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What are heart valves and why are they important?
The valves in your heart play a key role in regulating the heart's blood flow. Blood is pumped in one direction through the heart and the valves open and close with each heart beat to keep the blood flowing in one direction. The valves have flap-like closures (called cusps or leaflets) that open and close with the pressure of the heart beat. They open with the pressure of the heart beat when blood is flowing forward and close when the beat stops to prevent the backflow of blood. There are four valves in the heart:
- Tricuspid Valve
- Pulmonary Valve
- Mitral Valve
- Aortic Valve
The majority of valve surgeries are for the mitral or aortic valves because these valves are located on the left side of the heart, which works the hardest.
When is valve surgery needed?
There are several types of problems that can affect the functioning of the valve which requires surgical repair or replacement of the valve:
- Congenital Valve Defects. Sometimes people are born with a valve defect (congenital defect) which requires the valve to be repaired or replaced.
- Stenosis. Stenosis is the hardening or thickening of the leaflets which prevents the valve from opening fully and only allows a small amount of blood to flow through the valve. Surgery is performed to either repair the leaflets, or to replace the valve.
- Regurgitation. Regurgitation means that blood leaks backwards instead of flowing forward because the valve does not close properly. Surgery is required to tighten or replace the valve.
Valve repair involves the surgeon rebuilding or fixing the valve while valve replacement requires the surgeon to implant a new valve. If valve replacement is required, there are two types of valves that can be used:
- Mechanical Valves. These valves are made from materials such as plastic, carbon or metal. The benefit of these valves is that they are strong and last a long time. However, there is a higher risk of blood clots forming with this type of valve and patients will need to remain on blood-thinning medicine (called anti-coagulants) for the rest of their lives.
- Biological Valves. These valves are made of animal or human tissue. Patients with biological valves usually do not need to take blood thinning medication, but biological valves usually do not last as long as mechanical valves and may need to be replaced every 10 - 12 years or so. Biological valves are used mostly in older patients since they tend to deteriorate faster in younger patients.
How do I prepare for surgery?
Several medical tests will be scheduled to ensure that you are healthy enough to undergo the surgery, including an EKG, blood tests, urine tests, dental exam and a chest x-ray. After these tests are completed, the surgeon or physician assistant will review all the pre-operative instructions for your surgery. It is very important that you let them know about all medications you are taking, including over-the-counter medications since they may contain aspirin which is important for your physician to know. It is also important for you to let them know about any changes in your health, especially fever, chills, coughing or a runny nose because colds can lead to infections that may affect your recovery.
How is the surgery performed?
Valve surgery is performed under general anesthesia, so you will sleep through the procedure. The breast bone is divided to expose the heart. The heart needs to be opened and still during the surgery, so all valve repair and replacement surgeries require the use of a heart-lung machine. This machine will keep oxygen-rich blood flowing through your body while your heard is stopped. Once the surgeon has completed the surgery, the heart is started and the heart-lung machine disconnected. The surgery can take anywhere from 3-4 hours or more.
What is the recovery period?
You will stay in the hospital for several days following the procedure. The recovery period after valve surgery may take a long time. You will need to rest frequently and limit your activity. Your physician may place you on an exercise program or cardiac rehabilitation program. If you have an office job, you can usually go back to work in 4-6 weeks. If you have a more physically-demanding job, it may take longer.
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