Heart valves fail or deteriorate with age, among other factors, and can calcify, become stiff or not fit as tightly as they need in order to function. Sometimes the valve can be repaired, in some circumstances the valve is beyond repair and needs replacement.
When a valve isn’t functioning the blood doesn’t flow in the direction it is supposed to entirely; when blood retreats in the direction of its origin, it is called regurgitation. Regurgitation can put pressure on the ventricle pumping the blood, due to increased volume, which over time can enlarge and damage the ventricle. Stiffness of the cusps of the valve is called stenosis. This prevents a coordinated, fluid functioning of the valve.
Valve Options for Replacement:
- Bioprosthetic: These valves come from animals or humans (a tissue bank); they are processed to minimise rejection. The advantage of bioprosthetic valves is that there is no need for anticoagulation therapy in the future (eg. Warfarin). There could possibly be a need for reoperation in the future, as bioprosthetic valves have a lifespan.
- Biomechanical: These valves are man made, and require some form of anticoagulation in the future. The benefit of these valves is they do not need replacement in the future.
The balance of advantages vs. disadvantages of a bioprosthetic and biomechanical valve will be discussed with the patient at their preoperative consultation. Mr Pick will make a recommendation after consideration of the patient’s opinions and preferences.
What is a Valve Repair?
The valve component of the heart is made up of the valve, and the annulus, which is where the valve attaches to the ventricle in the case of the mitral and tricuspid valve, and to the aorta in the case of the aortic valve. Valves have cusps which open and close, controlling the flow of blood in one direction. Sometimes the cusps need revising (trimming and suturing) to tighten them up, so they don’t leak when the valve is closed. The annulus can become slack and not perform the opening and closing effectively; in this case an annuloplasty band can be placed around the annulus, to repair the function of the annulus. The mitral and tricuspid valves are attached to the corresponding ventricles with string like structures called chordae, which attach to papillary muscles. The chordae can be replaced with a cord that resuspends the valve to the ventricle, correcting the problem. Mr Pick will discuss the nature of your valve repair at the preoperative visit.
How is valve repair/replacement performed?
The patient is placed on bypass and a sternotomy is performed. In certain circumstances, the valve repair is done minimally invasively (in the case of mitral and aortic valves). This obviates the need for a sternotomy, and the incision is a thoracotomy, which is a small incision through the ribs. The advantage is a less invasive procedure, with less down time for recovery.