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Heart Valve Replacement Surgery in India

Heart Valve Replacement

n most cases, heart valve replacement is an open heart operation. This means that the surgeon opens your chest andheart to remove the damaged valve. The new artificial (prosthetic) valve is then sewn into place. In some cases, thevalve can be replaced without opening the chest. Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must also flow through a heart valve.
These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.
There are four valves in your heart:

  • Aortic valve
  • Mitral valve
  • Tricuspid valve
  • Pulmonic valve

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. Only rarely is the tricuspid valve or the pulmonic valve repaired or replaced.

Types of Heart Valve Replacement

Open-heart valve replacement surgery

Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain.
In open heart surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. You are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart, providing oxygen and removing carbon dioxide.

Minimally Invasive Heart Surgery

Minimally invasive valve surgery is done through much smaller cuts than open surgery, or through a catheter inserted through the skin. Several different techniques are used:

If your surgeon can repair your mitral valve, you may have:

        • Ring annuloplasty. The surgeon repairs the ring-like part around the valve by sewing a ring of plastic, cloth, or tissue around the valve.
        • Valve repair. The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve. Valve repair is best for the mitral and tricuspid valves. The aortic valve is usually not repaired.

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery.

valvuloplasty

In valvuloplasty, a very small, narrow, hollow tube (known as a catheter) is advanced from a blood vessel in the groin through the aorta into the heart. Once the catheter is placed in the valve to be opened, a large balloon at the tip of the catheter is inflated until the leaflets (flaps) of the valve are opened.

Types of Valves Used in Replacement

When heart valve disease progresses to the point that treatment by medicines does not provide relief from a patient’s symptoms, surgery to repair or replace the valves becomes the best alternative. If the surgery is not a repair, homograft or autograft, the choice is most likely between carbon-based mechanical valves and biological tissue valves.
The physician and patient will choose the type of valve, taking into account the patients’ overall condition and preference. Some of the patient factors considered are:

        • Age and life expectancy: Although age is not a rigid indicator, the American College of Cardiology and American Medical Association guidelines indicate that mechanical valves are generally appropriate for a majority of patients 65 years old and younger, or patients already on coumadin.
        • Other diseases: Lung, liver and kidney disease, diabetes, cancer and other chronic conditions can affect life expectancy and alter the age criterion.
        • Heart and vascular system condition: Coronary, carotid and peripheral artery diseases and heart rhythm disturbances can affect valve selection.
        • Patient lifestyle and preference: Life situations or intangible factors often influence valve selection.

Mechanical Heart Valves

The most widely used mechanical valves are made from pyrolytic carbon, which has been used for many years. Most are bileaflet designs, meaning that they employ two carbon “leaflets” to regulate flow to a single direction.
The primary advantage of mechanical valves is that they will last a patient’s lifetime. Mechanical valves are preferred for patients with life expectancies beyond 10-15 years because they eliminate the mortality risk inherent in the replacement of a worn out tissue valve.

Tissue Heart Valves

Tissue valves are harvested from pig heart valves (porcine) or cow heart sac (bovine). These tissues are treated and neutralized so that the body will not reject them. Some are mounted on a frame or stent; others are used directly (stentless)

Homografts or Allografts

When a valve is obtained from the body of a donor, it is known as homograft or allograft. This type of valve is beneficial for children’s and pregnant women as it does not require long-term anticoagulation therapy.

Procedure of Valve Replacement Surgery

In most valve operations, your surgeon will:

  • reach your heart by making an incision down the middle of your breastbone
  • use a heart-lung machine to circulate blood around your body during the operation
  • open up your heart to reach the affected valve, and
  • perform the repair or replacement.
  • Transesophageal echocardiogram is done to confirm whether the new valve is functioning properly or not.

In a small number of cases, one or more small incisions can be made in your chest and your breastbone may not even need to be cut

Benefits of Heart Valve Surgery

Over time, you should be able to engage in your normal activities again. Each patient recovers at his or her own pace. Recovery depends on your overall strength. The effects of your old, damaged valve on your body will gradually fade as your new heart valve begins to help your heart function more efficiently. Patient get rid of all problems like breathing difficulties, chest pain, edema and heart palpitations