Heart Valve Surgery - Repair and Replacement of Valves, Risks and Benefits - Health Education - DesiMD Healthcare - India

Heart Valve Surgery

Dr.S C Manchanda profile Authored by Dr.S C Manchanda on 2 Feb 2015 - 09:51.

The heart has valves to enable the blood flow between different chambers of the heart and also into the large arteries going out from the heart into the body. These valves open just enough to allow the blood to flow out and close to stop the blood flowing back into the heart.

There are four heart valves, namely Aortic, Mitral, Pulmonary and Tricuspid which collectively function to regulate the blood flow into and out of the heart.

The heart valve surgery is done to repair or replace diseased heart valves. However, acute valve diseases and conditions may be effectively treated with medication, but in severe cases, surgery may be considered depending on the need. 

The aortic valve is the most common valve to be replaced because it cannot be repaired. The mitral valve is the most common valve to be repaired. The tricuspid valve or the pulmonic valve are rarely repaired or replaced.

What are the heart valve diseases or conditions that may require surgery?

Basically, there are various conditions that may disturb the valve function causing a difficulty in valve closing or opening,thereby altering the blood flow through the heart. These diseases or conditions may be congenital (birth defects) or may be developed later due to some other underlying reasons, including endocarditis, rheumatic heart disease, aging, and so on. Following are some of the common diseases that often require valve surgery:

Valve stenosis: This is a problem with the opening of the valve due to significant narrowing that restricts blood flow to the next chamber. A narrowing may occur due to stiffening of the valve, severe scarring of the valve tissues or accumulation of the calcium deposits. 

Valve regurgitation: This is a problem with the proper closing of the valve that may reverse the blood flow causing severe consequences like muscle damage in case of mitral valve regurgitation. The valve closing issue may occur due to the loose supportive structure, tearing of tissues, excessive thinning or stretching of the valve tissues. 

Tricuspid atresia: It is a congenital heart disease in which Tricuspid valve (valve connecting right atrium and right ventricle) is blocked due to the thickening of the valve wall. 

Ebstein's anomaly: This occurs when the tricuspid valve is malformed and causes backflow of the blood into the heart. 

What is valve repair surgery?

Usually, birth defects require valve repair, especially defects in the mitral valve. Based on the individual’s condition and requirement, any of the following procedure may be performed to correct the valve defect.
  • Commissurotomy: This is an open-heart surgery performed to open up the narrowed valve by cutting the joint, where the leaflets are fused. 
  • Balloon Valvuloplasty: To open up the narrowed valves (aortic and mitral) with the help of catheter equipped with a balloon that enters inside the valve and flattens the narrowed valve.  
  • Valve reshaping: It is the procedure of cutting an unwanted section and then sewing the leaflet to restore proper closing of the valve. 
  • Decalcification: It is a procedure performed to remove the debris of calcium deposits that blocks the valve.
  • Structural repair: It is a procedure of replacing or shortening of the support muscles that allows the respective valve to close properly.
  • Patching: It is a procedure of correcting the tears in the valve tissue by covering it with healthy tissues. 

What is valve replacement surgery?

When the heart valve is extensively damaged and cannot be repaired, surgeons often prefer replacing it with a prosthetic valve. This is mainly required when the aortic or mitral valve is severely damaged. Any of the following prosthetic valves can be chosen:

Mechanical valves: These are strong and long lasting valves, made-up of metals, carbon or plastic. Adverse reaction associated with this valve is risk of forming blood clots.

Biological valves: These may be allograft (from donated heart), an auto graft (from the patient’s own tissues) or xenograft (made up of animal tissues). These are commonly recommended in elderly patients than among children or youngsters. This is advantageous over mechanical valves as it does not pose a risk of blood clotting, however, it should be replaced after 5 to 15 years. 

What is minimally invasive valve surgery (endoscopic or robotic heart surgery)?
Unlike traditional valve repair, it does not require opening the chest; rather the doctor will observe the structure of your heart on a video screen and the valve repair will be done by inserting the long-handled surgical tools or robotic arms into the heart via small incisions. In some cases, robotic arms are used. 

What to expect?

Before surgery:

  • Stop smoking or drinking at least two weeks before the surgery
  • One may have to get hospitalized about a day before the planned surgery.
  • Several drugs and medications will be prescribed.
  • As a part of the preparation of the surgery several laboratory tests and procedure may be performed to screen the patient thoroughly.
  • The doctor will explain about the risks and benefits of the surgery and will check on  other allergies or family history of diseases. 
  • The patient will be asked to bathe and disinfect his/ her skin and chest will be waxed in male patients.
  • Eating or drinking will be strictly restricted for 10-12 hours before the surgery. 

During surgery:

  • Based on the individual’s condition, the most suitable surgery will be selected.
  • The surgery will be done under general anesthesia.
  • Incisions will be made (smaller in case of minimally invasive surgery) to operate.
  • The heart will be stopped during the procedure while maintaining the pumping of the oxygenated blood, using a heart-lung machine.
  • As per the individual’s condition and need, the valve/s will be either repaired or replaced. 
  • An incision will be closed after the respective procedure and normal heart functions will be retained. 
After surgery: 
  • The patient will be shifted to a recovery room or ICU, if needed.
  • Recovery may take a bit longer in case of traditional valve surgery.
  • One may get back to work and normal activities by 4 to 6 months after the surgery.
  • If the patient is involved in an occupation that needs physical strength, one may have to wait for a few more weeks to resume his/ her work. 
How much time does a valve surgery may take and how long one has to be hospitalized?
The time required for the surgical procedure may be different for different types of surgery, number of valves to be corrected etc. However, the procedure may take anywhere from 2 to 4 hours. Post-surgical hospital stay may be about a week or more, based on the patient’s overall condition. However, if a minimally invasive procedure is performed, both hospital stay and recovery time will be shorter than expected. 
What are the complications and risks associated with valve surgery?
Like every procedure, valve surgery, also poses several risks as listed below:
  • Pain at the surgical site
  • Swelling
  • Bleeding or drainage from the surgical wound
  • Fever and chills
  • Feeling tired
  • Risk of surgical site infection
  • Arrhythmia (too fast or too slow heart beats)
  • Stroke
  • Need for another surgery
What are the benefits of the valve surgery?
Heart valve surgery offers:
  • Good quality of life
  • Treats worrying symptoms
  • Restores normal heart functions
  • Prevents further damage and associated complications
*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.