Can Heart Valves Be Repaired?

Valve Repair or Replacement

Middle valves play a key role in this one-way blood menstruum, opening and closing with each heartbeat

Claret is pumped through your heart in only ane direction. Eye valves play a key role in this ane-mode blood flow, opening and closing with each heartbeat. Force per unit area changes on either side of the valves cause them to open their flap-similar "doors" (called cusps or leaflets) at just the right fourth dimension, and so close tightly to preclude a backflow of claret.

There are 4 valves in the centre: tricuspid, pulmonary, mitral, and aortic.

In the United States, surgeons perform about 106,000 heart valve operations each twelvemonth. Virtually all of these operations are done to repair or supplant the mitral or aortic valves. These valves are on the left side of the middle, which works harder than the right. They command the catamenia of oxygen-rich blood from the lungs to the balance of the body.

If valve damage is balmy, doctors may be able to treat information technology with medicines. If damage to the valve is severe, surgery to repair or supersede the valve may be needed.

What is valve repair?

Valve repair can usually be done on congenital valve defects (defects you are born with) and has a good success record with treating mitral valve defects.

Hither are some procedures surgeons may use to repair a valve:

Commissurotomy is used for narrowed valves, where the leaflets are thickened and perhaps stuck together. The surgeon opens the valve past cut the points where the leaflets meet.
Valvuloplasty strengthens the leaflets to provide more back up and to let the valve shut tightly. This back up comes from a ring-similar device that surgeons adhere around the outside of the valve opening.
Reshaping is washed when the surgeon cuts out a section of a leaflet. Once the leaflet is sewn back together, the valve can shut properly.
Decalcification removes calcium buildup from the leaflets. In one case the calcium is removed, the leaflets tin can shut properly.
Repair of structural support replaces or shortens the cords that requite the valves support (these cords are called the chordae tendineae and the papillary muscles). When the cords are the right length, the valve tin can close properly.
Patching covers holes or tears in the leaflets with a tissue patch.

What is valve replacement?

Severe valve damage means the valve must be replaced and virtually often involves the aortic or mitral valve. It is likewise used to treat whatsoever valve affliction that is life-threatening. Some patients may demand more than than one valve repaired or replaced.

Two kinds of valves can be used for replacement:

Mechanical valves are usually made from materials such equally plastic, carbon, or metal. Mechanical valves are strong, and they last a long time. Because claret tends to stick to mechanical valves and create claret clots, patients with these valves volition need to accept blood-thinning medicines (called anticoagulants) for the rest of their lives.
Biological valves are fabricated from animal tissue (chosen a xenograft) or taken from the human tissue of a donated middle (called an allograft or homograft). Sometimes, a patient's own tissue tin be used for valve replacement (called an autograft). Patients with biological valves ordinarily do non need to have claret-thinning medicines. These valves are not every bit strong every bit mechanical valves, though, and they may need to be replaced every ten years or then. Biological valves break downwardly even faster in children and young adults, so these valves are used about often in elderly patients.

You and your doctor will decide which blazon of valve is best for you lot.

During valve repair or replacement surgery, the breastbone is divided, the heart is stopped, and blood is sent through a heart-lung car. Considering the heart or the aorta must be opened, heart valve surgery is open heart surgery.

What to Await

The operation will be scheduled at a fourth dimension that is best for you lot and your surgeon, except in urgent cases. Be sure to tell your surgeon and cardiologist about any changes in your health including symptoms of a cold or the influenza. Whatever infection may impact your recovery.

Also, review all medications (prescription as well as over-the-counter and supplements) with your cardiologist and surgeon.

Before surgery, you may have to have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a breast x-ray to give your surgeon the latest data about your health.

If you smoke, your doctor will want y'all to stop at least two weeks earlier your surgery. Smoking earlier surgery can lead to issues with blood clotting and breathing.

The night before surgery, you lot will be asked to bathe to reduce the corporeality of germs on your pare.

A medicine (anesthetic) will brand yous sleep during the operation. This is called "anesthesia." Because anesthesia is safest on an empty tum, you will be asked not to eat or potable after midnight the dark before surgery. If you lot do eat or drink anything subsequently midnight, it is important that you tell your anesthesiologist and surgeon.

You will go consummate instructions from your cardiologist and surgeon about the process, simply hither are some basics you can await every bit a valve surgery patient.

Solar day of Surgery

About patients are admitted to the hospital the day earlier surgery or, in some cases, on the forenoon of surgery.

Small metal disks chosen electrodes will exist attached to your breast. These electrodes are continued to an electrocardiogram machine, which will monitor your heart's rhythm and electric activity. You will receive a local anesthetic to numb the expanse where a plastic tube (called a line) will exist inserted in an artery in your wrist. An intravenous (IV) line volition be inserted in your vein. The Four line will give you the anesthesia during the operation. You will be given something to assistance you relax (a balmy tranquilizer) before y'all are taken into the operating room.

Afterward you lot are completely asleep, a tube will exist inserted down your windpipe and continued to a machine called a respirator, which volition accept over your breathing. Another tube will be inserted through your nose and downwardly your pharynx, into your stomach. This tube will stop liquid and air from collecting in your breadbasket, and then yous will not feel sick and bloated when you wake up. A thin tube called a catheter volition exist inserted into your bladder to collect whatsoever urine produced during the operation.

