Surgical Valve Treatments
What is it for?
The four valves of the heart – named aortic, mitral, tricuspid and pulmonary – open enough to allow blood to flow through, and then close to prevent blood from flowing backwards. Heart valve surgery is performed when the valve does not open enough (stenosis) or does not close properly, causing a leak (regurgitation). Surgeries are performed to repair or replace faulty valves. While repair usually is preferable to replacement, it’s not always possible. For cases in which a valve cannot be performed satisfactorily, a surgeon will replace the valve.
If you need surgical treatment for a heart valve problem, your surgeon might not know whether your valve can be repaired until the surgery has begun.
How is it done?
Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain. In most of these surgeries, you will be connected to a heart-lung bypass machine or bypass pump that will do the work of your heart during the surgery.
Heart Valve Repair
Valve surgery can be performed with traditional or open heart surgery, or it can be done using minimally invasive procedures. During open heart surgery, the surgeon will open the chest and then cut through the breastbone to expose the heart. Once the heart is exposed, the surgeon will begin the valve repair or replacement surgery.
Some surgeons will perform valve repair and replacement using minimally invasive surgery techniques. There are a number of minimally invasive techniques used in heart valve procedures, including:
- Robotic or robot-assisted surgery
- Percutaneous surgery (see percutaneous valve replacement)
The most common reason for valve repair is a leaky or regurgitant valve (valvular insufficiency). Surgeons at Loyola will choose valve repair over replacement whenever possible, thus preserving your own valve. Valve repair is preferable because it tends to have the best long-term outcome and it helps avoid the necessity of taking blood thinning medication.
There are two basic techniques a surgeon can use to repair a damaged valve. Sometimes these techniques are used separately and sometimes they are used together.
Valve repair - During a valve repair, your surgeon may repair your valve by reshaping, rebuilding or trimming one or more of the valve leaflets of the damaged valve or valves.
Ring annuloplasty - Sometimes surgeons repair the outer ring of the valve by replacing it with a ring made of tissue, cloth or metal around the valve. These rings can also help add support to a repaired valve.
Heart Valve Replacement
If your valve cannot be repaired, you will need a new valve. During a valve replacement surgery, your damaged valve will be removed and your surgeon will replace it with a new valve. There are several types of valves used in valve replacement. The most common are:
Mechanical valves are created from man-made materials like metal, such as titanium, stainless steel or ceramic. The benefit of mechanical valves is that they last longer than other types of valves and don’t typically need to be replaced. But people who have them must take medication to thin their blood for the rest of their lives, which is not ideal. This is because the metal valves can cause blood clots to form on the valve, which can lead to life-threatening problems. The blood thinners help keep blood from clotting, which helps keep blood flowing through the valves as it should.
Biological valves are made of human or animal tissue. The most common animal tissue used is bovine (cow) tissue. They don’t last as long as mechanical valves do, but people with biological valves don’t normally have to take blood thinners for life. Research has shown that biological valves made from cow tissue tend to be quite durable. It is not uncommon for them to last 15 years.
Your own valve
There are times when surgeons will use a patient’s pulmonary valve to replace a damaged aortic valve. The surgeon then replaces the pulmonary valve with an artificial valve (biological or mechanical). This procedure, called the Ross Procedure, is often a good option for people who don’t want to take blood thinners for life. However, it can only be used to replace aortic valves. If you are having your aortic valve replaced, ask your surgeon whether this is an option for you.