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Heart Valve Replacement Surgery

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The heart pumps blood all through the body. Within the heart, the blood flows in Uni direction. This happens with the help of valves that open and close with a heartbeat. Thus, heart valves are very important in maintaining the flow of blood in one direction.

There are four heart valves:

  • The tricuspid valve,
  • Pulmonary valve,
  • Mitral valve,
  • Aortic valve

When one or more valves are damaged or diseased, it causes the blood to flow in two different directions within the heart. This happens when the valve does not open fully, causing blood flow obstruction. This condition is called as valve stenosis or narrowing. In some cases, the valve does not close properly, leading to blood leakage in the backward direction. This is called as valve incompetence or valve regurgitation or a leaky valve.

In order to improve the quality of life and reduce the symptoms of valve diseases as well as improve the quality of life, at times surgery is needed.

Treatment Options for Heart Valve Disease

There are two surgical options for heart valve treatment. This includes valve repair and valve replacement.

We shall learn more about heart valve replacement surgery in the following paragraphs.

What to Expect – Heart Valve Replacement Surgery

Heart valve replacement surgery is usually an open heart surgery. The surgeon will open the chest and heart and perform the valve replacement surgery. In a few cases, minimally invasive surgery is carried out. Here, a small incision is made near the breastbone and the damaged valve is replaced.

Damaged Valve Replacement Options

The damaged valve is replaced with the help of the following body compatible materials:

  • Mechanical valve – This valve is made of durable materials that last longer like metal or pyrolytic carbon. However, patients with these valves need to take blood-thinning medications that help prevent clotting.
  • Bioprosthetic valve – These are valves made from animal tissues, but last for only 10 to 15 years. Such patients do not require the use of blood-thinners.
  • TAVI/TAVR Procedure – This is a minimally invasive, surgical procedure. Here, the damaged valve is not removed. Instead, it is attached to a replacement valve.
  • ROSS Procedure -  In this procedure, a healthy valve is moved in place of the damaged valve.

What Happens Before the Procedure

The surgeon will speak to you and help you prepare for the surgery. He will ask you to stop smoking, in the case of smokers. As the procedure requires to be carried under general anesthesia, one is required to fast at least  6 to 8 hours before the procedure. The nurse will check your heart rate, blood pressure and urine in the hospital. One may also have to undergo a chest X ray, electrocardiogram and other required tests before the surgery.

You can ask the surgeon regarding any questions that you may have related to the surgery or recovery. You will also be asked to sign consent papers related to the surgery. And if the patient is in no state to sign, the immediate family member will have to give consent. Anti-clogging medications will be given to prevent blood clot formation.

During the Procedure

In case of open heart surgery, the surgeon will open the chest and heart and reach the damaged valve. The patient will be under anesthesia and thus, will not feel any pain. All the vitals of the patient will be monitored continuously. The heart/lung machine will breath and help in blood circulation during the procedure. The damaged valve will be replaced and then the surgeon will sew back the heart and chest.

In case of minimally invasive technique or keyhole surgery, smaller incisions will be made in the chest and the valve replaced. Balloon valvuloplasty is one such procedures where open heart surgery is not required.

After the Surgery

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After the surgery, the patient will be shifted to the ICU. The body vitals such as blood pressure, heart beat as well as breathing will be monitored. The patient may require a ventilator for 24 hours that helps in breathing. Pain medications will be given according to the pain experienced by the patient after the anesthesia wears off. A catheter will be inserted into the urethra to collect urine. After about 2 days, a physiotherapist will visit the patient and help teach the patient exercises that help with recovery.

The patient will be discharged after a week or so. However, the patient, especially an open heart surgery patient requires a family member or friend to stay with them for a few days. The stitches are dissolvable, so one does not have to visit the doctor to have them removed.

Recovery After Heart Replacement Surgery

One may have to take over-the-counter painkillers like paracetamol for the pain. Those with mechanical valve replacement, require anticoagulant medication warfarin for the rest of their life. Biological valve replacement requires these medications for a few months after the surgery.

Complications of Heart Replacement Surgery

Heart replacement surgery can lead to the following complications in some rare cases:

  • Wound infection
  • Formation of blood clots
  • Heart block, in case the electrical function of the heart gets damaged, requiring a pacemaker to correct the problem
  • Tears in the aorta leading to aortic dissection
  • Heart attack
  • Stroke

Heart valve replacement surgery has a prognosis in majority of the cases. Speak to your surgeon regarding any questions you have related to this procedure.

Written by: Saptakee sengupta
Date last updated: April 06, 2015