What is Heart Valve Replacement Surgery and how is it performed?

Heart valve replacement surgery procedure is performed to remove the damaged heart valve and
replace or repair it with a new working valve. Valves are necessary for proper circulation of blood
in single direction through all chambers of the heart. If there is problem in the heart, this flow of
blood is affected. If there is problem in closing of the valve, then the blood will leak and flow in
backward direction. This condition is called as valve regurgitation or incompetency. Problems also
arise if the valve has narrowed and blood flow through the heart is obstructed. This condition is
called as Stenosed.
Hospitals are now well equipped and have experienced cardiac surgeons to perform heart valve
replacement surgery in India. The surgery will be needed if the symptoms of the heart valve are not
controlled with help of medicines. If the problems have become serious, then to secure the heart
from further damage, the valve has to be removed or repaired at the proper time.
Candidates requiring this surgery face the following symptoms:

Frequent or sudden pain in the chest

Difficulty in breathing
Swelling in feet or ankles
Swelling in belly region
Irregular heartbeats
Rapid weight gain

Surgery is also performed in following conditions:

Heart valve congenital diseases like narrowing of valve or bicuspid aortic valves
Acquired heart valve diseases like calcification of valves
Syphilis or infective endocarditis
Disease to Rheumatic valve
Felling of chest pain or pressure and squeezing of the heart muscles
Valve tumors
Cardiomyopathy or enlarged heart muscles
Increased opening of the valve annulus
Aortic aneurysm
Hypertension

Treatment procedure and types

Aortic and severely damaged valves are commonly treated by replacement. The treatment can be
performed using two types of valves. Your doctor will discuss with you the possible pros and cons
of each and according to your condition, he/she will choose the best option for you.
The two types of valves are:
1. Biological valves: They are made up of animal valves like pig valve or are bovine
pericardial engineered valves. Human tissues of heart are also most often used, but it
requires a donor in most cases. The tissue of the patient can also be used many times if his
pulmonary valve is working properly. This procedure is called as Switch procedure. The

donated tissue of the heart is then replaced with the patient's own tissue. Biological valves
need to be replaced after five to fifteen years. The patient will also need to take blood
thinners.
2. Mechanical valves: These valves are made from sturdy metals, ceramics , carbon and
plastics. The tissues in the patient's heart are fixed with the valve by using a fabric sewing
ring. Even if these mechanical valves are durable, the patient needs to take blood thinning
medications to prevent from risk of blood clotting for rest of his/her life. The valve will
make soft clicking sound, but this is normal and the patient will get used to this.
Two types of surgical procedures can be used in Valve replacement surgery
1. Non- surgical or Percutaneous valve replacement
This is the non surgical approach of valve replacement. In this method, long, flexible tubes called as
catheters are used. The catheter is infused in the artery instead of opening the chest for operating
heart. The catheter is then threaded over the blood vessels in the heart. This procedure doesn't
require to stop the heart or use of heart-lung machine.
2. Minimal invasive valve replacement
In this operation, long handled devices are infused in the chest by making four or more than four
incisions. The surgery is performed by the doctor with use of surgical devices, looking at the video
monitor. In more advanced cases, robotic arm is also used to operate the tools for the doctor. This
procedure of minimal invasion is performed in very few hospitals. This surgery is also called as
endoscopy or robotic heart surgery.
Preparation before the operation

Your doctor will give you full idea about what is going to happen during the operation. If
you have any queries, make sure you clear them before the procedure is started.
A consent form needs to be signed for permission to perform surgery. Please ensure to read
it properly and carefully and ask questions in case of ambiguity.
The doctor will perform your complete physical exam to ensure that you are healthy to
undergo the operation. He/she will also need to have full idea about all the medications you
are taking.
You also need to get some blood tests performed along with some diagnostic tests
You will be advised not to eat or during anything apart from water before eight hours of the
operation
If you are pregnant, or think you are pregnant, always inform your surgeon about it
If you are taking any medications, vitamins, supplements and herbs, inform your surgeon
about that
If you have sensitivity or allergies to any anesthetic agents, medicines, or any other thing,
tell your surgeon needs to be informed about these
If you face any bleeding disorder or if you are taking any blood thinning medicines; aspirins
or any other medicine which have effects on blood clotting, inform your surgeon. You may
have to stop taking them before the operation.
Inform your surgeon if you are using pacemaker
Your surgeon will also test clotting time of blood
Try to stop smoking (if applicable) to have quicker recovery after the surgery

What happens during the surgery?

You will need to stay in hospital according to your condition and procedure technique used
Your bladder should be empty prior to surgery
The surgery takes about 4 to 5 hrs to complete
You have to lie on your back and an intravenous line will be inserted in your arm to inject
medicines and monitor the IV fluids
Catheters will be placed in blood vessels of your neck and wrist to administer the heart and
blood pressure status and to take blood samples
Your blood pressure, oxygen level in blood and heart rate will be continuously monitored by
the anesthesiologist
You will be connected to a ventilator and a breathing tube will be passed through your
mouth in your lungs. This will help you to breath during the surgery.
The skin from your chest will be cleaned with some antiseptic solution
Chest hair if present will be removed or clipped off to have a better view of the surgical
location
Incision will be made according to the surgical procedure used. In case of open heart
surgery, an incision is made in the center of the chest below the Adams apple above the
navel region. In less invasive surgery smaller incisions are made.
The breastbone is cut in half for separating it and spreading it apart
The heart has to be stopped for this operation, so tubes are inserted in the heart to pump the
blood through your body by using bypass machine
Once the blood is being diverted in the bypass machine, the heart needs to be stopped using
cold solution injections. After that, the faulty valve is removed and an artificial valve is
placed.
Once the surgery is completed, the bypass machine will be removed and blood will be
allowed to re-enter your heart.
You will be given shocks with small paddles to start your heartbeat again
Once the heartbeats starts normally, your doctor will check if your new valves are working
properly and there are no leaks due to the surgery
The incisions made will be stitched
Tubes will be inserted in your chest to drain blood or other fluid around the heart
Sterile bandage or dressing will be applied

Heart valve replacement surgery can give you very satisfying results. Most of the patients have seen
rapid improvement and have returned to their normal activities in just few weeks. Care should be
taken by consuming proper medication and making healthy lifestyle changes to avoid any further
complications.
The cost of heart valve replacement surgery in India changes according to the procedure chosen,
facilities in the hospital and the type of valve used. Do refer MediFee.com. All major hospitals
have specialized surgeons and advanced technology to perform this surgery. So do proper research
and choose the best procedure and doctor, as this is very important for the success of this surgery.