What is Mitral and Aortic Valve Repair and Replacement?
The heart has four valves that include:
- Mitral valve: This is located between the upper left chamber or left auricle and the lower-left chamber or left ventricle. It has two flaps or leaflets.
- Aortic valve: This is located between the lower-left chamber or left ventricle and the aorta, which is the big blood vessel through which blood from the heart passes to other parts of the body. It has three flaps or leaflets.
- Tricuspid valve: Also called the right atrioventricular valve, this valve is located between the right upper chamber and the right lower chamber. It has three flaps.
- Pulmonary valve: Also called the pulmonic valve, this valve is located between the right lower chamber and the pulmonary artery. It has three flaps.
For efficient heart function, the valves must be able to open fully while the blood is passing through, then close tightly afterward. Simply put, blood should flow only in one direction.
Abnormal or sick valves allow less blood to pass through and/or make it leak backward. This may be due to:
- Weakened flaps
- Fusion of the flaps
- Holes or tears on the flaps
- Deformity on the valve due to scar tissue
- Hardening of the valve due to deposits that are either waxy or calcified (called plaques)
To resume efficient function, sick valves need to undergo a surgical procedure called valve repair or valve replacement.
Valve repair is usually preferred due to its proven and improved results. The faulty valve is repaired by:
- Cutting through and separating fused flaps
- Patching holes and sewing tears on flaps
- Reshaping deformed valves by removing excess tissue, scars, and plaque deposit
This is done only when a repair is not possible. The diseased valve is removed and replaced with either an artificial metallic valve or a biological valve (from pig, cow, or human tissue).
Metallic Valve vs. Biological/Bioprosthetic Valve
- Metal valves last longer while bioprosthetic valves need to be replaced in 10-15 years.
- People with metal valves are maintained on lifelong blood-thinning medication while those with biological valves may not need lifelong medication depending on their condition.
- Metal valves are recommended for younger individuals
- Bioprosthetic valves are recommended for the elderly and for women of childbearing age.
What are the Conditions that May Require a Mitral Valve Repair or Replacement?
The conditions that could necessitate a mitral valve repair or replacement include the following:
- Mitral Regurgitation: Mitral regurgitation is caused when the heart beats and blood in the left lower chamber, which is supposed to be pumped out towards the other parts of the body, leaks back to the left upper chamber. It could be due to weakening or sometimes protrusion of the valve flaps (the mitral valve has two).
- Mitral Stenosis: Mitral stenosis occurs when the mitral valve does not fully open thereby allowing only a small amount of blood to pass through from the left auricle to the left ventricle. It could be that the flaps of the valve got stuck to each other (fused), or they may have stiffened or hardened due to scars, calcified deposits, or plaques.
What are the Conditions that May Require an Aortic Valve Repair or Replacement?
The conditions that could necessitate an aortic valve repair or replacement include the following:
- Aortic Insufficiency/Aortic Regurgitation: The aortic valve is unable to close snuggly, allowing the blood that has already flowed out to the aorta to flow back to the left ventricle of the heart. This may be due to softening, weakening, tear, or disfigurement of the flaps.
- Aortic Stenosis: The aortic valve is unable to open fully, thereby allowing only a small amount of blood to pass through towards the aorta. This might be due to scarring, adhesion, or sticking together (fusion) of the flaps of the valve, or the presence of waxy deposits or plaques in the valves.
How is Valve Repair or Replacement Performed?
The procedure is performed in the operating room by a heart surgeon under general anesthesia. Tubes for delivery of oxygen and IV fluids are hooked up and the middle part of the front of the chest is opened to expose the heart. The patient is put on a heart-lung bypass machine (also called cardiopulmonary bypass pump) to ensure continuous oxygenated blood flow to all parts of the body except, of course, the heart.
Meanwhile, the heart is made to stop beating by either lowering its temperature or injecting a substance to make it stop. Actual repair or replacement of the faulty valve is done (utilizing any of the specific procedures listed under valve repair and valve replacement above).
The heart resumes its beating either by itself or through the use of mild electric shocks.
When the heart is seen to be beating normally again, the heart-lung bypass pump is withdrawn and excess blood around the operation area is suctioned off and a drainage system is set up.
The chest opening is then closed and dressed.
Recovery Period Following Valve Repair or Replacement
After heart surgery, the patient is made to recover for a few days in an intensive care unit where his vital signs are monitored closely. Once he/she awakens and is stronger, he/she is transferred to the post-surgery unit. Most often, pain medication, antibiotics, and anticoagulants are given. When the range and duration of movement and physical activity have increased (usually in 5 to 15 days), the patient is allowed to go home. The patient will usually feel stronger than he was before the operation within a month or two.
Recovering at Home Following Valve Repair or Replacement
You need to consider the following things while recuperating at home:
- Medication: You may require certain medications such as blood thinners for a lifetime
- Wound care
- Exercise and physiotherapy
- Complications to watch out for
- When to go back to work
- Lifestyle modifications
- Cardiac rehab
Talk to your doctor regarding these before going home. Ensure you have all the necessary information to contact your healthcare provider if you need any assistance.
Outlook of Valve Repair and Replacement
Nowadays, the success rate of open-heart surgeries, valve repair and replacement included, has gone up. More so if the disorder or defect is corrected at a stage before severe irreversible complications have set in. Other determining factors for the success of valve repair and replacement are age (the younger the better), previous lifestyle (those who didn’t smoke, drink, and used to eat healthy diets tend to fare well), and, of course, the new lifestyle the patient chooses.