Friday, February 3, 2023

Replacement Heart Valve Surgery

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Sex After Heart Surgery

Transcatheter Aortic Valve Replacement (TAVR) – A Less-Invasive Alternative to Open Heart Surgery

Before your operation, symptoms of fatigue or shortness of breath may affect your sex life. After your operation, you may feel like having a more active sex life. You can do so as soon as you feel able to, although avoid strenuous positions and be careful not to put any pressure on your wound until it has fully healed.

Some people find that having a serious illness can cause them to lose interest in sex. In men, the emotional stress can also cause impotence, where it is difficult to get and maintain an erection. If you are worried about your sex life, talk to you partner, a support group or your GP.

How Is Yale Medicine Unique In Its Approach To Heart Valve Replacement And Repair

Yale Medicine cardiac surgeons working at Yale New Haven Hospital have treated every type of valve disorder. More mitral valve operations and transcatheter aortic valve replacements are done at YNHH than at any other hospital in Connecticut. For patients who need it, we have a special mitral valve repair program that makes use of robotic surgery. We also offer aortic valve repair aimed at treating leaking aortic bicuspid and tricuspid aortic valves, a procedure that can be performed in conjunction with aneurysm surgery.

At the Yale New Haven Hospital Heart & Vascular Center, our doctors collaborate to determine the best options for each patient, whether its open heart surgery, minimally invasive surgery, or transcatheter procedures.

Patients generally experience significant improvement in symptoms following valve surgery and should expect near normalization of their life expectancy. Yale is one of the few cardiac surgery programs in the U.S. that has three-star ratings from the Society of Thoracic Surgeons for both aortic valve and mitral valve procedures with or without concomitant coronary artery bypass procedure, says Arnar Geirsson, MD, chief of Yale Medicine Cardiac Surgery.

How Long Does It Take To Recover

Open heart surgery requires 57 days of hospital stay, while home care continues for 710 days afterward. Minimally invasive procedures generally require less time in the hospital and have quicker recovery periods. However, recovery after a sternotomy, a surgical incision through the sternum, can take several weeks or months.

A range of factors, such as age and other health conditions, can influence healing. A persons doctor will provide guidance on recovery time.

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When Is A Heart Valve Replacement Necessary

A heart valve replacement is necessary when valve repair surgery isnt a treatment option. Valve replacement surgery is most often used to treat people with aortic valve disease, particularly aortic stenosis .

Other conditions that may require a heart valve replacement include:

  • Mitral, pulmonary or tricuspid valve stenosis .

What Are The Symptoms Of Aortic Stenosis

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Aortic stenosis, in many patients, remains a mystery until the amount of blood flowing through the aortic valve is greatly reduced by the valves hardened flaps. Others, in fact, might notice a change in your health first, such as signs of fatigue or reduced physical activity.

Here are other common symptoms of aortic stenosis:

  • Chest pain: Angina, or tightening of the chest. During physical activity, pain can radiate to the neck, jaw or arm.
  • Breathing difficulties, especially during exercise
  • Easily fatigued

Sound familiar? An estimated 2.5 million people over age 75 — more than 12 percent of that demographic in the United States — have aortic stenosis. People with severe aortic stenosis have only a 20 percent chance of surviving five years without an aortic valve replacement.

Doctors at Hartford HealthCares Heart & Vascular Institute at Hartford Hospital have performed more than 800 TAVR procedures, creating one of the largest programs in New England. Hartford Hospital is now one of 35 hospitals participating in a nationwide study that allows TAVR for low-risk patients. The procedure is currently approved by the Food and Drug Administration for high-risk and intermediate-risk patients.

Many experts foresee TAVR, a less-invasive procedure with a success rate comparable to open heart surgery, as the eventual preferred treatment for all aortic-valve replacement patients.

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Symptoms Of Aortic Valve Disease

Sometimes, if you have a problem with your aortic valve, you may not experience any symptoms until later on in the disease process. Any symptoms you feel occur because your heart cannot pump blood around your body efficiently. Symptoms you may have include:

  • chest pain brought on by physical activity this is caused by your heart having to work harder due to restricted blood flow through your aortic valve
  • shortness of breath at first you may notice this only when you exercise, but later you may experience this even when resting
  • dizziness or light-headedness this is caused by the obstruction of the flow of blood from your heart to the rest of your body
  • loss of consciousness this is also a result of reduced blood flow caused by the obstruction in your heart

Transcatheter Mitral Valve Repair With Mitraclip

Transcatheter mitral valve repair is the least invasive mitral repair procedure, but it does come with some limitations on what surgeons and/or cardiologists can do. The only FDA-approved transcatheter mitral valve repair surgery is called MitraClip® . This procedure is for patients who are at higher risk and cannot get open-heart surgery. In most cases, this procedure will not stop a leak, but it can reduce the leak and improve symptoms.

