Heart Valve Surgery

Jai Ganesh · Yesterday 22:45:10

Heart Valve Surgery

Gist

How is heart valve surgery done?

The surgeon makes a long cut down the centre of your chest, through your breastbone. Your heart is connected to a machine to keep blood flowing around your body during the operation (heart-lung bypass machine). The surgeon cuts into your heart to reach the damaged valve.

Can you walk after heart valve surgery?

People are usually practicing very basic self-care and are encouraged to get up, to breathe deeply and to resume eating, drinking and walking as soon as possible after surgery.

Summary:

What is heart valve surgery?

Heart valve surgery and procedures are performed to repair or replace a valve in the heart that is not working properly because of valvular heart disease (also called heart valve disease). Heart valve surgery is open-heart surgery through the breastbone, into the chest. It is a major operation that can last two hours or longer and recovery often takes several weeks. There are newer, less invasive procedures suitable for some types of valvular heart disease, but they are only done at certain hospitals.

Why is it done?

In a healthy heart, valves control the flow of blood by making it move in one direction through the heart and the body. If a valve is not working correctly, blood flow and the delicate network of blood vessels that carry oxygen throughout the body are affected.

If your valve problem is minor, your doctor may monitor your symptoms or treat you with medication. If your condition is more serious, surgery is usually required to repair or replace the valve to prevent any lasting damage to your heart valve and your heart.

Heart valve surgery and procedures are performed to repair or replace a valve in the heart that is not working properly because of valvular heart disease (also called heart valve disease). Heart valve replacement surgery is open-heart surgery through the breastbone, into the chest. It is a major operation that can last two hours or longer and recovery often takes several weeks. There are newer, less invasive procedures suitable for some types of valvular heart diseases.

In a healthy heart, valves control the flow of blood by making it move in one direction through the heart and the body. The valve can either become stenotic, which means it is narrowed and thus does not allow the blood to flow smoothly from one chamber to another or it starts leaking which hampers the forward flow of blood.

If your valve problem is minor, your doctor may monitor your symptoms or treat you with medication. If your condition is more serious, surgery is usually required to repair or replace the valve to prevent any lasting damage to your heart valve and your heart.

What is Done?

Depending on the problem, there are several different procedures for repairing or replacing valves.

1. Surgical Valve Repair

Surgical procedures are generally used for problems with the mitral or tricuspid valves.

2. Commissurotomy

It is a treatment for a tight valve. The valve flaps (leaflets) are cut to loosen the valve slightly, allowing blood to pass easily.

3. Annuloplasty

It is done for a leaky valve. There is a ring of fibrous tissue at the base of the heart valve called the annulus. To repair an enlarged annulus, sutures are sewn around the ring to make the opening smaller. Or, a ring-like device is attached around the outside of the valve opening to support the valve so it can close more tightly.

4. Valvulotomy

It is a procedure to enlarge narrowed heart valves. It can also be done with the help of a balloon.

5. Non-Surgical Valve Repair

Percutaneous or catheter-based procedures are done without any incisions in the chest or stopping the heart. Instead, a thin flexible tube called a catheter is inserted into a blood vessel in your groin or arm and then threaded through the blood vessels into your heart. Percutaneous or balloon valvuloplasty/valvotomy is used for stiffened or narrowed (stenosed) pulmonary, mitral, or aortic valves. A balloon tip on the end of the catheter is positioned in the narrowed valve and inflated to enlarge the opening. Percutaneous mitral valve repair methods – such as edge-to-edge repair – can fix a leaky mitral valve in a patient who is considered at high risk for surgery. A catheter holding a clip is inserted into the groin and up into the left side of the heart. The open clip is positioned beyond the leaky valve and then pulled back so it catches the flaps (leaflets) of the mitral valve. Once closed, the clip holds the leaflets together and stops the valve from leaking.

Details

Heart valve surgery repairs or replaces a valve that’s too narrow or doesn’t close right. Valves need to work efficiently to help blood flow the right direction through your heart. Heart valve surgery options include open, minimally invasive or through vein access to your heart. It takes one or two months to recover, depending on the surgery.

Overview:

What is heart valve surgery?

Heart valve surgery is an operation that fixes or replaces one or more of the four valves in your heart. Your valves, located between your heart’s four chambers, keep your blood moving the right way. Valves act like doors that open and close with each heartbeat, letting blood flow in and out of the chambers. When valves are working right, your blood should flow through your heart in one direction each time your heart beats.

Your four heart valves are:

* Tricuspid, between your right upper and lower chambers.
* Pulmonary, between your right ventricle (lower chamber) and your pulmonary artery.
* Mitral, between your left upper and lower chambers.
* Aortic, between your left ventricle (lower chamber) and your aorta.

Some of the blood may go back to the chamber or room it just left. Other times, a valve may become narrow, which may prevent blood from moving forward. This is a problem because it keeps your heart from working efficiently. Although heart valve surgery may make you feel fearful, it helps your heart work better. And if your heart’s working better, you’ll feel better, too.

