Heart Valve Surgery

What is heart valve surgery? 

A heart surgery is a heart procedure that replaces or repairs a malfunctioning heart valve. Such malfunctioning could be mainly because of the effects of heart valve disease. 

Heart valve dysfunction is primarily due to leaky valves and valve stiffness. Your heart comprises four valves that promote the correct flow of blood through it:  

• Aortic valve – This valve is situated between the aorta and left ventricle 
• Pulmonary valve – This is situated between the pulmonary artery and your right ventricle 
• Mitral valve – Links the left ventricle with the left atrium 
• Tricuspid valve – Links the right ventricle with the right atrium  

In case of a stiff valve, it means your heart has to work extra hard to accomplish its pumping action. Infections like rheumatic fever may cause stiff or narrowed valves. 

Leaky valves limit the flow of blood pumped by your heart. Depending on the symptoms you present to your doctor, he will recommend heart valve replacement or repair. 

Conventional open-heart surgery is the main procedure for replacing or repairing heart valves. During this procedure, your surgeon makes a large incision through your chest cavity so that he can have access to the heart chamber. 

Your heart and lungs are connected to a heart-lung bypass machine to aid in pumping and breathing during surgery. 

The majority of healthcare providers have now embraced newer, less invasive heart procedures. Such surgeries are less painful and involve smaller incisions. 

Your healthcare provider will advise you on whether minimally invasive heart surgery or open heart surgery is the best option for your heart condition. 

In heart valve repair, the surgeon supports your damaged valve via a ring. In the case of heart valve replacement, the diseased valve gets replaced with an artificial valve made of tissue or coated plastic.

Why do you need heart valve surgery?

If one or more of your heart valves is diseased, you need valve replacement or repair. A damaged heart valve presents with the following symptoms:

• Chest pain

• Palpitations

• Shortness of breath

• Tiredness

• Dizziness

• Swelling of legs and ankles

Your healthcare provider will recommend heart valve replacement or repair surgery to correct the above symptoms.

Explore the various treatment options available to you with your healthcare provider.

If you present with mild symptoms, your healthcare provider may recommend medication or lifestyle modification to correct those.

Although lifestyle change and medication will improve your symptoms, heart valve surgery remains the only effective permanent solution. 

Types of heart valve surgery

Heart valve surgery falls under two major categories:

Valve repair

A heart valve repair is a surgical procedure administered by your surgeon to repair a faulty or damaged heart valve. During the procedure, your surgeon tries as much as possible to retain your own tissue.

Most valve repair surgeries involve the mitral valve. The tricuspid and aortic valves can also be repaired this way.

Valve replacement

This heart procedure is done with the goal of removing a diseased valve and replacing it with an alternative one.

There are two main types of replacement valves used in heart valve surgery.

A biological valve is obtained from either human tissue or animal tissue, mainly cow or pig. A mechanical valve is made of carbon or metal.

Before you undergo a heart valve replacement procedure, your healthcare provider will conduct tests to ensure compatibility of the valve with your immune system.

It reduces rejection of the replacement valve by your immune system. Your healthcare provider will also order other tests to determine the nature, extent, and location of valve disease.

Such tests are useful because they assist your healthcare provider in recommending the best procedure that works for you. 

Your healthcare provider will consider the following in choosing the right procedure:

• Age

• Lifestyle

• Heart structure

• Preexisting health conditions

Your surgeon may integrate heart valve surgery with other heart procedures like aortic aneurysms surgery.

Preparing for heart valve surgery 

Your heart surgeon will order several days a day or two before your scheduled surgery. Examples of such tests include: 

• Chest X-ray 

• Echocardiogram 

• CT Scan 

• Electrocardiogram (EKG) 

• Lab tests 

• Heart catheterization 

• Blood work 

• Urine sample  

Your doctor will also conduct a complete physical examination to establish that you can handle surgery. 

Your surgeon will ask you to fast after midnight on the day of your surgery. If you are on any medication, let your healthcare provider know about it.

Such medication could be prescription drugs over-the-counter medication, or health supplements.

Your doctor is best placed to advise you on which drugs you can continue taking and which ones you may need to stop taking.

Make sure you bring easy-to-wear shoes to surgery. Ensure your clothes are comfortable but loose.  

You will require someone to accompany you to surgery.

Your surgeon will explain the surgery to you in more detail, make sure you have keenly understood it. If you have questions, ask them. 

You will sign a consent form that gives the cardiac surgery team permission to conduct surgery. Read through this form carefully and ask all the questions you have.

If you are pregnant or suspect to be pregnant, let your healthcare provider know of this.

Let your healthcare provider know of any allergies you might have. This may include anesthetic agents or medication.

In case you have a bleeding disorder or are on blood thinning medication, it would be a good idea to let your healthcare provider know about this as well. 

If you have a heart implant, let your surgeon know about it.

If you are a smoker, your healthcare provider will encourage you to stop the habit as it can delay recovery.

During surgery

A heart replacement or repair procedure is administered in a hospital. The process of surgeries differs based on practices adopted by your healthcare provider and your overall health.

An anesthetist will administer general anesthesia to put you to sleep during surgery. 

During open heart surgery, your surgeon will stop the heart to allow for the repair of the valve. A heart-lung bypass machine will be connected to your body.

The machine assumes the pumping role of your heart. 

The surgeon cuts through your breastbone to gain access to the heart, resulting in larger incisions.

A conventional heart valve procedure lasts two or more hours. It will be determined by whether one or more valves are being replaced or repaired.

If you are undergoing minimally invasive surgery, the incisions are smaller. 

Your surgeon often uses a robotic arm to perform this procedure. Your stay in the hospital is shorter because the incisions are smaller. 

