired or replaced.
Surgeons have different types of procedures to repair a valve. Each one has particularities. In first place, Commissurotomy, which is used for narrowed valves, where the leaflets are thickened and perhaps stuck together. In second place, Valvuloplasty, this strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening. Also, there is Reshaping, where the surgeon cuts out a section of a leaflet. In fourth place, Decalcification, this removes calcium buildup from the leaflets. In fifth place, Repair of structural support, this replaces or shortens the cords that give the valves support. Finally, Patching, where the surgeon covers holes or tears found in the leaflets with a tissue patch.
The valves can be repaired or replaced with natural (biological) or artificial (mechanical) valves: natural valves from human donors (cadavers), modified natural valves from animal donors like porcine (pig) or bovine (cow) or artificial valves made of metal. On the other hand, there are alternative treatments to avoid surgery of the heart valves. If the patient has mild heart valve disease, certain medicines (such as diuretics, angiotensin-converting enzyme -ACE- inhibitors, and digoxin) can relieve the symptoms. If the patient’s valve is seriously damaged, it may need to be repaired or replaced.
- How is the post-surgery process
The success rate of the heart valve surgery is high. The operation can relieve the patient’s symptoms and prolong his life. The patient can expect to stay in the hospital for about a week, including at least 1 to 3 days in the Intensive Care Unit (ICU).
Recovery after valve surgery may take a long time, depending on how healthy the patient was before the operation. The patient will have to rest and limit his activities. The doctor may organize an exercise program or may convince the patient to join a cardiac rehabilitation program. Patients can usually go back to work in 4 to 6 weeks. Those who have more physically demanding jobs may need to wait longer. The death rate averages 2% to 5%, depending on the heart valve. About 2 of every 3 patients who received an artificial mitral valve are still alive 9 years after the surgery.
Heart Valve Repair Surgery is commonly performed and generally safe. However, problems can occur during or after the operation. Most people aren't affected, but there are risk’s possibilities. There are risks for any anesthesia (problems with the breathing, reactions to medications), for any surgery (bleeding, infection) and risks specifically for cardiac surgery (death, heart attack, irregular heartbeat -arrhythmia-, kidney failure, stroke, temporary confusion after surgery due to the heart-lung machine). About death, there is a risk of death but this is rare -however, it's important to consider that having no treatment, or having an alternative treatment, may have a higher risk-. It is very important to take steps to prevent valve infections. After the procedure, the patient may need to take antibiotics indefinitely.
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