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, then close tightly to prevent a backflow of blood.
There are 4 valves in the heart:
- Tricuspid
valve
- Pulmonary
valve
- Mitral
valve
- Aortic
valve
Nearly all of these operations are done to
repair or replace the mitral or aortic valves. These valves are on the left
side of the heart, which works harder than the right. They control the flow of
oxygen-rich blood from the lungs to the rest of the body.
Valve Disease
If valve damage is mild, doctors may be able to
treat it with medicines. If damage to the valve is severe, surgery to repair or
replace the valve may be needed.
Valve repair can usually be done on congenital
valve defects (defects you are born with) and has a good success record
with treating mitral valve defects.
Here are some procedures surgeons may use to
repair a valve:
- Commissurotomy, which is used for narrowed
valves, where the leaflets are thickened and perhaps stuck together. The
surgeon opens the valve by cutting the points where the leaflets meet.
- Valvuloplasty, which 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.
- Reshaping, where the surgeon cuts out a
section of a leaflet. Once the leaflet is sewn back together, the valve
can close properly.
- Decalcification, which removes calcium buildup
from the leaflets. Once the calcium is removed, the leaflets can close
properly.
- Repair of structural support, which replaces or shortens
the cords that give the valves support (these cords are called the chordae
tendineae and the papillary muscles). When the cords are the right length,
the valve can close properly.
- Patching, where the surgeon covers holes
or tears in the leaflets with a tissue patch.
What is valve replacement?
Severe valve damage means that the valve will
need to be replaced. Valve replacement is most often used to treat aortic
valves and severely damaged mitral valves. It is also used to treat any valve
disease that is life-threatening. Sometimes, more than one valve may be damaged
in the heart, so patients may need more than one repair or replacement.
There are 2 kinds of valves used for valve
replacement:
- Mechanical valves, which are usually made from
materials such as plastic, carbon, or metal. Mechanical valves are strong,
and they last a long time. Because blood tends to stick to mechanical
valves and create blood clots, patients with these valves will need to
take blood-thinning medicines for the rest of their lives.
- Biological valves, which are
made from animal tissue (called a xenograft) or taken from the human
tissue of a donated heart (called an allograft or homograft). Sometimes, a
patient's own tissue can be used for valve replacement (called an
autograft). Patients with biological valves usually do not need to take
blood-thinning medicines. These valves are not as strong as mechanical
valves, though, and they may need to be replaced every 10 years or so.
Biological valves break down even faster in children and young adults, so
these valves are used most often in elderly patients.
You and your doctor will decide which type of
valve is best for you.
During valve repair or replacement surgery, the
breastbone is divided, the heart is stopped, and blood is sent through a
heart-lung machine. Because the heart or the aorta must be opened, heart valve
surgery is open heart surgery.
What to Expect
The operation will usually be scheduled at a
time that is best for you and your surgeon, except in urgent cases. As the date
of your surgery gets closer, be sure to tell your surgeon and cardiologist
about any changes in your health. If you have a cold or the flu, this can lead
to infections that may affect your recovery. Be aware of fever, chills,
coughing, or a runny nose. Tell the doctor if you have any of these symptoms.
Also, remind your cardiologist and surgeon about
all of the medicines you are taking, especially any over-the-counter
medicines such as aspirin or those that might contain aspirin. You
should make a list of the medicines and bring it with you to the hospital.
It is always best to get complete instructions
from your cardiologist and surgeon about the procedure, but here are some
basics you can expect when you have valve repair or replacement surgery.
Before the Hospital Stay
Most patients are admitted to the hospital the
day before surgery or, in some cases, on the morning of surgery.
The night before surgery, you will be asked to
bathe to reduce the amount of germs on your skin. After you are admitted to the
hospital, the area to be operated on will be washed, scrubbed with antiseptic,
and, if needed, shaved.
A medicine (anesthetic) will make you sleep
during the operation. This is called "anesthesia." Because anesthesia
is safest on an empty stomach, you will be asked not to eat or drink after
midnight the night before surgery. If you do eat or drink anything after
midnight, it is important that you tell your anesthesiologist and surgeon.
If you smoke, you should stop at least 2 weeks
before your surgery. Smoking before surgery can lead to problems with blood
clotting and breathing.