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Why The Procedure Is Performed

Aortic valve surgery is done when the valve does not work properly. Surgery may be done for these reasons:

  • Changes in your aortic valve are causing major heart symptoms, such as chest pain, shortness of breath, fainting spells, or heart failure.
  • Tests show that changes in your aortic valve are harming the work of your heart.
  • Damage to your heart valve from infection .

A minimally invasive procedure can have many benefits. There is less pain, blood loss, and risk for infection. You will also recover faster than you would from open heart surgery.

Percutaneous valvuloplasty and catheter-based valve replacement such as TAVR are done only in people who are too sick or at very high risk for major heart surgery. The results of percutaneous valvuloplasty are not long-lasting.

What Are Heart Valves And How Do They Work

Watch a Transcatheter Aortic Valve Replacement (TAVR) Procedure at St. Luke’s in Cedar Rapids, Iowa

The heart is made up of four chambers: two upper chambers and two lower chambers . As the heart beats, blood moves through the heart, flowing into and out of these chambers, then passes onward to the lungs and the rest of the body.

The flow of blood through the heart is regulated by four valves. These valves ensure that blood moves only in one direction as it passes through the heart. The four valves are:

  • The tricuspid valve regulates blood flow from the right atrium to the right ventricle.
  • The mitral valve regulates blood flow from the left atrium to the left ventricle.
  • The pulmonary valve regulates blood flow from the right ventricle to pulmonary artery .
  • The aortic valve regulates blood flow from the left ventricle to the aorta. Each valve has leaflets, or flaps, that act like small gates. These leaflets open to let blood flow into the hearts chambers or to the bodys arteries, and close to keep the blood from flowing backward.

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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.

When Is It Necessary To Replace The Aortic Valve

The aortic valve may need to be replaced for 2 reasons:

  • the valve has become narrowed the opening of the valve becomes smaller, obstructing the flow of blood out of the heart
  • the valve is leaky the valve allows blood to flow back through into the heart

The problems can get worse over time and in severe cases can lead to life-threatening problems such as heart failure if left untreated.

There are no medicines to treat aortic valve problems, so replacing the valve will be recommended if you’re at risk of serious complications but are otherwise well enough to have surgery.

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What To Expect After An Aortic Valve Replacement

You will be taken to the intensive care unit for monitoring, then to a ward until you are ready to leave hospital.

Full recovery from aortic valve replacement can take from several weeks to months, during which you may have pain and tiredness.

You will need to take anti-clotting medication for life if you receive a mechanical valve, or for a few months after receiving a biological valve.

Why Might I Need Heart Valve Repair Or Replacement Surgery

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Valve repair or replacement surgery is done to correct the problems causedby one or more diseased heart valves.

If your heart valve becomes damaged or diseased, you may have thefollowing symptoms:

  • The repaired or replaced valve doesn’t work correctly

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your healthcare provider before theprocedure.

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What Are Heart Valve Replacements Made Of

There are two types of heart valve replacements:

Mechanical heart valves. These valves are created from man-made materials, which can be plastic or metal. Because they are considered to be the most durable, these valves are often used for younger patients. People who have a mechanical valve must take blood-thinning medications such as warfarin. They are also at higher risk for thrombosis . Though this is rare, it is a serious complication that is more likely to occur with a mechanical valve.

Tissue valves. While a tissue valve does not require long-term use of blood-thinners, and they are less likely to be associated with thrombosis, they are also less durable. Most will need to be replaced in 10 to 20 years. The tissue can be taken from animals or cadavers. A third option is the Ross procedure, a surgery that replaces a defective aortic valve with the patients own pulmonary valve.

When Surgery Is Required

If your symptoms are mild, you will be invited to come in for an echocardiogram every year or two to check whether the problem is getting worse.

If your symptoms are severe, it is highly likely that surgery to replace the valve will be recommended. Without treatment, stenosis or regurgitation of your aortic valve is likely to get worse and will eventually lead to heart failure, which is a long-term and sometimes debilitating condition.

There is also a small risk that the heart will suddenly stop beating , which can also be fatal.

