Valvular heart disease is a form of heart disease that
occurs when one or more of the heart’s four valves don’t function properly.
Valve replacement surgery is a solution for patients whose valves are too
fragile, scarred, or otherwise damaged to repair.
Reasons
for Replacement
The valves of the heart are responsible for allowing
nutrient-rich blood to flow to the chambers of your heart. Like a locked gate,
each valve is supposed to close completely after ushering in the blood flow. Diseased heart valves aren’t always able to
perform the job as well as they should.
Stenosis, or a narrowing of the
passageway, causes a less-than-normal amount of blood to flow to the heart,
causing the muscle to work harder. Leaky valves can also pose a problem.
Instead of closing tightly, a valve may remain slightly open, letting blood
flow backwards. Signs of valvular heart disease can include:
- fatigue
- dizziness or lightheadedness
- shortness of breath
- chest pain
- fluid retention, especially in the lower limbs
Heart valve repair is also a
solution for valve disease, but in some people, the damage is too far advanced
and a total replacement of the affected valve is required.
Types of Replacement Valves
Mechanical and biologic valves are used to replace faulty valves. Mechanical
valves are artificial components that fulfill the same job as a natural heart
valve. They’re created from carbon and polyester materials that are
well-tolerated by the human body, and can last between 10 and 20 years,
according to the National Institutes of Health (NIH). However, one of the risks
associated with mechanical valves is blood clots. Recipients of mechanical
heart valves are required to take blood-thinning medication for the rest of
their lives to reduce their risk of stroke.
Biologic valves, also called bioprosthetic valves, are
created from human or animal tissue. Three types of biologic heart valves
exist:
- human: called allografts or homografts, tissue is taken
from a donor heart
- porcine: made from pig tissue, the valves can be
implanted with or without a frame called a stent
- bovine: crafted from cow tissue, bovine valves connect to your heart with silicone rubber
Biologic valves don’t increase your risk of developing blood
clots. Therefore, you most likely won’t need to commit to a lifetime of
anti-clotting medication. The lifespan of a bioprosthetic isn’t as long as a
mechanical valve, explains the Mayo Clinic, and may require replacement at a
future date. Your age, overall health, age, and ability to take anti-coagulant
medications, as well as the extent of the disease, will help determine which
type of valve you receive.
Types of Valve Replacement Surgery
Aortic Valve Replacement
The aortic valve is located on the left side of the heart and serves as an
outflow valve. Its job is to allow blood to leave the left ventricle (the
heart’s main pumping chamber) and close so that blood doesn’t leak back into
the ventricle. Surgery on the aortic valve may be required due to a congenital
(from birth) defect or disease that causes the valve to narrow (stenosis) or
leak (regurgitation).
Mitral Valve Replacement
The mitral valve is located on the left side of the heart. It serves as an
inflow valve. Its job is to allow blood from the left atrium to flow into the
heart’s main pumping chamber, the left ventricle. Surgery may be required if
the valve doesn’t fully open or completely close. When the valve is too narrow,
blood may have difficulty entering and can back up, causing pressure in the
lungs. When the valve doesn’t close properly, blood can leak back into the
lungs. This can be due to a congenital defect, infection, or a degenerative
disease (a worsening over time due to age or normal wear and tear).Double Valve Replacement
Double valve replacement is replacement of both the mitral and the aortic
valve, or the left side of the heart. This type of surgery is not as common as
the others and the mortality rate is slightly higher.
Pulmonary Valve Replacement
The pulmonary valve separates the pulmonary artery—which carries blood to
the lungs for oxidation—and the right ventricle (one of the heart’s chambers).
Its job is to allow blood to flow from the heart to the lungs, via the
pulmonary artery. The need for pulmonary valve replacement is usually due to
stenosis, which restricts blood flow. Stenosis may be caused by a congenital
defect, infection, or carcinoid syndrome.
Heart valve replacement surgery is
performed under general anesthesia with techniques that are either conventional
or minimally invasive. Conventional surgery requires a large incision spanning
from your neck to your navel. Less
invasive measures can reduce the length of incision and also reduce your risk
of infection.
For a surgeon to successfully remove
the diseased valve and replace it with a new one, your heart must be still.
You’ll be placed on a bypass machine that keeps blood circulating through your
body and your lungs functioning during
surgery. The surgeon will make incisions into your aorta, through which the
valves will be removed and replaced. Cleveland Clinic reports a 1.8 percent
risk of death associated with valve replacement surgery.
Recovery
The majority of heart valve
replacement recipients remain in the hospital for approximately five to seven
days. If your surgery was minimally invasive, you may be able to go home
earlier. Medical staff will offer pain medication as needed and continuously
monitor your blood pressure, breathing, and heart function during the first few
days after a heart valve replacement.Full recovery may take a few weeks or up
to several months, depending on your rate of healing
