Heart Valve Surgery

Heart valve surgery is a procedure to treat heart valve disease. Heart valve disease
involves at least one of the four heart valves not working properly.

The four valves are the mitral valve, tricuspid valve, pulmonary valve and aortic
valve. Each valve has flaps — called leaflets for the mitral and tricuspid valves and
cusps for the aortic and pulmonary valves.

These flaps open and close once during each heartbeat. Valves that don't open or
close properly disrupt blood flow through your heart to your body.

In heart valve surgery, the surgeon repairs or replaces the affected heart valves.
Many surgical approaches can be used to repair or replace heart valves, including
open-heart surgery or minimally invasive heart surgery.

Why it is done?

There are two basic types of heart valve defects: a narrowing of a valve (stenosis)
and a leak in a valve that allows blood to back up (regurgitation).

Patient might need heart valve surgery if these defects and it's affecting the heart's
ability to pump blood.

If there are no signs or symptoms, or the condition is mild, the doctor might suggest
monitoring over time. In that case, healthy lifestyle changes and medications might
help manage symptoms.

Eventually, the valve might need to be repaired or replaced. In some cases, doctors
recommend heart valve repair or replacement even if there are no symptoms.

Doctors often recommend heart valve repair when possible, as it preserves the heart
valve and might preserve heart function. But sometimes valve replacement is
necessary and the best option.

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How it is done?

Incisions in minimally invasive heart surgery and open-heart surgery

Anesthetist puts patient in a sleep-like state during the procedure. Connected to a

heart-lung bypass machine, which keeps blood moving through the body during the
procedure.

Heart valve surgery can be performed using standard open-heart surgery, which
involves cutting the chest through the breastbone. Minimally invasive heart surgery
involves smaller incisions than those used in open-heart surgery. It should be noted
that fewer hospitals offer minimally invasive surgeries because the advanced
techniques involved require special training, expertise, and equipment.

Minimally invasive heart surgery includes surgery performed using long instruments
inserted through one or more small incisions in the chest (thoracoscopic surgery),
surgery performed through a small incision in the chest, or surgery performed by a
surgeon using the assistance of a robot (robot-assisted heart surgery).

Minimally invasive heart surgery might involve a shorter hospital stay, quicker
recovery and less pain than open-heart surgery.

Heart valve repair

Heart valve repair surgery may include:

• Patching holes in a valve

• Reconnecting valve flaps (leaflets or cusps)
• Removing excess valve tissue so that the leaflets or cusps can close tightly
• Replacing cords that support the valve to repair the structural support
• Separating valve flaps that have fused
• Tightening or reinforcing the ring around the valve (annulus)

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Doctors might treat a valve with a narrowed opening with a catheter procedure called
a balloon valvuloplasty. A doctor inserts a catheter with a balloon on the tip into an
artery or vein in your arm or groin and guides it to the affected valve.

The balloon is inflated, which expands the opening of the heart valve. Doctors then
deflate the balloon and remove the catheter and balloon.

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Heart valve replacement

If the heart valve cannot be repaired and a catheter-based procedure is not feasible,
the valve might need to be replaced.

To replace a heart valve, the doctor removes the heart valve and replaces it with a
mechanical valve or a bioprosthetic valve made from cow (porcine), pig (bovine) or
human donor valve.

Bioprosthetic valves often eventually need to be replaced, as they degenerate over

time. If mechanical valve is implanted, patient needs to take blood-thinning
medications for the rest of life to prevent blood clots.

Bioprosthetic valve Mechanical valve

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