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valve Repair

Heart valve surgery is used to repair or replace diseased heart valves.

Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must flow through a heart valve.

These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

There are four valves in your heart:

  • Aortic valve
  • Mitral valve
  • Tricuspid valve
  • Pulmonary valve

Description

Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain.

In open surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.

Minimally invasive valve surgery is done through much smaller cuts than open surgery. There are several different techniques used:

  • Laparoscopy or endoscopy
  • Percutaneous surgery (through the skin)
  • Robot-assisted surgery

If your surgeon can cover your aortic valve, you may have:

  • Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.
  • Valve repair -- The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve.

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one into place. There are two main types of new valves:

  • Mechanical -- made of man-made materials, such as cloth, metal (stainless steel or titanium), or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
  • Biological -- made of human or animal tissue. These valves last 12 - 15 years, but you may not need to take blood thinners for life.

Why the Procedure is Performed

You may need surgery if your valve does not work properly.

  • A valve that does not close all the way will allow blood to leak backwards. This is called regurgitation.
  • A valve that does not open fully will restrict blood flow. This is called stenosis.

You may need heart valve surgery for these reasons:

  • Changes in your heart valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
  • Tests show that the changes in your heart valve are beginning to seriously affect your heart function.
  • Your doctor wants to replace or repair your heart valve at the same time as you are having open heart surgery for another reason.
  • Your heart valve has been damaged by infection of the heart valve (endocarditis).
  • You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.

Some of the heart valve problems treated with surgery are:

  • Aortic insufficiency
  • Aortic stenosis
  • Mitral regurgitation - acute
  • Mitral regurgitation - chronic
  • Mitral stenosis
  • Mitral valve prolapse
  • Pulmonary valve stenosis
  • Tricuspid regurgitation

Risks:

The risks for any anesthesia include:

  • Problems breathing
  • Reactions to medications

The risks for any surgery include:

  • Bleeding
  • Blood clots in the legs that may travel to the lungs
  • Infection, including in the lungs, kidneys, bladder, chest, or heart valves

The risks for cardiac surgery include:

  • Death
  • Heart attack
  • Irregular heartbeat (arrhythmia)
  • Kidney failure
  • Post-pericardiotomy syndrome -- low-grade fever and chest pain that can last for up to 6 months
  • Stroke
  • Temporary confusion after surgery due to the heart-lung machine

It is very important to take steps to prevent valve infections. You may need to take antibiotics before dental work and other invasive procedures.

Heart Valve Repair, Replacement and Surgery

Blood is pumped through the heart in one direction and one direction only. Simply put, the four heart valves located in the heart ensure that the blood is flowing in the proper direction. Each time the heart beats, the valves open and close to ensure that the correct amount of blood enters the heart and the correct amount leaves the heart. Sometimes these heart valves can malfunctions. In cases where the valves are not working properly they will either not open up wide enough or not close completely. When one of these malfunctions is detected it is necessary to have surgery in many cases. The surgery is aimed at either repairing the already existing heart valve. This is known as heart valve repair surgery. If the existing valve can't be repaired then it will need to be replaced. This is known as heart valve replacement surgery.

Heart Valve Repair

Heart valve repairs are usually done on patients who have had a damaged valve since birth. The success rate when operating on people who have these circumstances is very high.

  • Commissurotomy  is a surgery that is aimed at repairing a heart valve. During this surgery the doctor cuts the points where the leaflets of the valve meet. Most often this is done on patients that have narrow valves.
  • Valvuloplasty  is performed in order to strengthen the valve and provide it more support so that it can close completely. The surgery will have to do with placing a ring around the outside of the valve to provide support and make it stronger.
  • Reshape leaflets  If one of the leaflets is floppy, a segment may be cut out and the leaflet sewn back together, allowing the valve to close more tightly. This procedure is called quadrangular resection
  • Chordal transfer  If a leaflet of the mitral valve has prolapse (floppy; lacking support), the chordae are transferred from one leaflet to the other. Then, the leaflet where the chordae was removed is repaired by quadrangular resection.
  • Decalcification  This is where calcium deposits that have built up on the valve are removed. Once the calcium is removed the valve will function properly.
  • Patching  is when a doctor repairs a tear in the valve by covering it with body tissue. This is helpful if slight damage has occurred to the valve before birth.

The advantages of heart valve repair surgery include:

  • decreased need for life-long blood thinner (anticoagulant) medication
  • preserved heart muscle strength

Heart Valve Replacement

If you have severe damage to a valve it will need replaced. Heart valve replacements are reserved for people who are in danger of their condition being life threatening.

Mechanical valves are made from plastic, carbon or metal. These valves are strong and durable and are meant to last for life. The downside of a mechanical valve is that blood tends to stick to it which can cause a clot over time. In order to combat the blood clots, people with mechanical valves will have to take a blood thinning medicine.

Biological valves are made from animal tissue or human tissue from a donated heart. These valves are as strong as mechanical valves but may need replaced every ten years. Also, people who have biological valves will not have to take blood thinning medication.

What Are the Pros and Cons of Each Type of Heart Valve?

  • Mechanical heart valves  The advantage to mechanical heart valves is their sturdiness. They are designed to last for many years. There are also drawbacks. Due to the artificial material involved, people who receive these valves will need to take life-long blood-thinner medication (anticoagulants) to prevent clots from forming in the mechanical valve. These clots can increase the risk for a stroke. Also, some people report a valve ticking sound that is usually not bothersome. It is the sound of the valve leaflets opening and closing.
  • Biological heart valves  The advantage of biological heart valves is that most people do not need to take life-long blood thinners, unless they have other conditions (such as atrial fibrillation) that warrant it. Biologic valves, traditionally, were not considered as durable as mechanical valves, especially in younger people. Previously available biologic valves usually needed to be replaced after about 10 years. However, some studies show that some biologic valves may last at least 17 years without decline in function. This represents a new milestone in the durability of biologic valves.
  • Homograft heart valves  Homografts are ideal heart valves for aortic valve replacement, especially when the aortic root is diseased or there is infection. The heart's natural anatomy is preserved and patients do not need to take life-long blood thinners. However, the limited availability is a drawback in some settings.

Outlook (Prognosis)

The success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.

Mechanical heart valves do not often fail. Artificial valves last an average of 8 - 20 years, depending on the type of valve. However, blood clots can develop on these valves. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.

The clicking of mechanical heart valves may be heard in the chest. This is normal.