A center-lung automobile is used for all valve repair or replacement surgeries. This will keep oxygen-rich blood flowing through your body while your heart is stopped. A perfusion technologist or blood-menses specialist operates the heart-lung auto. Before you are hooked up to this machine, a blood-thinning medicine called an anticoagulant will be given to prevent your blood from clotting. The surgical team is led by the cardiovascular surgeon and includes other assisting surgeons, an anesthesiologist, and surgical nurses.

Subsequently you are hooked upward to the heart-lung motorcar, your centre is stopped and cooled. Adjacent, a cutting is fabricated into the heart or aorta, depending on which valve is being repaired or replaced. One time the surgeon has finished the repair or replacement, the heart is then started again, and you are asunder from the heart-lung machine.

The surgery tin can have anywhere from 2 to 4 hours or more than, depending on the number of valves that need to be repaired or replaced.

Recovery Time

You can expect to stay in the hospital for about a week, including at least 1 to three days in the Intensive Care Unit (ICU).

Recovery later on valve surgery may take a long time, depending on how salubrious y'all were before the operation. You will take to rest and limit your activities. Your physician may want you lot to begin an exercise programme or to join a cardiac rehabilitation program.

If you have an office job, you tin can usually go back to work in 4 to six weeks. Those who have more physically demanding jobs may need to wait longer.

Life After Valve Replacement

Nigh valve repair and replacement operations are successful. In some rare cases, a valve repair may fail and another operation may be needed.

Patients with a biological valve may need to accept the valve replaced in ten to 15 years. Mechanical valves may also fail, and so patients should alert their md if they are having whatever symptoms of valve failure.

Patients with a mechanical valve will need to take a blood-thinning medicine for the rest of their lives. Because these medicines increase the risk of bleeding within the torso, you should always vesture a medical alert bracelet and tell your doctor or dentist that you lot are taking a claret-thinning medicine.

Fifty-fifty if you lot are not taking a blood-thinning medicine, you must e'er tell your doctor and dentist that y'all take had valve surgery. If y'all are having a surgical or dental procedure, you lot should take an antibiotic before the procedure. Bacteria tin enter the bloodstream during these procedures. If bacteria become into a repaired or artificial valve, it can lead to a serious status chosen bacterial endocarditis. Antibiotics can forestall bacterial endocarditis.

Patients with mechanical valves say they sometimes hear a tranquility clicking audio in their chest. This is just the sound of the new valve opening and endmost, and it is naught to be worried about. In fact, information technology is a sign that the new valve is working the way information technology should.

Minimally Invasive Valve Surgery

Minimally invasive middle valve surgery is a technique that uses smaller incisions to repair or replace heart valves. This means there is less pain. Minimally invasive surgery also reduces the length of the infirmary stay and the recovery time.

Minimally invasive valve surgery can but exist done in certain patients. This type of surgery cannot exist done in patients

With astringent valve damage
Who need more than 1 valve repaired or replaced
Who accept clogged arteries (atherosclerosis)
Who are obese

In some cases, minimally invasive valve surgery can be done using a robot. Robotic surgery does not crave a large incision in the chest. Information technology is not bachelor at all hospitals, and patients with severe valve damage cannot have the process. The Texas Heart Establish has a robot.

With robotic surgery, the surgeon has a control console, a side cart with 3 robotic artillery, a special vision system, and instruments. A reckoner translates the surgeon'due south natural hand and wrist movements made on the control panel to instruments that have been placed inside the patient through small incisions. The robot'south controls can read even the tiniest of movements the surgeon makes.

Robotic surgery can reduce the time it takes to do valve surgery, as well as shorten the hospital stay and recovery time.

Transcatheter Aortic Valve Implantation (TAVI)
As well called transcatheter aortic valve replacement (TAVR)

Transcatheter aortic valve implantation is a minimally invasive procedure to repair a damaged or diseased aortic valve. A catheter is inserted into an avenue in the groin and threaded to the heart. A balloon at the stop of the catheter, with a replacement valve folded around it, delivers the new valve to take the place of the quondam.

The tissue valve is made of bovine (cow) pericardium supported past a metal stent.

Likewise called TAVR (transcatheter aortic valve replacement), the FDA-approved TAVI procedure is only appropriate for select patients with severe symptomatic aortic stenosis (narrowing of the aortic valve opening) who are not candidates for traditional open chest surgery or who are high-risk operable candidates.

TAVI is performed while the heart is beating and does non usually require cardio-pulmonary bypass (use of a heart-lung auto). For the TAVI procedure, a catheter is placed in the femoral artery (in the groin), equally is washed for angioplasty. The catheter is guided into the eye. A compressed tissue heart valve is placed on the balloon catheter and positioned direct inside the diseased aortic valve. In one case the new valve is in position, the balloon is inflated to secure the valve in place. The balloon is so deflated and the catheter withdrawn.

The procedure is performed with full general anesthesia in a hybrid suite (which has both catheterization and surgical capabilities). A team of interventional cardiologists and imaging specialists, center surgeons and cardiac anesthesiologists work together, using fluoroscopy and echocardiography to guide the valve to the site of implantation/replacement.

Recovery from the process is generally similar to that described for surgical valve replacement.

See "TAVI gave Nancy renewed health with minimal surgery," a patient story on YouTube.