Heart Valve Replacement: What is it and How is it Done?

Heart valve replacement surgery is a procedure that treats diseased, damaged, or defective valves. It is the condition where at least one out of four heart valves does not function properly. Heart valves are responsible for the blood to flow in the correct direction through the heart. The four valves responsible for healthy blood flow throughout the body are the aortic valve, tricuspid valve, mitral valve, and pulmonary valve. 

Valves are made of cusps or flaps which open and close with every heartbeat. However, the flaps that do not open and close properly disturb the blood flow from the heart to the body.

In heart valve replacement, the surgeons repair and replace the infected heart valves. There are a few types of valve replacement surgery that help replace and repair heart valves. 

Types of Valve Replacement Surgery 

There are 4 types of heart valve replacement surgeries:

Aortic Valve Replacement 

The aortic valve serves as an outflow valve on the left side of the heart. It connects the left ventricle to the aorta. The left ventricle is the heart’s main pumping chamber which pumps blood into the aorta and then to the other parts of the body. The job of the aortic valve is to close after the ventricle pumps the blood so that there is no backflow of the blood into the left ventricle. 

In cases where the aortic valve stops functioning correctly or due to a congenital defect or diseases causing stenosis or regurgitation, you may require an aortic valve replacement surgery. 

Mitral Valve Replacement

The mitral valve is placed between the left atrium and left ventricle. The responsibility of the mitral valve is to serve as an inflow valve. Hence, this valve allows the blood from the left atrium to flow into the left ventricle. 

When the flaps do not close properly, the blood can flow back into the lungs. This can be due to a degenerative disease, congenital defect, or infection.

Double Valve Replacement

A double valve replacement surgery is a surgical replacement of both aortic and mitral valves or the entire left side of the heart. This surgery is not as common as others and death risks are slightly higher than others.

A person undergoing double heart valve replacement surgery should discuss possible risks and health threats before the surgery. 

Pulmonary Valve Replacement

The pulmonary valve separates the pulmonary artery that carries blood to lungs for oxygenation and the right ventricle. Narrowing of the pulmonary valve can be due to a congenital defect or infection.

Depending on age, fitness, health condition and severity of the heart valve issue, a person is suggested to undergo the surgery.

What is Heart Valve Replacement for?

The four valves are responsible for allowing blood to flow through via different chambers of the heart. Each flap of the four valves should close completely after blood flow. However, when the valves do not close completely, it pushes the blood backwards. This is called regurgitation and based on the seriousness of it, a heart valve replacement may be suggested.

Valvular heart disease signs include:

• Chest pain
• Breathing issues
• Dizziness
• Lightheadedness
• Fluid retention, especially in the lower limbs
• Fatigue
• Cyanosis

What are the Risks of Heart Valve Replacement?

The following are the possible risks of heart valve replacement surgery:

• Infection can occur after valve replacement
• Blood clots that may cause heart attack or stroke and lung problems
• Arrhythmias (abnormal heart rhythms)
• Difficulty in breathing
• Damage to the blood vessels or bleeding during or after treatment
• Pneumonia
• Side effects of anesthesia
• Valve failure
• Stroke
• Death

How to Prepare for Heart Valve Replacement?

Here is the list of things that you should consider before undergoing heart valve replacement:

• Ask possible questions and doubts regarding the surgery, discuss risks and other aspects with the doctor.
• Understand the surgery and its benefits. Also, know lifestyle changes required after heart valve surgery.
• A patient is generally asked to fast or avoid eating or drinking for 8 hours before the surgery.
• A patient should inform the doctor of their list of medicines, supplements, herbs, and drug usage for numerous reasons. Also, women should inform a doctor, if they are pregnant or think she they. 
• A patient should tell his or her surgeon about their allergies to any medicines, anesthesia, latex, or tape.
• If you have a medical history of bleeding disorders or if you are on blood thinners, your physician will stop these anticoagulant medicines before your surgery.
• Your physician will get your blood tested for checking the bleeding time and clotting time.
• Inform your physician if you have any pacemaker or other implanted cardiac devices in your body. 
• Smoking increases the risks of developing post-surgical complications. Hence if you are a smoker, it is best to stop smoking immediately. 
• Based on your medical history and current status of health, your physician will ask you to get any other specific tests done before the surgery.

