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Valve Repair or Replacement

Heart valves play a very important role as the blood is pumped through your heart in one direction, opening and closing with each heartbeat. The pressure changes on either side of the valves which cause them to open their flap-like "doors"(called cusps or leaflets) at the right time, and then tightly to prevent a back flow of blood.

There are 4 valves in the heart:
  • Tricuspid valve
  • Pulmonary valve
  • Mitral valve
  • Aortic valve

What is valve repair?

If you are born with any defects, then value repair can usually be done on congenital valve defects.

Here are some procedures surgeons may use to repair a valve:
  • Commissurotomy - The surgeon uses different procedures,like commissurotomy, is used when the valve are narrowed when the leaflets are thickened and also in some cases stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.
  • Valvuloplasty - This support comes for a ring-like device which the surgeon uses to attach around the outside of the valve opening, to help strengthen the leaflets to provide more support.
  • Reshaping - When the surgeon cuts a portion of the leaflet and sews back the leaflet together, for the valve to close properly.
  • De calcification - For the leaflets to close properly, de calcification method is used to remove the calcium build up
  • Repair of structural support - This is to shorten the cords or replaces the chords which gives support to the valves(these chords are called chorda tendonae and papillary muscles). When the chords are of the right length the value closes properly.
  • Patching - The surgeon patches the holes or tears in the leaflets with a tissue.

What is valve replacement?

When the value is damaged and it needs to be replaced. Valve replacement procedure is done most often when the aortic and the mitral valves are severely damaged, this procedure is also used to treat valve disease which is life-threatening,there are cases which shows that sometimes more than one valve may be damaged in the heart, and patients may need more than one replacement or repair.

There are 2 kinds of valves used for valve replacement:
  • Mechanical valves - These valves are made of plastic,carbon, and metal, and are said to be strong, and they last long. These values are used because the blood tends to stick to the mechanical valves are creates blood clots, the physician will recommend medication to patient with these valves to thinning the blood (called anticoagulants) for the rest of their life.
  • Biological valves - These valves are made from animal tissue(called a xenograft), or also taken from human tissue of another heart which is donated (called allograft or homograft), it depends from case to case, sometimes a patients own tissue can be used for valve replacement(called autograft). Patients who are considered to have biological valves usually do not need to take blood thinning medication, as these valves as these valves are not as strong as mechanical valves,and these biological valves may need to be replaced every 10 years or so. There is no such life span for these valves and they break down faster in children and young adults, as these valves are used most often in elderly patients.

The physician will decide the best type of valve for you.

During the procedure of a valve repair or replacement surgery, the breastbone is divided , and the heart is stopped, and the blood is sent through a heart-lung machine, as the heart or the aorta must be opened, the heart valve surgery is also known as open heart surgery.

What to Expect

The surgery is scheduled according to the best time that the surgeon and you are comfortable with, except in an emergency. You would need to keep a close tab on your health as the surgery gets closer ,you also need to inform your surgeon and cardiologist about any changes in your health. In case you have a cold or a flu, or any kind of infection or running a fever, you would need to keep your doctor aware of these symptoms

You also need to remind your cardiologist and surgeon that the medication you are taking, especially over the counter medication , such as aspirin , or drugs which might contain aspirin.

It is very important that you get all the instructions from your cardiologist, before the surgery about the procedure, but there are some basics you can expect when you are undergoing valve repair or replacement surgery.

Recovery Time

The recovery time is in the hospital for about a week, which includes about 3 days in ICU.

It all depends how health you are, as the recovery time varies from person to person to. It could take a long time, and the physician would advise you to take rest, from your activities, and instruct you to begin an exercise program with the cardiac rehabilitation program.

If you are a working person you can resume duty in 4-6 weeks , those who work in jobs which requires more physical task have to wait a little longer.

Life After Valve Replacement

Its known that all valve replacement operations are known to be successful, in rare cases it may fail and another operation may be required. If the patient has a biological valve, then the patient needs to get this replaced in 10-15 years. Mechanical valves are also said to fail, however patients should alert the doctor if they are facing any discomfort and any symptoms of valve failure.

Patient who have a mechanical valve , need to take blood-thinning medication for the rest of their lives, the reason is that these medications increases the risk of bleeding within the body, you should always wear an alert bracelet , to notify your doctor on dentist that you are taking blood-thinning medication.

If you are not taking any blood thinning medication, you must keep your notified that you have done a valve surgery, if you taking any kind of surgical produce, and also dental procedure, you should take an antibiotic before the procedure, the reason could be that bacteria can enter to blood stream during these procedures , if bacteria get into a repaired or valve, this could lead to complications and known as bacterial endocarditis Antibiotics can prevent bacterial endocarditis.

Patients who have mechanical valves, hear a kind of clicking in their chest, there is nothing to worry, this is just the sound of the new valve opening and closing,it is only to show that the valve is working the way it should.

Minimally Invasive Valve Surgery

It is a surgery where the surgeon uses, smaller incisions to repair or replace heart valves. This surgery has less pain and also reduces the length of the hospital and less time to recover.

Minimally Invasive Valve Surgery, cannot be conducted in with patients who have

  • severe valve damage
  • More than one valve to be repaired or replaced
  • Who have a disease known as (atherosclerosis)
  • Obesity

Minimally Invasive valve surgery can be done by using a robot, as robotic surgery does not require a large incision in the chest, however it is not available at all hospitals, and patients who have severe valve damage cannot have this procedure.

With a robotic surgery the surgeon has control over the robot with the console and a side cart with 3 robotic arms and a special vision system and instruments, and the computer translates the surgeon's natural hand and wrist movements made on a control with a help of a console, which have been placed inside the patients through small incisions The robot's controls can read even the tiniest of movements the surgeon makes.

This type of robotic surgery can help reduce the time it takes to do valve surgery, as well as to shorten the hospital stay and recovery time.

Aortic valve replacement is a type of open-heart surgery. It is used to treat problems with the aortic valve in the heart.