Heart Valve Repair or Replacement
Heart Valve Repair or Replacement
What is it?
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.
How does it work?
Both valve repair and replacement are typically open-heart surgeries. Minimally invasive types of surgery may be another option.
Reasons for Valve Repair or Replacement
Surgery may be required for patients with valve disease when medicine does not cure the condition. 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.
Surgery is required for mitral valve prolapse when severe mitral valve regurgitation is present and there is atrial fibrillation, elevated blood pressure in the lungs, mild to sever left ventricular dysfunction. Also, surgery is performed when there are symptoms of heart failure or when ejection fraction rates drop to a dangerous low.
The decision between repairing or replacing the valve depends on the type of damage to the mitral valve. But replacement is usually preferred for people who have a hard, calcified mitral valve ring (annulus) or widespread damage to the valve and surrounding tissue.
Valve repair can usually be done on congenital valve defects (defects you are born with) and for treating mitral valve defects. Surgeons perform procedures to repair a valve including:
- Commissurotomy – narrowed valves
- Valvuloplasty – strengthens leaflets to provide more support and to let valve close tightly
- Reshaping – cutting a section of a leaflet so valve can close properly
- Decalcification – removes calcium buildup so leaflets close properly
- Patching – covers holes or tears in leaflets with a tissue patch
- Other Repairs – to shorten or replace the cords which give the valves support
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 – made from plastic, carbon or metal
- Biological valves – made from animal or human tissue
What to expect
The surgery can take anywhere from two to four hours or more, depending on the number of valves that need to be repaired or replaced. A hospital stay is required. One week is the usual hospital stay with the first one to three days being in the Intensive Care Unit (ICU).
Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery. After being admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.
A mild tranquilizer, to relax the patient, will be given before entering the operating room. Small metal disks (electrodes) will be attached to the chest. These electrodes are connected to an electrocardiogram machine, which will monitor the heart's rhythm and electrical activity. The patient will then receive a local anesthetic to numb the area where a plastic tube (line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in the vein. The IV line will be used to give the anesthesia during the operation to make the patient sleep during the operation.
After the patient is completely asleep, a tube (ventilator) will be inserted down the windpipe and connected to a machine (respirator), which will take over breathing. Another tube will be inserted through the nose and down the throat, into the stomach. This tube will stop liquid and air from collecting in the stomach, so you the patient will not feel sick and bloated after surgery. A thin tube (catheter) will be inserted into the bladder to collect any urine produced during the operation.
A heart-lung machine is used for most valve operations. Before being hooked up to this machine, a blood-thinning medicine (anticoagulant) will be given to prevent your blood from clotting. Once the heart-lunch machine is hooked up, the 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 the patient disconnected from the heart-lung machine.
After surgery, the remaining hospital stay is for testing and monitoring the patient’s condition.
Once discharged, 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 symptoms of valve failure reoccur. Also, patients with a mechanical valve will need to take a blood-thinning medicine for the rest of their lives.