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Heart Valve Replacement Surgery
Relevant information about Heart Valve Replacement Surgery.
The heart valves maintain the unidirectional flow of blood in the heart by opening and closing depending on the difference in pressure on each side. Heart valve disease occurs when a valve doesn't work satisfactory. A valve may not open all the way or a valve may have problems closing. If this happens, blood doesn't move through the heart's chambers the way it should, causing complications to person´s cardiac heath. Incorrect blood circulation puts extra strain on person heart and could cause symptoms such as breathlessness and swollen ankles. Heart valve disease can cause your heart to pump less efficiently. Heart valve replacement can relieve symptoms and prolong life.
- Heart valve malfunction symptoms
The Valvular stenosis is one of the two possible malfunctions of a heart valve. This occurs when a valve opening is smaller than normal due to stiff or fused leaflets. The narrowed opening may make the heart work very hard to pump blood through it. This can lead to heart failure, and person health´s deterioration.
The second malfunction is called valvular insufficiency. Also known as regurgitation, incompetence or "leaky valve", this occurs when a valve does not close tightly. If the valves do not seal completely, some blood will leak backwards across the valve. As the leak worsens, the heart has to work harder to make up for the leaky valve, and less blood may flow to the rest of the body. It is important to say that any of the heart’s valves might be affected by one of these conditions.
Some of the symptoms patients might feel are: difficulties to breathe, either to catch of hold the air. Patient might suffer of weakness or dizziness, and feel a discomfort in his/her chest. Patient also may feel a pressure or weight in your chest with activity or when going out in cold air. Palpitations are a common sign too.
The type and grade of pain and duration does not necessary keep a relation with the illness´s grade of advance.
- What does the surgery consist on
There are two kinds of artificial heart valves. The Mechanical valves are made of synthetic materials. They are reliable, and last a long time. Most mechanical heart valves are made from solid pyrolytic carbon and other materials that have been proven to provide excellent biocompatibility and durability. Because blood tends to stick to mechanical valves and create blood clots, patients with these valves will need to take anticoagulants. On the other hand, Biological valves are made from animal tissue (from a cow or a pig), or taken from the human tissue of a donated heart. Sometimes, a patient's own tissue can be used for valve replacement. Patients with biological valves usually do not need to take anticoagulants. However, these valves are not as durable as mechanical valves, and they may need to be replaced. Biological valves are used most often in elderly patients. The heart surgeon is the one that will decide which of the artificial valve type is the most appropriated to the patient.
In order to get to patient´s heart, one or more incisions must be made in his/her chest. For minimally invasive valve surgery, these incisions are often much smaller than those made for traditional valve surgery. Instead of making a cut down the sternum, the operation is performed through small cuts without opening patient´s ribcage. Special instruments are passed through these cuts and the surgeon looks at a monitor to see inside patient´s chest. One of two types of incisions may be used. Which type surgeon chooses depends on the location of the valve and the method of surgery used. The surgeon will talk with the patient about which incision he/she will receive.
In the traditional incision procedure, the surgeon will make a cut approximately 25cm long, down the middle of the patient´s breastbone (sternum) and will open the ribcage to reach the heart. During valve surgery, patient´s heart must not beat. Medication is used to temporarily stop it. To keep the blood flowing, it is passed through a heart-lung machine. This machine provides oxygen to patient´s blood and pumps the blood back through his/her body. The surgeon may choose to connect your body to the machine through the vessels in the heart or through vessels in the groin. After the heart has been disconnected, the surgeon will remove his/her diseased valve and sew in a prosthetic (artificial) valve. The right-sized replacement valve is selected, positioned in the valve opening, and sewn firmly into place. The incision is then closed. Once the valve surgery is done, the patient’s heart and lungs take over again.
- Anesthesia: In this type of procedure, commonly known as “open heart surgery”, general anesthesia is used. Patients must be careful with the food, cigarettes and alcohol before the surgery. The surgeon will give him/her more specific indications to follow.
- How is the post-surgery process
After the procedure is completed, the patient will be taken to the intensive care unit of the hospital and will be closely monitored for about 24 hours. Once the anesthesia effects are gone, the patient might be connected to machines that record the activity of his/her heart, lungs and other body functions. These might include a ventilator machine to help you breathe.
Medications to counter any pain or discomfort might be provided by the surgeon to the patient. On the other hand, patients may have a catheter to drain urine from him-her bladder into a bag. Patient may also have fine tubes running out from the wound. These drain fluid into another bag and are usually removed a few days after the procedure. The patient will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in his/her legs.
The patient is able to return home after a couple of weeks. The surgeon and nurses last advises might be told the last day at hospital. The wires holding the patient´s sternum together are permanent. Dissolvable stitches will usually disappear in around one to three weeks, but this can take up to six weeks, depending on the type of stitches patient has.
If patient feels pain, analgesics could be used, with previous surgeon´s authorization. The patient’s sternum will take about six weeks to heal but a full recovery can take up to two to three months. After many exams and checkups, the surgeon will tell patient when he/she will be able to return to work. Any type of exercise and sports is suspended until the surgeon determinates the patient has no risk.
The possible complications of this procedure are: negative anesthesia secondary effect, viral or bacteriological infection and body rejection of the valve. However, in the last case, mechanic valves are more biocompatible with the body´s agents than biological ones.
After surgery, patients can return to their normal life in six mouths. Patients that couldn´t make sports before; will be able to practice them. Mechanic valves type are more durable and resistant than biological; this one’s do not require anticoagulants and often adapt better to patient’s valve original size.
The valve could be rejected by the body defend agents. Biological valves do not last very much. Mechanical valves obligate the patient to consume anticoagulation medicine.
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