Tuesday, November 29, 2022

Surgery For Heart Valve

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Is Keyhole Mitral Valve Surgery Risky

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

Mitral valve surgery is both very safe and very effective. If performed by keyhole heart surgery, the risks are even lower with less bleeding, less infection, less pain, and swifter recovery. The only caveat to this is that keyhole heart surgery must always be performed by experienced teams, and we always recommend that you ask your surgeon how many cases he/she has performed.

Why The Procedure Is Performed

You may need surgery if your valve does not work properly.

  • A valve that does not close all the way will allow blood to leak backwards. This is called regurgitation.
  • A valve that does not open fully will limit forward blood flow. This is called stenosis.

You may need heart valve surgery for these reasons:

  • Defects in your heart valve are causing major heart symptoms, such as chest pain , shortness of breath, fainting spells , or heart failure.
  • Tests show that the changes in your heart valve are beginning to seriously affect your heart function.
  • Your doctor wants to replace or repair your heart valve at the same time as you are having open heart surgery for another reason, such as a coronary artery bypass graft surgery.
  • Your heart valve has been damaged by infection .
  • You have received a new heart valve in the past and it is not working well, or you have other problems such as blood clots, infection, or bleeding.

Some of the heart valve problems treated with surgery are:

  • Aortic insufficiency

Your recovery after the procedure will depend on the type of valve surgery you are having:

  • Aortic valve surgery – minimally invasive
  • Aortic valve surgery – open
  • Mitral valve surgery – minimally invasive
  • Mitral valve surgery – open

The average hospital stay is 5 to 7 days. The nurse will tell you how to care for yourself at home. Complete recovery will take a few weeks to several months, depending on your health before surgery.

Why Choose Geisinger For Heart Valve Surgery

  • Valve repair expertise: We lead the way in repairing mitral valves. At Geisinger, the great majority of people with mitral regurgitation who require surgery have their valve repaired rather than replaced. Repair is often safer and better.
  • Team approach: Our heart care team works as one, carefully reviewing which cases need surgery and what other alternatives may be available. You not only benefit from your doctors expertise, but also the expertise and experience of everyone on the team. The team includes several top leaders in the field.
  • Continuity of care: Surgery can feel overwhelming for you and your family. Our heart care team is with you every step of the way, from heart valve disease diagnosis through surgery and recovery. Our goal is to return you to doing the things you love.

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What Happens During Heart Valve Replacement

Your heart valve replacement surgery will take two to five hours.

Your healthcare provider will give you medication to make you sleep and be pain-free.

Depending on which kind of surgery youre having, your provider will make:

Your provider will use a machine to do the work of your heart and lungs during your operation so your heart doesnt move during the operation.

Your provider will remove your diseased valve and replace it with a biological or mechanical valve. For a transcatheter procedure, theyll place your new valve inside your original one.

Theyll close your incisions and start your heart again.

Clothing And Personal Items

Heart valve replacement surgery cost in India  Vitamins Click

If you’re having heart valve surgery, your treatment team might recommend that you bring several items to the hospital, including:

  • A list of your medications
  • Eyeglasses, hearing aids or dentures
  • Personal care items, such as a brush, a comb, shaving equipment and a toothbrush
  • Loose, comfortable clothing
  • A copy of your advance directive
  • Items that help you relax, such as portable music players or books

During heart valve surgery, don’t wear:

You may need to have your body hair shaved where the incisions will be made. A special soap might be used to wash your skin to help prevent infection.

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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.

  • What Happens Before Heart Valve Replacement

    Your healthcare provider may take a chest X-ray and do an electrocardiogram a day before your operation.

    Avoid eating or drinking anything during the night before or the day of your surgery.

    Follow your providers instructions about which medications to take or stop taking before your operation.

    Take comfortable clothes with you to the hospital, along with shoes you can slip into instead of tie. Your relative or friend who drove you to your appointment can hold your belongings for you during surgery.

    Your provider will prepare your incision site by shaving and cleaning it.

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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.

