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A flexible fabric ring is sutured to the valve annulus to provide support and reconstruction for the patient's valve annulus.
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What is an annuloplasty?
An annuloplasty is the use of plastic to repair a cardiac valve.
Heart valve surgery?
DefinitionHeart valve surgery is used to repair or replace diseased heart valves.Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must flow through a heart valve.These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.There are four valves in your heart:Aortic valveMitral valveTricuspid valvePulmonary valveAlternative NamesValve replacement; Valve repair; Heart valve prosthesisDescriptionBefore your surgery you will receive general anesthesia. You will be asleep and unable to feel pain.In open surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.Minimally invasive valve surgery is done through much smaller cuts than open surgery. There are several different techniques used:Laparoscopy or endoscopyPercutaneous surgery (through the skin)Robot-assisted surgeryIf your surgeon can cover your aortic valve, you may have:Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.Valve repair -- The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve.If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one into place. There are two main types of new valves:Mechanical -- made of man-made materials, such as cloth, metal (stainless steel or titanium), or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.Biological -- made of human or animal tissue. These valves last 12 - 15 years, but you may not need to take blood thinners for life.For more detailed information, see:Aortic valve surgery - minimally invasiveAortic valve surgery - openMitral valve surgery - minimally invasiveMitral valve surgery - openWhy the Procedure Is PerformedYou may need surgery if your valve does not work properly.A valve that does not close all the way will allow blood to leak backwards. This is called regurgitation.A valve that does not open fully will restrict blood flow. This is called stenosis.You may need heart valve surgery for these reasons:Changes in your heart valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.Tests show that the changes in your heart valve are beginning to seriously affect your heart function.Your doctor wants to replace or repair your heart valve at the same time as you are having open heart surgery for another reason.Your heart valve has been damaged by infection of the heart valve (endocarditis).You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.Some of the heart valve problems treated with surgery are:Aortic insufficiencyAortic stenosisMitral regurgitation - acuteMitral regurgitation - chronicMitral stenosisMitral valve prolapsePulmonary valve stenosisTricuspid regurgitationRisksThe risks for any anesthesia include:Problems breathingReactions to medicationsThe risks for any surgery include:BleedingBlood clots in the legs that may travel to the lungsInfection, including in the lungs, kidneys, bladder, chest, or heart valvesThe risks for cardiac surgery include:DeathHeart attackIrregular heartbeat (arrhythmia)Kidney failurePost-pericardiotomy syndrome -- low-grade fever and chest pain that can last for up to 6 monthsStrokeTemporary confusion after surgery due to the heart-lung machineIt is very important to take steps to prevent valve infections. You may need to take antibiotics before dental work and other invasive procedures.Before the ProcedureFor more information, see:Aortic valve surgery - minimally invasiveAortic valve surgery - openMitral valve surgery - minimally invasiveMitral valve surgery - openAfter the ProcedureFor more information, see:Aortic valve surgery - minimally invasiveAortic valve surgery - openMitral valve surgery - minimally invasiveMitral valve surgery - openThe average hospital stay is 5 - 7 days. Complete recovery will take a few weeks to several months, depending on your health before surgery.Outlook (Prognosis)The success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.Mechanical heart valves do not often fail. Artificial valves last an average of 8 - 20 years, depending on the type of valve. However, blood clots can develop on these valvves. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.The clicking of mechanical heart valves may be heard in the chest. This is normal.ReferencesFullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patiens with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.
Aortic valve surgery - open?
