Overview

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 (called anticoagulants) 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.

Traditional heart valve surgery :

During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves. While this approach remains in use, today most patients with isolated valve disease can be treated with minimally invasive techniques.

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

The tricuspid valve :-

The tricuspid valve separates the right atrium from the right ventricle. When the tricuspid valve develops stenosis, increased pressure in the right atrium leads to high pressure in the veins throughout the body, causing edema (swelling) of the liver, abdomen and legs. When tricuspid regurgitation occurs, both the right atrium and right ventricle tend to dilate, reducing the efficiency of both these cardiac chambers.

The pulmonic valve :-

The pulmonic valve separates the right ventricle from the pulmonary artery. With pulmonic stenosis there is increased pressure in the right ventricle. With pulmonic regurgitation there is volume overload of the right ventricle. Either way, the right ventricle can ultimately fail.

The mitral valve :-

The mitral valve separates the left atrium from the left ventricle. Mitral stenosis causes damming up of blood in the left atrium, and ultimately in the lungs. Mitral regurgitation causes dilation of both the left atrium and left ventricle, and can lead to failure of both cardiac chambers. Mitral valve prolapse (MVP) is a common condition that results in one of the leaflets of the mitral valve flopping backwards into the atrium during the contraction of the left ventricle. MVP often involves at least mild regurgitation. Click here for a discussion of MVP.

The aortic valve :-

The aortic valve separates the left ventricle from the aorta. Aortic stenosis causes increased pressure in the left ventricle. (Click here for a complete discussion of aortic stenosis.) Aortic regurgitation causes dilation of the left ventricle. Both of these aortic valve problems can lead to heart failure


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.


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.


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 Valve Surgery :-

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.

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.


After Valve Replacement Surgery :

During the first day or two after valve replacement surgery, tubes placed in the body to help the patient breathe, to monitor pressures in the heart and arteries, and to prevent blood from accumulating in the lungs, are removed. Most patients remain in the hospital for a week after surgery and recovery takes approximately 3 to 4 weeks, after which most patients can resume leisure activities and many return to work. Patients who receive a mechanical valve must continue to take the blood thinner warfarin (Coumadin®) to decrease the risk for blood clot formation on the valve.

Patients with an artificial valve carry an increased risk for developing an infection on the valve. Because the potential for bacteria to enter the bloodstream exists during any invasive procedure, patients who have an artificial heart valve are treated with antibiotics before undergoing any type of invasive procedure (called endocarditis prophylaxis).

Because artificial valves can malfunction, most physicians perform echocardiograms every 6 months or every year to monitor the valve.

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