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Surgical Solutions for Heart Valve Issues: Cutting Through the Confusion
A person’s heart has four valves. Two of them do the most work. The mitral valve pumps blood between the heart’s two left chambers. The aortic valve controls blood flowing from your heart into the body’s main blood vessel.
Two common problems happen with valves. In one case, the valve can’t close properly. In the other, the valve opening narrows, limiting the amount of blood that can flow through.
This article looks at the surgical options, when medication and lifestyle changes won’t eliminate symptoms and problems.
“Balloon Valvuloplasty (also called a balloon valvotomy) is technically a non-surgical procedure,” says McLeod Cardiothoracic Surgeon Dr. Scot Schultz. “But it is a procedure that requires anesthesia and a small incision. Similar to an angioplasty, a thin tube is inserted through a blood vessel into the heart. A balloon on the end is inflated, opening up the partial blockage.”
An excellent option for narrowed mitral valves, it is less successful for aortic valves. They often start closing again within 2 years.
Surgeons can 1) open valves that have thickened or stuck together, 2) reshape a valve by cutting out a section and sewing it back together, 3) insert a ring-like device to make the opening smaller or 4) strengthen the cords and muscles that support the valve.
When the valve is too badly damaged to repair, the surgeon will recommend replacing the valve. This is serious open-heart surgery, where the chest is opened to get to the heart. Swapping out the aortic valve due to narrowing (stenosis) is the most common valve replacement surgery, with aortic and mitral valve leakage (regurgitation) also a common cause for surgery.
Replacement valves come in two basic forms. Neither is a perfect choice and like much in life, there are trade offs with each option.
Mechanical valves are constructed of metal and plastic. They are very durable but require the recipient to take blood-thinning medication for the remainder of their life to prevent blood clots. If clots form, stroke or heart attack can result.
Bioprosthetic means the valve is made of human tissue (the patient’s or a donor’s) or animal tissue usually pigs or cows, (because they closely mirror the human heart valve). Human heart valves are more durable than the animal version. In some cases, the new valve is fashioned from the patient’s own tissue. About half the patients with animal-based valve replacements develop problems within 15 years.
Age is one consideration in the choice of a valve replacement. For younger patients undergoing aortic valve replacement, a mechanical valve’s durability seems to make it an optimal choice. The American Heart Association and American College of Cardiology recommends the bioprosthetic for patients over age 65, who receive aortic valve replacement.
Several Special Procedures have been development for heart valve replacement.
Transcatheter Aortic Valve Replacement/Implantation (TAVR or TAVI) is a minimally invasive procedure, which does NOT require open-heart surgery. Using a thin tube (catheter) inserted through a blood vessel into the heart, a compact replacement valve is positioned and expanded in place. TAVI is relatively new but is used for people in their 70s and 80s or have a medical condition that may limit their ability to survive heart surgery.
The Ross Procedure is a double valve replacement. A damaged aortic valve is replaced with the patient’s pulmonary valve from the right heart chamber. A donor valve replaces the pulmonary valve. This procedure can be useful for younger patients because the new aortic valve continues to grow with the child. Long-term blood thinning medication is not needed.
Final thought. As you can see, many options and decisions are needed when heart valve problems arise. Talk with your primary care physician, a cardiologist and a cardiothoracic surgeon specializing in valve repair and replacement to fully understand your choices.
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Sources include: McLeod Health, National Institutes of Health, American Heart Association, Society of Cardiovascular Angiography & Interventions, Heart & Stroke Foundation of Canada