December 26, 2018
Heart Valve Surgery

Valves in the heart ensure unidirectional flow of blood inside the heart. There are 4 important valves, namely Mitral, Tricuspid, Pulmonary and the Aortic valve. This mechanism ensures proper circulatory system with progressive flow of blood to different parts of the body.

Due to various conditions from infection, genetics to ageing, these valves undergo degeneration and malfunction.

Valves can undergo

  • Stenosis leading to narrowing of the channel through which the blood flows
  • Widening leading to regurgitation/ leak and back flow of the blood when the valve closes
  • At these times, there is severe compromise of the circulation and delivery of blood to different parts of the body.

    Common symptoms of heart valve failure are-

    • Chest pain
    • palpitations (rapid rhythms or skips)
    • Shortness of breath, difficulty catching your breath
    • Fatigue, weakness, or inability to maintain regular activity level.
    • Lightheadedness or loss of consciousness
    • Swollen ankles, feet or abdomen

    Surgery is recommended to repair or replace the valves with artificial ones for efficient functioning of the circulatory system when medications are not sufficient to relieve the symptoms. During a heart valve surgery, cardiac surgeons repair or replace the existing damaged heart valves with new artificial ones by open heart or minimally invasive cardiac surgery.

    Different types of heart valve surgeries:

    1. Open Valve Replacement Surgery

    A traditional technique that has stood the test of time is the open valve surgery which uses artificial valves to replace the existing diseased valves.

    This is a preferred method in cases of

    • Mechanical Valves: These are valves made of titanium that are easy to insert, long-lasting but with a burden of keeping the patients on anticoagulant treatment for the rest of their lives.
    • Biological Valves: These are valves derived from pig or cow tissue treated with chemicals and have little burden of thrombosis, since they are biologically made. They are durable and lasts close 2 decades. For a young person with a tissue valve replacement, the need for additional surgery or another valve replacement later in life is highly likely.
    • Homograft Valves: One of the best types of valves harvested from a dead donor, especially for patients with endocarditis leading to valvular dysfunction.
    • Stentless Valves: The latest type of tissue valve without any requirement of stents. These valves are wider, for proficient flow of blood used commonly in small aorta.

    2. Trans-Catheter Valve Replacement (TVR)

    One of the novel minimally invasive surgeries that has revolutionized the treatment of aortic stenosis. Compared to the traditional open valve surgery, this technique enables the patient for early recovery, early mobility, and much shorter duration of hospital stay, generally reserved for patients who are high risk for open-heart valve surgery.

    3. Valve Repair

    Valves with pliable, thin leaflets, with tear of the leaflet segment or which are near normal and redundant because of a flail segment are generally repaired to preserve the native valve and reduce the morbidity associated with valve replacement.

    Minimally Invasive Heart Valve Surgery

    Since long, heart surgeries have always been open heart surgeries where they involved opening of the chest cavity and directly visualising the heart to perform the procedure. This involved increased ICU stay, high rates of infection, prolonged bed rest, increased need for pain-killers, prolonged recovery periods, usually weeks. With novel techniques and better understanding of the anatomy and development of radiology, we are now able to perform minimally invasive, key-hole surgeries that can replace or repair heart valves offering better outcomes on all terms, compared to the traditional approach. Some of the commonly performed minimally invasive techniques are:

    • Trans-aortic valve replacement
    • Left atrial appendage closure device
    • Mitral clip
    • Intrepid TMVR