    The Details Of Valve Replacement Surgery In Thailand

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

    Surgery to replace or repair heart valves has advanced to the level that its now performed every day around the world. One of the hospitals most practiced in valve replacement surgery in Thailand is Vejthani Hospital in Bangkok.

    Valve replacement surgery is required when the edges of the heart valves that control the blood flowing through the heart no longer seal tightly and leak or allow blood to flow to the wrong direction or when heart valve stenosis occur.

    With the expertise of the the surgeons at Vejthani Hospital, the surgery can be performed with high level of safety. This surgery is responsible for extending patients lifespans and giving them a better quality of life.

    The three main types of valve replacement techniques are TAVI, MIS and open heart surgery. There is also a fourth option, which is valve repair surgery. Its a viable alternative in certain cases where repair is a more favorable option because of the good condition of the existing valve, or where valve tightening is the problem.

    With advances in techniques, heart surgery has become a lot safer for the patient and more of a routine operation for surgeons. These surgeons can now choose between these three replacement procedural options, meaning they can tailor the procedure more closely to the patients condition, ensuring a more favorable outcome, making the patient more comfortable in their recovery, and able toreturn to their normal lifestyle in less time.

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    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.

    What Are The Advantages Of Heart Valve Surgery

    Heart valve surgery can ease your symptoms, improve your life expectancy and help prevent death.

    The potential advantages of heart valve repair vs. valve replacement are:

    • Lower risk of infection.
    • Less need for lifelong anticoagulant medication.

    Valve surgeries, including valve repair and valve replacement, are the most common minimally invasive procedure.

    The benefits of minimally invasive surgery include:

    • Lower risk of infection.
    • Other medical conditions you have.
    • How many procedures you have in a single operation.

    Your cardiologist and surgeon will talk to you about these risks before your surgery.

    If youve had a valve fixed or replaced, you may be at a higher risk of getting infective endocarditis. But this can also happen with a faulty valve that isnt repaired. In certain cases, your healthcare provider may prescribe antibiotics to keep you from getting endocarditis from some types of dental work. You can reduce the risk of endocarditis yourself by taking good care of your teeth.

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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.

    Transcatheter Aortic Valve Implantation

    Mitral Valve Repair Heart Surgery High

    TAVI involves inserting a thin catheter into a blood vessel in your body, usually in your upper leg or chest. The catheter is then fed through to your aortic valve, where its used to guide and fix an artificial valve that replaces your natural one.

    Undergoing TAVI has advantages. Theres no need to put the patient on a heart-lung bypass machine as the heart doesnt need to be stopped. And the procedure does not result in a large incision in the chest, the tissue trauma that goes along with it, and a long recovery phase.

    TAVI is the surgeons choice for patients who may be too frail to risk open heart surgery but require valve replacement.

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    Acquired Valvular Heart Disease

    Acquired valvular heart disease mainly affects the aortic and mitral valves, while the pulmonary valve is affected almost exclusively by congenital defects.

    The calcific form of aortic stenosis is by far the most common type in industrialized countries, with an incidence of 2% to 9% among persons over age 65. The post-rheumatic form, in contrast, has become rare. Concentric left-heart hypertrophy with diastolic dysfunction is the typical finding in longstanding aortic stenosis. Aortic stenosis takes a progressive course, with a decrease in the valvular opening area by roughly 0.1 cm2 per year, although marked interindividual variability has been observed .

    In the asymptomatic phase of the disease, the risk of sudden cardiac death is less than 1% per year. Patients with symptomatic aortic stenosis, on the other hand, will survive untreated for an average of only two to three years from the onset of cardiac symptoms. If aortic stenosis is clinically suspected and auscultation reveals the typical findings, the diagnosis can be confirmed by Doppler echocardiography.

    Aortic stenosis is said to be severe when a mean pressure gradient higher than 50 mm Hg and a valve opening area less than 0.75 to 1.0 cm2 are measured in the setting of a normal stroke volume. The determination of the degree of stenosis in patients with reduced left ventricular function presents a particular diagnostic challenge, because falsely low gradients can be measured in this situation .

