Valvular heart surgery

What is heart valve surgery?

Cardiac valve surgery is a technique used to solve problems or conditions of the heart valves, such as valve stenosis, which occurs when there is a narrowing or closure of the valve, or valve insufficiency, also known as regurgitation, which occurs when the valve closes inadequately.

This surgery is an open-heart surgery in which the chambers and vessels of the heart are opened under general anesthesia.

There are two ways of approaching this problem from a traditional surgical perspective: sternotomy, which is performed through an incision in the sternum, or repair or replacement, in which the blood vessel is opened and repaired or replaced with a valve prosthesis.

Why is valvular heart surgery performed?

The heart has four valves: the aortic, mitral, tricuspid and pulmonary valves. The function of these four valves is to control the direction of blood flow through the heart.

The main diseases for which heart valve surgery is indicated are aortic stenosis, mitral stenosis, aortic insufficiency and mitral insufficiency.

Valvular procedures aim to repair or replace the mitral valve or the aortic valve. Both are located on the left side of the heart, i.e., the part of the heart that is most stressed, since it controls the flow of oxygenated blood from the lungs and supplies it to the rest of the body.

The aim of valve surgery is to repair or replace the mitral valve or the aortic valve.

What does valve surgery consist of?

In valve replacement or repair operations, a heart-lung machine is used. In turn, the patient will be given an anticoagulant to prevent the formation of blood clots.

After the patient is connected to the heart-lung machine, the heart is stopped and cooled. Subsequently, an incision will be made in the heart or aorta, depending on the valve to be repaired. Once the process is completed, the heart is restarted and disconnected.

There are cases in which the repair may be ineffective and require another intervention. At the same time, it should be noted that patients with a biological valve may need to have it replaced after fifteen or twenty years.

In the case of mechanical valves, which can also fail, patients will have to take anticoagulants for the rest of their lives. In the event that bacteria manage to penetrate the repaired or artificial valve, bacterial endocarditis, a very serious disease, may develop.

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Preparation for valve surgery

A large number of patients who come to the hospital for valve surgery are admitted to the hospital the day before the procedure, and in some cases even the same day. The patient will be asked to come bathed, to avoid the presence of bacteria on the skin.

However, once the patient arrives at the hospital, the skin will be disinfected with an antiseptic and, if necessary, the area where the incision will be made will be shaved.

The patient should be operated on an empty stomach, since the risks of suffering complications derived from the anesthesia are reduced. In the event that the patient has drunk or eaten before, it is necessary to inform the anesthesiologist and the surgeon.

If the patient is a smoker, the doctor will ask him/her to stop smoking at least two weeks before the operation, since smoking can cause problems related to coagulation.

Care after the operation

The hospital stay following this type of surgery is approximately one week. Complete healing may take several months, although the recovery period will vary depending on the patient’s health prior to undergoing the procedure.

Once operated, the patient must be under constant cardiac surveillance, with regular check-ups and contacting his or her specialist if any symptoms are noticed.

The intake of medication may be altered depending on the intervention.

In the event that the patient has a dental problem or infection, he/she should contact his/her medical team and immediately start taking the indicated antibiotics.

Alternatives to valve surgery

The alternative treatment to valve surgery is minimally invasive and percutaneous surgery. These are techniques with advances, such as videothoracoscopy, which introduces a micro camera through the thorax and allows this type of surgery to be performed.

We can talk about the HearPort procedure and the percutaneous aortic valve.

  • HeartPort: a small incision is made in the mammary fold and the extracorporeal circulation is done through the femoral artery and vein.
  • Percutaneous aortic valve: it is performed through a catheter introduced through the femoral artery through which a biological valve is introduced.