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Heart valve surgery

Surgery to repair or replace heart valves is performed to restore normal blood flow to, through and from the heart. Depending upon a diagnosis and other factors, this surgery can be performed as a minimally invasive or as an open surgical procedure. Some conditions that can indicate the need for heart valve repair or replacement include:

  • A valve that does not close fully, allowing blood to leak backwards (regurgitation)
  • A valve that does not open fully limiting forward blood flow (stenosis)
  • Defects that cause major heart symptoms such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure
  • Changes in valve performance that affect heart function
  • Replacement or repair of a valve at the same time open heart surgery is being performed for another reason
  • A valve damaged by infection of the valve (endocarditis)
  • A new valve replaced in the past that is not working well or causing other problems such as clotting, infection, or bleeding

Heart valve repair and replacement

Depending upon the condition of your heart valve, your surgeon may elect to repair it or replace it. The heart valves involved in these procedures include:

  • Aortic valve
  • Mitral valve
  • Tricuspid valve
  • Pulmonary valve

Heart valve repair

If the condition of your heart valve is such that repair it appropriate, a surgeon can repair it by using several techniques:

  • Ring annuloplasty - Involves repairing the ring-like part around the valve by sewing a ring of plastic, cloth, or tissue around the valve.
  • Valve repair - Involves trimming, shaping, or rebuilding one or more of the leaflets of the valve. The leaflets are the flaps that open and close the valve. Valve repair is best for the mitral and tricuspid valves. The aortic valve is usually not repaired.

Heart valve replacement

If the heart valve is seriously damaged, your surgeon will remove it and replace it. The main types of new replacement valves include:

  • Mechanical - Made of man-made materials, such as metal (stainless steel or titanium) or ceramic, these valves last the longest, but require patients to take a blood-thinning medication, such as warfarin (Coumadin) or aspirin, for the rest of their life to prevent blood clotting.
  • Biological - Made of human or animal tissue, these valves last 12 - 15 years, but may require using blood thinners for the rest of your life.
  • Homografts - Donated human aortic valves that are used in select cases. In some cases, surgeons can use your own pulmonary valve to replace the damaged aortic valve. The pulmonary valve is then replaced with an artificial valve (Ross Procedure).

Minimally Invasive and open surgical approaches

Depending upon your condition and other factors, your surgeon can elect to perform your heart valve repair or replacement as either an open or minimally invasive procedure. In both cases you will need to be placed on a heart-lung by-pass machine during the surgery to do the work of your heart while it is stopped.

Open surgery - requires a large surgical cut in your breastbone to reach the heart and the valve(s) requiring treatment.

Minimally invasive surgery - Done through much smaller cuts than open surgery, or through a catheter inserted through the skin. Several different techniques can be used and include:

  • Laparoscopy or endoscopy
  • Percutaneous surgery (through the skin)
  • Robotic-assisted surgery
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