Heart valve replacement surgery

 

Valve replacement surgery is a safe and effective way to treat patients with diseased or non-functional heart valves. In the last 40 years, new surgical and valve technologies have provided a wide array of durable valves and improved surgical techniques, and patients are doing better than ever before.

 

The heart and valves

 

The heart has four valves that open and close to allow the movement of blood between the chambers of the heart.  They are:

 

·        the aortic valve, which regulates blood flow between the heart and aorta

·        the mitral valve, which regulates flow between the left atrium and left ventricle

·        the pulmonary valve, which regulates flow between the heart and lungs

·        the tricuspid valve, which regulates flow between the right atrium and right ventricle

 

When a valve or valves become diseased, the pumping ability of the heart decreases.

 

Valve disease

 

There are two common causes of heart valve disease:

 

1.      The valve opening becomes narrow, a condition called stenosis

2.      The valve does not close completely, called insufficiency or regurgitation

 

When a valve narrows, the heart’s pumping ability is diminished. This can lead to several problems. A narrowed mitral valve, for example, which regulates blood flowing from the left atrium to the left ventricle, will not allow enough blood to fill the ventricle. This, in turn, limits the amount of blood that can flow out to the body through the aorta.

 

When a valve does not close completely, blood can flow back into the chamber it came from. Using the example above, if the mitral valve does not close completely, blood can flow from the left ventricle back into the left atrium. This condition, known as regurgitation, can put increased pressure on the left atrium and lungs.

 

Diagnosis of valve disease

 

Cardiologists can detect heart valve problems by evaluating symptoms, listening the to the heart and conducting other diagnostic tests, including echocardiography (an ultrasound of the heart).

 

Valve disorders may have a variety of symptoms. These include:

 

·        chest pain or tightening

·        shortness of breath

·        fatigue

·        inability to perform everyday activities

·        inability to sleep

·        swollen extremities (ankles or wrists)

·        abnormally large abdomen

 

Treatment of valve disease

 

There are three primary treatment options for patients with heart valve disease:

 

1.      medication

2.      surgical valve repair

3.      surgical valve replacement

 

The cardiologist and cardiothoracic surgeon consider a variety of factors in selecting the right approach for treatment. Patients are encouraged to discuss treatment options with their physician.

 

Medications are generally used to improve the heart’s pumping ability, which in turn can improve the symptoms of valve disease.

 

Cardiothoracic surgeons can repair damaged heart valves. In many cases, a simple device called an annuloplasty ring is used to support the newly repaired valve.

 

For most patients, however, repair is not possible, or would only result in short-term benefit. In these cases, the surgeon chooses to replace the valve.

 

Types of replacement valves

 

There are two main types of prosthetic valves used in valve replacement surgery:

 

1.      bioprosthetic or “tissue” valves, either stentless or stented

2.      mechanical valves

 

Stentless tissue valves are most similar to the heart’s natural valves. Composed of either human or animal tissue, the valves are specially treated to increase their durability. By not having a stent (a plastic or metal frame that supports the tissue), the valve can provide improved blood flow.

 

Stented valves, made from animal tissue, are also specially treated to provide increased durability. The tissue is supported by a cloth-covered metal or plastic frame.

 

Mechanical valves, made from metal or plastic, are extremely durable.

 

Choosing the right valve

 

After a careful diagnosis of valve disease, the surgeon will discuss which type of replacement valve will be most appropriate. Many factors are considered when making this decision, including:

 

·        presence of other heart disease

·        presence of other diseases

·        your lifestyle

·        level of physical activity

·        whether the patient can tolerate daily anticoagulant medication (coumadin, for example), which prevents blood clots from forming on the replacement valve (Anticoagulant medication is usually prescribed for all patients receiving a mechanical valve, and for some patients receiving tissue valves.)

·       women of childbearing age, with the desire to have future children (anticoagulant medication may be difficult to manage during pregnancy)

 

Surgical approaches

 

Valve replacement procedures have been performed safely and effectively for more than 40 years. Advances in surgical techniques and medical instrumentation have led to new, minimally invasive surgery. Patients may wish to discuss the opportunity for minimally invasive surgery with their surgeon.

 

The difference between minimally invasive and conventional surgical procedures lies in the location and size of the incision that the surgeon must make in order to reach the valve. A smaller, minimally invasive procedure may reduce the chance for infection, speed healing and be less painful during recovery. It is also cosmetically appealing because it leaves a smaller scar. It is important to note, however, that a small incision is not appropriate for every patient.

 

Regardless of the surgical approach used to reach the valve, the procedure will require the use of a heart-lung machine (also called cardio-pulmonary bypass), that takes over the function of your heart during the operation.

 

Before surgery

 

As with any major medical procedure, patients may feel anxious about your valve replacement surgery. To ease concerns, you are encouraged to ask questions and discuss the operation with the surgical team. An informed patient is more likely to have a positive attitude about their surgery, and that positive attitude may help facilitate a speedy recovery.

 

During surgery

 

The typical valve replacement procedure will last a minimum of two hours, and is often longer. Patients are under general anesthesia throughout the operation.

 

After surgery

 

After the operation, patients are taken from the operating room to the intensive care unit (ICU), where they remain for a few hours or overnight. Most patients will be drowsy immediately after the operation, as the anesthesia wears off.

 

The ICU staff will constantly monitor heart rate, blood pressure and temperature. Nurses also assist patients in turning, coughing and deep breathing to speed recovery. Family and friends are usually allowed to visit during this time – the ICU staff will inform guests regarding appropriate visiting hours.

 

When constant monitoring is no longer necessary, patients are moved to a “step-down” or other unit in the hospital. Many patients report feeling surprised at how quickly they feel better, and are often walking 2-3 hours after the operation. The total hospital stay may be as short as one day, or as long as seven days.

 

Making a full recovery

 

Most patients will not need to change their lifestyle dramatically after surgery. In fact, most feel much better, physically, after the operation because the symptoms of valve disease have been eliminated. Most symptoms will improve gradually in the first few weeks after the operation, with more changes weeks and months into recovery.

 

Following surgery, patients are prescribed an exercise regimen and recommended diet.

 

Patients may also experience unexpected feelings after the operation. They may include:

 

·        depression, which could last as long as a few weeks

·        elation

·        loss of appetite

·        disturbed vision

·        disturbed sleep

·        swollen legs

 

Patients should understand that these feelings are common, and they are not the only one experiencing them.