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Introduction to Heart Valve Surgery

Diseased heart valves can be treated both surgically (traditional heart valve surgery) and non-surgically (balloon valvuloplasty).

What Happens During Traditional Heart Valve Surgery?

During traditional heart valve surgery, a surgeon will make an incision down the center of your sternum (breastbone) to get direct access to your heart. The surgeon then repairs or replaces your abnormal heart valve or valves.

What Happens During Minimally Invasive Heart Valve Surgery?

Minimally invasive heart valve surgery is a type of surgery performed through smaller incisions. This type of surgery reduces blood loss, trauma, and length of hospital stay.

Your surgeon will review your diagnostic tests prior to your surgery to determine if you are a candidate for minimally invasive valve surgery.

Often, the surgeon and cardiologist (heart doctor) will use transesophogeal echo (an ultrasound transducer probe that is passed down the throat) to help determine the functioning of the valve before and after surgery.

What Is Heart Valve Repair Surgery?

The mitral valve is the most commonly repaired heart valve, but the aortic, pulmonic, and tricuspid valves may also undergo some of these repair techniques. The valves are made up of leaflets or flaps.

If your valve can be repaired, your surgeon will perform any of the following types of valve repair procedures.

  • Commissurotomy. Fused valve leaflets, or flaps, are separated to widen the valve opening.
  • Decalcification. Calcium deposits are removed to allow the leaflets to be more flexible and close properly.
  • Reshape leaflets. If one of the leaflets is floppy, a segment may be cut out and the leaflet sewn back together, allowing the valve to close more tightly. This procedure is called quadrangular resection.
  • Chordal transfer. If a leaflet of the mitral valve has prolapse (floppy; lacking support), the chordae are transferred from one leaflet to the other. Then, the leaflet where the chordae was removed is repaired by quandrangular resection (see above).
  • Annulus support. If the valve annulus (the ring of tissue supporting the valve) is too wide, it may be reshaped or tightened by sewing a ring structure around the annulus. The ring may be made of tissue or synthetic material.
  • Patched leaflets. The surgeon may use tissue patches to repair any leaflets with tears or holes.

The advantages of heart valve repair surgery include:

  • decreased need for life-long blood thinner (anticoagulant) medication
  • preserved heart muscle strength

Heart Valve Surgery

What Are the Pros and Cons of Each Type of Heart Valve?

  • Mechanical heart valves. The advantage to mechanical heart valves is their sturdiness. They are designed to last for many years. There are also drawbacks. Due to the artificial material involved, people who receive these valves will need to take life-long blood-thinner medication (anticoagulants) to prevent clots from forming in the mechanical valve. These clots can increase the risk for a stroke. Also, some people report a valve ticking sound that is usually not bothersome. It is the sound of the valve leaflets opening and closing.
  • Biological heart valves. The advantage of biological heart valves is that most people do not need to take life-long blood thinners, unless they have other conditions (such as atrial fibrillation) that warrant it. Biologic valves, traditionally, were not considered as durable as mechanical valves, especially in younger people. Previously available biologic valves usually needed to be replaced after about 10 years. However, some studies show that some biologic valves may last at least 17 years without decline in function. This represents a new milestone in the durability of biologic valves.
  • Homograft heart valves. Homografts are ideal heart valves for aortic valve replacement, especially when the aortic root is diseased or there is infection. The heart's natural anatomy is preserved and patients do not need to take life-long blood thinners. However, the limited availability is a drawback in some settings.

What If My Valves Cannot Be Repaired?

When you have aortic or pulmonic heart valve disease, valve replacement surgery is usually performed. In some cases, the aortic valve can be repaired.

During valve replacement surgery, the faulty valve is removed and a new valve is sewn to the annulus of your original valve. The new valve can be a:

  • Mechanical valve. It is made totally of mechanical parts that are tolerated well by the body. The bi-leaflet valve is used most often. It consists of two carbon leaflets in a ring covered with polyester knit fabric.
  • Biological valve. Tissue valves (also called biologic or bioprosthetic valves) are made of human or animal tissue. Animal tissue heart valves may come from pig tissue (porcine) or cow tissue (bovine). Tissue valves may have some artificial parts to help give the valve support and to aid placement.
  • Homograft valve (also called allograft). It is an aortic or pulmonic human valve that has been removed from a donated human heart, preserved, and frozen under sterile conditions. A homograft may be used to replace a diseased aortic or pulmonic valve.

What Are the Pros and Cons of Each Type of Heart Valve?

  • Mechanical heart valves. The advantage to mechanical heart valves is their sturdiness. They are designed to last for many years. There are also drawbacks. Due to the artificial material involved, people who receive these valves will need to take life-long blood-thinner medication (anticoagulants) to prevent clots from forming in the mechanical valve. These clots can increase the risk for a stroke. Also, some people report a valve ticking sound that is usually not bothersome. It is the sound of the valve leaflets opening and closing.
  • Biological heart valves. The advantage of biological heart valves is that most people do not need to take life-long blood thinners, unless they have other conditions (such as atrial fibrillation) that warrant it. Biologic valves, traditionally, were not considered as durable as mechanical valves, especially in younger people. Previously available biologic valves usually needed to be replaced after about 10 years. However, some studies show that some biologic valves may last at least 17 years without decline in function. This represents a new milestone in the durability of biologic valves.
  • Homograft heart valves. Homografts are ideal heart valves for aortic valve replacement, especially when the aortic root is diseased or there is infection. The heart's natural anatomy is preserved and patients do not need to take life-long blood thinners. However, the limited availability is a drawback in some settings.

Are There Non-Surgical Options for Valve Disease?

Yes. Balloon valvotomy is used to increase the opening of a narrowed (stenotic) heart valve. It is used for select patients who have mitral valve stenosis (narrowing of the mitral valve) with symptoms, select older people who have aortic stenosis (narrowing of the aortic valve) but are not able to undergo surgery, and some patients with pulmonic stenosis (narrowing of the pulmonic valve).

What Happens During Balloon Valvotomy?

During a balloon valvotomy, a specially designed catheter is inserted into a blood vessel in the groin and guided to the heart. The tip is directed inside the narrowed heart valve. Once there, a tiny balloon is inflated and deflated several times to widen the valve opening. Once the cardiologist is satisfied the valve has been widened enough, the balloon is removed.

During the procedure, the cardiologist may perform an echocardiogram (ultrasound of the heart) to get a better picture of the valve.

New research-based, non-surgical procedures to treat regurgitation (leaky valves) are being tested and may provide additional treatment options using a catheter for valve disease in the future.

SOURCES:

Cleveland Clinic Heart Center.

The National Institutes of Health.

The American Heart Association.

Reviewed by Robert J Bryg, MD on September 15, 2009

Last Editorial Review: 9/15/2005

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Reviewed on 9/15/2005
References
SOURCES:

Cleveland Clinic Heart Center.

The National Institutes of Health.

The American Heart Association.

Reviewed by Robert J Bryg, MD on September 15, 2009

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