PD MD Wolfgang Harringer
The heart valves are important parts of blood circulation. Human heart consists of four chambers and blood flow through them in a certain direction. The valves allow blood going in right direction and prevent it from flowing in backward direction. There are four valves:
The valves rhythmically close and open when the heart beats and their failure can lead to serious heart disorders. The two most common problems that leads to valves dysfunction are:
To restore normal blood circulation you may need valve repair or valve replacement.
It is difficult to determine when you have valve dysfunction on your own but common symptoms are chest pain, dizziness, palpitations, breathing problems and swelling of the feet or abdomen. Those symptoms can relate to many others heart disorders. That is why if you have any of them you should see your doctor. Quite often symptoms appear when valve dysfunction is already in advanced stage and you may need surgery shortly.
Some patients can have benefit of valve repair surgery but, in many cases, replacement is the only option, e.g. regurgitation of aortic valve hardly can be improved with repair due to high blood pressure in the left ventricle. Once damaged, the aortic valve with a high degree of probability may start leaking again.
If it came to replacement surgery you may have a few options to choose:
If you are surprised with some options please ask your doctor to explain the benefits and disadvantages of each valve types.
As a rule, valve replacement surgery is performed with open heart surgery when a surgeon accesses the heart via large (10-12 inches) incision in the chest. After the heart become visible the surgeon establishes a heart-lung machine to provide blood circulation during the surgery. This technique is called cardiopulmonary bypass. The blood is drained out of the heart to the machine; the heart is washed with salt water and stopped. Aorta is clamped to prevent blood flowing into the operation field.
After preparations the surgeon examines the situation and start replacing the valve. First, he/she makes a cut to remove old valve. Once the damaged valve is cut out, the surgeon measures the size of removed part to choose a right implant, which is then aligned and fitted, and finally stitches the valve. It is very important it to be stitched tightly to avoid a leakage.
If a few replacements intended in one surgery, the procedure might be repeated. If the patient is also required coronary artery bypass graft (CABG) it also can be performed at the same surgical intervention.
After finishing manipulations the surgeon switched cardiopulmonary bypass off, starts the heart and checks how replaced valves works. Normally, the heart starts beating itself as soon as blood flows trough it but sometimes it could be stimulated with electrical shock.
Finally, the surgeon closes the chest wiring it and sews the incision. The patient is moved to Intensive Care Unit for 24 hours.
Though open chest surgery is more common option for valve replacement, sometimes it can be done with minimally invasive methods. The surgeon access the heart via a few smaller incisions or using a catheter. For example, with transcatheter aortic valve replacement (TAVR) procedure a new valve is delivered into the old one through the catheter. Then, the new valve can be expanded with ballooning technique and old tissues are pushed out.
There are also some other type of minimally invasive intervention can be used as robotic surgery what the surgeon operates using computed. All of those options have benefits of faster recovery and lower risks of complications but they are still rare. Often the complex problems are easier to eliminate in one open chest surgery.
In every individual situation a multidisciplinary team decides what the better option is in every particular case. Cardiologists, radiologists, perfusionists, cardiac and thoracic surgeons weigh and consider on treatment taking into consideration slightest details. The goal of professional team is not in using the most advanced method but in providing better result, which is increasing a lifetime. The specialists of Heart Surgery Department of the Clinic of Braunschweig always place patient’s benefit in the first priority.
If you need consultation of experienced doctor on your heart surgery please contact us and we will give you detailed information on treatment as well as the cost of heart valve replacement.