Aortic Heart Valve Replacement (Heart Valve Disease Treatment)

Heart valve surgery  repairs or replaces diseased heart valves. Blood that flows between different chambers of  heart must flow through a heart valve. Blood that flows out of your heart into large arteries must also flow through your heart valve. These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

There are four heart valves:

• Aortic valve- the most common valve to be replaced

• Mitral valve-the most common valve to be repaired

• Tricuspid valve - rare valve to be replaced or repaired

• Pulmonic valve- rare valve to be replaced or repaired

The surgery is also known by alternative names: Valve replacement; Valve repair; Heart valve prosthesis; Mechanical valves; Prosthetic valves

Procedure:

1. The procedure is performed under general anesthesia.

2. In open heart surgery, the cardiac surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. You will be connected to a heart-lung bypass machine. Your heart is stopped while you are connected to this machine. This machine does the entire work of heart.

3. Minimally invasive valve surgery may use several different techniques,  like Percutaneous surgery (through the skin), Robot-assisted surgery.

4. There may be a possibility to repair the valve, in which case the surgeon may perform the following procedures: 

1. Ring annuloplasty in which the surgeon repairs the ring-like part around the valve by sewing a ring of plastic, cloth, or tissue around the valve.

2. Valve repair in which the surgeon trims, shapes, or rebuilds one or more of the leaflets (laps that open and close the valve) 

When is Valve Replacement surgery Done?

If the heart valve is too damaged, a new valve is required. The main types of new valves consist of: 

• Mechanical -- are made of man-made materials, like metal (stainless steel or titanium) or ceramic. These valves do last the longest, but the patient is required to take blood-thinning medicine, for the rest of life.

• Biological -- are made of human or animal tissue. These valves last 12 -15 years, but then patient may not need to take blood thinners for life.

• In some cases, surgeons can use the patient’s own pulmonic valve to replace the damaged aortic valve. The pulmonic valve is then replaced with an artificial valve ( the Ross Procedure). This procedure may be useful for people who do not want to take blood thinners for the rest of their life. However, the new aortic valve does not last very long and may need to be replaced again by either a mechanical or a biologic valve.

Why the Procedure is Performed? 

• if a valve that does not close all the way allows blood to leak backwards (regurgitation)

• if  valve that does not open fully limits forward blood flow (stenosis)

• if defects in the heart valve are causing angina (chest pain), shortness of breath, fainting spells, or heart failure

• If the reports reveal changes in heart valve seriously affecting  heart function

• If the doctor recommends replacing or repairing a damaged heart valve simultaneously while undergoing open heart surgery such as a coronary artery bypass graft surgery (CABG)

• If the heart valve has been damaged by endocarditis (infection)

• If the patient has received a new heart valve in the past and it is not working well, or has other problems such as blood clotting, infection, or bleeding

Which heart valve problems are treated with surgery?

• aortic insufficiency

• aortic stenosis

• congenital heart valve diseases

• acute mitral regurgitation 

• chronic mitral regurgitation 

• mitral stenosis

• mitral valve prolapse

• pulmonary valve stenosis

• tricuspid regurgitation

• tricuspid valve stenosis

Risks

• heart attack

• heart failure

• bleeding needing reoperation

• heart rupture

• arrhythmia (Irregular heartbeat)

• kidney failure

• post-pericardiotomy syndrome (mild fever and chest pain that can last up to 6 months)

• stroke or other temporary or permanent brain injury

• infection ( treatable with antibiotics, medication or surgery)

• issues with the breast bone healing

• temporary confusion after surgery due to the heart-lung machine

• death

Before the Procedure

Preparation for valve replacement surgery depends on the kind of valve surgery being done:

• Aortic valve surgery - minimally invasive

• Aortic valve surgery - open

• Mitral valve surgery - minimally invasive

• Mitral valve surgery - open

After the Procedure

The recovery after the procedure too shall depend on the type of valve surgery you are having:

• Aortic valve surgery - minimally invasive

• Aortic valve surgery - open

• Mitral valve surgery - minimally invasive

• Mitral valve surgery - open

The average hospital stay is 5-7 days. Full recovery may take a few weeks to couple of  months, depending on your health before surgery.