What Happens During this Procedure?

A heart valve replacement and repair surgery steps vary depending on the age, condition, and severity of the valve issue. 

Generally, heart valve replacement procedure includes:

• The surgeon will ask the person to remove particular jewelry or objects that may interfere during the procedure.
• A patient will be laid down on the operating bed and the healthcare professionals will start an intravenous (IV) line in the hand or arm to inject medicines or IV fluids. 
• The surgery is performed under general anesthesia.
• The professionals will put catheters in blood vessels around the neck and wrist to monitor the heart rate, blood pressure, and draw blood samples. 
• The physician will put you on ventilatory support to help you breathe normally during the surgery.
• The doctor will place a transesophageal echocardiogram (TEE) into the esophagus so that the surgeon can monitor the patient’s valve functions.
• The medical professionals will put a soft and flexible tube called a Foley Catheter into the bladder to get urine out from the body.
• Also, a tube will be put into the stomach through the nose or mouth to drain stomach fluids. 
• A medical professional will clean the skin over the chest with an antiseptic. Also, the professional may shave off hair around the surgical site. 

When the surgery starts

• For the surgery, the surgeon will make an incision at the center of the chest. If the patient is having a less invasive procedure, it may require smaller incisions.
• The breastbone of the sternum is cut in half lengthwise. The surgeon will then separate the breastbone halves to expose the heart. 
• For valve replacement or repair, the doctor must stop the heart and connect a tube to the heart so that the blood can be pumped through a heart-lung bypass machine.
• Once the blood is completely diverted into the bypass machine for pumping, the doctor will inject a cold solution to stop the heart.
• Once the heart is stopped, the doctor will remove the diseased valve and place the artificial or metal valve.
• After placing the valve, the doctor will shock the heart with small paddles to restart the heartbeat. Next, the surgeon will make blood circulation through the bypass machine to re-enter the heart. 
• Once the heart starts working again, the surgeon will monitor if the heart and valves are working properly. Also, the surgeon ensures there are no leaks from the surgery.
• After confirming the healthy functioning of valves and heart, the surgeon will rejoin the sternum, sewing it back together.
• The surgeon will put small tubes into the chest to drain blood and other fluids around the heart.
• Next, the surgeon will stitch the skin over the sternum and close the incision with surgical staples or sutures.
• The surgical site will be covered by a sterile bandage or dressing.

Recovery Period

The majority of patients after heart valve replacement stay in the hospital for a week or two. For the initial few days, the patient remains in the intensive care unit (ICU). The medical staff will monitor the blood pressure, heart pulse, and breathing for a few days post-surgery. Depending on the type of valve that is used, a patient may need to take blood-thinning medicines for life.

Full recovery may take a few weeks or months, depending on the type of heart valve replacement and the healing process. 

Infection is one of the major risks that might occur. Therefore, keep the incisions clean. Ensure that the patient immediately rushes to the surgeon if he or she experiences the symptoms of infection like:

• Fever
• Increased drainage from the incision site
• Chills
• Tenderness or swelling at the incision site

Post-Surgical Care

Once a patient is at his or her home, it is important that the surgical area and incisions are kept clean and dry. This helps to prevent any possible infection in the surgical area. 

The surgeon will give specific bathing instructions that should be followed strictly. The sutures or surgical staples will be removed within a few days or before getting discharged from the hospital.

A patient should not perform any stressful activities until the doctor suggests to do so. Doctors will also recommend that the patient avoid driving in the meantime. 

A patient should immediately rush to the surgeon if he or she experiences the following:

• Weakness in the legs and arms
• Easy bruising
• Severe pain around the incision
• Irregular or rapid heart pulse
• Redness, swelling, bleeding, or drainage from the incision or any of the catheter sites
• Frequent nausea or vomiting
• Fever of 100.4 degrees F (38 degrees C) or higher, or chills
• Breathing issues
• Increased swelling in the abdomen and legs 

The surgeon will give necessary instructions looking at the patient’s condition. Also, it is advisable to consult the doctor before using any drug, medicine, herb, supplement, or taking up any physical activity that promises recovery from heart valve replacement or boosting heart health.