Valve Replacement India
What is Heart Valve Replacement?
Heart valve replacement is a surgical procedure during which surgeons
remove a damaged valve from the heart and substitute it by grafts from
your own tissues or replace them by artificial heart valves.
Why is Heart valve replacement surgery done?
Four valves
direct blood to and from the body through the heart: the aortic valve,
the pulmonic valve, the tricuspid valve, and the mitral valve. Any of
these valves may malfunction because of a birth defect, infection,
disease, or trauma. When the malfunction is so severe that it
interferes with blood flow, an individual will have heart palpitations,
fainting spells, and/or difficulty breathing. Unless the damaged valve
is replaced surgically, these symptoms may progressively worsen and
cause death.
What are the various types of artificial valves used for Heart Valve Replacement?
- Mechanical Valves - also called prosthetic valves. These valves are
made of immunologically inert material that does not react with the
body's own tissues. These valves are similar in structure and function
as own heart valves permitting proper flow of blood through the heart
chambers. T
The mechanical valves have an un-limited life span. Mechanical valves
are resistant to the flow of blood and are prone to blood clot
formation on the leaflets. As a result if you undergo Heart Valve
Replacement with mechanical valves, then you will have to be on blood
thinning medication for the rest of your life.
- Tissue Valves - also called biological valves, bio-synthetic or
bio-prosthetic valves. These valves are made from animal tissue i.e.
pig tissue (porcine) or cow tissue (bovine) with fine mesh sewn around
it to provide support and stability. The most important advantage of
tissue valves is that after Heart Valve Replacement there is no danger
of clot formation.
- Homograft Valves - Homograft or allograft valves are obtained from
human donors which are frozen under sterile conditions and used for
qualified candidates. These valves are not as durable as mechanical or
tissue valves.
However, the biggest advantage of using these valves is that after
Heart Valve Replacement surgery, there is no danger of clot formation.
How is the Valve replacement surgery done?
After cutting through and separating the breastbone and ribs, surgeons
place the patient on a cardiopulmonary bypass machine, which performs
the functions of the heart and lungs during the operation. They then
open the heart and locate the faulty valve. Slicing around the edges of
the valve, they loosen it from the tendons that connect it to the rest
of the heart and withdraw it. The new valve is inserted and sutured
into place. The patient is then taken off the bypass machine and the
chest is closed. The surgery takes three to five hours.
Which valve is best for me?
There is no single ideal replacement valve. The choice between an
animal valve or a mechanical valve depends largely on the age of the
patient. Because valves obtained from animals have a life expectancy of
7-15 years, they usually are given to older patients. Mechanical valves
are used in younger patients because they are more durable. Because
mechanical valves are made of foreign material, however, blood clots
can form on their surface. Therefore, patients who receive these valves
must take anticoagulants the rest of their lives.
Donor or pulmonic valves are given only to those patients who will
deteriorate rapidly because of a narrowing of the passageway between
the aorta and the left ventrical (aortic stenosis). These valves are
limited in their use because of the small supply available from donors
and the strain that could be caused by removing and transferring a
patient's own pulmonic valve.
What is the aftercare and how long is the recovery period?
The patient usually spends 1-3 days in the hospital intensive care unit
(ICU) after heart valve replacement so that the working of his or her
heart and circulation can be monitored closely. When first brought to
the ICU after surgery, the patient undergoes a neurological examination
to be sure he or she has not suffered a stroke. The patient continues
to breathe by means of a tube inserted in the trachea at the time of
surgery. This mechanical ventilation is not withdrawn until the patient
is fully awake from anesthesia, shows signs that he or she can breathe
satisfactorily without mechanical support, and has steadfast
circulation.
Once stablilized, the patient is transferred to a standard
medical/surgical unit where he or she receives drugs that will prevent
excess fluid from building up around the heart. As soon as possible,
the patient begins walking and exercising to regain strength. He or she
is also placed on a diet that is low in salt and cholesterol. After
being released from the hospital, the patient continues a daily
exercise program that includes vigorous walking, and he or she may also
join a recommended cardiac rehabilitation program. He or she usually
can return to work or other normal activities within two months of the
surgery.
What are the risks associated with the Valve replacement surgery?
Complications following heart valve replacement are not common, but can
be serious. All valves made from animal tissue will develop calcium
deposits over time. If these deposits hamper the function of the valve,
it must be replaced. Valves may become dislodged. Blood clots may form
on the surface of the substitute valve, break off into the general
circulation, and become wedged in an artery supplying blood to the
brain, kidneys, or legs. These blood clots may cause fainting spells,
stroke, kidney failure, or loss of circulation to the legs. These blood
clots can be treated with drugs or surgery.
Infection of heart muscle affects up to 2% of patients who have heart
valve replacement. Such an infection is treated with intravenous
antibiotics. If the infection persists, the new valve may have to be
replaced.
How successful is Valve replacement surgery?
Few patients die as a result of the surgery. Approximately 3% of all
patients die during or immediately after heart valve replacement, and
less than 1% of patients below the age of 65 die because of the
operation. The vast majority of patients who have heart valve
replacement return to normal activity after the surgery. Depending on
the type of valve they receive, these patients will have no symptoms of
valve abnormality for at least seven years. Also, their quality of life
will improve because they may no longer will have difficulty breathing,
fainting spells, or palpitations.