Day of Surgery
Before surgery, you may have an electrocardiogram
(ECG or EKG), blood tests, urine tests, and a chest x-ray to give your surgeon
the latest information about your health. You will be given something to help
you relax (a mild tranquilizer) before you are taken into the operating room.
Small metal disks called electrodes will be
attached to your chest. These electrodes are connected to an electrocardiogram
machine, which will monitor your heart's rhythm and electrical activity. You
will receive a local anesthetic to numb the area where a plastic tube (called a
line) will be inserted in an artery in your wrist. An intravenous (IV) line
will be inserted in a vein. The IV line will be used to give you the anesthesia
before and during the operation.
After you are completely asleep, a tube will be
inserted down your windpipe and connected to a machine called a respirator,
which will take over your breathing. Another tube will be inserted through your
nose and down your throat, into your stomach. This tube will stop liquid and
air from collecting in your stomach, so you will not feel sick and bloated when
you wake up. A thin tube called a catheter will be inserted into your bladder
to collect any urine produced during the operation.
A heart-lung machine is used for all valve
repair or replacement surgeries. This will keep oxygen-rich blood flowing
through your body while your heart is stopped. A perfusion technologist or
blood-flow specialist operates the heart-lung machine. Before you are hooked up
to this machine, a blood-thinning medicine called an anticoagulant will be
given to prevent your blood from clotting. The surgical team is led by the
cardiovascular surgeon and includes other assisting surgeons, an
anesthesiologist, and surgical nurses.
After you are hooked up to the heart-lung
machine, your heart is stopped and cooled. Next, a cut is made into the heart
or aorta, depending on which valve is being repaired or replaced. Once the
surgeon has finished the repair or replacement, the heart is then started
again, and you are disconnected from the heart-lung machine.\
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.
Recovery Time
You 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 you were before the operation. You will have to
rest and limit your activities. Your doctor may want you to begin an exercise
program or to join a cardiac rehabilitation program.
If you have an office job, you can usually go
back to work in 4 to 6 weeks. Those who have more physically demanding jobs may
need to wait longer.
Life after Valve Replacement
Most valve repair and replacement operations are
successful. In some rare cases, a valve repair may fail and another operation
may be needed.
Patients with a biological valve may need to
have the valve replaced in 10 to 15 years. Mechanical valves may also fail, so
patients should alert their doctor if they are having any symptoms of valve
failure.
Patients with a mechanical valve will need to
take a blood-thinning medicine for the rest of their lives. Because these
medicines increase the risk of bleeding within the body, you should always wear
a medical alert bracelet and tell your doctor or dentist that you are taking a
blood-thinning medicine.
Even if you are not taking a blood-thinning
medicine, you must always tell your doctor and dentist that you have had valve
surgery. If you are having a surgical or dental procedure, you should take an
antibiotic before the procedure. Bacteria can enter the bloodstream during
these procedures. If bacteria get into a repaired or artificial valve, it can
lead to a serious condition called bacterial endocarditis.
Antibiotics can prevent bacterial endocarditis.
Patients with mechanical valves say they
sometimes hear a quiet clicking sound in their chest. This is just the sound of
the new valve opening and closing, and it is nothing to be worried about. In
fact, it is a sign that the new valve is working the way it should.
Minimally invasive heart valve surgery is a
technique that uses smaller incisions to repair or replace heart valves. This
means there is less pain. Minimally invasive surgery also reduces the length of
the hospital stay and the recovery time.
Minimally invasive valve surgery can only be
done in certain patients. This type of surgery cannot be done in patients
- With
severe valve damage
- Who
need more than one valve repaired or replaced
- Who
have clogged arteries (atherosclerosis)
- Who
are obese
In some cases, minimally invasive valve surgery
can be done using a robot. Robotic surgery does not require a large incision in
the chest. It is not available at all hospitals, and patients with severe valve
damage cannot have the procedure. The Texas Heart Institute has a robot.
With robotic surgery, the surgeon has a control
console, a side cart with 3 robotic arms, a special vision system, and
instruments. A computer translates the surgeon's natural hand and wrist
movements made on the control console to instruments that have been placed
inside the patient through small incisions. The robot's controls can read even
the tiniest of movements the surgeon makes.
Robotic surgery can reduce the time it takes to
do valve surgery, as well as shorten the hospital stay and recovery time.
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