When Heart Valve Replacement is required?
Valves regulate the blood flow in the body and if it’s normal functioning is disrupted, then the flow of the blood gets impaired. To replace a damaged valve in the heart, heart valve replacement surgery is conducted. If the defect is minor, proper medications can help fixing it. However, if a valve doesn’t close properly then it might lead to leakages, referred to as valve regurgitation. Also, in case of a narrowed valve, the normal blood flow gets restricted. Thus, in such severe cases, heart valve replacement surgery is required.
Types of Valve Replacement
There are primarily five categories of valve repairs and replacement surgery. These comprise:
- Transcatheter aortic valve replacement (TAVR) –For treating aortic stenosis, TAVR is performed in a minimally invasive way. The risk for this surgery is moderate and suitable for those patients who are unable to have an open heart surgery.
- Bioprosthetic valve replacement- If the first tissue replacement valve wears down, a second can be implanted with a catheter based minimally invasive procedure like TAVR.
- Transcatheter mitral valve repairs (TMVR) – For mitral regurgitation, catheters are often used along with a special medical device called Mitraclip to facilitate the repair.
- Balloon valvuloplasty – Stenosis can be curbed by inflating a balloon in the valve for a temporary span. This method is recommended for patients who are not able to undergo the surgery immediately and in cases where no other procedures come to much help.
- Double valve replacement – It includes the replacement of both the mitral and the aortic valve. At times it might also replace the entire left side of the heart. This surgery is not much common like the others and the patients undergoing this leaky heart valve treatment has a higher mortality rate.
Different methods to perform
The various methods of performing heart valve surgery include some distinct methods. The common ones being:
- The surgical method is inclusive of different techniques. Among them the frequently conducted are commissurotomy ( a surgery to open up thickened valves), annuloplasty ( repairment of a ring of fibrous tissue called annulus situated at the end of the heart valve), decalcification( to discharge the accumulation of calcium in the valve), shortening or replacement of chordae tendineae that supports the valves.
- Apart from the conventionally performed open heart surgery, the minimally invasive valve repair method can also be taken in consideration. It does not require the opening up of the chest and is referred to as the endoscopic or robotic heart surgery.
- Non surgical valve repair comprises the catheter based techniques which needs no incision in the chest. A catheter is inserted into a blood vessel from the groin or the arm and then guided up to the defected region of the valve.
How it is done?
The replacement of one or more damaged heart valves with artificial valve or bioprothesis is known as valve replacement surgery. In majority of the cases, heart valve replacement is an open heart surgery. This operative method helps to sewn into place the new artificial prosthetic valve in place of the damaged one. The heart valve repair can also be done in a minimally invasive way, where through a small incision near the breastbone, the damaged valve is replaced.
The four common ways of conducting the surgery are:
- Aortic valve replacement
- Mitral valve replacement
- Tricuspid valve replacement
- Pulmonary valve replacement.
Implants used in Heart Valve Replacement
In acute cases of damaged aortic or mitral valve, replacement is done. The two kinds of valves used for this purpose are:
- A mechanical valve that is made of durable metals has a fabric sewing ring aiding in its attachment of the valve to the patient’s heart. However, using this type of valve demands the usage of blood thinners to prevent blood clots.
- A biological valve on the other hand is composed of animal tissues or human tissue of a donated heart or can be a patient’s own tissue also. These valves are not durable and have to be replaced between 5 to 15 years. Blood thinners to prevent clotting is needed only for a short span.
Precautions / Points to remember
Before the necessary operation, patients are advised to consider some significant health and other related aspects. The precautions that need to be paid heed to, are the following:
- Whether the patient suffers from any allergic reactions.
- Suffers from asthma or diabetes
- Have any kidney problems or are on dosage of blood thinning medication.
- If the patient is pregnant.
