How Dangerous Is Percutaneous Heart Valve Replacement Surgery?

Pictured is an artificial heart valve. Percutaneous (less-invasive) heart valve repair is widely performed and carries the typical surgical risks of a cardiac procedure. Percutaneous heart valve replacement techniques are still evolving. The associated risks are expected to decline with advancements in this field.

A percutaneous valve replacement is a minimally invasive procedure to replace a diseased heart valve. The native valve is replaced with an artificial valve sewn into a stent. The valve may be made of animal tissue or human tissue from the heart’s protective membrane (pericardium). 

Percutaneous valve repair is widely performed and carries the typical surgical risks of a cardiac procedure. Percutaneous heart valve replacement techniques are still evolving. The associated risks are expected to decline with advancements in this field.

Percutaneous pulmonary valve replacement has a reasonably good outcome since it is performed primarily on young patients with congenital heart disease.

Percutaneous aortic valve replacement carries higher risks and the procedure is performed only when open surgery is not feasible. The patients are primarily those who are elderly with already compromised health and have associated risks including:

• Emergency nature of the procedure
• Congestive heart failure
• Left ventricular dysfunction
• Coronary disease
• Previous surgeries
• Other coexisting conditions (comorbidities)

Percutaneous valve replacement procedure is performed in a cardiac catheterization laboratory. A specially trained interventional cardiovascular physician performs the procedure. The physician may use general anesthesia or local anesthesia with mild sedation, depending on the patient’s condition and the complexity of the procedure.

A flexible tube (catheter) is used to carry and deploy the valve. The catheter may be inserted through the ribs into the apex of the heart (transapical), an artery in the wrist (transradial), neck (transjugular), or the groin (transfemoral). The cardiologist uses ultrasonagraphy and continuous X-ray (fluoroscopy) images for guidance. The procedure may take up to four hours depending on how many valves are replaced.

Preparation

In preparation for the procedure, the patient must

• Avoid eating or drinking for eight hours prior to the procedure
• Inform the doctor of any allergies
• Inform the doctor if they are pregnant
• Check with the doctor before taking any regular medications

Before the procedure

The patient undergoes

• Complete blood tests that include coagulation parameters
• Cardiac radiography tests such as
• Chest X-ray
• echocardiography
• electrocardiography

Procedure

The anesthesiologist

• Administers painkillers and sedation through an IV line in case of local anesthesia
• Intubates the patient to provide oxygen, in the case of general anesthesia
• May attach external defibrillator pads
• Inserts a urinary catheter
• Connects the patient to the electrocardiogram to monitor the heart’s electrical impulse
• Monitors the patient’s vital functions including
  • heart rate
  • blood pressure
  • oxygen levels

The cardiovascular physician

• Injects a local anesthetic in the site chosen for catheter insertion.
• Makes a tiny incision in the skin, punctures the blood vessel and inserts the catheter using a guidewire.
• Gently advances the catheter through the artery towards the heart, using ultrasound images for guidance.
• In the case of transapical approach, the surgeon inserts the catheter directly into the ventricle through the space between the ribs (intercostal space) to reach the heart valve.
• Injects a dye to scan the blood vessels through fluoroscopy.
• Deploys the replacement valve in position and inflates it with a balloon to fit tightly in place.
• Ensures that the valve is in position and functioning properly.
• Withdraws the catheter gently.
• Arrests bleeding from the insertion site and bandages it.
• Post-procedure, the patient is monitored for several hours until stable.

Percutaneous valve replacement patients may need hospitalization for a week. Most people resume light activities in a week.  However, they must avoid heavy lifting and strenuous activities. Complete recovery may take up to three months.

Patients must have regular checkups to assess cardiovascular health. Most people need to make permanent changes in lifestyle and food habits.

The life expectancy depends on the patient’s age and severity of the condition. Average life expectancy of a 60-year-old after aortic valve replacement is approximately 12 years.

Complications of percutaneous valve replacement include

• Hemorrhage
• Severe fluid collection in the pericardium (cardiac tamponade)
• Cardiac arrest
• Heart attack or failure
• Irregular heartbeat (arrhythmia)
• Blood clot and stroke
• Improper valve functioning
• Valve slipping out of place
• Allergic reaction to medications or dye material
• Injury to
  • heart
  • lung
  • blood vessels
  • nerves
  • lymphatic duct
• Bleeding and infection at the catheter insertion site
• Infection and sepsis
• Kidney disease
• Death