Cardiac Valve Replacement

Although tiny, your heart's valves play a crucial role. They regulate the heart's blood supply and flow. Your heart will strain to perform as it should if they aren't functioning properly, and your health may suffer as a result. Some heart valve issues are congenital (existing at birth), some are brought on by disease or infection, and some arise with aging

One of the things your doctor listens for while using a stethoscope to listen to your chest is heart valve issues. A common warning sign that a patient may have a heart valve malfunction is a murmur, sometimes known as a lub-dub sound. The first sign that something is wrong may be tiredness or shortness of breath in cases where heart valve abnormalities have developed gradually.

The intervention is tailored to the patient's needs and preferences when a heart valve must be repaired or replaced, whether using catheters, robotic or minimally invasive techniques, or conventional open incisions.

 

Aortic Valve Replacement

A damaged or malfunctioning aortic valve must be removed and replaced with a brand-new valve composed of synthetic materials or animal tissue. It's a major procedure that not everyone should undergo and that can have a prolonged recovery period.

 

What are Cardiac Valves?

There are two upper chambers (the left and right atria) and two lower chambers in the heart (the left and right ventricles). Blood circulates through the heart as it beats, entering and exiting these chambers before continuing to the lungs and the rest of the body. Four valves control the heart's ability to pump blood. These valves make sure that blood only flows through the heart in one direction. There are four valves.

• Blood circulation from the right atrium to the right ventricle is controlled by the tricuspid valve.
• Blood circulation from the left atrium to the left ventricle is controlled by the mitral valve.
• Blood circulation from the right ventricle to the pulmonary artery (which transfers blood to the lungs) is controlled by the pulmonary valve.
• Blood circulation from the left ventricle to the aorta is controlled by the aortic valve. Every valve has leaflets, which are flaps that function as tiny gates. These leaflets open to let blood enter the chambers of the heart or the arteries of the body, and they close to prevent blood from flowing in the opposite direction.

 

What is Cardiac Valve Disease?

When a heart valve develops an abnormality that affects how well it functions, this condition is known as heart valve disease. The cardiac valves are mostly affected by two issues:

• Leaky or regurgitating valve. A defective valve may not be able to close completely. Blood may seep backward through the valve as a result of this.
• Valve stenosis. This occurs when the opening of a valve narrows, limiting the amount of blood that can pass through it.

Any heart valve can be compromised by regurgitation or stenosis, and more than one valve can be affected at once. A valve might be both narrowed and leaky at the same time.

Each of these conditions makes it more difficult for the heart to circulate blood throughout the body. They can result in heart failure and other heart issues by making the heart work harder than it normally would.

 

What are the Signs of a Cardiac Valve Disease?

The main indication that you have a valve issue is a heart murmur, or odd heartbeat, which a doctor can hear while using a stethoscope to listen to your heart. However, a valve issue isn't always present if you have a heart murmur. Fatigue, fainting, shortness of breath, abrupt weight gain, swelling in the ankles, distended neck veins, and other body parts are further signs of heart valve dysfunction.

Some patients can put off having a heart valve replaced by making lifestyle modifications and medications. However, depending on factors including age, health, and symptoms that are worsening, many people will eventually require surgery.

 

Types of Valves Used in Cardiac Valve Replacement

The aortic or mitral valves are the most frequently affected by severe valve damage, which necessitates valve replacement. Any life-threatening valve problem is also treated with it. Some patients could require the replacement of several valves. Two types of valves can be replaced:

• Metal, plastic, or carbon are frequently used to create mechanical valves. Mechanical valves are durable and have a long lifespan. Patients with mechanical valves will need to take blood-thinning medications (also known as anticoagulants) for the rest of their lives since blood tends to clot on them.
• Biological valves are created using animal tissue (known as a xenograft) or human tissue obtained from a donor heart (called an allograft or homograft). A patient's tissue (called an autograft) may occasionally be utilized to replace a valve. Blood-thinning medications are typically not necessary for patients with biological valves. However, because they are not as durable as mechanical valves, these valves can require replacement every 10 to 15 years. The majority of the time, biological valves are utilized in elderly patients because they deteriorate even more quickly in children and young adults.

Which type of valve is ideal for you will be decided by both you and your doctor. The breastbone is separated, the heart is halted, and blood is pumped through a heart-lung machine during valve replacement surgery. Heart valve replacement is open heart surgery because the heart or aorta must be opened.

 

Cardiac Valve Replacement Options

Heart valves that are diseased or faulty are frequently replaced or repaired surgically. Heart valves can be replaced using a variety of techniques by cardiac surgeons. A group of experts will collaborate to choose the best course of action for your circumstance.

• Minimally invasive procedures. In some situations, a catheter (a small tube) may be used to do minimally invasive valve replacement. The catheter is placed through the skin and into a blood vessel. Transcatheter aortic valve replacement, or TAVR, is one method that can be used to replace the aortic valve in this way. Other cardiac valves could undergo similar procedures for replacement or repair. Valve replacement may occasionally be accomplished with minimally invasive surgery. Compared to open heart surgery, this requires fewer incisions and requires less time for recovery. The surgeon will operate on you using a robot to do robotic heart surgery, and they will do so while watching their work on a television monitor.
• Open-heart surgery. Open cardiac surgery may be the best course of action for some conditions. Opening the breastbone during this important procedure gives the surgeon immediate access to the heart.

General anesthesia and the use of a cardiopulmonary bypass machine sometimes referred to as a heart-lung machine, are typically required for heart valve surgery. While the heart is stopped during the treatment, a synthetic system keeps blood flowing throughout the body.

