Heart valve replacement

Overview

Heart valve replacement is a surgical procedure used to replace a malfunctioning heart valve with either a biological or mechanical valve. When a heart valve is not functioning properly, patients may require medication or valve repair initially, but if these treatments are ineffective, valve replacement becomes necessary.

Sometimes, a heart valve may not develop correctly from birth or may deteriorate over time, becoming too narrow, stiff, or leaky. In such cases, the heart’s ability to effectively pump blood is compromised.

The heart has four valves that regulate the flow of blood. During a normal heartbeat, these valves open and close in a synchronized manner, ensuring the controlled circulation of blood throughout the body. However, when a valve malfunctions, it hinders the proper flow of blood, potentially leading to various health issues.

The following are the types of valves:

• Biological valves: Biological valves, which are also known as tissue or bioprosthetic valves, are composed of human tissue (allografts or homografts), pig tissue, or cow tissue.
  The types of biological valves are same in terms of durability. Artificial components may be added to biological valves to sustain them and facilitate the placement.
• Homograft valves: An allograft, or homograft, is a human heart valve that has been removed from a deceased donor. It is usually used in children or young adults to replace an unhealthy aortic valve, as well as in adults to treat an aortic valve that has been harmed by an infection. In Ross procedure, it is also used to replace the pulmonary valve.
• Mechanical valves: Mechanical valves function similarly to natural valves and are constructed of carbon or metal. The most common type of mechanical valve is the bileaflet valve. It is constructed from two carbon leaflets positioned in a ring and covered with polyester knit fabric. Mechanical valves are long-lasting, very resilient, and well-tolerated.

Types

There are choices about the surgical technique the surgeon employs in addition to the biological or mechanical valve possibilities. They can enter a blood vessel, perform minimally invasive surgery, or perform open heart surgery.

• Transcatheter Aortic Valve Replacement (TAVR): Some patients with significant aortic stenosis (narrowing) may be candidates for transcatheter aortic valve replacement. Although a healthcare provider can utilize TAVR for patients at any risk level, it may be necessary for high-risk patients.
  Open heart surgery is more common in younger patients, those with bicuspid valves, and those requiring additional procedures such as coronary bypass or maze procedure.
  The defective valve is replaced with a biological valve in TAVR by the healthcare provider using a catheter. The catheter is inserted into a cut (incision) in the chest or an artery in the groin. The new valve was installed within the old one. Additionally, the pulmonary valve can be replaced by the healthcare provider using this technique.
• Ross procedure: The Ross procedure involves implanting a pulmonary homograft after moving the pulmonary valve to the aortic valve position. This is a really complex process. Nonetheless, there are a lot of advantages, particularly for young patients with aortic valve dysfunction.

Reasons for undergoing the procedure

When valve repair surgery is not a viable treatment option, the necessity for a heart valve replacement arises. One of the primary indications for valve replacement surgery is the management of aortic valve disease, particularly aortic stenosis, which involves the narrowing of the aortic valve.

A heart valve replacement may also be necessary for the following conditions:

• Narrowing of the mitral, pulmonary, or tricuspid valves.
• Prolapse of the mitral valve.
• Regurgitation (blood flowing in the incorrect direction due to a leaking valve) in the aortic, mitral, or tricuspid valves.
• Congenital heart valve disease, present from birth.

Risk

Surgery to replace a heart valve carries certain risks.

• Bleeding.
• Infection.
• Abnormal heartbeat.
• Heart failure.
• Heart attack.
• Kidney failure

Before the procedure

An electrocardiogram (EKG) and a chest X-ray may be performed by the healthcare provider the day before the procedure.

Patient should not consume any food or liquids the night before or the day of the procedure.

Regarding which medications to take or stop taking prior to the procedure, follow the advice of the healthcare provider.

The patient should come to the hospital dressed comfortably and with slip-on shoes rather than ties. Their possessions can be held by the friend or relative who drove them to the appointment while they undergo surgery.

The healthcare provider will clean and shave the area where they made the incision.

During the procedure

The procedure to replace the heart valve will take two to five hours.

The patient will receive medication from the healthcare provider to help them fall asleep and pain-free throughout the procedure.

The healthcare provider will make the following decisions based on the type of surgery the patient is having:

• An incision of 6 to 8 inches made in the breastbone for open cardiac surgery.
• An incision of three to four inches for minimally invasive surgery.
• Making a small incision in the groin and inserting a catheter all the way to the heart.

In order to prevent the heart from moving throughout the procedure, the healthcare provider will employ a machine to perform the functions of the heart and lungs.

The healthcare provider will remove the damaged valve and install a mechanical or biological valve in its place. They will install the new valve into the old one during a transcatheter operation.

Healthcare provider will close the incision site and will restart the heart again.

After the procedure

In order for the healthcare provider to closely monitor the patient, the patient will start their hospital stay in an intensive care unit (ICU). They will then transfer to a standard room. Five to seven days may pass throughout the hospital stay.

It is anticipated that the patient will have devices monitoring their heart rate and blood pressure.

It’s possible that tubes are draining fluid from the chest.

As soon as the patient feels well enough after the procedure, they can eat, drink, and move around. With the healthcare provider’s assistance, walk a few steps around the room and then down the hallway.

To help the patient to recover, the patient may start their cardiac rehab program once they return home.

Outcome

Heart valve replacement surgery can effectively resolve a patient’s valve problem, alleviating their symptoms and extending their lifespan while also improving their overall quality of life.

Opting for a minimally invasive procedure offers several advantages for patients, including shorter hospital stays, quicker recovery times, and reduced risk of infection.

Typically, recovery from a heart valve replacement procedure spans one to two months, but a less invasive approach can potentially expedite the recovery process.

During the initial three weeks of recovery, patients may experience fatigue more quickly, so it’s important to take it easy during this period.

Patients should refrain from driving for a few weeks following the procedure, and they should avoid lifting objects heavier than 10 pounds for the first six to eight weeks post-surgery.

Seek medical attention if the patient experiences any of the following symptoms:

• Fever.
• Chest pain
• Depression
• Gaining weight more than five pounds.