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Heart Valve Repair

By

Sarah Lewis, PharmD

What is a heart valve repair?

A heart valve repair is a surgery to fix a diseased or damaged heart valve. Heart valves keep blood flowing in one direction through the four chambers of your heart. They have tissue flaps that open to allow blood to flow forward to the body. The flaps then close tightly so blood does not leak backwards into the heart. 

Diseased or damaged heart valves allow a backflow of blood or do not allow blood to flow forward normally. Heart valve repair is preferred over heart valve replacement because it preserves the strength and function of your heart muscle. 

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Heart valve repair is a major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a heart valve repair. 

Types of heart valve repair

The types of heart valve repair procedures include:

  • Balloon valvuloplasty is a catheter procedure that opens a stenosed (narrowed) heart valve. Your doctor inserts the catheter through a vessel in your groin or arm and threads it to your heart valve. Your doctor inflates a balloon in the tip of the catheter to widen or open your heart valve.

  • Commissurotomy opens or separates valve flaps that are fused together. This widens the valve opening.

  • Decalcification removes calcium deposits on heart valves, which causes stiffness of valves.  It improves the flexibility of the tissue flaps and allows the heart valve to work better.

  • Patched leaflets fixes holes or tears in the heart valve flaps, or leaflets. Your doctor will repair the damage with a tissue patch.

  • Ring annuloplasty repairs the ring-like base of your heart valve with metal, tissue, or a special cloth material. This helps tighten a valve that is too loose or too wide.

  • Triangular resection repairs a floppy mitral valve flap (leaflet) that does not close properly. Your doctor will remove a section of the floppy leaflet and sew the remaining parts back together. This allows the valve to close more tightly.

Other surgical procedures that may be performed

Your doctor may perform other procedures in addition to heart valve repair.  These include:

  • Coronary artery bypass graft (CABG, heart bypass surgery) uses a graft to make a new route for blood to flow around blocked coronary arteries in the heart. Grafts are made with healthy vessels taken from other places in the body.

  • Percutaneous coronary intervention (angioplasty) involves widening or opening blocked or narrowed coronary arteries in the heart. A stent is typically placed in the artery to keep it open longer.

Why is a heart valve repair performed? 

Your doctor may recommend a heart valve repair when one or more of your heart valves does not open or close correctly. A heart valve that does not close all the way leads to regurgitation. Regurgitation lets blood flow backward instead of forward.

A heart valve that does not open all the way is called stenosis. Stenosis is a narrowing of the valve opening. It prevents blood from flowing forward effectively.

Your doctor may consider a heart valve repair for you if your heart valve disease causes serious symptoms. These include fatigue, dizziness, passing out, shortness of breath, and swelling of the ankles. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a heart valve repair.

Your doctor may recommend a heart valve repair to treat:

  • Aortic regurgitation or stenosis. The aortic valve opens to allow blood to leave the heart and closes to prevent blood from flowing back into the heart.

  • Congenital heart valve disease, a condition that is present at birth

  • Mitral valve regurgitation or stenosis. The mitral valve opens to allow blood to leave the left atrium and enter the left ventricle. It closes to prevent blood from flowing back into the left atrium.

  • Pulmonary valve regurgitation or stenosis. The pulmonary valve opens to allow blood to leave the heart and go to the lungs to pick up oxygen. It closes to prevent blood from flowing back into the heart.

  • Tricuspid valve regurgitation or stenosis. The tricuspid valve opens to allow blood to leave the right atrium and enter the right ventricle. It closes to prevent blood from flowing back into the right atrium.

Who performs a heart valve repair?

A cardiac surgeon performs a heart valve repair. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. A cardiac surgeon may also be known as a cardiothoracic surgeon

A subspecialist called a congenital cardiac surgeon may perform the surgery on a heart valve with a congenital defect (a defect present at birth).

How is a heart valve repair performed?

Your heart valve repair will be performed in a hospital using one of the following approaches:

  • Minimally invasive surgery involves inserting special instruments and an endoscope through a three to four inch incision in the chest. The endoscope is a small, thin camera that transmits pictures of the inside of your body to a video screen. Your surgeon views the surgical area on the video screen while performing the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open heart surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision instead of a larger one used in open heart surgery. Surgical tools are threaded around structures, such as the breastbone and muscles, instead of cutting through or displacing them as in open heart surgery. Minimally invasive surgery may also include the use of a surgical robot or special imaging technologies (computer-assisted surgery) to help your surgeon view the area and perform the surgery.

  • Open heart surgery involves making a six to 10 inch incision in the chest through the breastbone (sternum). Open heart surgery allows your surgeon to view and access the heart directly. Open heart surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open heart surgery may be a safer or more effective method for certain patients.

  • Catheter surgery may be an option for patients who are not candidates for other types of valve surgeries. Catheter surgery involves inserting a catheter through a blood vessel in your groin. Your surgeon threads the catheter up to your heart until it reaches the diseased valve. The catheter tip has a deflated balloon that your surgeon expands once the catheter is in place. This type of repair is more common for infants and children, and for treatment of mitral valve stenosis.

Surgeons sometimes combine minimally invasive techniques with an open procedure. Your surgeon may also decide after beginning a minimally invasive technique that you require an open surgery to safely complete your surgery. 
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different heart valve repair procedures and ask why your surgeon will use a particular type for you.

Types of anesthesia that may be used

Your surgeon will perform your heart valve repair using either general anesthesia or regional anesthesia, depending on the specific procedure. General anesthesia is more common for this surgery.

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

  • Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your heart valve repair

You will be admitted to the hospital the day before your open heart valve repair surgery. For minimally invasive procedures, you will probably report to the hospital the morning of your surgery. The day of surgery, you can generally expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

  • Remove all clothing and jewelry and dress in a hospital go