What Happens During Heart Valve Repair Or Replacement Surgery
Heart valve repair or replacement surgery requires a stay in a hospital.Procedures may vary depending on your condition and your healthcareproviders practice.
Generally, open-heart valve repair or replacement follows this process:
You will be asked to remove any jewelry or other objects that may interfere with the procedure.
You will change into a hospital gown and empty your bladder.
The surgical team will position you on the operating table, lying on your back.
A healthcare professional will start an intravenous line in your arm or hand for injection of medicine and to give IV fluids. More catheters will be put in blood vessels your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples.
The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
Your doctor will put a breathing tube through your mouth into your lungs and connect you to a ventilator, a machine that will breathe for you during the surgery.
Your doctor will place a transesophageal echocardiogram probe into your esophagus so he or she can monitor the function of the valves.
A soft, flexible tube will be put into your bladder to drain urine.
A tube will be put through your mouth or nose into your stomach to drain stomach fluids.
Someone on the surgical team will clean the skin over your chest with an antiseptic solution. If there is a lot of hair at the surgical site, it may be shaved off.
British Columbia Specific Information
There are several different types of heart valve disorders and many different treatments available. Treatments could include lifestyle changes, medication, or surgery. To learn more about heart valve disorders and treatments, visit the Heart and Stroke Foundation – Valve Disorders.
In some cases, a blood thinner may be prescribed as part of your treatment. Blood thinners are medicines that help prevent blood clots. If you are taking a blood thinner, always talk to your health care provider before you buy any over the counter medicines.
For more information you may also call 8-1-1 to speak to a registered nurse or pharmacist. Our nurses are available anytime, every day of the year and our pharmacists are available every night from 5:00 p.m. to 9:00 a.m.
What Happens During The Procedure
The standard procedure is done under a general anaesthetic, so you will be completely unconscious.
The surgeon will cut through the breastbone to reach the heart and a machine will take over the working of the heart and lungs during surgery.
The faulty valve will be replaced with a new valve, either made of human or animal tissue or of metal . During the surgery you may need a blood transfusion.
Newer techniques involve smaller cuts or no cuts to the chest wall. Transcatheter Aortic Valve Implantation is done by inserting a balloon catheter into an artery and guiding it to the heart. The balloon is gently inflated to open up the aortic valve. The doctor then inserts the new valve, which inflates to push aside the old valve.
Your doctor will be able to discuss the risks and benefits of each procedure with you.
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Survival Rate Of Heart Valve Replacement Surgery
The survival rate for a heart valve replacement surgery depends on which valve is involved. This was analyzed in a large study in which the lifespan of a large population, who went ahead with the surgery, is observed for a specific timeframe.
The 5-year survival rate means what percentage of people lived for at least 5 years after the surgery. Similarly, the 10-year survival rate means what percentage of people lived for at least 10 years after the surgery.
For example, the 5-year survival rates for aortic valve replacement surgery is 94%. This means 94 out of 100 people who underwent AVR surgery could live at least 5 years.
Table 1: The Survival Rates as Per the Type of Valve in Heart Valve Replacement Surgeries
Survival rates for heart valve replacement surgery are often used as predictors of how long patients can live beyond a certain number of years after the surgery. However, these may vary for you depending on your age, your overall health, and the current status of your heart function. Discuss with your doctor about these factors to know about your life expectancy after the surgery.
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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Enhancing Healthcare Team Outcomes
For patients with severe aortic stenosis who are not candidates for open heart surgery, an alternative is transcatheter aortic valve replacement. The procedure is done by an interprofessional team that involves a cardiac surgeon, an interventional cardiologist, anesthesiologist and a radiologist. After the procedure, the patient needs monitoring in a cardiac ICU by critical care nurses. Such an approach may provide the best results with minimal morbidity. TAVR has now been done in thousands of patients in the US and Europe with a procedural success rate of 90%. The 30 day mortality rates have varied from 3-15%. At 2 years, some studies have shown mortality rates of about 35%. Early deaths are usually due to arrhythmias, heart failure and pulmonary complications. It should be emphasized that TAVR is only for patients deemed at high risk for an open procedure.
