Heart Valve Replacement

What is Heart Valve Replacement?

The aortic value, mitral valve, tricuspid valve, and pulmonary valve are the valves of the heart which are considered as gateways which control the one-way blood flow in the heart. Variations in pressure on whichever side result in the opening of their cusps at the right moment, and closing firmly to avoid regurgitation. When one or more of these valves incur irreversible damage, or when blood does not travel all the way through the four chambers the way it should be, the patient may experience palpitations, black outs, respiratory impairment and even death.

The patient must undergo heart valve replacement right away in an attempt to curtail impending cardiopulmonary problems. This is a cardiac surgery method which follows the open heart surgery approach and involves the implantation of an artificial valve to replace the diseased valve. Nearly all heart valve replacement cases involve the aortic and the mitral valves.

In situations where the heart valve has already sustained enough damage and repair is already impractical, the physician will eliminate the failing valve and is replaced with a prosthetic valve. Heart valve replacement is indicated when there is mitral valve regurgitation or prolapse, or to patients, whose valves have been damaged by rheumatic disease, birth defects or by certain drugs, calcified due to accumulation of calcium or which have been narrowed such as in the case of valvular stenosis.

Mechanical or biological valve

Heart valves are replaced either with a mechanical or biological valve. In a mechanical valve, the main component is metal, ceramic, pirolytic carbon, polymer or other synthetic materials which is intended for long term use. It has analogous configuration and function to a normal heart valve which allows blood circulation through the chambers. Mechanical valves are immunologically nonreactive with the body’s own tissues.

Young patients most commonly have the mechanical valve as it lasts longer than the organic one. On the other hand, blood may attach to the prosthetic valve, resulting to the formation of blood clots. That’s why; patients are prescribed with lifetime anticoagulants. One downside related to the effect of the blood thinning agent is that it increases the risk for hemorrhage. Other disadvantages include increased risk of endocarditis and its perceptible click in every heartbeat which can be bothersome for some.

In a biological valve, the main component used is tissue. It may be an animal tissue from pigs or cows, a human tissue or from the client’s own pulmonary valve (Ross procedure). Around these bio-synthetic animal tissues are sewn fine mesh which offers foundation and steadiness. An alternative to animal tissues is homograft. The tissues from a human donor are frozen up in sterile environment and are given to eligible clients.

For a biological valve, there is no need for anticoagulants. Young patients may have slightly oversized valve to accommodate more growth. Another advantage in childbearing women is its lowered risk in pregnancy in opposition to the mechanical type which entails the administration of anticoagulants. In spite of this, the durability of the biological valve is lesser than the mechanical type and is considered necessary to be replaced for quite some time, usually every ten to fifteen years. This type of valve is often used in older patients.

A newer type of valve that fuses some elements of a mechanical valve with that of a biological type is labeled as the hybrid valve. These kinds of valve differ in the components and in the advantages and disadvantages they have.

Surgery

The valve replacement is done only by expert cardiologist. Before the procedure, the patient is informed about the operation, the risks and the problems which may arise such as heart attack, cerebrovascular accident and even mortality and other specific instructions concerning surgical preparation. In order to obtain latest patient health information, the patient may be scheduled for an electrocardiogram, hematologic exam, urinalysis and chest radiography.

On the day of the surgery, the patient must wear a hospital gown. The nurse goes over the patient’s chart and verifies if all the necessary documents are organized. In the pre-operative nursing unit, an anesthesiologist starts an intravenous fluid. A mild tranquilizer may be administered to help the client relax. Subsequently, the client is brought to the operating room.

The duration of the surgical operation depends greatly on the number of valves to be repaired or replaced. Usually, the procedure goes on for three to four hours all through which, the patient is placed under general anesthesia. A heart-lung machine is attached to the patient to guarantee an uninterrupted respiratory function during the operation. Even if the heart is stopped, the flow of oxygen-rich blood is continuous. This machine is manipulated and monitored by a perfusion technologist. In a traditional heart valve surgery, a cut is made in the chest down the breastbone to expose the heart. Once the heart is exposed, the blood is redirected to the machine in order for the blood to be propelled and oxygenated at the same time; the doctor carries out the operation.

To get into the aortic valve, the aorta is incised. The damaged valve leaflets are then taken out and substituted with a fitting artificial or biological valve. The new valve is sutured in place to secure its position, followed by the closure of the aorta.

Another method is robotic surgery. This is a minimally invasive valve surgery which does not make a large cut in the chest. Smaller incisions are made by the robotic hands.

Cost

The cost of heart valve replacement surgery will depend radically on a variety of factors including the insurance coverage, gender, age, location of the hospital and etc. A traditional heart valve replacement surgery may rate for about $50,000 and up, which mostly comprises the surgical and hospitalization fees.

Recovery time

After the operation, the patient is admitted to the intensive care unit for about 48 to 72 hours for continuous surveillance. Before being discharged, the patient is commonly required to stay for another week in the cardiac ward. The patient is prescribed with drugs aimed at preventing the formation of blood clots, relaxing the arteries and avoiding coronary contractions.

In a few days, the patient can carry on with his usual light activities. Until the patient has completely improved, exhausting activities are delayed. The patient is also instructed to report for a follow-up health check in 3 to 4 weeks. If, throughout the visit, the client is already in good health and the findings in the repeat ECG are very satisfactory, then the physician may arrange future visits every 3 months or once a year. Clients who have deskbound jobs can go back to work in 4 to 6 weeks, while those whose occupations are physically stressful, they will have to remain longer at home.

Complications

The surgical outcome can be influenced by multiple factors including the general health and age of the client and the skillfulness of the cardiologist. In aortic valve replacement, the risk of mortality due to major complications is usually minimal; estimated between 1 to 3%.

Generally, the patient becomes at risk for post-operative hemorrhage and anti-coagulant-related bleeding, infection such as infective endocarditis and breathing difficulty and hypersensitive reaction due to anesthesia. Thrombi may snap off from the walls of the heart valves and may penetrate the general circulation. These clots may obstruct major arteries resulting to unconsciousness, cerebrovascular accident and kidney failure.