Transcatheter Aortic Valve Implantation
Transcatheter aortic valve implantation is a relatively new procedure. It involves accessing the aortic valve through the femoral artery or vein , or through a small surgical incision in your chest.
A balloon catheter is guided into the left ventricle chamber in your heart, and it is used to position the prosthetic valve over the old one.
TAVI may be used if someone is too frail to cope with the stress of standard valve replacement surgery, for example due to their age or another illness.
While it is not as effective as traditional open surgery, a TAVI does offer a marked improvement in survival for people with severe aortic valve diseases. One study found that this type of treatment could half a persons risk of death.
However, there is around a 1 in 16 chance of having a stroke in the first year after a TAVI.
What Is The Success Rate Of Heart Valve Replacement Surgery
The success rate of heart valve surgery usually depends on various factors like the patients overall health, age and so on. Damage in the heart valve is primarily a serious condition and should be treated without much delay. Replacement surgery of the heart valve definitely increases the life expectancy of the patient, improving quality of life. Due to the advances in the medical field and use of latest technologies and heart care facilities, doctors have reported a success rate of around 94 to 97 percent of such a surgery. The mortality rate due to the heart valve replacement surgery has also decreased over the years of advancement.
Frequently Asked Questions About Heart Valve Repair Or Replacement
Because families are bound to have many questions about heart valve repair or heart valve replacement, our pediatric cardiologists have developed answers to some of the most frequently asked questions about these surgeries. It is important to remember that this information is not intended to replace instructions provided by the childs health care team.
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What Should I Do After Valve Replacement Surgery
It requires 5-7 days hospitalization for open heart surgery. If your surgery is done minimally invasive technique or robotic valve replacement surgery, you might go home earlier.
Your doctor will advise some pain medications after discharge from the hospital as needed. You need to monitor your blood sugar, breathing, wound site, and heart function during the first few days of valve replacement surgery.
Full recovery takes from a few weeks to several months, depending on the type of surgery, your age, other medical ailments, and the healing process.
Infection is the most important factor to watch as this is the primary risk directly after surgery. Always connect with your cardiac surgeon or healthcare provider if you have symptoms that indicate infection.
- Swelling at the site of incision
- Increased drainage from the wound site
- Difficulty in breathing
How Long Will My Valve Last
The amount of time your valve repair or replacement lasts depends on several things:
- Whether you have heart valve repair or replacement.
- The type of valve you have placed .
Mechanical valves rarely wear out, but they may need replacement if a blood clot, infection or tissue growth keeps them from working right. Biological valves may need to be replaced, especially if youre younger.
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What Is The Recovery Time
Heart valve replacement recovery takes about one or two months. You might have a quicker recovery if you had a minimally invasive operation.
For the first three weeks of your recovery, youll probably get tired easily.
Youll need to avoid driving for several weeks after your operation.
During the first six to eight weeks after surgery, dont pick up anything more than 10 pounds.
Open Heart Surgery: Traditional Treatment Of Aortic Stenosis
Once AS is diagnosed and symptoms are present, it needs to be treated. The historical gold standard for treatment of AS has been open-heart surgery with surgical aortic valve replacement .
Open heart surgery is a major operation in which the surgeon opens the chest to access the heart. During open-heart surgery the heart is stopped, and blood is bypassed through a heart-lung machine. With SAVR, the diseased valve is removed and a new artificial valve is sewn into place.
SAVR has had good outcomes in patients who are suitable candidates for surgery. However, SAVR does have a long recovery period that generally requires five to seven days of hospitalization after surgery, and upwards of six weeks to make a full recovery. Also, there are many patients who require aortic valve replacement but have too many other medical conditions that make them unsuitable candidates for SAVR.
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Aortic Valve Balloon Valvuloplasty
Aortic valve balloon valvuloplasty involves passing a catheter through a large blood vessel and into the heart. A balloon is then inflated to open up the narrowed aortic valve.
This can prevent the need for open-heart surgery, although, in adults, surgery is still the first treatment choice.
The National Institute for Health and Clinical Excellence has recommended that aortic valve balloon valvuloplasty should only be used in people who are not suitable for traditional open surgery. It can also be used as a short-term treatment in babies and children until they are old enough for valve replacement.
The main drawback with this type of treatment is that the effects usually only last around 2 to 3 years. After this, further treatment is required.
Who Is A Candidate For Minimally Invasive Heart Valve Surgery
Although there are rare cases in which I would recommend traditional surgery, most people are eligible for a minimally invasive surgery.Its common for people to hear that theyre too old, sick, or frail to have heart valve surgery. They may not be physically able to handle a long procedure or recovery period. If they have bad knees or hips and rely on their arms to stabilize themselves, it can be even more difficult to allow the breastbone to heal following traditional heart valve surgery.This is not a problem with the minimally invasive procedure. The surgery is much shorter, which eliminates some potential complications from being under general anesthesia for a long time. And because we dont divide the breastbone, we don’t need to wait for it to heal before my patients return to their normal activities.Minimally invasive surgery also is preferable for patients who need to return to work to pay the bills. Instead of waiting a month or more, they will be back to work much quicker.
