Blood is pumped through the heart in one direction via the heart valves. The heart valves have cusps (flip-flap doors) which aids in one-way flow of the blood. Pressure changes on the side of the valves causes them to open and close at the right time, preventing any black flow of the blood. In the human heart, there are four kinds of valves. They are Aortic valve, Mitral valve, Tricuspid valve, and Pulmonic valve. The valves of the heart sometimes impair the blood flow that suggests the valve has either stopped functioning or are not functioning properly. In such cases, the blood may leak or flow backwards causing major problems like valve regurgitation, insufficiency, or incompetence. Minor problems of the valve can be treated via medication. But if the valve is severely damaged a surgery is required. To replace or repair a valve of the heart, Heart Valve Replacement Surgery is performed. Aortic valve is the most common valve to be replaced because it cannot be repaired. Next, the mitral valve is also repaired. In rare cases, the tricuspid valve or the pulmonic valves are repaired or replaced.
Causes of Heart replacement Surgery
- When the valve does not close and allow blood to leak backwards. This is called regurgitation.
- When the valve does not open fully and limits up the forward blood flow. This is called stenosis.
- When the valve is functioning improperly causing symptoms like chest pain, shortness of breath, and heart failure.
- Heart valve damaged by an infection called endocarditis.
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Procedures performed for valve repair and valve replacement
Valve repair is done in cases of congenital valve defects that are the one you are born with. The procedures to repair valve are as follows:
- Commissurotomy: It is used for narrowed valves, where the cusps are thick and stuck together. For surgery, the valve is opened by the cutting the point where the cusps meet.
- Valvuloplasty: It strengthens the leaflets to provide more support and close the valve tightly. For surgery, a ring-like device is attached at the opening of the valve.
- Reshaping: For surgery, a section is cut out and sewn back together so as to allow the valves to close properly.
- Decalcification: It is done to remove the calcium build up on the sides of the wall that does not allow the valve to close properly.
- Providing structural support to the valves by shortening or replacing the papillary muscles.
- Patching the holes or tears of the valves.
Valve Replacement is done when the valve is damaged severely. Most often the aortic or mitral valve is replaced. For replacement the following two kinds of valves are used:
- Mechanical valves which are made of plastic, carbon or metal. These are strong valves. The only disadvantage is sometimes the blood sticks to them. For this purpose, blood thinning medicines are given to the patients.
- Biological Valves that are made from the animal tissue also called Xenograft. The one made from a human tissue of a donated heart are called allograft. The one made from the patient’s own tissue is called autograft. The disadvantage is they break down faster and are not that strong. These valves are generally used for the older patients not for children.
Before the Heart Valve Replacement Surgery
The heart surgeon first analyses the amount of defect present and the time of surgery depends upon the amount of defect. Before surgery an electrocardiogram, blood tests, urine tests, and chest X-ray are performed. Patient’s daily routine is accessed. In case the patient smokes, smoking has to be stopped 2 weeks before surgery as it causes breathing problems and blood clotting. Before the surgery the patient is asked to maintain hygienic conditions so as to reduce the chance of any infection after surgery. A night before surgery the patient would be asked not to eat or drink anything after midnight as the patient would be given anesthesia which may lead to vomiting.
How the Heart Valve Replacement Surgery is performed?
The patient has to be given anesthesia before performing the surgery so that they could not feel the pain. A local anesthesia is given to numb the area where a plastic tube is inserted to the artery in the wrist. An intravenous (IV) line will be inserted inside the vein, which will provide anesthesia during the operation. Before, taking the patients to the operating room the patient is given a tranquilizer. The surgery starts by opening the chest to get the valve and the heart.
Opening the chest requires an incision to be made in the breast bone or under the right pectoral muscle. The heart functioning is stopped, a heart or lung machine is connected to carry on the blood circulation and breathing process. Thereafter, the surgeon repairs or implant the valve. The procedure takes 2to3 hours. Today with the advancement in technologies, the surgeon opt for mini surgeries. It reduces the pain, and recovery time.
Risks of Heart Valve Replacement Surgery
- In some cases it may result in death
- Heart failure is also a possibility
- Irregular heart beats
- Kidney failure
- Post-pericardiotomy syndrome, which causes low fever and chest pain lasting up to 6 months
- Stroke
- Brain Injury
- Valve infection
Recovery after Surgery
The patient has to stay for 1 to 3 days in ICU, thereafter in the hospital for a week. The recovery stage takes a bit longer time depending on the condition of the patient before surgery. For an initial 1 month ample amount of rest is required with minimal activities. Some doctors even ask to join a cardiac rehabilitation program. Healthy diet, medication, and care increase the success rate of the surgery. The patients who go for biological valve have to go for another surgery after 10 to 15 years. The patient implanted with mechanical valve has to take blood-thinning tablets and prevent themselves from any kind of infection. The life after recovery is easy if proper care pattern and lifestyle is followed.
Cost of the Surgery
The cost of Heart Valve Replacement surgery is quite high all over the world as it is an invasive procedure. India has become a hub of medical facilities. The cost of Heart valve Replacement Surgery in India is lesser than other countries. The cost starts from around 14 lakhs and goes higher with the facilities provided. The cost is majorly dependent on the surgeon, the hospital, and the kind of valve that is being replaced.
Heart Valve Replacement Surgery is a long and risky procedure. Although, the success rate is quite high. The surgery is bound to relieve the pain, discomfort, and provide a healthy life thereafter. After the surgery, infection risk is greater, so preventing the patient from infection through out the life is a challenging task. There are exclusively best heart surgeons all over the world which makes the surgery process easier, comfortable, and more successful.