DefinitionBlood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.Aortic valve surgery is done to either repair or replace the aortic valve in your heart.An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation.An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.In open surgery, the surgeon makes a large incision (cut) in your breastbone to reach the heart and aorta.See also: Aortic valve surgery - minimally invasiveAlternative NamesAortic valve replacement; Aortic valvuloplasty; Aortic valve repair; Replacement - aortic valve; Repair - aortic valve; Ring annuloplasty - aortic valveDescriptionBefore your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.Your surgeon will make a 10-inch-long cut in the middle of your chest.Next, your surgeon will separate your breastbone to be able to see your heart and aorta (the main blood vessel leading from your heart to the rest of your body).Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.If your surgeon can repair your aortic valve, you may have:Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.Once the new or repaired valve is working, your surgeon willClose your heart and take you off the heart-lung machine.Place catheters (tubes) around your heart to drain fluids that build up.Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside your body.This surgery may take 3 to 6 hours.Sometimes other procedures are done during open aortic about surgery. These include the Ross (or switch) procedure, the David procedure, and a graft of the ascending aorta.Why the Procedure Is PerformedYou may need surgery if your aortic valve does not work properly. You may need open-heart valve surgery for these reasons:Changes in your aortic valve are causing major heart symptoms, such as angina (chest pain), shortness of breath, syncope (fainting spells), or heart failure.Tests show that changes in your aortic valve are beginning to seriously harm how well your heart works.Your heart valve has been damaged by endocarditis (infection of the heart valve).You have received a new heart valve in the past and it is not working well, or you have other problems such as blood clots, infection, or bleeding.RisksRisks for any anesthesia are:Reactions to medicinesBreathing problemsBlood clots in the legs that may travel to the lungsInfection, including in the lungs, kidneys, bladder, chest, or heart valvesBlood lossPossible risks from having open heart surgery are:Heart attack or strokeIncision infection, which is more likely to occur in people who are obese, have diabetes, or have already had this surgeryPost-pericardiotomy syndrome, which is a low-grade fever and chest pain. This could last up to 6 months.Memory loss and loss of mental clarity, or "fuzzy thinking."Heart rhythm problemsBefore the ProcedureAlways tell your doctor or nurse:If you are or could be pregnantWhat drugs you are taking, even drugs, supplements, or herbs you bought without a prescriptionYou may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood.For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.During the days before your surgery:Ask your doctor which drugs you should still take on the day of your surgery.If you smoke, you must stop. Ask your doctor for help.Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.Prepare your house for when you get home from the hospital.The day before your surgery, shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked to take an antibiotic, to prevent infection.On the day of your surgery:You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.Take the drugs your doctor told you to take with a small sip of water.Your doctor or nurse will tell you when to arrive at the hospital.After the ProcedureExpect to spend 5 to 7 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and stay there for 1 or 2 days. Two to 3 tubes will be in your chest to drain fluid from around your heart. These are usually removed 1 to 3 days after surgery.You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in a vein) lines to deliver fluids. Nurses will closely watch monitors that show information about your vital signs (your pulse, temperature, and breathing).You will be moved to a regular hospital room from the ICU. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine to control pain around your incision.Your nurse will help you slowly resume some activity. You may begin a program to make your heart and body stronger.A temporary pacemaker may be placed in your heart if your heart rate becomes too slow after surgery.Outlook (Prognosis)Mechanical heart valves do not fail often. However, blood clots develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.Biological valves tend to fail over time. But they have a lower risk of blood clots.ReferencesFullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.Chiam PTL, Ruiz CE. Percutaneous transcatheter aortic valve implantation: Evolution of the technology. American Heart Journal. Feb 2009;157(2).Otoo CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
Mitral valve surgery - open?
DefinitionBlood that flows between different chambers of your heart must flow through a valve. This valve is called the mitral valve. It opens up enough so blood can flow from one chamber of your heart (left atria) to the next chamber (left ventricle). It then closes, keeping blood from flowing backwards.Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.In open surgery, the surgeon makes a large incision (cut) in your breastbone to reach the heart.See also: Mitral valve surgery - minimally invasiveAlternative NamesMitral valve replacement - open; Mitral valve repair - open; Mitral valvuloplastyDescriptionBefore your surgery, you will receive general anesthesia. This will make you unconscious and unable to feel pain during the entire procedure.Your surgeon will make a 10-inch-long cut in the middle of your chest.Next, your surgeon will separate your breastbone to be able to see your heart.Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.A small cut is made in the left side of your heart so your surgeon can repair or replace the mitral valve.If your surgeon can repair your aortic valve, you may have:Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two main types of new valves:Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.Once the new or repaired valve is working, your surgeon willClose your heart and take you off the heart-lung machine.Place catheters (tubes) around your heart to drain fluids that build up.Close your breastbone with stainless steel wires. It will take about 6 weeks for the bone to heal. The wires will stay inside your body.You may have a temporary pacemaker connected to your heart until your natural heart rhythm returns.This surgery may take 3 to 6 hours.Why the Procedure Is PerformedYou may need surgery if your mitral valve does not work properly.A mitral valve that does not close all the way will allow blood to leak back into the left atria. This is called mitral regurgitation.A mitral valve that does not open fully will restrict blood flow. This is called mitral stenosis.You may need open-heart valve surgery for these reasons:Changes in your mitral valve are causing major heart symptoms, such as angina (chest pain), shortness of breath, syncope (fainting spells), or heart failure.Tests show that the changes in your mitral valve are beginning to seriously affect your heart function.Your doctor may want to replace or repair your mitral valve at the same time you are having open-heart surgery for another reason.Your heart valve has been damaged by endocarditis (infection of the heart valve).You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.RisksRisks for any surgery are:Reactions to medicinesBreathing problemsBlood clots in the legs that may travel to the lungsInfection, including in the lungs, kidneys, bladder, chest, or heart valvesBlood lossPossible risks from having open-heart surgery are:Heart attack or strokeIncision infection, which is more likely to happen in people who are obese, have diabetes, or have already had this surgeryPost-pericardiotomy syndrome, which is a low-grade fever and chest pain. This could last up to 6 months.Memory loss and loss of mental clarity, or "fuzzy thinking."Heart rhythm problemsBefore the ProcedureAlways tell your doctor or nurse:If you are or could be pregnantWhat drugs you are taking, even drugs, supplements, or herbs you bought without a prescriptionYou may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood.For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.Prepare your house for when you get home from the hospital.The day before your surgery. Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked to take an antibiotic, to guard against infection.During the days before your surgery:Ask your doctor which drugs you should still take on the day of your surgery.If you smoke, you must stop. Ask your doctor for help.Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.On the day of the surgery:You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.Take the drugs your doctor told you to take with a small sip of water.Your doctor or nurse will tell you when to arrive at the hospital.After the ProcedureExpect to spend 4 to 7 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Two to 3 tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery.You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in the vein) lines to get fluids. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).You will be moved to a regular hospital room from the ICU. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine to control pain around your incision.Your nurse will help you slowly resume some activity. You may begin a program to make your heart and body stronger.Outlook (Prognosis)Mechanical heart valves do not fail often. However, blood clots develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.Biological valves tend to fail over time. But they have a lower risk of blood clots.ReferencesFullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
Mitral valve surgery - minimally invasive?
DefinitionBlood that flows between different chambers of your heart must flow through a valve. This valve is called the mitral valve. It opens up enough so blood can flow from one chamber of your heart (left atria) to the next chamber (left ventricle). It then closes, keeping blood from flowing backwards.Mitral valve surgery is surgery to either repair or replace the mitral valve in your heart.Minimally invasive mitral valve surgery is done through much smaller incisions (cuts) than the large incision needed for open surgery.See also: Mitral valve surgery - openAlternative NamesMitral valve repair - right mini-thoracotomy; Mitral valve repair - partial upper sternotomy; Robotically-assisted, endoscopic valve repair, Percutaneous mitral valvuloplastyDescriptionBefore your surgery you will receive general anesthesia. This will make you unconscious and unable to feel pain.There are several different ways to perform minimally invasive mitral valve surgery.Your heart surgeon may make a 2-inch to 3-inch-long incision (cut) in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided so your surgeon can reach the heart. A small cut is made in the left side of your heart so the surgeon can repair or replace the mitral valve.In endoscopic surgery, your surgeon makes 1 to 4 small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.For robotically-assisted valve surgery, the surgeon makes 2 to 4 tiny cuts (about ? to ? inch) in your chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a 3-dimensional view of the heart and aortic valve on the computer. This method is very precise.You will not need to be on a heart-lung machine for these types of surgery, but your heart rate will be slowed by medicine or a mechanical device.If your surgeon can repair your aortic valve, you may have:Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.If your mitral valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your mitral valve and sew a new one into place. There are two main types of new valves:Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.The surgery may take 1 to 3 hours.This surgery can also be done through a groin artery, with no incisions on your chest. The doctor sends a catheter (flexible tube) with a balloon attached on the end. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.Why the Procedure Is PerformedYou may need surgery if your mitral valve does not work properly.A mitral valve that does not close all the way will allow blood to leak back into the left atria. This is called mitral regurgitation.A mitral valve that does not open fully will restrict blood flow. This is called mitral stenosis.Minimally invasive surgery may be done for these reasons:Changes in your mitral valve are causing major heart symptoms, such as angina (chest pain), shortness of breath, syncope (fainting spells), or heart failure.Tests show that the changes in your mitral valve are beginning to seriously affect your heart function.Your heart valve has been damaged by endocarditis (infection of the heart valve).A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery.RisksRisks for any surgery are:Reactions to medicinesBreathing problemsBlood clots in the legs that may travel to the lungsInfection, including in the lungs, kidneys, bladder, chest, or heart valvesBlood lossMinimally invasive surgery techniques have far fewer risks than open surgery. Possible risks from minimally invasive valve surgery are:Irregular heartbeat that must be treated with medicines or a pacemakerDamage to other organs, nerves, or bonesHeart attack, stroke, or deathBefore the ProcedureAlways tell your doctor or nurse:If you are or could be pregnantWhat drugs you are taking, even drugs, supplements, or herbs you bought without a prescriptionYou may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood.For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.Prepare your house for when you get home from the hospital.The day before your surgery. Shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked to take an antibiotic, to guard against infection.During the days before your surgery:Ask your doctor which drugs you should still take on the day of your surgery.If you smoke, you must stop. Ask your doctor for help.Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.On the day of the surgery:You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.Take the drugs your doctor told you to take with a small sip of water.Your doctor or nurse will tell you when to arrive at the hospital.After the ProcedureExpect to spend 3 to 5 days in the hospital after surgery. You will wake up in the intensive care unit (ICU) and recover there for 1 or 2 days. Nurses will closely watch monitors that show information about your vital signs (pulse, temperature, and breathing).Two to 3 tubes will be in your chest to drain fluid from around your heart. They are usually removed 1 to 3 days after surgery. You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in a vein) lines to get fluids.You will go from the ICU to a regular hospital room. Your nurses and doctors will continue to monitor your heart and vital signs until you are stable enough to go home. You will receive pain medicine for pain in your chest.Your nurse will help you slowly resume some activity. You may begin a program to make your heart and body stronger.A temporary pacemaker may be placed in your heart if your heart rate becomes too slow after surgery.Outlook (Prognosis)Mechanical heart valves do not fail often. However, blood clots develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.Biological valves tend to fail over time. But they have a lower risk of blood clots.Techniques for minimally invasive heart valve surgery have improved greatly over the past 10 years. These techniques are safe for most patients, and they reduce recovery time and pain.ReferencesFullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.Popma JJ, Baim DS, Resnic FS. Percutaneous coronary and valvular intervention. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 55.Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
Aortic valve surgery - minimally invasive?
DefinitionBlood flows out of your heart and into the aorta through a valve. This valve is called the aortic valve. It opens up so blood can flow out. It then closes, keeping blood from flowing backwards.Aortic valve surgery is done to either repair or replace the aortic valve in your heart.An aortic valve that does not close all the way allows blood to leak back into your heart. This is called aortic regurgitation.An aortic valve that does not open fully will restrict blood flow. This is called aortic stenosis.Minimally invasive aortic valve surgery is done through much smaller incisions (cuts) than the large cut needed for open aortic valve surgery.Alternative NamesBalloon valvuloplasty; Mini-thoracotomy aortic valve replacement or repair; Cardiac valvular surgery; Mini-sternotomy; Ring annuloplasty - minimally invasive; Robotically-assisted endoscopic aortic valve repairDescriptionBefore your surgery you will receive general anesthesia. This will make you unconscious and unable feel pain.There are several different ways to do minimally invasive aortic valve surgery. Techniques include laparoscopy or endoscopy, robot-assisted surgery, and percutaneous surgery.Your surgeon may make a 2-inch to 3-inch-long incision (cut) in the right part of your chest near the sternum (breastbone). Muscles in the area will be divided to so your surgeon can reach the valve. This allows the surgeon to reach your heart and aortic valve.For the endoscopic, or "keyhole, approach, your surgeon makes 1 to 4 small holes in your chest. Then your surgeon uses special instruments and a camera to do the surgery.For robotically-assisted valve surgery, the surgeon makes 2 to 4 tiny cuts (about ? to ? inch) in your chest. The