Cardiac valve surgery

Heart valve surgery is used to repair or replace diseased heart valves.

Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must flow through a heart valve.

These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

There are four valves in your heart:

  • Aortic valve
  • Mitral valve
  • Tricuspid valve
  • Pulmonary valve

 

 

Descripition

Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain.

In open surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta.

Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.

Minimally invasive valve surgery is done through much smaller cuts than open surgery, or through a catheter inserted through the skin. Several different techniques are used :

  • Laparoscopy or endoscopy
  • Percutaneous surgery (through the skin)
  • Robot-assisted srurgey

 

Valve Repair

Valve repair can usually be done on congenital valve defects (defects you are born with) and has a good success record with treating mitral valve defects.

Here are some procedures surgeons may use to repair a valve:

Commissurotomy, which is used for narrowed valves, where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve by cutting the points where the leaflets meet.

Valvuloplasty, which strengthens the leaflets to provide more support and to let the valve close tightly. This support comes from a ring-like device that surgeons attach around the outside of the valve opening.

Reshaping, where the surgeon cuts out a section of a leaflet. Once the leaflet is sewn back together, the valve can close properly.

Decalcification, which removes calcium buildup from the leaflets. Once the calcium is removed, the leaflets can close properly.

Repair of structural support, which replaces or shortens the cords that give the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve can close properly.

Patching, where the surgeon covers holes or tears in the leaflets with a tissue patch.

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.
Double and triple valve Replacement

Heart valve disease can be presented extensively and this may cause a double (mitral-aortic, mitral-tricuspid), or a triple (mitral, aortic and tricuspid) valvular regurgitation.

The surgical correction of important valvular regurgitation usually consists of the repair or replacement of all valves affected by a pathologic process.

The median full-length sternotomy still serves as a classic approach for single, double and triple valve operations in most of the patients.

Here, we attempt to present a minimally invasive approach for the surgery of a double and triple heart valve disease through a limited single-access right minithoracotomy in the 3rd intercostal space with central aortic and percutaneous venous cannulation.

Redo valve Replacement

Redo's for "surgical error" is quite low. Although it demonstrates again why a patient should seek out an institution or a surgeon who does a significant volume of valves and has obtained an "experience" with valve repair or replacement. This also demonstrates why we prefer to repair valves earlier as the tissues are typically better with less calcium and more likely repairable.

Valve re-operations are very rarely due to "surgical error" but there is definitely a slow degenerative process that affects tissue valves that ultimately leads to re-operation unless the patient is over 70 at initial surgery. As for coming up with a number for what percent of valve operations are re-do cases that is a little hard to estimate.

Mechanical, Tissue and homograft valves are used

Tissue heart valves are usually made from animal tissue, either animal heart valve tissue or animal pericardial tissue. The tissue is treated to prevent rejection and calcification.

There are alternatives to animal tissue valves. In some cases a homograft - a human aortic valve-can be implanted. Homograft valves are donated by patients and recovered after the patient dies. The durability of homograft valves is comparable to porcine and bovine tissue valves. Another procedure for aortic valve replacement is the Ross procedure (or pulmonary autograft). In a Ross procedure, the aortic valve is removed and replaced with the patient's own pulmonary valve. A pulmonary homograft (pulmonary valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. This procedure was first used in 1967 and is used primarily in children, as the procedure allows the patient's own pulmonary valve (now in the aortic position) to grow with the child.

Mechanical valves are designed to outlast the patient, and have typically been stress-tested to last several hundred years. Although mechanical valves are long-lasting and generally present a one-surgery solution, there is an increased risk of blood clots forming with mechanical valves. As a result, mechanical valve recipients must take anticoagulant (blood thinning) drugs such as warfarin for the rest of their lives, making the patient more prone to bleeding. The sound of mechanical valves may be heard and decrease the quality of life.

You and your doctor will decide which type of valve is best for you.

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