Heart Valve Surgery
Repair & Replacement

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Valve Functions  |  Types of Disease  |  Causes |  Symptoms |  Diagnosis |  Types of Surgery |  FAQ’s
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Heart valve surgery mostly comprises of Mitral valve and Aortic valve surgery. Sometimes we do tricuspid and pulmonary valve surgery also. It is mostly done as heart valve repair or replacement surgery and performed by a cardiac surgeon. It can be done by three techniques viz; conventional – Open heart surgery, minimal invasive valve surgery, catheter guided procedure.

Heart valve conditions like regurgitation or stenosis can damage the heart leading to heart failure and can be life threatening. Correcting the problem will help to prevent complications and patient can live a healthy normal life.

Overview of Heart Valve Structure & Function

The function of heart valve is to allow one way blood circulation. Mitral valve is bicuspid valve allowing blood flow from left atrium to left ventricle of heart. Aortic valve is tricuspid valve (having three cusps) allowing blood flow from left ventricle to Aorta and to the whole body. These are left sided valves, on right chamber of heart lies Tricuspid valve between right atria and right ventricle. Pulmonary valve is between right ventricle and pulmonary artery allowing blood to flow to lungs for oxygenation.

Types of Heart Valve Disease

There are mainly two structural type of heart valve diseases:

1: Stenotic – valve aperture size becomes narrow leading to obstruction of flow.

Eg: Mitral stenosis, Aortic stenosis

2: Regurgitant:  valve loses its one-way flow direction function. Blood flows in bi-direction. Also call valve leakage in lay man terms.

Eg: Mitral regurgitation, Aortic regurgitation, Tricuspid regurgitation.

Conditions That Require Heart Valve Surgery

  • Mitral valve stenosis
  • Mitral valve regurgitation (degenerative/rheumatic/ischemic)
  • Aortic stenosis
  • Aortic regurgitation
  • Tricuspid stenosis or regurgitation
  • Pulmonary stenosis or regurgitation
  • Sometimes both mitral and aortic valve disease together

Causes of Heart Valve Disease

There are three common causes:

  1. Rheumatic heart disease:  Most common in India. most commonly affected valves are mitral and aortic. This disease affects leaflets of valves leading to either stenosis or regurgitation or both. This is seen mostly in middle age population.
  2. Degenerative heart valve disease:  Mostly seen in elderly people. It leads to calcification of valve leading to stenosis or thinning and damage to valve leading to regurgitation.
  3. Congenital heart disease:  Defects in heart valves by birth or some diseases like bicuspid aortic valve, leads to valve diseases requiring surgery.
  4. Others: Ischemic heart diseases (mostly mitral valve regurgitation), Infective endocarditis, dilated cardiomyopathy etc.

Symptoms and Early Warning Signs of Heart Valve Problems

  • Early warning signs include fatigue, breathlessness.
  • As disease progresses breathlessness increases also called dyspnea on exertion.
  • Chest pain, giddiness, loss of appetite are common as it becomes severe.
  • Patients mostly land up in hospital with heart failure.

Diagnosis of Heart Valve Disease

Clinical – On auscultation we can hear heart murmur. Depending on sound of murmur doctors can make out which valve is affected.

2D Echo – It is nothing but sonography of heart with doppler study. This is best diagnostic tool available for detecting heart valve diseases. We can measure severity of disease. Depending on these findings, treatment is finalized.

Types of Heart Valve Replacement Surgery

Surgery Video (Watch on Youtube): Triple Valve Heart Surgery: Aortic, Mitral Replacement, Tricuspid Repair & Left Lung Bullectomy by Dr. Amjad Shaikh

Open Heart – Surgical Procedure Overview

Pre-op preparation:

  • Preoperative detailed blood investigations will be done, 2D echo and x ray chest will be done. If patient is on blood thinners like acitrom or warfarin or ecosprin, it will be stopped 4 days prior to surgery.
  • Patient can carry normal routine activities prior to surgery.
  • Patient will be admitted one day prior to operation in normal ward.
  • Minimum 6 hours of fasting will be required prior to surgery.