In the post operative period, the patient should take proper remedial care of the incision and watch out for acute pain, swelling or bleeding and redness. Proper diet should be followed and regular checkups with the doctor are mandatory. However, the patient is likely to contract endocarditis i.e. infection of the valve after the surgery and thus are recommended to take antibiotics.
Success rate of valve replacement surgery
With recent advancement in medical science and procedural techniques, minimally invasive methods are frequently used by cardiac surgeons to replace the heart valves. This technique ensures a quick recovery and minimizes the chances of post operative pain. Recent finding have shown a 94% five year survival rate for those patients undergoing a heart valve repair. Survival rate is dependent on the patient’s age, physical health, and other existing medical disorders if any.
Full recovery after the surgery depends on the type of surgery performed and the healing rate of the patient. Occurrence of infections is a very common symptom after valve replacement along with tenderness, increased drainage from the incision site and fever. Minimally invasive surgery needs less time for complete recovery in comparison to the traditional method.
Valve replacement cost in India?
In India, heart valve surgery price differs according to the city, the average being Rs. 3, 20,000 INR. The surgery price starts from Rs. 80,000 INR and the open heart surgery amounts between Rs. 1, 25,000 to Rs 2,25,000. However, the treatment offered by the hospitals here is affordable and is almost 30% less in comparison to the western countries. The open heart surgery method cost varies from that of the minimally invasive technique.
Top Indian hospitals for Heart Valve Replacement
India with its reasonable treatment cost and quality treatment has become the hub for many international patients. Some of the leading hospitals are:
- Medanta-The Medicity, Gurgaon
- Aster CMI Hospital, Bangalore
- Jaslok Hospital, Mumbai
- Narayana Institute of Cardiac Science, Bangalore
- Kokilaben Dhirubhai Ambani Hospital, Andheri
- Fortis Malar Hopital,Chennai
- Apollo Health City,Jubilee Hills
- Fortis Escorts Heart Institute, Delhi
Best cardiac surgeons in India
India is known for its proficient doctors and cardiac surgeons whose contribution to the history of valve replacement surgery has been remarkable. They not only successfully operate but also facilitate proper post operative remedial care for better and quicker recovery. Some of the eminent surgeons in this field include
- Devi Shetty
- Naresh Trehan
- Ramamkanta Panda
- A.G.K Gokhale
- Ashok Seth
- Ajay Kaul
- S.K. Singh
Patients from all across the world have shared their experiences on their successful valve replacement surgery.
- Roxanne from Philippines was suffering from heart valve disorder due to rheumatic fever problems. After she came to know about the effective treatment rendered to patients in India, she chose Fortis Escorts Institute in Delhi, which is well known for its effective and successful cardiac surgeries. Her medical history was taken into consideration by the respective cardiac surgeons and the surgery was performed by Dr. Z.S Meharwal. She says that the procedure had been really smooth for her and the treatment package was also moderate. She was satisfied with the medical care provided to her by the hospital staff who made her healing period comfortable and claims that her experience had been “extremely good and satisfactory”. Modern surgical means and cardiac specialists in India aided her complete recovery and proper post operative care ensured a normal and active life in a short span.
- Minimally invasive technique was utilized by Dr. Sathyaki Nambala in the case of a 27 year old man who was suffering from a congenital bicuspid aortic valve disorder. A minor incision of 1.5 inches was done in the middle of the chest and then the dilation of the pericardium took place. Dr. Nambala observes that in such kind of surgeries the fixing of the pericardium consumes longer time than the procedure itself. The blood circulation was carried out by the heart-lung machine as the heart had stopped during the surgery. A cannula was inserted to separate the aorta and the pulmonary artery. An inferior vena cava (IVC) was performed in a conventional way through the right atrium. The defected valve was replaced with an artificial tissue valve.
The doctor had diagnosed hypertension and aortic regurgitation in the patient before conducting the surgery. Thus, he was on proper care in the post operative span and had a gradual and easy recovery. He was discharged within 3-4 days and no health complexities or deterioration was reported.