Recovery From Surgical Heart Valve Replacement
In the ICU, the staff will keep a close watch on the heart rate, temperature, blood pressure, and other vital body signs. The patient may feel a little uncomfortable because of all the monitoring equipment attached to them. The nurses will try to keep them as comfortable as possible. Friends and family are usually welcome to visit them.
When intensive care monitoring is no longer needed, the patient will be moved to a regular hospital room. Typically, they may be in the hospital for three to 10 days, depending on how quickly they recover.
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When Is Heart Valve Surgery Necessary
You may have been born with a valve problem or developed a leak, stiffness or narrowing in your valve.
Youll most likely need treatment for heart valve disease if youre having symptoms like:
Note: While medication can help improve your symptoms and quality of life, surgery is the only effective long-term option. Ask your healthcare provider when you should start considering heart valve surgery.
What Are The Signs And Symptoms Of A Valve Problem
The primary sign that you have a valve problem is a heart murmur, or unusual heartbeat, that a doctor can hear when he or she listens to your heart with a stethoscope. However, having a heart murmur doesnt necessarily mean you have a valve problem.
Other symptoms of heart valve disease include fatigue, dizziness, fainting, shortness of breath, sudden weight gain, and swelling in the ankles, neck veins, and other areas of the body.
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How Is A Heart Valve Replacement Performed
Your heart valve replacement will be performed in a hospital using one of the following approaches:
Surgeons sometimes combine minimally invasive techniques with an open procedure. Your surgeon may also decide after beginning a minimally invasive technique that you require an open surgery to safely and effectively complete your surgery. Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different heart valve repair procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform your heart valve replacement using either general or regional anesthesia, depending on the specific procedure. General anesthesia is more common for these procedures.
What to expect the day of your heart valve replacement
You will be admitted to the hospital the day before your heart valve replacement surgery. For minimally invasive procedures, you will probably report to the hospital the morning of your surgery. The day of your surgery, you can generally expect to:
During The Surgical Heart Valve Replacement Procedure
During the procedure, the surgeon opens the chest to get to the heart and the diseased valve. The procedure varies from patient to patient, lasting a minimum of two hours and often longer. During this time, the patient is under general anaesthesia.
The surgeon will remove any tissue and calcium deposits that are interfering with the normal function of the valve. The damaged valve may be completely removed. Then, the new valve will be sewn into the space where the patient’s own valve used to be. After the surgeon makes sure the valve is working properly, blood flow will be restored to the heart and the incisions will be closed. The surgery is performed while the function of the heart is taken over by a heart-lung machine called cardiopulmonary bypass or CPB.
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What Causes Aortic Valve Disease
The aortic valve may be abnormal at birth or become diseased over time, usually seen in older patients .
Congenital aortic valve disease
Patients with bicuspid aortic valves are born with them and are present in about 1 – 2 percent of the population.
Normal aortic valve
Bicuspid aortic valve
Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two. Without the third leaflet, the valve opening may not close completely and leak or not open completely and become narrowed or leak.
In many cases, bicuspid aortic valves may function normally for several years without requiring treatment.
About 25 percent of patients with bicuspid aortic valves may have some enlargement of the aorta above the valve. If it is greatly dilated, the aorta is known as being aneurismal.
Acquired aortic valve disease
With acquired aortic valve conditions, changes occur in the structure of the valve. Acquired aortic valve conditions include:
Robotic And Minimally Invasive
Our cardiovascular surgeons specialize in robotic-assisted and minimally invasive cardiac surgeries to treat heart valve disease. We offer:
Transcatheter aortic valve replacement
Your physician places an expandable replacement valve into the heart via a catheter inserted through the femoral artery. AHN is a national leader in TAVR procedures.
MitraClipâ¢ mitral valve repair
This innovative device stops valve regurgitation by closing leaky valve leaflets. During minimally invasive heart surgery, your physician implants the device via a catheter inserted through the femoral artery in the groin.
