Overview
Heart valve surgery aims to restore the proper functioning of dysfunctional heart valves caused by valvular heart disease, commonly known as a heart valve ailment. This valve surgery is often performed using an open-heart technique and a chest incision through the breastbone. This intricate procedure is considered a major operation, lasting at least two hours or more, and the recovery period often spans several weeks.
While advancements have led to less invasive alternatives for certain types of heart valvular disease, these procedures are limited to specific hospitals that offer them.
Types of the Heart Valves
The heart consists of four interconnected chambers that receive and pump blood. Each chamber is made up of small flaps (valves) that open and close, ensuring that blood flows in the correct direction. These four primary heart valves are:
Tricuspid Valve: This valve allows oxygen-poor blood from the right atrium to move more easily into the right ventricle.
Mitral Valve: The mitral valve allows blood from the lungs to move from the left atrium, the upper chamber, to the left ventricle, the lower chamber.
Aortic Valve: The aortic valve helps the aorta, which distributes oxygen-rich blood all around the body, more easily transport blood from the left ventricle, the body’s lowest chamber.
Pulmonary Valve: Blood with low oxygen content must pass through the pulmonary valve to reach the pulmonary artery from the right ventricle (lower chamber). The pulmonary artery carries the blood to the lungs, where it receives oxygen.
Purposes of Cardiac Valve Surgery
Heart valve surgery is performed when one or multiple valves in your heart are affected by disease or damage. This can disrupt blood flow in two ways:
- Valve stenosis, where the valve becomes stiff or does not open fully, blocking forward blood flow
- Valve incompetence or regurgitation occurs when the valve does not close properly, causing blood to leak backwards
Both conditions put a strain on the heart, requiring it to work harder to pump blood through the affected valves. Some symptoms that can appear due to these issues include, palpitations, swelling in the ankles and legs, shortness of breath and fatigue, and chest pain.
You can explore your treatment options, which may include modifying your lifestyle and taking medication for minor symptoms, by speaking with your doctor.
Heart Valve Disease Surgery Treatment Options
Following are the available treatment options, both surgical and non-surgical, for treating heart valve disease, based on the problem.
Surgical valve repair
This option is generally used when there are issues with the tricuspid or mitral valves.
- Commissurotomy: Cutting the valve flaps to alleviate their tightness.
- Annuloplasty: Repairing an enlarged valve opening using sutures or a supporting ring.
- Valvulotomy: Enlargement of narrowed valves, sometimes with the help of a balloon.
Non-surgical valve repair
Percutaneous/ balloon valvuloplasty/valvotomy: Inflating a balloon to enlarge narrowed valves with the help of the catheter.
Percutaneous mitral valve repair: Using a catheter and clip to fix a leaky mitral valve.
Heart valve replacement
When the heart is damaged badly beyond repair, a replacement with a new biological or mechanical valve is needed.
- Mechanical valves: Materials with a long lifespan are used to make sturdy valves that require lifetime blood-thinning medicine.
- Biological valves: These are animal-sourced or human heart valves. These are less resilient but less prone to causing blood clots.
Minimally invasive valve repair and replacement
Transcatheter aortic valve implantation (TAVI/TAVR): Minimally invasive replacement of the aortic valve by small incisions, suitable for high-risk patients.
Note: Treatment options depend on the specific valve problem, patient characteristics, and medical team evaluation.
What to Expect during Heart Valve Surgery
Before the Procedure
To ensure a smooth heart valve operation and minimise complications, it is advised to quit smoking at least 2 weeks prior to the procedure. Smoking can increase the blood clotting risk and respiratory issues.
You may need to go to the pre-admission facility of the hospital about one week before the scheduled cardiac valve surgery. During the visit, you will receive a thorough explanation of the procedure’s risks and benefits and will be required to sign a form of consent to move forward with the procedure.
In addition, pre-operative tests such as a chest X-ray, electrocardiogram (ECG), blood tests, and urine sample analysis may be performed.
During the Surgery
Surgical valve repairs and replacements are performed under general anaesthesia, ensuring you remain unconscious during the operation.
To ensure your body receives oxygenated blood during traditional heart valve disease surgery, a heart-lung machine will temporarily take over the process of pumping blood.
The duration of the surgery varies from two to six hours, depending on how many valves need to be replaced or repaired.
After the surgery
You will either be in a recovery room or an ICU (Intensive Care Unit ) when you awaken.
Hospitalisation typically lasts around a week, although the speed of your recovery is influenced by your pre-surgery health condition.
A heart-lung machine will not be needed, and your heart will not be stopped if you have minimally invasive surgery. This approach often leads to shorter hospital stays and a faster recovery than traditional open-heart surgery.
Returning Home
Once discharged, it is important to monitor your surgical wound. Some bruising is common, but if you experience worsening pain, swelling, redness, bleeding, a wound’s discharge, a fever, a cold, or a general feeling of being sick, call your doctor immediately.
