The classic approach for the surgical treatment of valvular heart disease is through a median sternotomy, although current trends to reduce surgical aggression lead us to perform less invasive approaches. For example, to act on the aortic valve I usually use a partial sternotomy, through a 7-8 cm incision, instead of the 15-20 cm of the complete sternotomy.
Once the heart is exposed, technology is needed to exclude cardiac function and this is achieved by connecting the patient to the heart-lung machine (heart-lung machine). Under these conditions, the heart can be stopped and opened safely for the patient and, in this way, the heart valves can be accessed.
Two procedures for heart valves
There are two types of procedures in heart valve surgery: reparative and prosthetic surgery. In the former, the damaged valve is restored to proper function by means of various surgical techniques. It is the mitral valve that can benefit most from this type of surgery. On the other hand, there is prosthetic surgery, in which the irreparably damaged valve is replaced by a prosthesis.
As for the type of prosthesis, we can distinguish between mechanical and biological prostheses. The former are made of metal alloys that are resistant and durable but require lifelong decoagulation treatment with synthrom. They are especially indicated for people under 65 years of age. Biological prostheses, made of animal tissue, deteriorate over time and may need to be replaced after approximately 10 to 15 years, but they do not require decoagulation and therefore allow a better quality of life. These are most commonly used in people over 65 years of age.
Diseases that are treated
Different diseases can cause valve stenosis or narrowing (it does not open properly), insufficiency (it does not close properly) or double lesion (it neither opens nor closes properly). The most common valve diseases are degenerative disease, those related to ischemic heart disease (myocardial infarction), rheumatic fever, and finally endocarditis, caused by an infection on one or more valves.
Risks and benefits of heart valve surgery
Usually the patient has clear symptoms, but sometimes, when there are no symptoms, the diagnosis can be fortuitous and a significant damage to cardiac function can already be observed. It is therefore important to diagnose and perform surgery as early as possible. If it is detected at the right time and the operation is not delayed, recovery can be complete.
Nowadays most heart surgeries are part of the daily routine of cardiac surgeons, which allows us to offer the patient a relatively safe surgery. In fact, the risk is generally conditioned more by other pathologies of the patient than by the cardiac technique itself. Although, obviously, the complexity of the surgery also determines the risk, it is data such as age, kidney or lung condition, extracardiac arteriopathy or the “fragility” of the patient that finally decide the real risk of the operation.
Recovery from surgery is progressive and depends on each patient, social situation, preoperative situation and above all, the mood with which they face the surgery. It is a recovery that is tolerated quite well, and many patients can already lead a relatively normal life a month and a half after the operation.