Types of heart valve surgery

The type of heart valve surgery you have will depend on several factors. Your provider will consider:

* Your heart’s structure.
* Your age.
* Other medical conditions you may have.
* Your lifestyle.

Tests will tell your healthcare provider the location, type and extent of your valve disease. Your heart valve issue may have started at birth, or you may have developed a leak, stiffness or narrowing in your valve. The test results help determine the best type of procedure for you.

Your cardiac surgeon can combine valve surgery with other heart surgeries. Examples include surgeries that involve more than one valve procedure and combining heart valve surgery with:

* Bypass surgery.
* Aortic aneurysm surgery.
* Surgery to treat atrial fibrillation.

Heart valve repair surgery

A repair surgery fixes the damaged or faulty valve while preserving much of your own tissue. Surgeons repair mitral valves more than the other valves, but repair surgery can also treat problems with the aortic and tricuspid valves.

Heart valve replacement surgery

Heart valve replacement surgery removes the faulty valve and replaces it with a biological (pig, cow or human tissue) or mechanical (metal or carbon) valve. All valve replacements are biocompatible. That means your immune system won’t reject your new valve. Replacement options include the Ross procedure and minimally invasive procedures like TAVR.

Can a heart valve repair itself?

No, a heart valve can’t repair itself. Valve disease doesn’t go away. It gets worse with time. As the disease gets worse, you’ll have more symptoms and your overall health will suffer. These changes often happen slowly, but they can also occur very quickly.

Depending on the type and extent of valve disease you have, medication may help with symptoms for the short term. Surgery is the only effective long-term solution. Your healthcare provider will help determine when it’s time for surgery.

When is heart valve surgery necessary?

You’ll most likely need heart valve surgery if medicine doesn’t help anymore for symptoms like:

* Chest pain.
* Difficulty breathing.
* Fainting.

Treatment Details:

How should I prepare for heart valve surgery?

You may have tests the day before your surgery. These may include:

* Chest X-ray.
* Echocardiogram.
* Electrocardiogram (EKG).
* CT (computed tomography) scan.
* Cardiac catheterization.
* Blood tests.

Check with your healthcare provider about which medications you can take before surgery. Don’t eat or drink anything after midnight the day of your surgery.

On the day of your procedure, wear loose, comfortable clothes and shoes that are easy to put on. If you wear a bra, you may want to bring one that’s easy to put on without raising your arms. The person who brings you to the hospital can hold on to these items for you during surgery.

Before your surgery, a healthcare provider will shave and clean the area where your surgeon will be working.

What happens during valve surgery on your heart?

During heart valve surgery, a provider will:

* Give you medicine through an IV in your arm or hand so you can sleep deeply and painlessly.
* Use the smallest incision they can for your surgery.
* Set up a machine to take over for your heart and lungs during surgery.
* Repair or replace your heart valve.
* Restart your heart.
* Close your chest.

Heart valve surgery options include:

* Traditional or open-heart surgery: An incision (6 to 8 inches) through your breastbone.
* Minimally invasive heart valve surgery: A smaller incision (3 to 4 inches or smaller). Techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery.
* Transcatheter: Your provider will put a catheter into a larger artery, like your femoral artery in your groin, and do the work without cutting your chest.

How long does this procedure take?

Open-heart surgery for a heart valve replacement can take two to five hours. Repairs or minimally invasive procedures may take less time.

What happens after heart valve surgery?

After surgery, your healthcare team may move you to an intensive care unit (ICU) where they can monitor you closely. After that, you’ll be in a regular room. You may be in the hospital for five to seven days.

Machines connected to you will monitor your blood pressure and heart rate. You may have tubes coming out of your chest to drain fluids.

Your provider will encourage you to eat, drink and walk as soon as you can after surgery. You can start with short walks around your room or down the hall and increase your distance little by little.

Your provider may sign you up for cardiac rehab, a carefully monitored exercise program.

Risks / Benefits:

What are the benefits of heart valve surgery?

Heart valve surgery can ease your symptoms, improve your life expectancy and help prevent death.

The potential advantages of heart valve repair vs. heart valve replacement surgery are:

* Lower risk of infection.
* Less need for lifelong anticoagulant (blood thinning) medication.
* Valve surgeries, including heart valve repair and replacement, are the most common minimally invasive procedure.

The benefits of minimally invasive surgery include:

* Lower chance of infection.
* Less bleeding and trauma.
* Shorter hospital stay.
* Shorter recovery.
* Improved cosmesis (appearance) and smaller wounds.

What are the risks or complications of heart valve surgery?

Any surgery involves risks. Heart valve surgery risks may include:

* Heart attack.
* Heart failure.
* Abnormal heart rhythm — you may need a pacemaker.
* Stroke.
* Blood clots.
* Infection.
* Bleeding.