surgeon uses a special computer to control robotic arms during the surgery. The surgeon sees a 3-dimensional view of the heart and aortic valve on the computer. This method is very precise.You will not need to be on a heart-lung machine for any of these surgeries, but your heart rate will be slowed by medicine or a mechanical device.If your surgeon can repair your aortic valve, you may have:Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of metal, cloth, or tissue around the valve.Valve repair -- The surgeon trims, shapes, or rebuilds 1 or more of the 3 leaflets of the valve. The leaflets are flaps that open and close the valve.If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve and sew a new one into place. There are two main types of new valves:Mechanical -- made of man-made materials, such as cloth, metal, or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.Once the new or repaired valve is working, your surgeon willClose the small cut to your heart or aortaPlace catheters (flexible tubes) around your heart to drain fluids that build upClose the surgical cut in your muscles and skinThe surgery may take 1 to 3 hours.Aortic valve surgery is also now being done through a groin artery. No incisions are made on your chest. The doctor sends a catheter (tube) with a balloon attached on the end to the valve. The balloon stretches the opening of the valve. This procedure is called percutaneous valvuloplasty.Why the Procedure Is PerformedAortic valve surgery is done when the valve does not work properly. Surgery may be done for these reasons:Changes in your aortic valve are causing major heart symptoms, such as angina (chest pain), shortness of breath, syncope (fainting spells), or heart failure.Tests show that changes in your aortic valve are beginning to seriously harm how well your heart works.Your heart valve has been damaged by endocarditis (infection of the heart valve).A minimally invasive procedure has many benefits. There is less pain, blood loss, and risk of infection. You will also recover faster than you would from open heart surgery.RisksRisks for any anesthesia are:Reactions to medicinesBreathing problemsBlood clots in the legs that may travel to the lungsInfection, including in the lungs, kidneys, bladder, chest, or heart valvesBleedingAdditional risks vary by the patient's age. Some of these risks are:Irregular heartbeat that must be treated with medicines or a pacemakerDamage to other organs, nerves, or bonesHeart attack, stroke, or deathBefore the ProcedureAlways tell your doctor or nurse:If you are or could be pregnantWhat drugs you are taking, even drugs, supplements, or herbs you bought without a prescriptionYou may be able to store blood in the blood bank for transfusions during and after your surgery. Ask your surgeon about how you and your family members can donate blood.For the 2-week period before surgery, you may be asked to stop taking drugs that make it harder for your blood to clot. These might cause increased bleeding during the surgery.Some of them are aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).If you are taking warfarin (Coumadin) or clopidogrel (Plavix), talk with your surgeon before stopping or changing how you take these drugs.During the days before your surgery:Ask your doctor which drugs you should still take on the day of your surgery.If you smoke, you must stop. Ask your doctor for help.Always let your doctor know if you have a cold, flu, fever, herpes breakout, or any other illness in the time leading up to your surgery.Prepare your house for when you get home from the hospital.The day before your surgery, shower and shampoo well. You may be asked to wash your whole body below your neck with a special soap. Scrub your chest 2 or 3 times with this soap. You also may be asked to take an antibiotic, to prevent infection.On the day of your surgery:You will usually be asked not to drink or eat anything after midnight the night before your surgery. This includes chewing gum and using breath mints. Rinse your mouth with water if it feels dry, but be careful not to swallow.Take the drugs your doctor told you to take with a small sip of water.Your doctor or nurse will tell you when to arrive at the hospital.After the ProcedureAfter your operation, you will spend 3 to 7 days in the hospital. You will spend the first few hours in an intensive care unit (ICU). Nurses will monitor your condition constantly.Usually within 24 hours, you will be moved to a regular room or a transitional care unit in the hospital. You will slowly resume some activity. You may begin a program to make your heart and body stronger.You may have 2 to 3 tubes in your chest to drain fluid from around your heart. These are usually removed 1 to 3 days after surgery.You may have a catheter (flexible tube) in your bladder to drain urine. You may also have intravenous (IV, in the vein) lines for fluids. Nurses will closely watch monitors that display information about your vital signs (pulse, temperature, and breathing). You will have daily blood tests and EKGs to test your heart function until you are well enough to go home.A temporary pacemaker may be placed in your heart if your heart rhythm becomes too slow after surgery.Once you are home, recovery takes time. Take it easy, and be patient with yourself.Outlook (Prognosis)Mechanical heart valves do not fail often. However, blood clots develop on them. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.Biological valves tend to fail over time. But they have a lower risk of blood clots.Techniques for minimally invasive heart valve surgery have improved greatly over the past 10 years. These techniques are safe for most people, and they reduce recovery time and pain.ReferencesFullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 62.Popma JJ, Baim DS, Resnic FS. Percutaneous coronary and valvular interfention. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 55.Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 62.