 

Cardiac Valve Replacement Preparation

Except in urgent situations, the surgery will be arranged at a time that is convenient for both you and your surgeon. Any changes in your health, even those brought on by the flu or a cold, should be brought to the attention of your surgeon and cardiologist. Any infection could hinder your healing.

Additionally, talk to your surgeon and cardiologist about any medications, including supplements and over-the-counter and prescription drugs.

An electrocardiogram (ECG), blood tests, urine tests, and a chest x-ray may be required before surgery so that your surgeon has the most up-to-date information on your health.

Your doctor will advise you to cease smoking at least two weeks before surgery if you currently do so. Smoking before surgery might cause respiratory and blood clotting issues.

You will be asked to take a bath the night before surgery to lessen the number of germs on your skin.

During the procedure, an anesthetic will put you to sleep. Anesthesia is what doctors call this. You won't be permitted to eat or drink after midnight before surgery since an anesthetic is most effective when administered on an empty stomach. It is essential that you inform your anesthesiologist and surgeon if you do consume anything after midnight.

Here are some fundamentals you may anticipate as a patient undergoing valve replacement surgery. You will receive comprehensive information from your cardiologist and surgeon about the process.

 

Cardiac Valve Replacement Procedure

The majority of patients are checked into hospitals the day before surgery or, in exceptional cases, the morning of the procedure.

Your chest will be placed with electrodes, which are tiny metal disks. These electrodes are linked to an electrocardiogram device, which will track the electrical and rhythmic activity of your heart. The area where a plastic tube (referred to as a line) will be implanted in an artery in your wrist will be numbed with a local anesthetic. Your vein will be used to insert an intravenous (IV) line. You will receive the anesthetic throughout the procedure via an IV line. Before being taken into the operating room, you will be given medication to help you relax (a mild tranquilizer).

A tube will be placed down your windpipe and connected to a device called a respirator, which will take over breathing once you are soundly asleep. Another tube will be put into your stomach through your throat, nose, and mouth. This tube will prevent liquid and air from building up in your stomach, preventing you from waking up feeling queasy and bloated. Your bladder will have a tiny tube called a catheter introduced to collect any urine produced throughout the procedure.

All valve replacement procedures involve the use of a heart-lung machine. While your heart is halted, this will maintain oxygen-rich blood moving through your body. The heart-lung machine is run by a blood-flow specialist or perfusion technologist. An anticoagulant, a blood-thinning medication, will be administered before you are connected to this machine to stop your blood from clotting. The cardiovascular surgeon is in charge of the surgical team, which also consists of several supporting surgeons, an anesthesiologist, and surgical nurses.

Your heart is stopped when you are connected to the heart-lung machine, and it is then cooled. Depending on which valve is being replaced, a cut is then made into the heart or aorta. You are removed from the heart-lung machine after the surgeon completes the replacement. The heart is then recovered.

Depending on how many valves need to be replaced, the procedure could last up to four hours or longer.

 

Heart Valve Replacement Recovery

Expect to spend about a week in the hospital, with at least one to three days in the intensive care unit (ICU).

Depending on how healthy you were before the procedure and how long it took you to recover from valve surgery. Rest and reduced activity are required. Your doctor could advise you to start an exercise regimen or participate in a cardiac rehabilitation program.

In 4 to 6 weeks, you can typically return to work if you have an office job. Those with professions that require more physical effort might have to wait longer.

 

What Happens After Cardiac Valve Replacement?

The majority of valve repair and replacement procedures are effective. A valve repair may occasionally fail, necessitating a second procedure.

In 10 to 15 years, patients with biological valves could need to have the valve replaced. Patients should notify their doctor if they experience any indications of valve failure because mechanical valves can also fail.

For the rest of their lives, people with mechanical valves must take blood-thinning medication. You should always wear a medical alert bracelet and let your doctor or dentist know that you are taking a blood-thinning medication because doing so increases your risk of internal bleeding.

You must always disclose that you have undergone valve surgery to your doctor and dentist, even if you are not taking any blood-thinning medication. Before having any type of surgical or dental operation, you should take an antibiotic. In the course of these procedures, bacteria may enter the circulation. Bacterial endocarditis, a dangerous condition, can develop if bacteria invade a prosthetic valve. Bacterial endocarditis can be avoided with antibiotics.

Patients with mechanical valves report hearing a soft clicking sound in their chest occasionally. There is no need to be concerned because this is simply the sound of the new valve opening and shutting. In reality, it is evidence that the new valve is operating as anticipated.

 

Cardiac Valve Replacement Risks

Heart valve surgery carries some risks, just like any other type of surgery. Risks that occur in more than 5% of patients are considered common risks. These may consist of:

• Bleeding
• Arrhythmias are abnormal cardiac rhythms that are typically transient.
• Issues with short-term memory, impaired vision, and concentration are typically transient.

Risks that less than 5% of patients may suffer are considered uncommon. These may consist of:

• Infection. You can take several steps to lower your chance of contracting an infection.
• Renal and lung problems
• Cardiac arrest and stroke
• Lung or leg blood clots
• Death

Before you agree to the operation, your doctor will go over these risks in detail with you. You are also encouraged to talk to your medical team about any concerns you may have.

 

Conclusion

Cardiac valve replacement is a surgical operation used to replace or repair the valves that control blood flow through the heart. for those who have severe cardiac valve abnormalities and who don't benefit from other treatments. Open cardiac surgery or minimally invasive techniques are available to surgeons. includes systems for robotic mitral valve repair, structural heart disorders, cardiac surgery, and interventional cardiology.