Risks are related to your age, other medical conditions you may have and how many procedures you have in a single operation. Your cardiologist and surgeon will talk to you about these risks before your surgery.

If you’ve had a valve fixed or replaced, you may be at a higher risk of getting infective endocarditis. But this can also happen with an unrepaired faulty valve. In certain cases, your healthcare provider may prescribe antibiotics to keep you from getting endocarditis from some types of dental work. You can reduce the risk of endocarditis yourself by taking good care of your teeth.

Recovery and Outlook:

How long is recovery after heart valve surgery?

Heart valve surgery recovery takes about four to eight weeks. But your recovery time may be shorter if you had minimally invasive surgery or surgery through a vein.

The way you feel after surgery depends on:

* Which valve was repaired or replaced.
* Your overall health before the surgery.
* Which method your provider used to get to your heart (large incision, small incision or through a vein).
* How the surgery went.
* How well you take care of yourself after surgery.

Caring for yourself after surgery

Recovery after heart valve surgery takes time. Be kind to yourself. Here are some tips:

* Go to your follow-up appointments during recovery so your provider can monitor your progress.
* Don’t take on more than you can handle. You can expect to tire easily for the first three weeks after surgery.
* Don’t drive for a few weeks after surgery.
* Don’t handle anything that weighs more than 15 pounds for the first six to eight weeks after surgery.
* Talk to your provider about when you can go back to work. It’s usually six to 12 weeks after surgery.

What is the survival rate following heart valve surgery?

A study found that people who were more physically active in the year after surgery had a lower risk of death than those who didn’t exercise much. The death rate ranges from 0.1% to 10% depending on the operation and a person's overall health.

When To Call the Doctor:

When should I call my healthcare provider?

Contact your provider if:

* You have chest pain or pain near your incision.
* You feel depressed. This can happen after surgery and can make your recovery take longer.
* You have a fever, which can be a sign of infection.
* You gain more than 5 pounds, which may mean you’re retaining fluid.

Additional Information:

Overview

Heart valve surgery is a procedure to treat heart valve disease. Heart valve disease happens when at least one of the four heart valves is not working properly. Heart valves keep blood flowing in the correct direction through the heart.

The four heart 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 should open and close once during each heartbeat. Valves that don't open and close properly change blood flow through the heart to the body.

In heart valve surgery, a surgeon repairs or replaces the damaged or diseased heart valve or valves. Methods to do this may include open-heart surgery or minimally invasive heart surgery.

The type of heart valve surgery needed depends on age, overall health, and the type and severity of heart valve disease.

Types

* Annuloplasty
* Valvuloplasty

Why it's done

Heart valve surgery is done to treat heart valve disease. There are two basic types of heart valve disease:

* A narrowing of a valve, called stenosis.
* A leak in a valve that allows blood to flow backward, called regurgitation.

You might need heart valve surgery if you have heart valve disease that affects your heart's ability to pump blood.

If you don't have symptoms or if your condition is mild, your healthcare team might suggest regular health checkups. Lifestyle changes and medicines might help manage symptoms.

Sometimes, heart valve surgery may be done even if you don't have symptoms. For example, if you need heart surgery for another condition, surgeons might repair or replace a heart valve at the same time.

Ask your healthcare team whether heart valve surgery is right for you. Ask if minimally invasive heart surgery is an option. It does less damage to the body than does open-heart surgery. If you need heart valve surgery, choose a medical center that has done many heart valve surgeries that include both repair and replacement of the valve.

Risks

Heart valve surgery risks include:

* Bleeding.
* Infection.
* Irregular heart rhythm, called arrhythmia.
* Problem with a replacement valve.
* Heart attack.
* Stroke.
* Death.

How you prepare

Your surgeon and treatment team discuss your heart valve surgery with you and answer any questions. Before you go to the hospital for heart valve surgery, talk with your family or loved ones about your hospital stay. Also discuss what help you'll need when you come home.

Food and medicines

Before you have heart valve surgery, talk to your care team about:

* Any medicines you regularly take and whether you can take them before your surgery.
* Allergies or reactions you've had to medicines.
* When you should stop eating or drinking the night before or the morning of the surgery.

Clothing and personal items

If you're having heart valve surgery, your treatment team might suggest that you bring certain items to the hospital, including:

* A list of your medicines.
* Eyeglasses, hearing aids or dentures.
* Personal care items, such as a brush, a comb, a shaving kit and a toothbrush.
* Loose, comfortable clothing.
* A copy of your advance directive. This is a legal document. It includes instructions about the kinds of treatments you want — or don't want — in case you become unable to express your wishes.
* Items that help you relax, such as portable music players or books.

During heart valve surgery, do not wear:

* Contact lenses.
* Dentures.
* Eyeglasses.
* Jewelry.
* Nail polish.

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Heart Valve Surgery

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