Heart Valve Repair

Heart valve repair is a surgery to treat or fix one or more diseased or damaged heart valves. Usually, this surgery is performed as an open-heart surgery through the breastbone (sternum), into the chest. It is a major surgery that can last two hours or longer, and recovery often takes several months. Newer, less invasive techniques have been developed to repair some types of heart valve abnormalities that involve smaller incisions and a shorter recovery time.

Anatomy

The heart is a fist-sized muscular organ that works around the clock pumping blood to various parts of the body. It is located between the right and left lungs in the middle of your chest. The heart has four muscular chambers. The upper two chambers are called the right and left atria, and the lower two chambers are called the right and left ventricles.

The valves of the heart control the flow of blood and guide its passage through the four heart chambers. The heart has four valves:

• Tricuspid valve: This allows the flow of oxygen-poor blood from your right atrium (upper chamber) to your right ventricle (lower chamber).
• Pulmonary valve: This allows oxygen-poor blood to move from your right ventricle to your pulmonary artery, which transports blood to the lungs in order to get oxygen.
• Mitral valve: This allows oxygen-rich blood coming back from the lungs to move from your left atrium down to your left ventricle.
• Aortic valve: This allows oxygen-rich blood to move from the left ventricle to your aorta, a large artery that sends blood to your entire body.

If a valve is not working correctly, blood flow and the delicate network of blood vessels that carry oxygen throughout the body are affected.

Indications 

Your surgeon may recommend a heart valve repair to treat a condition called valvular heart disease, also known as heart valve disease. Heart valve disease occurs when one or more of the heart valves do not open or close properly. Conditions that may cause heart valve dysfunction are valve stenosis (narrowing) and valve regurgitation (leaky valve). 

For efficient heart function, the valves must be able to open fully while the blood is passing through, then close tightly afterwards. Simply put, blood should flow only in one direction. Abnormal or diseased valves allow less blood to pass through and/or make it leak backwards. This may be due to the following:

• Weakened flaps
• Fusion of the flaps
• Holes or tears on the flaps
• A deformity on the valve due to scar tissue
• Hardening of the valve due to deposits that are either waxy or calcified (known as plaques)

To resume efficient function, damaged valves need to be restored or repaired through heart valve repair surgery.

Preparation

Preoperative preparation for heart valve repair surgery may involve the following:

• A review of your medical history and a complete physical examination
• Routine blood work, imaging, and other tests specific to your condition
• Informing your doctor of any allergies to medications, anesthesia, or latex
• A review of your medications and the need to refrain from certain medications for a specific period
• Refraining from solids or liquids at least 8 hours prior to the surgery
• Signing a consent form after the pros and cons of the procedure have been explained

Surgical procedure

Heart valve repair surgery is usually performed under general anesthesia. Your surgeon will make a long incision at the center of the chest. The breastbone or sternum is divided into 2 halves and separated to expose the heart. Blood from the heart is redirected to a bypass machine which performs the function of the heart. Your heart is stopped using a cold solution so that the beating of the heart does not interfere with the surgery. In order to restore valve function, your surgeon may perform any of these repairs:

• Cutting through and separating fused flaps
• Patching holes and sewing tears on flaps
• Reshaping deformed valves by removing excess tissue, scars and plaque deposits
• Adding tissue to patch holes or tears, or to increase the support at the base of the valve

Following repair of the valves, blood from the bypass machine is redirected back into the heart. The heart is restarted to resume its function. Your doctor monitors the heart for proper functioning of the valves. The breastbone is closed and sewn together with wire, and the incisions are closed with sutures. Tubes are inserted into the chest to drain out excess blood. A sterile bandage is applied over the surgical site.

Postoperative care

After the surgery, you will be transferred to the ICU where you will remain on a ventilator until you are stable enough to breathe on your own. Your vital signs will be monitored. Once the ventilator is removed, you may start a liquid diet and gradually advance to solid foods. You will then be able to gradually resume your normal activities. Most often, pain medication, antibiotics, and blood thinners are given. Instructions on incision site care and bathing will be provided to keep the wound clean and dry.  You should avoid strenuous activities and lifting weights for a defined period. A follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Possible risks and complications of heart valve repair surgery include:

• Bleeding
• Infection
• Breathing problems
• Pneumonia
• Adverse reactions to anesthesia
• Blood clots or deep vein thrombosis (DVT) that can cause heart attacks, stroke, or lung problems

Summary

Heart valve repair is a surgical procedure to repair a heart valve that is too narrow or does not close properly. Heart valves need to work efficiently to guide the flow of blood in the proper direction through your heart. A minor valve problem can be treated with medications. However, severe heart valve disease or damage necessitates surgical repair to restore the function of the heart valve.