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Stenosis Risks And Diagnosis
“Patients usually have a heart murmur,” Glotzbach says, “and the aortic stenosis murmur is one of the loudest, most classic murmurs in the heart. By the time you get moderate stenosis, the murmur is fairly prominent. A transthoracic echocardiogram is then used to confirm the diagnosis and determine the severity of stenosis.”
Symptoms of severe aortic stenosis includes:
- Shortness of breath
- Syncopepassing out with activity
“Stenosis is a common cause of passing out,” Glotzbach says, “because if the aortic valve gets tight enough, you literally can’t get enough blood out to your brain to maintain consciousness.”
What To Expect From Your Doctor
The health care provider who sees you for possible mitral valve stenosis may ask:
- What are your symptoms?
- When did your symptoms begin?
- Do you always have symptoms, or do they come and go?
- Do you have rapid, fluttering or pounding heartbeats?
- Have you coughed up blood?
- Does exercise or physical activity make your symptoms worse?
- Do you have any family members with heart valve disease?
- Have you had rheumatic fever?
- Are you being treated or have you recently been treated for any other health conditions?
- Do you or did you smoke? How much? When did you quit?
- Do you use alcohol or caffeine? How much?
- Are you planning to become pregnant in the future?
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During The Surgical Heart Valve Replacement Procedure
During the procedure, the surgeon opens your chest to get to your heart and the diseased valve. The procedure varies from patient to patient, lasting a minimum of two hours and often longer. During this time, you are asleep under general anesthesia.
The surgeon will remove any tissue and calcium deposits that are interfering with the normal function of the valve. Your damaged valve may be completely removed. Then, the new valve will be sewn into the space where your own valve used to be. After the surgeon makes sure your valve is working properly, blood flow will be restored to your heart and the incisions will be closed. Your surgery is performed while the function of your heart is taken over by a heart-lung machine called cardiopulmonary bypass or CPB.
Symptoms Of Mitral Valve Prolapse
Some people might have mitral valve prolapse without any symptoms at all, while others might experience symptoms ranging from mild to severe.
Mild symptoms usually include:
- Dizziness during exercise or exertion
- Heart palpitations or irregular heartbeat
- Feeling that your heart is “racing”
As the condition becomes more severe, your symptoms can get worse. You may notice:
- Significant swelling in your legs and feet
- Severe chest congestion
- Difficulty breathing or catching your breath
- Bloating in the abdomen area
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Surgical Heart Valve Replacement Procedure
In most cases, heart valve replacement is an open-heart operation. This means the surgeon opens your chest and heart to remove the damaged valve. In some cases, the valve can be replaced through a small incision near the breastbone or under your right chest muscle. This is called minimally invasive surgery.
To help you prepare for the procedure, your doctor may suggest:
- Talking with different members of the surgical team, such as the anesthesiologist, surgeon, cardiologist, respiratory therapist, and nurses
- Discussing the details of the operation with family members
- Visiting the intensive care unit where you may be sent for postoperative recovery
What Are The Risks Of An Open Mitral Valve Replacement
Most people who have an open mitral valve replacement have a successful outcome, but there are certain risks. Your particular risks will vary based on your overall health, your age, and other factors. Be sure to talk with your doctor about any concerns that you have. Possible risks include:
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How Does Minimally Invasive Heart Valve Surgery Work
There are four valves in the heart: the aortic valve, mitral valve, pulmonary valve, and the tricuspid valve. These valves open and close to allow blood to pass through the different chambers of the heart and distribute oxygen-rich blood throughout the body. Malfunction of any of these valves can cause inefficient blood flow.
Three main problems can arise when a valve doesnt work properly:
UT Southwestern is one of a handful of centers in the U.S. where heart valve surgery is performed through a small incision without breaking any bones. Generally, heart valve surgery is performed by splitting the sternum to access the heart, but our surgical approach does not require breaking any bones. Click on the animations below to see how minimally invasive heart valve surgery differs from traditional heart valve surgery.
Can A Heart Valve Replacement Surgery Be Done Without Open Heart Surgery
Yes, of course, heart valve replacement surgery can be done without open heart surgery. Minimal invasive surgeries are an alternative option to open heart surgeries. The risk of complications is less in minimally invasive heart replacement surgery. The stay in the hospital is also less if you go for minimally invasive heart replacement surgery. Apart from this Robotic Heart Valve Replacement is now an advanced technique in this field and is being accepted by most cardiac surgeons. The recovery rate of robotic heart surgery is faster than open heart surgery. The risk of infection, blood loss, and post-surgery complications are also minimal if compared with open heart valve replacement surgery.
