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Heart Valve Repair or Replacement

The heart pumps blood in just one direction only. The heart has four valves which open and close with each beat. Changes in pressure before and after these valves, which are like flaps, enables them to open and allow blood to flow through and then to close securely to prevent the blood from flowing back.

A heart valve repair or replacement is performed in the case of valve disease, which may involve stenosis, failure or regurgitation.

Stenosis occurs when the heart valves thicken, harden or fuse, meaning they do not open fully or that they only allow a small amount of blood through, meaning the heart has to work harder to pump blood around the body.

Heart failure occurs when a valve does not close correctly or allows blood to leak back, so that only a small amount is able to flow to the organs of the body. The heart tries to compensate for this by making its greatest effort, which causes it to dilate and reduces its capacity.

Benefits of the operation

Valve repair or replacement is suitable in cases of myxomatous degeneration, calcific degeneration, congenital defects, infectious endocarditis and coronary artery disease and acute myocardial infarct.

Medical-technical description

When the problem is congenital, valve repair has been shown to be an efficient solution for the treatment of mitral and tricuspid valve defects. This is done by:

  • Commissurotomy: When there is narrowing of a valve because the flaps have become thicker or have fused.
  • Valvuloplasty: This strengthens the valves to make them firmer and allow them to close properly using a ring-type device around the valve.
  • Plastic repair: A section is cut from the valve and sutured to the flap, allowing the valve to close correctly.
  • Repair of the structural support: the supporting cords are replaced or shortened, enabling the valve to close correctly.
  • Installing patches: to cover perforations or ruptures in the valves.

Valve replacement is used when the valve is badly damaged and needs replacement. This is the treatment for all potentially fatal valve disease.

There are two types of replacement valves: mechanical and biological.

  • Mechanical valves: these are usually made of plastic, carbon and metal. They are tough and long lasting. Because blood tends to stick to this type of valve and form clots, patients must take anticoagulants for the rest of their lives.
  • Biological valves: these are made with animal or human tissue. No anticoagulant treatment is required, but they are less resistant and may need changing after 15 years. They wear out more quickly and are preferred for elderly patients.

About the operation

Valve repair or replacement surgery is performed under general anaesthesia and takes between three to four hours. The chest is opened by an incision through the breastbone, the heart is stopped, the blood is sent through a heart-lung machine and the heart or aorta must be opened, which is why this type of operation is known as "open heart surgery".

Patients generally spend around a week in hospital during which time they are looked after in the intensive care unit for between one and three days. A cardiac rehabilitation plan is then started, and if the patient's work does not involve physical exertion, he or she can go back after between four and six weeks.

Before the operation

  • You will have blood and urine tests, a chest X-ray, an electrocardiogram, echocardiogram and cardiac catheterisation.
  • You must tell the surgeon if you have symptoms of fever, shivering, cough or nasal secretions.
  • You must stop taking drugs such as aspirin or any other antiaggregant drugs one week before the surgery.
  • It is a good idea to make a list of all the medicines you take and bring it with you on the day you are admitted.
  • If you smoke, you must stop smoking at least two weeks before undergoing surgery.
  • When you have been admitted to hospital, you will be washed with antiseptic soap and the site of the surgery will be shaved.
  • You must not eat or drink anything for 12 hours before the surgery.

Post-operative care

  • You will have drains in your chest for between 24 and 48 hours.
  • You will be given respiratory physiotherapy and cardiopulmonary rehabilitation.
  • You must not stretch your arms out or lift any weights for four weeks.
  • You must wash with antiseptic soap and dress the wounds every day.
  • If you are fitted with a mechanical valve, you will have to take anticoagulants for life and have regular coagulation tests to adjust the dose.
  • If you are going to have an operation or dental surgery you should tell the doctor that you are on anticoagulant therapy and should take an antibiotic before the surgery to prevent bacterial endocarditis.
  • You will be back to leading a normal life within approximately four weeks of the surgery.

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