Valve replacement surgery

How is Valve Replacement Surgery performed?

The human heart has four pumping chambers, two atria, and two ventricles. Between these chambers, four valves are situated for the unidirectional flow of blood through the heart. These are the tricuspid valve, pulmonary valve, mitral valve, and aortic valve. When these valves become damaged or diseased, they do not work correctly, forcing the heart to pump harder. In such cases, the diseased valves are either surgically repaired or replaced by mechanical or biological valves. This procedure is called “valve replacement surgery” and is typically done to treat any life-threatening valve disease.

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How is Valve Replacement Surgery performed? :

Open-heart surgery is usually done for replacing diseased valves in the patient. During this surgery, the patient will be connected to an electrocardiogram (ECG) machine for monitoring their heart’s rhythm and electrical activity throughout the surgery. The patient will then be anesthetized and, once completely asleep, they will be connected to a respirator by inserting a tube down the windpipe. [1] 

Valve replacement surgery

Another tube will then be inserted into the stomach via the nose and down the throat to prevent the accumulation of liquid and air in the abdomen during the surgery. A catheter will also be inserted into the bladder to collect any urine produced during the operation. Following this, the patient is connected to a heart-lung bypass machine to keep the oxygen-rich blood flowing through the body while the heart is stopped. After hooking the patient to this machine, the heart is stopped and cooled. [2]

The surgeon then cuts the aorta or heart depending on the valve being replaced and removes the diseased valve. An artificial valve will then be placed in this area. The surgeon then shocks the heart with small paddles to restart the heartbeat. The blood flowing through the bypass machine will be directed towards the heart. After this, the patient is disconnected from the machine. [3], [4], [5] 

Why are these performed? :

This surgery is typically done if there is a

backward flow of blood (regurgitation). It is due to improper closure of the valves. Or if the blood flow is restricted due to inadequate opening of the valves (stenosis). Heart valves that have been damaged by infection (endocarditis), diseased, or have defects. That gives rise to heart symptoms such as chest pain, shortness of breath, syncope, or heart failure are treated using this surgery. Some of the other heart valve problems that are generally treated by heart valve surgeries are –

  • Aortic stenosis
  • Congenital heart valve disease
  • Pulmonary stenosis
  • Mitral regurgitation – acute and chronic
  • Tricuspid valve stenosis
  • Tricuspid regurgitation

Read more about other Cardiac Disorders.

What are the different types of Heart Valve Replacement Surgeries? :

The different types of valve replacement surgeries are as follows –

  • Transcatheter Aortic valve replacement (TAVR) – This is a minimally invasive procedure used to replace the aortic valve that serves to carry blood out of the left ventricle.
  • Mitral valve replacement – In this surgery, the defective mitral valve is replaced with either an artificial metal valve or a biological valve to allow the proper blood flow from the left atrium to the left ventricle.
  • Double valve replacement – This surgery is done to replace both the aortic and mitral valves situated on the left side of the heart.
  • Pulmonary valve replacement – This is typically done to replace the pulmonary valve due to stenosis caused by a congenital defect, infection, or carcinoid syndrome.
  • Bioprosthetic valve replacement – This procedure is used to implant a second valve if the first tissue replacement valve has worn out. It is also a minimally invasive approach.

Are there any risks involved in it? :

The possible risks of heart valve replacement surgery are bleeding during or after the surgery, blood clots, infection, pneumonia, pancreatitis, breathing problems, arrhythmias, heart attack, stroke, lung problems, and even death.

FAQs: Valve Replacement Surgery

  1. What are preparations required from the patient? Before the srugery, the patient is expected to review all the medications with the surgeon. The doctor may ask to discontinue them if needed. Before the surgery, the patient will be asked to take ECG, blood tests, urine tests, and chest x – rays. The patient is instructed to stop smoking for at least two weeks before the surgery. They need to bathe the night before the surgery. 
  2. How long does it take? The heart valve replacement surgery can take around 2 to 4 hours or more to complete. The duration depends on the number of valves being replaced.
  1. Who performs it?

Cardiac surgeons, together with perfusionists, intensive care specialists, anesthesiologists, and nurses, will perform this surgery.

  1. How much does it cost?

The cost of a heart valve replacement surgery lies around INR 2.5 L to 8.5 L in India.

  1. When can I go home after the procedure?

You need to stay in the intensive care unit (ICU) for at least 1 to 3 days. The overall hospitalization is for about seven days. You will be discharged after this period but will usually be asked to limit your activities for a few weeks.

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