Heart Valve Surgery: What Happens Before, During, and After the Procedure

29 April,2024

Heart valve surgery, whether repair or replacement, can be a life-saving surgical intervention for patients suffering from malfunctioning valves. Each year, lakhs of valve replacement surgeries are performed worldwide. The procedure helps alleviate chest pain, dizziness, palpitations, and breathing difficulties.

Heart valve surgeries were scary back in the days when the success rates were low. But that’s not the case anymore. Recent developments in minimally invasive and robotic surgeries have significantly improved the procedure for repairing or replacing heart valves.

In this blog, you will learn about various heart valve surgeries and how they are done.

What is Heart Valve Surgery?

The heart is a pumping machine that pumps blood throughout the body. It has four chambers: two atria (upper chambers) and two ventricles (lower chambers). These chambers have different valves to keep blood flowing and prevent backflow.

• Tricuspid Valve: Valve separating the right ventricle and right atrium
• Aortic Valve: Valve between left ventricle and aorta
• Mitral Valve: Valve separating the left ventricle and atrium
• Pulmonary Valve: Valve between right ventricle and pulmonary artery

Heart valve surgeries are performed to replace or repair a valve that is not working correctly because of valvular heart disease. The procedure aims to correct the valve disorder, reduce or eliminate symptoms, increase lifespan, and improve the quality of life.

Why Do You Need Heart Valve Surgery?

The cardiologist will recommend heart wall surgery if you have valvular diseases (conditions affecting any of the four valves in the heart). The two most common heart valve diseases are –

• Stenosis: Narrowing and stiffening of the valve
• Regurgitation: A leaky valve that causes backflow of the blood

Both conditions put an extra burden on the heart and affect its efficiency in pumping blood. Hence, these abnormalities must be corrected with valve repair or replacement.

Heart valve replacement helps in alleviating symptoms such as –

• Chest pain
• Dizziness
• Palpitations
• Fainting
• Breathing issues
• Tiredness
• Swelling

What are the Different Types of Heart Valve Surgery?

Heart valve surgery can be performed using traditional open heart surgery or newer minimally invasive techniques. The type of surgery selected depends on your age, general well-being, and the type and severity of the valve disease. 

Heart Valve Repair

Heart valve repair involves surgical procedures that typically address issues with the mitral or tricuspid valves. The surgical interventions depend on the nature of the problem.

• If the valve is too tight, surgeons perform a commissurotomy. The procedure involves cutting the valve flaps (leaflets) to loosen the valve moderately, allowing blood to flow more efficiently.
• For leaky valves, surgeons perform annuloplasty. During this procedure, they sew sutures around the ring of fibrous tissue called the annulus at the heart valve's base. It repairs an enlarged annulus, making the opening smaller. Alternatively, surgeons can attach a ring-like device outside of the valve opening so it can close more firmly.
• To enlarge narrowed heart valves, surgeons perform valvulotomy. This procedure can also be done with the help of a balloon.

Catheter-Based Heart Valve Repair

In certain valve repair surgeries, the surgeon can use a thin and flexible tube catheter to access the heart valve through a blood vessel in the arm or groin. This kind of surgery doesn't require any incisions in the chest or stopping the heart.

• One procedure that can be done using a catheter is balloon valvuloplasty. This technique can treat stiffened or narrowed (stenosed) pulmonary, mitral, or aortic valves. The heart specialist inserts a catheter with a balloon tip into the narrowed valve and inflates it to enlarge the opening. 
• Another procedure, percutaneous mitral valve repair, can fix a leaky mitral valve in patients at high risk for surgery. The surgeon inserts a catheter with a clip into the groin and moves it up into the left side of the heart. They position the open clip beyond the leaky valve and then pull it back to catch the mitral valve's flaps. Once closed, the clip keeps the leaflets together and prevents leakage.

Heart Valve Replacement

If the heart valve is severely damaged and cannot be repaired, the surgeon may need to replace it with a new mechanical or biological valve. The surgeon's choice of valve often depends on the patient's age.

Mechanical Valves

• Mechanical valves consist of durable materials such as metals, carbon, ceramics, and plastic. 
• They have undergone refinement and improvement since their introduction in the 1960s. 
• The main benefit of mechanical valves is their durability.
• However, they can increase the risk of blood clots, which can cause a heart attack. 
• Therefore, people with mechanical valves must take anticoagulants daily for the rest of their lives. 
• The soft clicking sound of a mechanical valve may also bother some people.

Biological Valves

• Biological or tissue valves are natural valves specially prepared from human donors or animals. 
• Animal-source valves, usually from cows or pigs, are similar to human heart valves and are generally well-tolerated. Compared to mechanical valves, they are less likely to cause blood clots. 
• Human heart valves obtained from a donated heart (an allograft) are well-tolerated and tend to last longer than animal valves. 
• In a Ross procedure, the surgeon replaces the damaged aortic valve with the functioning pulmonary valve. They then replace the pulmonary valve with a donated one. 
• Unlike those with mechanical valves, people with biological valves do not need to take blood thinners for a long time. 
• However, biological valves are not as durable as mechanical valves.

Minimally Invasive Valve Repair and Replacement

• Minimally invasive interventions offer an alternative to traditional surgery that avoids opening the chest or sawing through the breastbone. 
• It does not require stopping the heart or using a heart-lung machine. Instead, the surgeon observes the heart on a video screen and uses long-handled surgical tools inserted through small incisions. 
• In some cases, robotic arms assist with the procedure. This type of surgery, also known as endoscopic or robotic heart surgery, effectively treats certain types of valvular heart disease.
• Transcatheter aortic valve implantation (TAVI) or transcatheter aortic valve replacement (TAVR) is a less invasive cardiac surgery that treats symptomatic aortic valve stenosis.
• Compared to open-heart valve surgery, people who undergo TAVI experience faster recovery times and shorter hospital stays, usually around three to five days. 
• Physicians typically recommend TAVI to individuals at high risk of complications from open-heart surgery.

