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key-hole minimally invasive replacement surgery

What is it?

This procedure, is done to repair the valve in the heart which is not working properly.

Why is it performed?

There are four valves in the heart:

  • Pulmonary
  • Tricuspid
  • Mitral
  • Aortic

Valves help to control the blood by making it move in one direction through the different chambers or parts of the heart. If one of the valve, is not working correctly,blood flow is impaired. For e.g. if one of the valves, does not close properly, blood may leak between the chambers or flow backwards, and this condition is known as valve regurgitation,the insufficiency or incompetence, of blood flow. If the valve is narrowed(known as stenosed) blood flow is restricted.

If there is a minor problem with the valve, it can be treated with medication. If the heart valve damage is severe, then a procedure may be required to repair or replace the malfunctioning of the valve.

If the valve is damaged, then valve repair or replacement may be required:

  • Congenital heart defect
  • Infection (edocarditis)
  • Rheumatic heart disease
  • Mitral/and/or aortic valve disease
  • Normal aging/wear

What is done?

There are a number of procedures, to repair & replace the valves. Surgery is the most common,however there are some newer,non-surgical procedures.

Valve repair

Surgical
  • To open the valves, that have thickened , and stuck together , to repair this a commissurotomy is done. The valve is opened by cutting, the points where the leaflets of the valve meet. This procedure of commissurotomy is a type of vlavuloplasty or known as re-shaping.
  • Annulopasty-This technique is used to repair, an enlarged annulus, a ring of fibrous tissue at the base of the heart valve, To repair the annulus, sutures are sewn around the ring to make the opening smaller. However , the ring-like device is attached around the outside of the valve opening. The ring helps to support the valve so that it can close tightly.
  • To reshape the valve the surgeon will cut section or sections of the leaflet and then sew the leaflet back together.
  • De-calcification- To remove the calcium build-up from the leaflets.
  • The valves are supported by chords, called chordae tendoninae and the papillary muscles. If these muscles, are weak or stretched the valve may not close properly, therefore the chords would need to be replaced or shortened, helping the valve to be strengthened, and close properly.
  • The surgeon who need to repair the holes and tears in the leaflet of the valve, if there are any to be found, with the help of a tissue patch.

Minimally invasive valve repair/replacement surgery

Unlike any other surgery, traditional or conventional. Minimally invasive surgery, is a shorter procedure, and does not involve sawing of the breastbone, and opening the chest. Instead the surgeon watches the heart on a video screen and operates using long-handled surgical tools which is inserted through small incisions. In some cases, robotic arms are used. This type of surgery is available only in some hospitals. This type of surgery is also referred to as an endoscopic or robotic heart surgery.

Non-surgical valve repair

Non-surgical valve repair is done, by a percutaneous or catheter-based procedure, which are done without any incisions in the chest or by stopping the heart. Instead, a thin flexible tube called a catheter is inserted into the blood vessel in the groin or the arm, and then threaded up into the interior of the heart.

  • If the mitral or aortic valves are stiffened or narrowed, then percutaneous or balloon valvularr-plasty is used, more commonly for the mitral valve, than the aortic valve. A balloon tip on one end of the catheter is positioned in the valve, and then inflated to enlarge the opening or the crack open calcified tissue.
  • There are several method of percutaneous mitral valve repair which are being developed, however, these procedures are still in the development phase and are available only at limited hospitals. A method known as edge-to-edge repair, which is used if the valve is leaking(mitral valve)in a patient, who is considered at high risk for a surgical repair or replacement of the valve. To seal the leak, a delivery catheter holding a clip, is inserted through the femoral vein from the groin, in the left side of the heart, under general anaesthesia. This clip is positioned , in such a way beyond the leaky valve in an open position, and then pulled back, so that it catches the flaps of the mitral valve. Once the valve is closed,the clip holds the leaflets together and stops the valve form leaking.

Valve Replacement

Valve replacement is commonly used , to treat severely damaged valves /mitral valves. There are two kinds of valves, that are used for valve replacement. The doctor will suggest which is the best for you.

The two types of valves are Mechanical valves/Biological valves:

Mechanical valves are made from durable metals, like carbon, ceramics and plastics. A fabric sewing ring is used, to attach the valve to the tissues in the patient's heart. The major advantage is durability, however blood thinners medication must be taken for the rest of the patient's life to prevent the blood from clotting. The valve makes a soft clicking sound ,when the floats are shut,which could bother some patients, but generally adjust quickly to the sound.

Biological valves are made from:Which are made from either, pig valve(animal tissue) or a bovine pericardial engineered valve(a xenograph). The human tissue of a donated heart is used(known as an allograft or homograft),used most often to replace infected valves.

In certain cases, the patient's own tissues(an autograft) is used, or a Ross procedure, (also called a Switch Procedure) which involves taking the patient's normal functioning pulmonary valve, and using it to replace a diseased aortic valve. The pulmonary valve is then replace with a donated homo-graft pulmonary valve.

A patient's own tissues (an autograft). A Ross Procedure (also called a Switch Procedure) involves taking the patient's normally functioning pulmonary valve and using it to replace a diseased aortic valve. The pulmonary valve is then replaced with a donated (homograft) pulmonary valve.

Patients with biological valves, are not so durable, than mechanical valves, and may need to be replaced between 5-15 years, however patients with biological valves will need to take blood thinners in the short term.

What you can expect

Usually when you do a valve replacement surgery, approximately a week before the surgery, the doctor may ask you to visit the hospital's pre-admission unit. A blood and urine test, and an electrocardiogram ,X-ray would be performed in preparation for the surgery. The doctor will explain the risks and benefits of the procedure, and you will be asked to sign a consent form, before the surgery.

Please let your doctor know if you have:

If you have any allergies /or allergic reaction to any contrast dye,iodine (example of an allergy bee sting or from eating shellfish)

  • Asthma
  • Any medications
  • Have any bleeding problem/taking any blood thinners
  • History of kidney problems or diabetes
  • Do have any kind of body piercings on the chest or abdomen
  • Past Medical history of any kind of heart disease
  • Change in healthcare
  • Pregnant/planning to be pregnant.

Patients are admitted to the hospital the day before the procedure. The night before the doctor will ask you to bathe & cleanse or disinfect your skin. The area of the body which is to be operated on,will be washed, scrubbed with an antiseptic cleanser, and the hair on the chest would be removed.

This procedure is conducted, under general anaesthesia,so that you will be able to relax and be comfortable, throughout the procedure. You will be asked not to eat or drink after midnight, so risk the chance of vomiting . If you smoke refrain, from smoking for 2 weeks, as smoking can cause blood to clot, and breathing problems.

To carry out this procedure, the heart must be stopped, so that the surgeon can work on the valve or valves. To ensure your body continues to receive a flow of oxygen-rich blood, the surgeon will hook you on to a heart-lung machine. This machine takes over the pumping action of the heart.

The surgery can take up to 2-4 hours, depending on the number of valves, that need to be repaired or replaced. After the surgery , you will taken to a recovery room or an ICU. The time you would stay in the hospital for about a week,It depends how low you take to recover from the surgery, that will depend on your health.

If you have done the Minimally invasive surgery, then your stay at the hospital will probably be shorter and your recovery time quicker

When you return home after the surgery, keep your eye on the incision. Some bruising on the incision is normal, but contact your doctor if you experience increased pain, redness, swelling, bleeding, or other draining from an incision, fever, chills or generally feeling unwell.