But the options for robotic surgery are very limited. Robotic heart surgery options are not available in all states or cities. You will have to find out an expert doctor and a minimally invasive robotic cardiac surgery setup.
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What Is A Heart Valve Replacement
Heart valve replacement is a procedure to replace one of your hearts valves with a biological or mechanical valve.
Sometimes, a valve doesnt form right when youre born. Some people may have a valve that gets too narrow, stiff or leaky. In these cases, your blood cant move through your heart efficiently.
You have four valves that control where your blood goes in your heart. Normally, your hearts valves are all opening and closing completely when your heart beats. This allows blood to move in an organized way.
Your blood moves:
- From one part of your heart to the next.
- To your lungs to get oxygen.
- To your aorta, which sends your oxygen-rich blood out to the rest of your body.
Like a sink drain that doesnt hold all the water or completely drain it, a diseased valve keeps some of your blood from going where its supposed to go.
If one of your valves isnt working right, you may need to take medicine or have your valve repaired. If these treatments dont work, you may need a heart valve replacement.
Types of Heart Valves
Biological valves are made of:
In general, theres no difference in durability between the types of biological valves. Biological valves may have some artificial parts to give the valve support and make it easier to put in place.
Homograft Valves
A homograft is:
Mechanical Valves
Mechanical valves are:
- Designed to last a lifetime.
Heart valve replacement: mechanical vs. tissue
Biological valves
Mechanical valves
Types of Heart Valve Replacement Surgery
Guidelines For Aortic Valve Replacement
As long-term data on the survival and quality of life of people following valve replacement have become available, evidence-based guidelines for aortic valve replacement have been developed. These help healthcare professionals decide when aortic valve replacement is the best option for a patient. Two widely accepted sets of guidelines used by surgeons and cardiologists are the American Heart Association and American College of Cardiology Guidelines for the Management of Patients with Valvular Heart Disease, and the European Society of Cardiology and the European Association for CardioThoracic Surgery Guidelines for the management of valvular heart disease.
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Details About The Studies
Two separate studies presented at the March 2019 American College of Cardiology conference supported similar findings: After one to two years of follow-up, TAVR outcomes were found to be similar to surgical aortic valve replacement outcomes in patients with aortic stenosis and low surgical risk.
In a TAVR procedure, a doctor can repair a diseased aortic valve without open heart surgery. The new heart valve is inserted via catheter through an incision in the groin, guided inside the affected valve, and expanded to reopen it. Approximately half of patients with aortic stenosis today are considered to have low surgical risk hence the excitement about those studies.
Medtronics trial studied the CoreValve platform. Researchers assessed two endpoints after two years: death and disabling stroke. This study found that 5.3 percent of patients who had TAVR died or suffered a disabling stroke compared to 6.7 percent of patients who had surgery. All-cause mortality rates were the same for both procedures. Disabling stroke affected 1.1 percent of TAVR patients and 3.5 percent of surgery patients. The mean age of participants was 74.
The two competing medical device companies have both since published two-year results, which are in line with the initial reported findings.
Benefits Of Avoiding Open
Aortic stenosis occurs when the opening of the hearts aortic value narrows. This narrowing hinders blood flow, causing chest pain, shortness of breath, fatigue, and fainting. Up to 1.5 million people in the United States have aortic stenosis, and it interferes with everything from taking a walk to playing with grandchildren. Aortic stenosis typically requires valve replacement when the disease becomes severe. Most people with aortic stenosis once needed open-heart surgery to replace their valve, but another option called transcatheter aortic valve replacement offers a minimally invasive alternative that can have significant benefits compared to surgery: faster recovery time, less pain, and lower risk of complications. TAVR was only approved to treat patients with an intermediate or high risk of complications from open-heart surgery, but recently, it was approved to include low-risk patients. Today, anyone with severe aortic stenosis may be a candidate for TAVR.
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How Long Do You Live After Heart Valve Replacement
Your life expectancy after a heart valve replacement depends on several factors, such as:
- How old you were when you received your heart valve replacement.
- What other health issues you have.
One study found that people considered low-risk lived anywhere from six to 16 years after a surgical aortic valve replacement. People aged 85 had shorter survival times, while those aged 60 to 64 lived longer.
Is Surgery Better For Me Than Medication Alone
Medications often help during the first stages of valve disease, but they don’t work as well as the disease gets worse. You dont need to wait until your symptoms become unbearable before you have surgery. In some cases, its best to have surgery before symptoms start. The decision to have surgery is a major one thats based on your individual needs. It involves input from you, your cardiologist and your surgeon.
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