Heart Valve Replacement Sugery

By Adam Pick - Patient, Author & HeartValveSurgery.com Founder

If you have recently been diagnosed with heart valve disease -- or, you were just informed that you may need cardiac surgery -- this page was created to help you learn about heart valve replacement surgery.

So you know... There many different reasons why patients need to have a heart valve replacement operation. The two most common disorders that require patients to undergo valve replacement surgery include:

  • The surgery may help to replace valves in the heart muscle that are leaking, known as regurgitation.
  • The surgery can replace narrowed heart valves that negatively impact bloodflow through the heart, a condition known as stenosis

Candidates for replacement valve surgery include people with congenital heart valve diseases and heart conditions, including heart muscle disease, rheumatic valve disease, cardiomyopathy, coronary artery disease, and heart attack damage. Reports suggest that 250,000 heart valve surgeries are performed worldwide each year, with approximately 99,000 of those occurring in the United States. In addition to heart valve replacement surgery, patients may also undergo heart valve repair surgery.

Why Do Patients Need Heart Valve Replacement Surgery?

Before we learn more valve replacement surgery, it may help you to better understand that anatomy of your heart valves. There are four valves in the human heart – the mitral, tricuspid, aortic, and pulmonary valves. All four valves must be functioning properly to manage blood flow through the human body.

Specifically, your heart valves manage the direction of blood through the heart. If a valve is not working properly, it may need to be repaired or replaced. Of all the valves in the human heart, the aortic and mitral valve typically require surgical treatment.

What Are The Common Symptoms of Heart Valve Replacement Patients?

If the valves fail to work properly, the patient can experience symptoms. The most common symptoms of heart valve disease include:

  • Shortness of breath
  • Difficulty catching your breath, especially after being active or after lying on your back in bed
  • Regularly feeling dizzy or weak, which interferes with your normal daily activities
  • Feeling weight or pressure on your chest, especially when you are outside in fairly cold weather or when you are being active
  • Heart palpitations or feeling like your heart is flip-flopping, skipping beats, or beating irregularly
  • Unexplained swelling in your belly, feet, or ankles Sudden unexplained weight gain – possibly two to three pounds in a single day

However, it should be noted that many patients are asymptomatic -- meaning, they experience no symptoms. This can be a very dangerous situation as permanent damage to the cardiac muscle may occur without the patient ever knowing it.

What Are The Different Types of Heart Valve Replacement Devices?

There are several different types of valves used by surgeons in valve replacement surgery. The two most common valves are mechanical and biological valves.

Mechanical heart valve replacements are composed of synthetic materials and are made to last for many years. The biggest risk is the possibility of developing blood clots, due to the tendency of blood sticking to the valves. With this type of valve, you will need to take anticoagulants (blood-thinning medicines) for the rest of your life.

Biological valves, also known as tissue valves, are either taken from the tissue of a donated human heart – called a homograft or allograft – or they are made from animal tissue, called a xenograft, which is taken from pigs, cows and even horses. In some cases, the patient’s own tissue can be used in what is known as an autograft or Ross procedure.

While biological valves are less durable and may need to be replaced in the future, they do not require a lifetime of taking blood-thinning medications. Older patients are most often given these valves for this reason.

  • Pig valve (porcine valve) replacement has commonly been used as an option for biological heart valve replacement for over 20 years. These valves are very similar to human heart valves in function and structure. Patients often choose these over mechanical valves because they have been around for a long time, they do not require the use of blood-thinners for the rest of the patient’s life, and they do not make the typical clicking sounds that many of the mechanical ones make. One major disadvantage to pig valves is they only last 10 to 15 years. As a result, younger patients are often inclined to request mechanical valves; older patients are more likely to choose porcine valves.
  • Cow valve (bovine valve) replacement is another commonly used biological heart valve replacement. They have been used for many years and like pig valves, they are very similar to human valves in tissue physiology, which helps the human body have a positive response to this procedure. Unlike a porcine valve replacement, a bovine valve uses tissue from the cow’s heart, instead of the actual structure. Common disadvantages include not being as durable, due to the shortened lifespan of a cow, as well as a higher susceptibility of calcification on the valve leaflets. These valves typically last 10 to 15 years, however, there is research implying cow valves may last over 20 years. When deciding whether to use a mechanical or a tissue valve, several factors will be taken into consideration, including any additional health issues, current medications, the patient’s age and life expectancy, and their lifestyle.

What Are The Different Surgical Approaches To Heart Valve Replacement Surgery?

There are two main types of valve replacement procedures. The first is open-heart valve replacement surgery. This surgery is the most invasive since it requires sternotomy – the cutting and spreading of the sternum so the heart muscle is exposed. The heart is then stopped and the patient is on a heart-lung machine during the operation.

Advances in techniques and surgical procedures have led to a second option – minimally invasive valve surgeries, which are performed by making smaller incisions on the side of the chest, called a mini-thoracotomy or to the middle of the chest, a mini-sternotomy. It should be noted that fewer hospitals offer minimally invasive surgeries because the advanced techniques involved require special training, expertise, and equipment. Key advantages to these surgeries are lower morbidity and mortality, less pain following surgery, faster recovery, and a shorter stay in the hospital.

Lastly, in November, 2011, the FDA approved a catheter based form of aortic valve replacement that causes no trauma to the sternum or ribs of the patient. That procedure, known as transcatheter aortic valve implantation (TAVI), is currently only available to patients who inoperable or in a 'high-risk' condition.

What Is The Lifespan Of A Heart Valve Replacement Patient?

Barring other cardiac issues, a patient that has received a replacement heart valve can lead a normal, healthy life -- however, reoperations may occur if the valve durability is compromised.  Remember, mechanical replacement valves have been shown to last as long as 25 years or more, while pig and cow valves typically last 10 to 15 years. So, depending on the age of the patient, a second surgery may or may not be required.

As for the recovery from cardiac surgery... Each patient will recover at their own pace, based on their age and their current state of health, all patients should eventually be able to participate in normal daily activities again. Eventually, the negative effects of the old, damaged valve will fade away as the new heart valve takes over and the heart begins functioning more efficiently.

Surgery to replace your heart valve is typically considered to be a safe surgery and the majority of patients should experience positive benefits of their new heart valve. Current mortality rates for heart valve replacement operations are less than 2%, according to The Society of Thoracic Surgeons.

 

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