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Surgery on the heart valve involves repair or replacement of the damaged valve or valves. An operation to repair a valve involves reconstruction to ensure that it works well. There are three different types of artificial valves, if a replacement is needed:
Bioprosthetic valves are generally known as “pig valves”, being mainly made from animal tissue which are treated with chemicals to avoid rejection. Therefore, the patient does not require anti-rejection medication.
Mechanical valves are made of metal or synthetic material which requires the patient to receive anticoagulation. That is, they have to take regular medication to thin the blood and prevent blood clots.
Biologic valves are made from human heart valves obtained from donors which have been treated in the laboratory. They are often referred to as homografts.
If a replacement valve is not required and repair is possible, this may involve using a ring, which is not a complete artificial valve.
Surgery for aortic valve
The aortic valve allows blood to move out of the left ventricle. Aortic valve replacement can be done through a standard incision, which is in the middle of the chest, or can be performed through a smaller incision, approximately six to eight centimetres long, again, in the middle of the chest. If you require more than aortic valve replacement and other forms of surgery are needed, the smaller incision is not normally used.
Surgery for mitral valve
The mitral valve allows blood to move from the left atrium into the left ventricle. These valves may require repair or replacement. This can be done through an incision in the middle of the chest or an incision on the side of your chest.
Surgery for tricuspid valve
The tricuspid valve allows blood to move from the right atrium into the right ventricle. This valve often requires repair as it is not commonly replaced.
Surgery for irregular heart rhythm (atrial fibrillation)
If you also have atrial fibrillation, after you have been assessed by your consultant, this can be treated at the time of your valve operation by using special probes which produce forms of energy, including radio frequency and cryoablation, a process which uses extreme cold to remove tissue.. This procedure is successful in up to approximately 70% of patients within the first three months of treatment. The success of the operation depends on multiple factors, some of which include the type and duration of atrial fibrillation, the size of your heart and the presence of other cardiac conditions.
Surgery for the aorta
Some patients may have enlargement of their aorta, which is often referred to as an aneurysm, and this will require treatment.
We treat all forms of diseases of the aorta including aneurysm, rupture, and dissection, in patients who develop the disease which may be associated with age or have a genetic element, such as Marfan syndrome. We are a specialist centre for the management of Marfan syndrome in Europe and work closely with the department of Vascular Surgery at St George’s University Hospitals NHS Foundation Trust.
We provide one of the largest specialist services in the country for treatment of diseases of aorta, including management of complex conditions. In addition to open surgery, in some of the conditions, insertion of a stent, a tube placed in the coronary arteries that supply the heart, is also required.
Transcutaneous aortic valve implantation (TAVI)
Traditionally, we have used open heart surgery to replace the aortic valve with an artificial valve. This is a well-established technique and used worldwide with good results, although the risks of surgery increase with age.
“Keyhole surgery” has also been used worldwide since 2004 to replace the aortic valve. This is called transcutaneous aortic valve implantation. It is regarded as having fewer risks than traditional surgery, can improve quality of life, and lead to shorter recovery times and reduced hospital stay.
Keyhole procedures are less invasive as they are not an open heart operation. They are performed via a small incision in the groin or the chest, where the valve is passed into the vessels and then the heart. St George’s is one of the main centres in the UK where this procedure is being performed. This technique is currently reserved for patients where risks of conventional surgery outweigh the benefits, as we are learning about the mid and long term results of this procedure.
Your heart valve surgery will be performed by a specialised team:
- Your cardiac surgeon
- Surgical registrars, who will assist with the procedure
- Operating theatre nurse, who provides instruments and also assist in the operation
- Perfusionist, who operates the heart / lung machine