Valvular Heart Disease
Inside your heart, four one-way valves keep the blood moving in the right direction. They are made of thin, strong flaps of tissue that open and close with each heartbeat. Over a lifetime a heart can beat more than two billion times, and valves sometimes weaken with age. Certain diseases can damage heart valves. Some people are born with a defective valve that worsens overtime and affects blood from flowing correctly. If you have a heart valve problem, the best option for correcting it may include surgery. The most appropriate surgical treatment depends on your age, health, valve condition and your preference. Your cardiologist and cardiac surgeon will help you choose the right operation.
Heart Valve Surgery
Heart Valve Repair
Repairing a valve leaves the patient with normal heart anatomy and function. The patients repaired valve better resists infection better than a valve replacement and does not mandate anticoagulation (blood thinning medication) after surgery.
Heart Valve Replacement
In some cases the faulty valve and its supporting structures must be removed and replaced with a mechanical or biological valve prosthetic. Your surgeon will discuss the pros and cons of each type of valve prior to your surgery to help you decide which type to use should you require a valve replacement.
What is used to replace the valve?
Heart valves can be replaced by mechanical (artificial) valves or valves made from animal tissue (biological valves). Mechanical valves typically do not wear out. However, people with mechanical heart valves must take an anticoagulant medicine for the rest of their lives to keep blood clots from forming on the valve.
Biological valves are usually made from cow (bovine) or pig (porcine) tissue. They are less likely to cause clots. However, these valves are less durable, and young patients may require another replacement later in life.
Homograft valves are procured from a human heart donor, preserved and frozen. They are ideal valve replacement material in the presence of infection and in older patients when aortic root replacement is necessary.
You and your surgeon will decide which type of valve is best for you.
Types of Valve Surgery
Traditional, Open-Chest Surgery - For this surgery, your surgeon makes an incision down the center of your chest and divides the breastbone for direct access to your heart. A heart-lung bypass machine will temporarily perform the work of your heart while the surgeon replaces or repairs the faulty valve. The traditional incision is rarely needed for isolated valve surgery.
Minimally-Invasive Heart Valve Surgery (MIS) - The majority of Aortic valve replacements at the Northwest Regional Heart Center are accomplished with a small incision between the ribs on the right side of the chest.
Robotic (da Vinci) Assisted Valve Surgery - This uses high-definition imaging and instruments introduced through several tiny ports that allow precise minimally invasive surgery. Robotic assistance is particularly useful in mitral valve surgery.
Percutaneous Valve replacement, also known as TAVI (Transcatheter Aortic Valve Implantation) - Particularly useful for aortic valve replacement in patients at high risk for surgical valve replacement
Mitral Valve Repair and Replacement Surgery
Mitral Valve Repair
Most isolated mitral valve surgeries are performed untilizing robotic assistance contributing to our team’s high rate of successful repair (94% repaired vs 6% requiring replacement). If the problem involves blood leaking through a dilated mitral valve your surgeon may sew a ring around the opening to restore its normal size. The attachments of the valve to the heart (chordae) may be replaced or the valve leaflets repaired to allow secure closure of the valve all with robotic assistance without the need for a large incision with division of the breastbone.
Mitral Valve Replacement
When necessary mitral valve replacement is also accomplished with robotic assisted minimally invasive technique. This may be necessary particularly in valves damaged by rheumatic fever or very heavily calcified valves.
Aortic Valve Repair and Replacement Surgery
Aortic Valve Repair
Some patients with leaking (insufficient) aortic valve are candidates for valve repair or aortic root reconstruction(David Procedure) which preserves the patients own leaflet tissue.
Aortic Valve Replacement
Most patients with Aortic valve disease will require valve replacement. Calcification, infection and congential (bicuspid valve) disease all may result in the need for valve replacement and in some cases replacement of part of the aorta. Most isolated aortic valve replacements are performed utilizing minimally invasive techniques. A specialized CT scan (computerized tomography) helps determine if you are an appropriate candidate for this procedure.
What can I expect after valve surgery?
Your recovery time will depend on the type of surgery you have and your general health status before surgery. Both minimally invasive surgery and Robotic Assisted Valve Surgery can result in shorter hospital stays, less pain and scarring, reduced requirement for blood transfusions, fewer restrictions and faster return to normal activities.
The average hospital stay at the Northwest Regional Heart Center for all patients undergoing Aortic valve replacement is 4.48 days vs. 7.5 days in the Society of Thoracic Surgeons registry data. The average length of stay for all patients undergoing mitral valve repair is 3.43 days compared with the national average from the Society of Thoracic surgeons of 7.0 days.
A list of medications and appropriate activity level will be prescribed at the time of hospital discharge. Cardiac Rehabilitation is often recommended after heart surgery to facilitate a return to normal activity level.