Heart valve surgery in India: Repair and Replacement

Valves control the flow of blood by making it move in one direction through the different chambers or parts of the heart. If a valve is not working correctly, blood flow is impaired.For example, if a valve does not close properly, blood may leak between the chambers or flow backwards, a condition known as valve regurgitation, insufficiency, or incompetence. If a valve is narrowed (also called stenosed), blood flow through the heart may be restricted.

If the valve problem is minor, it may be treated with medication. But if the heart valve damage is severe, a procedure may be required to repair or replace the malfunctioning valve.

Valve repair or replacement may be required if a valve has been damaged by:

• Infection (endocarditis).
• Rheumatic heart disease.
• Congenital heart defect.
• Mitral and/or aortic valve disease.
• Normal aging and wear.

What is done?
There are a number of procedures for repairing or replacing valves. Surgery is commonly required, although there are some newer, non-surgical procedures.
Valve repair

Minimally invasive valve repair 

Unlike conventional surgery, minimally invasive surgery does not involve sawing through the breastbone and opening the chest. The surgeon watches the heart on a video screen and operates using long-handled surgical tools inserted through small incisions. In some cases, robotic arms are used. Minimally invasive valve repair is only available in some hospitals. It is also referred to as endoscopic or robotic heart surgery.

Non-surgical valve repair 
Percutaneous or catheter-based procedures are done without any incisions in the chest or stopping the heart. Instead, a thin flexible tube called a catheter is inserted into a blood vessel in the groin or the arm and then threaded up into the interior of the heart.

• Percutaneous or balloon valvuloplasty is used in people with stiffened or narrowed (stenosed) pulmonary, mitral or aortic valves (more commonly for the mitral than the aortic valve). A balloon tip on the end of the catheter is positioned in the narrowed valve and inflated to enlarge the opening or to crack open calcified tissue.
• Several methods of percutaneous mitral valve repair are being developed. These procedures are still in the developmental phase and are available in a limited number of centres. One example is edge-to-edge repair, which can be used in the case of a very leaky mitral valve in a patient who is considered high risk for a surgical repair or replacement. A delivery catheter holding a clip is advanced through the femoral vein from the groin into the left side of the heart, under general anesthesia. The clip is positioned beyond the leaky valve in an open position and then pulled back so that it catches the flaps of mitral valve. Once closed, the clip holds the leaflets together and stops the valve from leaking.

Valve Replacement 

If your heart valve can't be repaired, your surgeon will remove your damaged valve and replace it with an artificial (prosthetic) valve You may need heart valve replacement if you have valve narrowing (stenosis) or severely damaged valves affected by calcium buildup in the valves (calcification) or rheumatic disease. Surgeons perform procedures often to replace mitral or aortic valves, but your surgeon can replace any heartvalve.



Heart valve replacements include:

• Mechanical valve - It is made totally of mechanical parts that are tolerated well by the body. The bi-leaflet valve is used most often. It consists of two carbon leaflets in a ring covered with polyester knit fabric.
• Biological valve - Tissue valves (also called biologic or bioprosthetic valves) are made of human or animal tissue. Animal tissue heart valves may come from pig tissue (porcine) or cow tissue (bovine). Tissue valves may have some artificial parts to help give the valve support and to aid placement.
• Homograft valve (also called allograft) - It is an aortic or pulmonary human valve that has been removed from a donated human heart, preserved, and frozen under sterile conditions. A homograft may be used to replace a diseased aortic or pulmonary valve.

Minimally invasive valve replacement surgery 

In minimally invasive valve surgery, long-handled tools are inserted into the chest through four or more small incisions. While watching a video monitor, the surgeon manipulates the tools and conducts the surgery. In some cases, robotic arms may be used to manipulate the tools for the surgeon. Only some hospitals can offer minimally invasive valve surgery. This type of surgery is sometimes referred to as endoscopic or robotic heart surgery.

Non-surgical valve replacement 

Percutaneous valve replacement is a non-surgical approach to valve replacement that uses long, flexible tubes called catheters. Instead of opening the chest to operate on the heart, a catheter is inserted into an artery (usually in the groin or arm) and threaded through the blood vessels into the heart. Percutaneous valve replacement does not require stopping the heart or the use of a heart-lung machine.

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