A Quick Guide to Valve Replacement Surgery
- There are 4 valves in heart, on left mitral and aortic valve while on right tricuspid and pulmonary valve.
- Generally left sided valves are more commonly diseased requiring either repair or replacement.
- Mitral valve in India and other developing countries is more commonly damaged by infection called Rheumatic heart disease. Aortic valve on the other hand is damaged also by age related changes.
What are symptoms of heart valve disease ?
- Patient slowly develop breathlessness on walking, increased heart beating often irregular along with swelling of feet and difficulty in lying down in advanced stages.
- Chest X ray and ECG can suggest heart valve disease but definitive diagnosis is made by echocardiography.
What are common heart valve problems ?
- Stenosis of Mitral valve: Damaged valve blocks flow of blood to left ventricle and there is buildup of blood in the lungs. So patient experiences weakness due to less blood to body and breathlessness due to accumulation of blood in lungs
- Mitral valve regurgitation: Leakage of mitral valve leads to enlargement of heart chambers. Patient experiences fast heart beat, often irregular along with breathlessness and tiredness.
- Stenosis of the aortic valve: Stenosis involves the narrowing or obstruction of the aortic valve, which makes it is more difficult for the heart to pump blood into the aorta. Typically patient experience chest pain on doing work with episodes of loss of consciousness in advanced stages.
- Aortic valve regurgitation: This happens when one-way direction of blood from the ventricle to the aorta is disturbed and blood flows backward through the aortic valve into the left ventricle. Patient experiences difficulty in lying down and feel breathless on exertion.
When is surgery recommended for heart valve disease ?
- For every valve disease, there are guidelines issued from international cardiac surgery councils which are updated every two yearly. Based on these guidelines surgery is recommended when medical management is insufficient for symptom relief.
- On echocardiography we assess the status of valves, heart function and pressures of lung. These measurements help us in determining the need for surgery.
What are different artificial valve options for such disease ?
- Based on the type of artificial heart valve, we have mainly two options:- mechanical and tissue valve.
- Mechanical valves are generally used for younger patients requiring heart valve surgery. These valves require life long blood thinning medications like acitrom or warfarin but they have advantages of low failure rate and very low chances of reoperation.
- Tissue valves are preferred for older age group patients or females expecting pregnancy in the near future. These valves are made from bovine or porcine pericardium and don’t require blood thinning medications after 3 months of surgery. Only disadvantage here is the limited life of these valves and need for reoperation after a certain number of years.
Is replacement of the natural heart valve always necessary, can’t it be just repaired ?
- Yes, it’s possible to repair heart valves depending upon their anatomy and type of disease. In general 30-40% mitral valves and only 10% aortic valves are repairable.
- Repair has the advantage of not requiring blood thinning medications but reoperation is mostly required after 10-15 years.
- Heart valve repair surgery is technically challenging and not all surgeons perform this surgery, but successful repair if possible, is always better than artificial heart valve.
Can heart surgery be done with minimally invasive technique, without cutting any bone ?
- Yes, with advances of surgical technique and development of newer instruments, now heart operations can be done without cutting any bone.
- In this novel technique a small surgical cut is given below the breast and operation is performed by gently spreading the ribs. This technique is called MICS i.e Minimally Invasive Cardiac Surgery.
- Patients have better recovery after MICS surgery and they return earlier to work. There are no restrictions of lying straight and can start weight bearing faster.
What are medications required after heart valve surgery ?
- After discharge from hospital, few antibiotics are required for 5 days along with mild pain killers.
- Blood thinning medications are needed for mechanical valves for the whole life and only for 3 months after repair surgery or tissue valve placement.
- Depending upon heart function and lung pressures few medications might be required for a few months.