Research has found that people with severe aortic stenosis who are not treated with surgery have a 25% chance of dying in the first year after the symptoms start. The risk is 50% in the second year.

People with severe aortic regurgitation who are not treated with surgery have a 25% chance of dying after 5 years following the start of symptoms. The risk is 50% after 10 years.

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Recovery: What To Expect

Things that can affect your surgery include your age, overall health, and the type of surgery. If you have a minimally invasive surgery you’ll be up and around in a few days.

If you have open heart surgery, your recovery will take longer. Your wound might be sore, swollen, and red. Youâll get tired easily. You might not feel like eating much, and you might find it hard to sleep. Thatâs all to be expected, and it gets better with time.

Your breastbone will take 6-8 weeks to heal, but it might be 3 months or so before you feel back to normal. Your doctor may suggest an exercise program or cardiac rehab to help.

As far as getting back to work, expect it to take 6-8 weeks for a desk job. If your work is more physical, it could take up to 3 months.

Aortic Valve Balloon Valvuloplasty

Heart Valve Replacement Surgery Explained Part 2

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.

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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.

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.

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The Medtronic Tavr Valve Cannot Be Used For Patients Who:

  • Have a serious infection
  • Cannot take medications that reduce the risk of blood clots
  • Have a reaction to some metals

If the Medtronic TAVR valve is used in these patients, it will not work properly. This could make you feel sick or even cause death.

For some patients, the Medtronic TAVR procedure risks may outweigh the benefits. Please talk to your doctor to decide whether this therapy is right for you.

After The Surgical Heart Valve Replacement Procedure

Mitral valve replacement through left atrial appendage 28 years after ...

When your heart valve has been replaced and the surgery is completed, your heart will be beating on its own and all incisions will be sewn or stapled closed.

Following the surgery, youll spend some time in the ICU, where you will be closely monitored to make sure there are no complications. Family and friends will be able to visit while you are in the ICU.

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What Is Heart Valve Disease

There are several types of heart valve disease that can decrease or damage the functioning of your heart. They include:

  • Aortic stenosis: narrowing of the aortic valve, one of the most common conditions requiring valve replacement.
  • Mitral stenosis: another condition that sometimes requires valve surgery.
  • Aortic regurgitation: when the valve allows blood to return back into the heart preventing forward flow out to the body. Also known as aortic insufficiency.
  • Mitral regurgitation: when the mitral valve allows blood to flow backwards into the lungs instead of continuing through the heart as it should. You may experience difficulty breathing, irregular heartbeat and chest pain.

Learn more about valve disorders.

Alternatives To Aortic Valve Replacement

Aortic valve replacement is currently the most effective treatment for aortic valve diseases. But having open-heart surgery can place tremendous strain on the body.

Surgery may be too dangerous in people who are in very poor health. In this case, less invasive alternative methods may be required. Some alternative methods are described below.

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How Is An Aortic Valve Replacement Carried Out

An aortic valve replacement is carried out under general anaesthetic.

This means you’ll be asleep during the operation and won’t feel any pain while it’s carried out.

During the procedure:

  • a large cut about 25cm long is made in your chest to access your heart although sometimes a smaller cut may be made
  • your heart is stopped and a heart-lung machine is used to take over the job of your heart during the operation
  • the damaged or faulty valve is removed and replaced with the new one
  • your heart is restarted and the opening in your chest is closed

The operation usually takes a few hours.

You’ll have a discussion with your doctor or surgeon before the procedure to decide whether a synthetic or animal tissue replacement valve is most suitable for you.

How Is A Heart Valve Replacement Surgery Performed

Heart Valve Replacement Surgery Explained Part 1

Heart valve replacement surgery can be performed via any of the two approaches:

  • Open-heart surgery: Traditional method of heart surgery in which a large incision is made in the chest the heart is stopped for a time so that the surgeon can repair or replace the valve.
  • Minimally invasive heart surgery: These are the newer techniques in which the doctors make smaller incisions over the chest to replace the heart valves.

The diseased valves may be replaced by any of the artificial valves that include:

  • Manufactured mechanical valve: Made up of carbon-coated plastic, the mechanical valve is the most durable type of valve that will usually last for your entire lifetime.
  • Donors valve: This is an actual human valve taken from a donor and implanted in your heart . It usually lasts for anywhere between 10 to 20 years.
  • Tissue valve: Created from animal valves or tissues, this type of heart valve is expected to stay healthy for 10 to 20 years after the surgery.

Your doctor will discuss the benefits and risks of the available surgical options as well as of the types of valves.

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