Heart Valve Surgery

Some people undergo what is known as heart valves surgery either to replace or repair the valve, as a result of a malfunction that has resulted in the loss of proper functioning. The heart consists of four chambers separated by valves that regulate the passage of blood and prevent the flow in the opposite direction. Each person has four valves: aortic valve, mitral valve, pulmonary valve and tricuspid valve. Replacement of the aortic valve is one of the most common procedures, but the mitral valve is the most common valve to be repaired. Pulmonary valves and tricuspid valve are rarely repaired or replaced.

A cardiothoracic surgeon can use one of several techniques to perform a heart valve. These techniques include:

• Open heart surgery through skin incision.
• Robot-assisted surgery, where the robot is used to perform the surgical steps.
• Annuloplasty by sewing a ring of tissue or other material around the valve.
• Valvuloplasty; repair the valve, by refining or reshaping the valve cusps.

In cases of valve replacement, the surgeon removes the damaged valve and replaces it with another that is made up of living cells, such as taken from another human or animal, or mechanical valve in the sense that it is made by man of metal or similar material.

The surgery of heart valves can be approved because of one of the following:

• Valve regurgitation: Due to the inability of the valve to prevent the return of blood in opposite direction, resulting in blood leakage in the wrong direction, the most common disorders are: tricuspid valve regurgitation, acute or chronic valvular regurgitation.
• Stenosis of the valve, which causes poor blood flow through it, such disorders includes: stenosis of the pulmonary valve or aortic valve or tricuspid valve.
• One of the deformities of the heart valves causing heart failure, apnea, fainting or angina.
• Inefficient aortic valve.

After scheduling the surgery, the patient undergoes a series of tests to verify the readiness of the surgery, which includes:

• Clinical examination.
• Radiography of the chest area using X-ray.
• Blood tests.
• Electrocardiogram (EKG).
• Cardiac stress test.

Despite of the good success rate of the surgery in repairing the defect by repairing or replacing the damaged valve with a healthy one, but as most surgeries, it may include some risks that the patient may have during or after the surgery, including:

• Bleeding.
• Heart attack.
• Infection.
• The inability of the new valve (in the case of replacements) to function properly.
• Stroke.
• Irregular heartbeat.
• Death.

This surgery consists of three main stages, as following:

• Preparing the patient: 

Once the open heart surgery is approved, the patient is prepared by the assistant medical team, but before that, he must go to the hospital to confirm check-in date and complete the procedures, the doctor sits with the patient before starting the preparation and discusses with him all the reasons for surgery and the patient is informed of all the risks clearly and explicitly, the patient agrees to the surgery and the risks involved signing the consent form.

The patient is then required to take a bath using antiseptic soap, and then shave hair on the abdomen or chest, if any. The patient is required to fast from midnight on the day of the surgery.

• During the surgery:

1. The patient is completely anesthetized.
2. A cardiac surgeon can either have an open heart operation through an incision in the chest area or through small incisions through which catheter tubes are inserted (may depend on robotic –assisted operation).
3. In cases of valve replacement, the damaged valve is removed and the new valve is installed (either made from living tissue or man-made materials).
4. In the case of valve repair, the surgeon closes the leakage site in the valve or removes excess tissues of the valve after the defect is repaired so that the valve can completely close, or separates the connected cusps in the valve, or tighten the valve by attaching a ring around it.

In this type of surgery, a heart-lung machine is used to ensure that blood is pumped throughout the body during heart surgery.

• After the surgery

After surgery, the patient remains under the influence of anesthesia for a few hours, during which he is transferred to the intensive care unit to stay under the supervision of the medical team of nurses and doctors for two to three days. During this period, the patient is given intravenous fluids and medications and remains connected to a number of tubes, one for draining urine and the other for draining fluid and blood from the heart and chest. A few days later, the patient will be moved to a regular room inside the hospital. The length of stay in hospital often varies depending on the patient's health, recovery, post-operative medication, and the type of the surgery he underwent; that open-heart operations require more time than minimal invasive surgeries.

During the hospital stay, the doctor advises the patient to move through regular walking and breathing exercises.

This stage is fraught with many fluctuations, as the period following the heart valve operation (especially if it is an open heart operation) requires a lot of care to ensure a faster recovery, the recovery period may extend for several months depending on the patient's health, age and willingness to recover through his commitment to the instructions given to him. During this period, the patient often suffers from sleep problems, chest pain and some symptoms of depression.

The doctor provides patients with a number of important tips, such as: the need to take anti-coagulant drugs, a healthy diet and some types of exercise, and avoid performing any work that requires physical effort that strains the body until the full recovery from the surgery side effects.

This type of operations can get the patient into a bout of depression; he should discuss this with the heart surgeon responsible for his case and can take antidepressant medications if he is unable to deal with the negative emotions he is experiencing.

The patient may have to be absent for a few weeks, but returning depends on the type of work the patient is doing, so he can discuss this with the doctor.