Robotic-assisted mitral valve repair
Your physician repairs a leaky mitral valve using a small camera and instruments inserted through small incisions between the ribs. Learn more about robotic heart surgery for mitral valve repair.
During this minimally invasive procedure for valve stenosis , your physician inserts a catheter tipped with a balloon through a blood vessel in the leg or arm. After inflating and deflating the balloon to stretch the valve opening, your physician removes the catheter and balloon.
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What Are The Four Types Of Heart Valves
The heart is made up of four pumping chambers:
- Two atria: Upper chambers of the heart
- Two ventricles: Lower chambers of the heart
There are valves between each of the heart’s pumping chambers that open and close in coordination with each other. Their action keeps blood flowing forward through the heart. There are four valves in the heart:
- Tricuspid valve: Between the right atrium and the right ventricle
- Pulmonary valve: Between the right ventricle and the pulmonary artery
- Aortic valve: Between the left ventricle and the aorta
Who Performs A Heart Valve Replacement
A cardiac surgeon performs a heart valve replacement. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. A cardiac surgeon may also be known as a cardiothoracic surgeon.
A subspecialist called a congenital cardiac surgeon may perform the surgery on a heart valve with a congenital defect .
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What Are Heart Valves And How Do They Work
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.
Risks Of An Aortic Valve Replacement
An aortic valve replacement is a big operation and, like any type of surgery, carries a risk of complications.
Some of the main risks of an aortic valve replacement include:
- wound, lung, bladder or heart valve infections
- a temporarily irregular heartbeat
- reduced kidney function for a few days
The risk of dying from an aortic valve replacement is around 2%, although this risk is much smaller than that of leaving severe aortic valve problems untreated.
Most people who survive surgery have a life expectancy close to normal.
Read more about the risks of aortic valve replacement.
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Preparing For The Surgery
Preparation for a valve replacement depends on the type of procedure a person is having.
Prior to open-heart surgery, people will typically meet with the medical team performing the procedure to discuss the steps involved and any possible risks and complications.
People will likely have to stay in the hospital the night before surgery to have blood work and other testing done. They must not eat after midnight before the surgery.
Before the surgery, a hospital employee will shave the surgical area and direct the person to put on a hospital gown. They may administer a sedative to help the person relax. They will then move the person to the operating area, where the person will receive general anesthesia.
What happens during the surgery depends on the type of procedure.
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 Is A Heart Valve Replacement
A heart valve replacement removes a diseased or damaged heart valve and replaces it with a new heart valve. Heart valves keep blood flowing in one direction through the four chambers of your heart. They open to allow blood to flow forward to the body. They then close tightly so blood does not leak backwards into the heart. Diseased or damaged heart valves can cause a backflow of blood or not allow blood to flow forward normally.
Heart valve replacement is a major surgery with significant risks and potential complications. You may have less invasive treatment options, such as a heart valve repair procedure. Consider getting a second opinion about all your treatment options before having a heart valve replacement.
Types of replacement heart valves
The new valve used in a heart valve replacement is called a prosthesis. The types of heart valve prostheses include:
Other surgical procedures that may be performed
Your doctor may also perform other procedures in addition to a heart valve replacement. These include:
Coronary artery bypass graft uses a graft to make a new route for blood to flow around blocked coronary arteries in the heart. Grafts are made with healthy vessels taken from other places in the body.
Percutaneous coronary intervention involves widening or opening a blocked or narrowed coronary arteries in the heart. A stent is typically placed in the artery to keep it open longer.
Replacing An Aortic Valve Without Open
Cardiologists expect wider use of the less-invasive techniqueknown as TAVRin the near future.
The one-way valve inside your aorta opens to allow blood to surge from the heart to the rest of your body. But as you age, the valve’s leaflets may stiffen and become clogged with calcium deposits, restricting blood flow. About 12% of people ages 75 or older have this condition, known as aortic stenosis. Symptoms include feeling dizzy, faint, tired, and breathless. Unless the valve is replaced, half of people with symptoms from aortic stenosis die within two years.
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