Heart valve replacement surgery aims to implant a new heart valve. industrial or biological, location of the affected valve, which is located between the chambers of the heart, In order to maintain the integrity of his performance.
There are four valves in the heart. It separates the heart’s upper chambers (atria) and lower heart chambers (ventricles). It also separates the chambers of the heart from the main arteries:
the mitral valve (also known as the mitral valve), tricuspid valve, aortic valve (aorta), and pulmonary valve.
The function of the heart valves is to allow blood to pass through the chambers of the heart. one way, When the atria and ventricles contract,
so that the blood passing through the heart reaches the main arteries, From there it goes to the lungs and the rest of the body. When a valve is damaged:
For example due to severe narrowing of the valve or insufficient closing of the valve (valvular insufficiency), the blood does not reach its destination properly (blood flows slowly or in the opposite direction), This makes it difficult for the heart to function properly.
When valve stenosis or valvular insufficiency affects the function or structure of the heart, Heart valve repair or replacement is needed.
Symptoms associated with valvular diseases are as follows:
feel helpless, pain in chest, shortness of breath, feeling tired when doing physical effort, and others.
The causes of valve diseases are many and different. They include:
valve damage with age, birth defects of the valves, and bacterial infections that directly affect the valves, and others.
Valve replacement can be performed through a simple invasive procedure, which is therapeutic cardiac catheterization.
But in cases where the entire valve must be replaced, There will be a need for surgery.
During the surgery, the heart-lung machine is entrusted with the task of operating blood circulation and breathing (it is an external pump for the patient’s blood, It works to provide it with oxygen and purify the body from dirt)
while replacing the diseased valve with the new one.
Today there is an additional surgical possibility, endoscopic valve replacement, which allows for a simpler and less complicated process, Which reduces complications.
Prepare for the operation:
Before having heart valve replacement surgery, The doctor directs the patient to undergo a series of examinations that include: complete blood count, blood chemistry, and coagulation tests.
In addition to examining the functioning of the kidneys and liver, urine test, chest x-ray, electrocardiogram, Ultrasound imaging of the heart (echo or ultrasound) in order to check the performance of the heart.
like that, It is possible that the doctor will have to perform a diagnostic cardiac catheterization (in order to check the level of pressure acting on the valves).
Valve replacement surgery is performed under general anesthesia. You should consult your doctor about everything related to stopping certain medications before heart valve replacement surgery. You must fast for 8 hours before the surgery.
After doing a complete sterilization of the chest area, The surgeon makes a long incision along the breastbone in the center of the chest.
after that, The breastbone is separated to facilitate access to the organs inside the rib cage.
The next step, It involves performing a heart-lung bypass by assigning the task of circulating blood and breathing to an artificial heart-lung machine,
In order to maintain a healthy blood circulation in the patient during the operation, Taking care that it does not pass through the chest (so that surgeons can work in a clean, well-defined surgical environment).
Heart-lung bypass is performed by stopping blood flow in the main blood vessels (aorta, pulmonary veins, etc..),
and make it flow into the machine, In order to provide the patient with oxygen and purify the blood from toxins, for a short period of time.
Later, The surgeon opens the pericardium (the outer covering of the heart), It locates the affected valve.
If the valve needs to be completely replaced, It is replaced with an artificial, biological valve, or even a valve donated from a dead person.
After the new valve is sewn in place, It checks whether the blood flow through it is normal, In addition to excluding the presence of leaks.
at the end of the process, The blood flow is returned back to the body.
after this stage, The pericardium of the heart is closed and the chest is sutured again.
A drain or a number of drains are also placed in order to drain the remaining fluid and blood from the tissues. After all this, The operation site is covered with a large bandage.
The process takes 3 hours.
Risks of surgeries in general:
Surgical incision infection – infection is often superficial and is treated topically.
But in some rare cases, may lead to more serious infection in the subcutaneous layers, It may even reach the breastbone.
The doctor may have to open the incision again in order to get rid of bacteria residues.
Bleeding – Bleeding usually occurs in the surgical area as a result of local tissue damage.
Bleeding may occur immediately after the operation. During the next 24 hours, or in some rare cases, Weeks or months after surgery.
Bleeding is caused by the rupture of small or large blood vessels. Or due to improper connection of the valve.
In cases where the bleeding is significant, Additional evacuation of blood should be performed.
In the event of severe bleeding causing the loss of large amounts of blood, Another operation must be done to stop the bleeding.
Scar The symmetry of the incisional scar to healing depends on the type of suture and on genetics. There is no way to predict in advance how and how quickly scars will heal after surgery.
The dangers of anesthesia – often such phenomena are caused by an allergy to anesthesia drugs.
in very rare cases, A serious reaction leading to a drop in blood pressure (anaphylactic shock) could occur.
Eye risks related to heart valve replacement:
Injury to the main blood vessels in the heart due to the use of sharp tools.
Causing damage to the heart structure of other valves, heart muscle, or its cover.
Tachycardia due to the presence of myocardial fibers in close proximity to the valve.
After heart valve replacement surgery, The patient stays between one and three days in the intensive care unit. This is for resuscitation and monitoring of his health.
sometimes, An external pacemaker is placed during the procedure. This is in order to help the heart work electrically during the first days after the operation. Until the heart regains its ability to regulate its own beats.
in addition to, The patient is given antibiotics to avoid infection. He is also provided with fluids in order to maintain his blood pressure after the operation.
Painkillers are often given intravenously. according to the need.
The bandage is removed and the sutures are removed from the surgical incision one to two weeks after the operation.
like that, The drains are drained according to the amount of fluid and blood drained.
If the valve is replaced with an artificial valve, The patient is given medications that prevent blood clotting for life.
You should go to the doctor immediately, In the following cases:
a sharp and sudden rise in temperature, hypotension, shortness of breath, urinary retention, severe bleeding, or severe, unbearable pain.
Surgical techniques for performing interventions on the aortic valve:
Two main methods of aortic valve intervention are used in modern surgical practice.
It is an open surgical procedure and the process of repairing or replacing the diseased valve through catheters.
The open surgery is performed under general anesthesia. With the obligatory connection of the patient to cardiac and artificial respiration machines.
The cardiac surgeon cuts the sternum by more than 25 cm and opens the chest. Open surgery provides an excellent overview of the surgical site – the heart with all its valves, and adjacent large blood and lymphatic vessels. It takes 3 to 6 hours.