It is also less painful than conventional surgery. You are also likely to recover more quickly compared to a person who has open-heart surgery.

Heart valve repair

Heart valve repair helps to maintain heart function. It may also save your life. Your doctor will do the following as part of the heart valve repair procedure:

• One or more of your heart valves might have holes that require patching

• Valve flaps may need reconnecting

• Leaflets/flaps may not close properly due to excessive valve tissue that requires removing

• Some valve flaps joined together and need to be separated

• The valve ring may need supporting or tightening

• Your doctor will need clips, a catheter, and plugs to perform heart valve repair surgery

• If the heart valve has narrowed, a balloon valvuloplasty procedure is necessary

• During this procedure, your surgeon inserts a catheter into the affected heart valve with a deflated balloon at the tip

• The doctor will then inflate the balloon to open up the narrowed valve

• The surgeon deflates the balloon and removes the flexible tube

Heart valve replacement

After conducting a diagnostic test your surgeon might recommend a heart valve replacement. This is after ascertaining the diseased valve cannot be repaired.

Usually, a biological tissue valve is used in place of the affected heart valve. Biological tissue valves are obtained from human or animal heart tissues.

Cows and pigs are the main sources of animal heart tissues.

Biological valves wear over time and require replacement. You are also at risk of suffering blood clots.

To minimize the risk of blood clots, your surgeon will recommend prescribed blood thinning medication.

You will have to take blood thinning medication for the remainder of your life.

Make sure you have explored all the advantages and disadvantages of each kind of valve with your healthcare provider.

Your surgeon may opt for a minimally invasive catheter surgery to replace the diseased heart valves.

After surgery

When you wake up after surgery, you will have your vitals such as oxygen and blood pressure levels monitored by the surgical nurse.

The cardiac surgery team will administer medication and fluids via an IV.

You will also have tubes attached to your chest and bladder to drain fluid and urine.

If you require oxygen, this will be delivered via nasal prongs or masks.

Your surgeon will adjust the ventilator to enable you to perform more of the breathing by yourself.

Once the doctor ascertains that you can comfortably breathe unaided, he or she will remove the breathing tubes.

The surgical nurse will assist you to take deep breaths and cough as soon as the breathing tube is removed.

At first, it may be hard to breathe on your own but deep breaths help to clear lungs mucus from your lungs and also the risks of pneumonia.

If you feel very uncomfortable breathing or coughing, let your doctor know about it. The doctor will prescribe pain medications.

You will continue receiving IV medication to control your heart rate and stabilize your blood pressure. It also helps to contain bleeding.

Your surgeon will stop this medication as soon as your condition has stabilized.

You can begin taking liquid drinks once the IV tubes are removed.

The surgical team will advise you on when to start taking solid foods.

The surgical team moves you to an intensive care unit (ICU) where you will continue with recovery.

The surgical team will encourage you to increase your activity levels around the surgical unit. This includes walking around the bed.

The surgical team will also advise you on the following as part of the recovery plan:

• Taking care of incisions

• Checking the site of incision for infection

• Pain management

• Taking your medication as prescribed

• Watching for any other side effects following surgery

You may be discharged from the hospital after a few days if there are no complications or infections in your incisions.

During discharge, the surgical team will advise you to keep your surgical area dry and clean.

The surgical team shall also advise you on bathing instructions.

Your surgeon will arrange a follow-up visit during which he or she will remove the surgical staples.

Avoid engaging in strenuous activities until your doctor gives you the go-ahead. 

If you experience any of the following signs, call your doctor immediately:

• Trouble breathing
• Fever or chills
• In case the incision site is bleeding, has a redness to it, or has swollen
• Chest pain
• Weight gain by over five pounds (this could be a sign of fluid retention)
• Feeling depressed
• Irregular or rapid pulse

Recovery after heart valve surgery

If you had open heart surgery, you may take between four, and eight weeks to recover. In the case of minimally invasive surgery, the recovery period is shorter.

Your recovery will depend on:

• Your general health before the procedure                                                                        
• How successful your surgery was
• The technique used by your surgeon to get to the heart
• Is the valve being replaced or repaired
• The care that you receive after the procedure

Benefits of heart valve surgery

Heart valve surgery is associated with the following benefits:

• Increased life expectancy

• Reduced risk of infection

• Eased symptoms

• Reduced requirements for anticoagulant medication

• Prevents death

If you have had minimally invasive surgery, the procedure comes with added benefits:

• The risk of trauma or bleeding reduces

• The recovery period is shorter

• Reduced risk of infection 

• Discharge from the hospital can be sooner 

Risks/complications

A heart valve procedure carries the following risks:

• Heart failure

• Bleeding

• Stroke

• Heart attack

• Abnormal heart rhythm

• Infection

The following factors may increase the risks of complications:

• If you have other medical conditions

• If the surgery also encompasses other procedures

• Age

Talk to your surgeon about these risks before the procedure.

Valve replacement or repair may also predispose you to infective endocarditis. For this, your doctor will prescribe antibiotics.

Cost of heart valve surgery in India

India boasts of top hospitals that offer world-class heart valve surgery. The cost starts from $4000 depending on the following:

• Type of hospital

• Consultation fee

• Surgeon’s fee

• Type and quality of implant

• Surgeon’s level of experience

• Room- Whether deluxe, single shared, or super deluxe

Diagnostic tests and evaluation 

The table below summarizes key heart valve surgeries in India and their average costs:

The cost of heart valve surgery in India is very affordable compared to what other countries charge.

Healthcare facilities that offer heart valve surgeries in India have invested heavily in state-of-the-art equipment while the medical team is highly experienced.

The aim is to offer the highest quality treatment.

The table below summarizes the average cost of valve replacement surgery in India relative to other countries offering similar procedures:

References

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