Recovery Duration After Heart Valve Surgery
Typically, you will be assisted in getting out of bed the day after the valve surgery. Some discomfort is expected, but pain relief medication will be provided to ensure your comfort. The duration of your recovery depends on the type of surgery and your individual response.
The time it takes to fully recover varies because of variations in treatment response, although it typically lasts between two and three months.
Heart valve surgery risks
It is critical to understand that heart valve surgery carries some risks, just like any surgical operation. Based on variables such as age, general health, and the severity of the valve disease, these risks can change. The following are the potential risks related to a heart valve operation:
Bleeding: In some circumstances, further surgeries may be necessary to stop post-operative bleeding.
Mortality: The risk of not surviving the operation is higher for individuals who have been significantly unwell prior to the surgery. It is advisable to discuss this risk with your surgeon during the consultation.
Atrial fibrillation: This refers to an abnormal heart rhythm that may occur after the surgery. It is typically treatable with medical intervention.
Renal (kidney) failure: Patients who already have kidney issues may be more likely to experience kidney failure after surgery. One possible form of treatment is dialysis.
Wound infection: Poorly controlled diabetes or other conditions that increase the risk of infection can lead to wound infections. If such infections occur, they can be treated with antibiotics.
Stroke: There is a possibility for blood clots to form, travel to the brain, and result in a stroke. This risk is higher for individuals who have previously experienced a stroke or transient ischemic attacks (TIAs). Medications will be administered during and after the operation to minimise the risk.
Before going through the process, it is essential to discuss any concerns or conditions you might have with your physician regarding both the advantages and risks of this operation.
Medication after Heart Valve Surgery
The type of valve replacement you receive will determine the medication you need to take after having heart valve surgery.
Mechanical Valve: You will require one or more blood-thinning medications if you have a mechanical valve to prevent blood clots. Artificial materials in the mechanical valve can trigger the formation of clots, so these medications are essential.
Your physician will determine how long you must take the medication and will also go over any necessary adjustments to your current medication plan.
Tissue Valve: If you have a tissue valve replacement, the need for anticoagulant medication is generally lower.
You might need to keep taking anticoagulants after the surgery for a few weeks to two or three months, depending on your circumstances. Your physician will advise on the most appropriate time and method of consumption.
It is essential to adhere to your doctor’s prescription guidelines for medication administration and to bring up any questions or suspected drug interactions with them. Your healthcare team can keep track of your progress and make any required modifications to your medication schedule with the help of regular follow-ups.
Advantages of Heart Valve Surgery
Most people benefit from cardiac valve surgery for the following reasons:
Relieving Symptoms: Chest pain, breathlessness, fatigue, and dizziness are symptoms of valve malfunction that can be relieved by valve surgery. The operation can enhance your general quality of life and restore your heart’s normal function by repairing or replacing the damaged valve.
Improved Life Expectancy: It can extend your life expectancy by addressing the underlying valve disease. Repairing or replacing the faulty valve helps restore proper blood flow and prevents complications that could lead to heart failure or other life-threatening conditions.
Prevention of Death: Heart valve disease surgery plays a vital role in preventing deaths related to severe valve disease. By repairing or replacing the dysfunctional valve, the heart valve operation reduces the risk of complications and improves long-term survival rates.
Advantages of Valve Repair
Lower Risk of Infection: Valve repair procedures often have a lower risk of infection compared to valve replacement surgeries. By preserving your own valve tissue and restoring its functionality, the need for foreign materials and prosthetics is minimised, reducing the risk of infection.
Reduced Dependency on Anticoagulant Medication: In some cases, valve repair allows for the preservation of the natural valve, eliminating the need for lifelong anticoagulant medication. This is advantageous as it reduces the risk of bleeding complications and the need for regular blood monitoring.
Advantages of Minimally Invasive Surgery
Reduced Infection Risk: Compared to conventional open-heart surgeries, minimally invasive cardiac valve surgeries, which require fewer incisions, typically carry a decreased risk of infection.
Minimised Bleeding and Trauma: Minimally invasive techniques result in less blood loss during surgery and reduced trauma to surrounding tissues. This may result in a quicker recovery, less discomfort, and a reduced risk of problems.
Shorter Hospital Stay: Minimally invasive surgery often allows for shorter stays in hospitals compared to traditional open-heart surgery. This means a quicker return home and a smoother transition to the recovery phase.
Accelerated Recovery: Minimally invasive procedures typically involve less tissue disruption and trauma, resulting in a shorter overall recovery period. Patients may experience less pain, have improved mobility, and return to their daily activities sooner.
It is vital to remember that the specific benefits of this cardiac valve surgery can vary depending on a person’s unique circumstances, including the type and level of the valve disorder, general health, and the surgical approach selected. Speak with your medical staff to get customised details on the potential advantages of heart valve surgery for your particular situation.
