Valve replacement and repair

Valve replacement and repair

For most people suffering from valve disease, the first step in treating it is with medication.

This is because many of the new drugs used to treat heart failure and valve disease are very effective. However, as the disease progresses, it is likely that valve surgery is required. There are 2 basic forms of valve surgery:

• Valve repair
• Valve replacement

Valve repair is more likely to be used for a damaged mitral valve. The mitral valve regulates the forward flow of blood from the left atria into the left ventricle. The aortic valve can also be repaired, but it is far more likely to be replaced with either a mechanical valve or a tissue valve. Modern mechanical valves are manufactured from carbon fibre.

They are extremely strong as they have to be able to withstand the internal pressures placed on them by the beating heart. Because mechanical valves are not made from human tissue, the blood flow over these valves has a greater propensity to clot; therefore lifelong anticoagulation is required. If a tissue valve has been used, it is unlikely that anticoagulation will be required after 2-4 weeks following surgery.

In order for the heart to be exposed, an incision is made down the middle of the chest.

The heart is then stopped and the circulating blood is pumped through a cardiopulmonary bypass machine. This machine takes over the function of the heart and lungs when the heart has been stopped. The heart valve can then be exposed, removed and a new artificial valve placed in position. Once the heart has been closed again, the heart is restarted and the chest cavity can then be closed. Operations of this kind will require intensive care support generally for 24-48 hours in routine cases.

Mechanical valves are more robust than tissue valves. Although they require the use of anticoagulants for life, they are designed to last a lifetime. Tissue valves, depending on the patients post operative lifestyle will generally need changing in 10-15 years.