Surgery steps, anesthesia

  • All patients of valve surgery will receive general anesthesia.
  • Central line and radial line will be placed to monitor heart and blood pressure.
  • After cleaning with antiseptic drugs chest is opened through midline of chest by cutting sternum bone.
  • Patients heart is canulated and heart is stopped with cardioplegia solution.
  • Depending on which valve to be replaced heart is opened accordingly and valve gets replaced.
  • Once surgery is done heart starts beating again and sternum is closed.
  • Patient is usually shifted to cardiac ICU post-surgery for monitoring.

Duration and Hospital Stay

  • In normal open heart surgery total hospital stay will be 6 to 7 days.
  • 3 days ICU and 3 to 4 days of ward stay will be needed.
  • Patient usually starts walking on next day of surgery.

Minimally Invasive and Robotic-Assisted Valve Surgery

  • With advance developments, mitral valve and aortic valves are replaced or repaired using minimal invasive surgery either Endoscopic or Robotic assisted.
  • Major advantage is no cutting of bone, minimal scar, less hospital stays and early return to routine life.
  • Young patients specially females will be happier by this procedure as it is cosmetically excellent.

Transcatheter procedures like TAVR (Transcatheter Aortic Valve Replacement):

  • Now we can replace or treat aortic valve without opening chest or heart, by using catheter-based valves.
  • TAVI is most commonly used for Aortic valve stenosis.
  • Indications of TAVI: Severe Aortic stenosis in surgically unfit patients, age more than 70 years, associated diseases like malignancy or COPD.
  • This procedure is carried out in a CATH LAB.
  • Catheter is inserted from femoral artery from leg and valve is deployed under fluoroscopic guidance.
  • No need of general anesthesia in this case.
  • Patient is discharged in 3 days of procedure.

Cons of TAVI Procedure:

1: Cost of valve and procedure is very high compared to normal surgery.
2: Only tissue valve can be used which is used in old patients only.
3: More chances of permanent pacemaker implantation in TAVI compared to routing surgery.

Robotic valve repair (if offered)

  • Mostly used for mitral valve repair surgeries.
  • Robotic hands are used to operate with more precision on accuracy.

Heart Valve Repair vs. Replacement

Indications for repair:

1: Stenotic disease: opening of cuspal fusion surgically done to open up valve.

2: Regurgitation: Valve Leaflets are examined carefully for damage. Corrective surgery of leaflets done by excision and resuturing. Most of the time neo chordee are used with mitral ring for this type of surgery.

Indications for replacement : Damaged leaflets of valve, infective endocarditis, patient not willing for repair as he or she may need replacement surgery in coming years.

Frequently Asked Questions (FAQs) about Heart Valve Surgery

How do I know if I need a mechanical or tissue valve?

It depends on age. If age of patient is less than 60 years, we prefer metallic valve. If more than 60 years Tissue valve is preferred. But if young female who wants kids can go ahead with tissue valve as no need for anticoagulant drugs in tissue valve.

 

Is heart valve surgery open-heart surgery?

Except catheter-based valve surgery like TAVI, all types of valve surgeries are open heart surgery as we need to stop heart and open chamber of heart to repair or replace it.

 

Will I need to take medications after the surgery?

Yes. Some drugs may be required depending on heart condition. Major difference is for anticoagulation drugs. In Metallic valve we need to give that as a rule.

 

How long does a replaced valve last?

Metallic valve is permanent valve. Tissue valve works for 12 to 15 years.

Can you live a normal life after heart valve surgery?

Yes. If surgery is done at right time and heart function is preserved then patient can live a very normal life.

 

What should you avoid after heart valve surgery?

Patient can do all normal activities. Avoid strenuous exercises, certain foods are avoided when patient is on anticoagulation drugs.

 

What are the risks of delaying heart valve surgery?

Most common risk is heart failure which may be fatal. Arrhythmias and sudden deaths are also common in untreated valve conditions.

 

Should I stop any medications before the surgery?

Mostly blood thinners will be stopped 4 days prior to surgery.

 

When can I return to work or drive again after surgery?

In routine open heart surgery patient can return to normal activity after 20 days. Driving can be started after 1 month of surgery. In minimal invasive surgery routine work can be started in 15 days and driving also can be started in 20 days.

 

How often will I need follow-up visits or imaging?

Post surgery visits will be 1 month, 3 month and 6 months. Then once a year. But patient need to remain in contact with doctor every 45 days for PT/INR report. Can be done on telephonic consultation.

 

Are there signs or symptoms I should watch for after surgery?

Breathlessness, pedal edema or bleeding from nose should be monitored.

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