    What To Expect Afterward

    After open-heart surgery, a person will wake up in the ICU and remain there for observation for up to 2 days. They will then go to the regular surgical unit for up to 5 days.

    Recovery generally takes several months. The speed of a persons recovery may depend on several factors, including their general health and age.

    While it is usually safe to resume typical activities not long after surgery, a doctor will likely advise a person to avoid high intensity activities and take several weeks off from work.

    It is typical to experience weakness and fatigue after this invasive surgical procedure. Most people will find that they regain their strength as they resume daily physical activities.

    Most valve replacement procedures are successful. However, people may need to have valves replaced again in the future.

    According to a 2021 Swedish study involving 33,018 people who underwent aortic valve replacement surgery, people who had this type of surgical procedure had a lower life expectancy than the general population. However, not all those who died within the follow-up period died as a result of heart problems.

    In 2019, published in the Journal of Cardiothoracic Surgery, involving 324 people who underwent mitral valve replacement, found that:

    • 1.9% of people died during the procedure
    • 9% of people died after 30 days
    • people who received a biological valve had a survival rate of 62.4% at 10 years
    • people who received a mechanical valve had a survival rate of 77.1% at 10 years

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    Procedural Overview Of A Typical Open

  • General anesthesia will be administered so that you remain asleep and pain-free during the procedure.
  • After preparation, an incision to access your heart is made.
  • You will be connected to a heart-lung machine to isolate the heart. Your heart is stopped.
  • The old valve is removed.
  • A new valve is placed.
  • Your newly replaced heart valve will begin working. This happens before weaned from CPB. The doctor will conduct a test to confirm the valve is working properly.
  • You are then weaned from cardiopulmonary bypass.
  • All incisions are closed.
  • You are then transferred to ICU and kept on a ventilator until you can fully breath on your own.

    Why Doesn’t Everyone Get A Minimally Invasive Procedure

    MitraClip : Minimally Invasive Mitral Valve Repair

    Your goal and the goal of your health care team is to get the best and safest treatment possible for you. That means tailoring the treatment to your heart, your valve disease, your age, your general health and other factors unique to you. Because were all different, not everyone with the same kind of valve disease needs the same kind of repair, the same kind or size of replacement valve, or the same approach.

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    Heart Valve Surgery In Infectious Endocarditis

    Excised septal leaflet of the tricuspid valve in an intravenous drug abuser with florid hepatitis C and acute endocarditis. Medically intractable right-heart failure and grade III to IV tricuspid regurgitation constituted the indication for surgery. At operation, the septal leaflet was found to be overlaid with massive, florid endocarditic deposits and to be almost totally detached from the valvular annulus. The valve was replaced with a biological prosthesis. Most cases of tricuspid endocarditis in intravenous drug users can, however, be treated conservatively.

    Operative Methods Of Heart Valve Replacement And Reconstruction

    Heart valves can be replaced with prostheses that are either mechanical or biological. Biological prostheses come in two types, xenografts and allografts.

    Very recently, catheter-assisted aortic valve implantation has attracted a great deal of attention . To date, more than 1000 patients around the world have been treated with this technique, which is still in the clinical testing phase. It has been used so far only in high-risk patients for whom conventional surgery is contraindicated. Two approaches for catheter-assisted aortic valve implantation have become established:

    Catheter-assisted aortic valve replacement by a transapical approach.

    The prosthesis is loaded in the catheter device and is ready for deployment.

    Intraoperative radiographic check of the position of the valve in the aorta after implantation.

  • the transapical approach, i.e., through the cardiac apex after exposure by minithoracotomy, and
  • the percutaneous transfemoral approach, by way of the femoral artery.
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    Leaky Heart Valve And Pulmonary Regurgitation

    Like the tricuspid valve, a small amount of pulmonic regurgitation may be present in healthy people. There are rare cases when a leaky pulmonary valve causes problems. These may be due to:

    • Elevated blood pressure in the pulmonary artery
    • Previous surgery as a child to repair a severe heart defect

    Usually, no treatment is required for pulmonary regurgitation. Treating the underlying medical condition is the best approach.

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