Heart valve surgery
Definition
Heart valve surgery is a procedure to treat heart valve disease. Heart valve disease involves at least one of the four heart valves not working properly. Heart valves allow blood to flow in the correct direction through your heart.
The four valves are the mitral valve, the tricuspid valve, the pulmonary valve and the aortic valve. Each valve has flaps - called leaflets for the mitral and tricuspid valves and cusps for the aortic and pulmonary valves. These flaps open and close once with each heartbeat. Valves that don't open or close properly disrupt blood flow from your heart to your body.
In valvular heart surgery, your surgeon repairs or replaces the affected heart valves. Many surgical approaches can be used to repair or replace heart valves, including open-heart surgery or minimally invasive heart surgery.
Your treatment depends on several factors, including your age, medical condition, condition of the affected heart valve, and severity of your condition.
Why is it done?
There are two basic types of heart valve defects: a narrowing of a valve (stenosis) and a leak in a valve that allows blood to come back up (regurgitation). You may need heart valve surgery if you have any of these abnormalities and it affects your heart's ability to pump blood.
Your doctor will assess you to determine the most appropriate treatment for your condition. If you have no signs or symptoms, or if your condition is mild, your doctor may suggest monitoring over time. In this case, healthy lifestyle changes and medication can help manage the symptoms.
Eventually, your valve may need to be repaired or replaced. In some cases, doctors recommend heart valve repair or replacement even if you don't have symptoms. If you need heart surgery for another condition, doctors can repair or replace the affected heart valve at the same time.
Your doctor will discuss with you whether heart valve repair or replacement is more appropriate for your condition. Doctors often recommend heart valve repair when possible, as it spares your heart valve and could preserve heart function. But sometimes valve replacement is necessary and is the best option.
Doctors can also assess whether you are a candidate for minimally invasive heart surgery. Your doctor will discuss the benefits and risks of each procedure.
Risks
Possible risks of heart valve surgery include:
Bleeding.
Heart attack.
Infection.
Valve malfunction affecting replaced valves.
Irregular heartbeat (arrhythmia).
Stroke.
Death.
What to expect during surgery
You will be given anesthetics to put you in a sleepy state during the procedure. You will be connected to a heart-lung bypass machine, which allows blood to flow through your body during the procedure.
Heart valve surgery can be performed using standard open-heart surgery, which involves cutting your chest through your breastbone. Minimally invasive heart surgery involves smaller incisions than those used in open-heart surgery.
Minimally invasive heart surgery includes surgery performed using long instruments inserted through one or more small incisions in the chest (thoracoscopic surgery), surgery performed through a small incision in the chest, or surgery performed by a surgeon using a robot (robot-assisted cardiac surgery).
Minimally invasive heart surgery may involve a shorter hospital stay, faster recovery, and less pain than with open heart surgery. Minimally invasive heart surgery should ideally be performed in medical centers that have medical teams experienced in performing these types of procedures.
Heart valve repair
Your doctor may often recommend repairing heart valves when possible, as this preserves your heart valve and may preserve heart function. Heart valve repair surgery may include:
Clogging holes in a valve.
Reconnecting valve flaps (leaflets or cusps).
Removal of excess valve tissue so that the leaflets or cusps can close tightly.
Replacement of the cords that support the valve to repair the structural support.
Separator flaps that merged.
Tightening or reinforcement of the ring around the valve (ring).
Some heart valve repair procedures are performed using a long, thin tube (catheter) and clips, plugs, or other devices, and regular advances in technology make it possible to perform new procedures.
Doctors can treat a valve with a narrowed opening with a catheter procedure called balloon valvuloplasty. A doctor inserts a catheter with a balloon on the end into an artery in your arm or groin and guides it to the affected valve.
The balloon is inflated, which widens the opening of the heart valve. Doctors then deflate the balloon and remove the catheter and balloon.
Heart valve replacement
If your heart valve cannot be repaired and a catheter-based procedure is not possible, the valve may need to be replaced. To replace a heart valve, your doctor removes the heart valve and replaces it with a mechanical valve or one made from cow, pig, or human heart tissue (biological tissue valve).
Biological valves often need to be replaced, as they degenerate over time. If you have a mechanical valve, you will need to take blood thinners for the rest of your life to prevent blood clots. Doctors will discuss the risks and benefits of each type of valve with you.
A minimally invasive catheter procedure can be used to replace some heart valves. For example, a catheter procedure could be performed to insert a replacement valve into a biological replacement valve in the heart that is no longer functioning properly.
Results
After heart valve surgery, you may be able to resume your daily activities, such as working, driving and exercise. Your doctor will discuss with you when you can resume your activities. You will usually need to take certain medications.
You will need to attend regular follow-up appointments with your doctor. You may have several tests to assess and monitor your condition.
Your doctor might tell you how to make changes to your healthy lifestyle — including physical activity, healthy eating, stress management, and smoking prevention — to keep your heart working well.
Your doctor may recommend that you participate in Cardiac Rehabilitation - an education and exercise program designed to help you recover from heart surgery and improve your general and cardiovascular health.