Annuloplasty

Overview

Annuloplasty, a surgical procedure aimed at repairing or fortifying a heart valve, involves encircling the valve’s annulus with a band to reinforce proper closure. This helps prevent backward blood leakage, optimizing blood circulation efficiency in the heart. In instances where heart valves fail to close correctly, mild symptoms or severe complications like heart failure or sudden cardiac arrest can ensue. Timely treatment is imperative upon a healthcare provider’s diagnosis of a leaky heart valve to avert potential complications. The procedure entails placing a permanent ring-like device, made of materials such as mesh, metal, or plastic, around the heart valve to mimic its natural movement and ensure proper opening and closing.

Reasons for undergoing the procedure

Annuloplasty is a surgical procedure performed to reshape, reinforce, or tighten the ring surrounding a damaged or diseased heart valve, commonly indicated for valve regurgitation. This condition arises when the annulus, the ring around the valve in the heart, widens or changes shape due to factors such as heart enlargement. The altered annulus can impede the proper opening and closing of valve flaps, leading to blood leakage backward through the valve. Annuloplasty addresses this issue by restoring the shape and function of the valve ring, often combined with other techniques for comprehensive heart valve repair

To address valve regurgitation, various annuloplasty procedures may be required, including:

• Mitral valve annuloplasty, a form of mitral valve repair.
• Aortic valve annuloplasty, a form of aortic valve repair.
• Pulmonary valve annuloplasty, a type of pulmonary valve repair.
• Tricuspid valve annuloplasty, a type of tricuspid valve repair.

Risk

Annuloplasties are generally considered safe procedures, but, like any surgery, there is a potential risk of postoperative infection or bleeding. The overall risks associated with annuloplasty depend on various factors such as your overall health and the condition of your heart. It is essential to consult with your healthcare provider, who can provide personalized information and help you comprehend the specific risks and potential complications associated with undergoing an annuloplasty.

Procedure

Annuloplasty is a surgical procedure aimed at reshaping, reinforcing, or tightening the ring surrounding a damaged or diseased heart valve. The ring, known as the annulus, may widen and change shape, particularly in cases of an enlarged heart or a leaky valve (valve regurgitation). This alteration in the annulus can disrupt the proper opening and closing of the valve flaps, leading to blood leakage backward through the valve. Annuloplasty serves to address these issues by repairing the valve, and it may be performed in conjunction with other techniques to effectively restore normal valve function.

Before the procedure

Preparation for an annuloplasty involves following specific instructions provided by your healthcare provider. Typically, you will be required to fast, refraining from drinking or eating, starting from the night before the procedure. It is crucial to inform your provider about any bleeding risks you may have. In cases where you are on blood-thinning medications (anticoagulants), there may be a temporary discontinuation of these medications as part of the preparation process for the annuloplasty.

During the procedure

Cardiac surgeons, specializing in heart procedures, conduct annuloplasties using either open-heart surgery or minimally invasive techniques. Regardless of the approach, general anesthesia is administered to ensure the patient remains asleep throughout the procedure.

During open-heart annuloplasty, the surgeon follows these steps:

• Creates a single large incision in the chest.
• Positions a ring made of plastic, metal, or surgical mesh around the heart valve.
• Closes the incision using stitches or surgical glue.

In minimally invasive annuloplasty, the surgeon opts for a less intrusive method:

• Makes a few small incisions in the chest.
• Inserts a small, flexible tube equipped with a camera (endoscope) through the incisions.
• Utilizes the camera view and miniature surgical tools to place the annuloplasty ring.
• Closes the incisions with surgical glue or stitches.

After the procedure

Following the procedure, patients typically spend a few hours in a recovery area. For those who underwent minimally invasive annuloplasty, a return home is usually possible within one to two days. In the case of open-heart annuloplasty, a longer hospital stay of up to seven days may be necessary.

Outcome

The overall recovery duration following an annuloplasty is influenced by various factors, such as the use of minimally invasive or open surgical techniques.

Post-annuloplasty, it is recommended to refrain from strenuous activities for a minimum of one week. Returning to work can typically occur within one to two weeks, but individuals with physically demanding jobs might need additional recovery time. Your healthcare provider will provide specific guidelines for your recovery process.

It is crucial to promptly contact your healthcare provider if you experience any of the following symptoms after annuloplasty:

• Chest pain (angina).
• Dizziness or fainting (syncope).
• Fever or chills.
• Nausea or vomiting.
• Persistent swelling or pain.