What Happens Before Heart Valve Surgery?

• Before undergoing heart valve surgery, you will have an initial consultation with your cardiac surgeon. They will explain the benefits and risks associated with the surgery. You will need to sign a consent form to authorize the hospital to conduct the surgery. During this consultation, the surgeon may perform a few tests, like –
  • Electrocardiogram
  • Chest X-ray
  • Urine Sample
  • Blood Test
• The surgeon might ask a few questions and take a past medical history. You must inform your surgeon if you –
  • Have asthma
  • Are allergic to any medication or contrast dyes
  • Have bleeding disorders
  • Take blood thinners or antiplatelet drugs
  • Have a pacemaker or any other cardiac device
  • Suffering from any ongoing infection
  • Have a history of kidney disorders
• You must abstain from drinking alcohol and smoking at least 2 weeks before the surgery. These habits have serious health effects and negatively impact surgery outcomes.
• Your surgery team will ask you to avoid eating before the procedure. Fasting 8 to 12 hours is necessary before any surgical procedure.
• You will also have a consultation with an anesthesiologist, during which they will discuss your anesthesia option and its risks.

How is Heart Valve Surgery Done?

You will be admitted to the hospital one day before the valve repair/replacement surgery. You will change into the hospital gown and be taken to the operating room by paramedical staff. The heart valve surgery will have several steps, which are as follows – 

• The surgical team will make you lie on the operating table and will insert an IV line to administer anesthesia and other medications.
• The surgeon will then insert a breathing tube through your mouth to your lungs and connect you to a ventilator to breathe for you. 
• Your doctor will also place a transesophageal echocardiogram (TEE) probe into your esophagus to monitor the function of your heart valves. 
• Someone from the surgical team will clean the skin over your chest and shave off the hair at the surgical site.
• If you are having open-heart surgery, the cardiac surgeon will make an incision down the center of your chest from the Adam's apple to the navel. 
• The surgeon will cut the breastbone or sternum in half.
• Next, the healthcare provider will separate the halves of the breastbone to expose your heart.
• Your doctor must stop your heart to repair or replace the valve. They will insert tubes into the heart and transfer the blood into the heart-lung bypass machine.
• Once the blood is completely diverted, the cardiac surgeon will stop your heart by injecting a cold solution.
• For a valve replacement, your doctor will remove the diseased valve and put it in the artificial valve in case of a valve replacement. 
• The procedure for valve repair will depend on your valve problem. Your doctor may repair torn leaflets, separate the fused valve leaflets, or reshape some valve parts to ensure smooth functioning.
• After the surgery, the surgeon will give light shocks to your heart to restart the heartbeat. 
• Then, they will allow blood to re-enter your heart and remove the tubes from the bypass machine. 
• Your doctor will monitor your heart to check its performance and ensure the surgery has not caused leaks. 
• To close the incision, your surgeon will sew the skin over the sternum and close the incision with sutures or surgical staples. 
• They will also put tubes into the chest to drain blood and other fluids around the heart and apply a sterile bandage or dressing.

What to Expect After a Heart Valve Surgery?

• After your surgery, your healthcare team may transfer you to a Cardiac Intensive Care Unit (CICU) for 1-2 days, where they can monitor your condition closely. 
• Later, you will be moved to a regular room. Your hospital stay may last for 5 to 7 days.
• Various machines will be connected to you to monitor your vital signs, such as heart rate, respiratory rate, and blood pressure. 
• Your healthcare provider will encourage you to eat, drink, and walk as soon as possible after your surgery. Initially, you can start with short walks around your room or down the hall and gradually increase your distance.
• Your healthcare provider may enroll you in a cardiac rehab program, which is a carefully monitored exercise program.
• Heart valve surgery recovery typically takes between 4 to 8 weeks. However, if you underwent minimally invasive surgery or surgery through a vein, your recovery time may be shorter. 
• During the first three weeks after surgery, it is expected to feel quickly tired, so take it easy. 
• It is essential to avoid driving for several weeks after surgery.
• Avoid lifting heavy objects (anything heavier than 7 kg) for the first six to eight weeks post-surgery. 
• Patients with a biological valve may need to get the valve replaced in 10 to 15 years.

What are the Benefits of Heart Valve Surgery?

Minor heart valve disorders are usually treated with medications as the first line of treatment. However, when medications fail to provide relief from the symptoms, a valve repair or replacement surgery is advised. For most people, heart valve surgery helps in the following ways – 

• Provide more energy to do everyday tasks
• Improves quality of life
• Doing physical activities becomes easier
• Improves mental health and mood
• Increases life expectancy
• Reduces symptoms such as dizziness, fainting, shortness of breath, tiredness, chest pain, and edema
• Reduce the risk of heart failure

What are the Risks of Heart Valve Surgery?

Just like any other surgery, heart valve surgeries are also not risk-free. However, procedure-related risks are much lower than the risks of leaving the valvular disease untreated. 

The overall rate of complications ranges from 2 to 10%. It depends on various factors such as age, current general health, and the severity of valve disease. Common risks include –

• Atrial Fibrillation (an abnormal heart rhythm)
• Systemic Infection
• Bleeding
• Renal Failure
• Stroke
• Wound Infection 
• Heart attack

Takeaway

Heart valve surgery is a major cardiac procedure that can significantly improve the quality of life of patients having a malfunctioning heart valve. Modern advancements in minimally invasive techniques have made the procedure safer and faster. If you're experiencing symptoms like shortness of breath, chest pain, or fatigue, consult a doctor to discuss whether valve repair or replacement surgery might be right for you.