What are the indications for Heart Valve Replacement?
The following are major causes of diseased heart valves and indications for Heart Valve Replacement surgery:
- Congenital Heart Valve Diseases
- Bicuspid aortic valves
- Stenotic (narrowed) or leaky valves
- Myxomatous valve disease - e.g. Marfan's syndrome
- Acquired Heart Valve Disease
- Calcification
- Infection
- Rheumatic valve disease
- Infective endocarditis
- Coronary artery disease
- Heart attack
- Cardiomyopathy (heart muscle disease)
- Syphilis
- Hypertension
- Aortic aneurysm
- Connective tissue diseases
- Tumors
- Dilatation of valve annulus
What does the procedure for Heart Valve Replacement involve?
Heart Valve Replacement is performed either as Open Heart Surgery using
the heart-lung bypass machine or Beating Heart Surgery procedure where
heart-lung bypass machine is not used. The surgery will be performed
under general anesthesia in a hospital setting. The surgery may take 3
- 5 hours. After cutting through the skin and the breast bone, the
heart is opened and the damaged valve is located.
The valve is loosened and disengaged from the surrounding tissue
that connects it to the heart, the new valve is inserted and sutured
into place. You will then be taken off the cardio-pulmonary bypass
machine and the chest will be closed with sutures thorough the bone and
all the overlying tissue structures. After the Heart Valve Replacement
surgery you will spend a couple of days in the ICU (Intensive Care
Unit) under observation for post-operative complications, to monitor
your breathing and circulation closely. Neurological assessment will be
conducted to make sure that you have not suffered a stroke during the
Heart Valve Replacement surgery.
How to prepare for Heart Valve Replacement Surgery?
The preparation for Heart Valve Replacement surgery is same as Open
Heart Surgery procedure for any other indication. Before your Heart
Valve Replacement surgery, you will have a complete and through
evaluation by your physician, cardiac surgeon and anesthesiologist. All
the routine pre-operative tests like blood and urine examination, x-ray
chest, Electrocardiogram, Echocardiogram, Cardiac Catheterization , and
Coronary Angiogram will be performed. Please make sure to inform your
doctor about all the prescription and non-prescription medication
including vitamin, mineral and herbal supplements that you might be
taking.
You will be instructed to eat a balanced diet, do some exercises to
clear your lungs and quit smoking completely before the Heart Valve
Replacement surgery . Also, plan on staying in the hospital for 5 days
or so and arrange for someone to help you around the house for the next
couple of weeks after Heart Valve Replacement surgery . Do not eat or
drink anything for at least 12 hours before the surgery and get a good
night's sleep. You will be instructed to shower both on the evening
before and the morning of surgery with a special antibacterial soap to
prevent infection during and following Heart Valve Replacement surgery.
What to expect during the recovery period following Heart Valve Replacement surgery?
The initial few days following the Open Heart Surgery for Heart Valve
Replacement can be crucial. There will be pain and discomfort which can
be relieved by pain medication. Some of the common unpleasant
experiences after Heart Valve Replacement surgery will be
forgetfulness, mood swings, lack of energy, tiring easily, lack of
appetite possibly even nausea or constipation, difficulty sleeping
through the night or perhaps nightmares or vision changes. Your doctor
will provide you a list of specific discharge instructions to follow
for the first three weeks at home, after your Heart Valve Replacement
surgery to help you return to a normal pace of life. Some of the
post-operative Heart Valve Replacement surgery guidelines will include:
- Get plenty of rest and sleep, this will help you heal and recover.
- Avoid extreme temperatures i.e. very cold and very hot weather including wind chill factor and humidity.
- Do not perform strenuous activities like lifting, pushing, pulling, mopping, vacuuming, yard work, car washing, laundry etc.
- Eat a well balanced, low salt, low calorie, nutritious diet comprising of fruits, vegetables, dairy and protein.
- Avoid alcohol and limit your caffeine intake.
- Continue coughing and deep breathing exercises.
- Bathe or shower daily with warm water.
- Keep your incision clean, do not apply oils, lotions or creams over your incision.
- Avoid driving or going for long outings.
- Avoid sexual intercourse for at least 4 - 6 weeks after Heart Valve Replacement surgery .
- Avoid constipation, eat lots of fruits and vegetables and drink plenty of water to keep your stool soft.
- Follow
the Cardiac Rehabilitation Program as outlined by your health care
professional team to provide emotional support and information about
the recovery process.
- Make long term lifestyle
changes like regular walking, exercising, eat low fat, low calorie
diet, quit smoking etc - in short make healthy lifestyle choices.
What is the outcome of Heart Valve Replacement surgery?
The morbidity and mortality rate following Heart Valve Replacement is
minimal. Depending on the type of valve that you receive, a heart valve
can last 7 - 10 years; if your heart valve wears out after that, you
will need a second similar kind of procedure. The decision to use a
mechanical or bio-prosthetic valve depends on you as well as on your
surgeon. In younger patients and in women of childbearing age, surgeons
prefer to use a bio-prosthetic valve as there is no need for long-term
anticoagulation. Majority of patients who receive Heart Valve
Replacement can return to their normal activity level in about 2
months. Above all, the quality of your life will improve immensely as
you will no longer suffer from palpitations, breathlessness and
fainting spells.
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