Inside your heart are four valves that act as traffic cops to ensure that blood flows in the correct manner. Sometimes these valves may become damaged, which may cause blood to back up into the heart (called aortic regurgitation) or not allow blood to pass through properly (aortic stenosis). Valve problems may arise from a number of conditions including birth defects, calcium deposits, infections such as rheumatic fever or side effects of medications.
At one time, valve surgeries were performed using an open procedure where doctors exposed the heart by cutting through the patient’s breastbone. Doctors would place the patient on a heart-lung bypass machine, which would take over the heart’s functions during surgery.
More recently, minimally invasive surgical procedures are allowing doctors to replace or repair heart valves using smaller incisions. These surgeries include the following:
Laparoscopy requires two- to three-inch incisions in the side of the chest between the ribs. Special instruments, including one with a fiber-optic camera, are inserted through these incisions, allowing the doctor to work on the heart.
Robotic surgery requires between two and four incisions that are no more than three-quarters of an inch long. The surgeon uses a computer-controlled robot to manipulate the surgical instruments.
Endoscopic or keyhole surgery uses one to four incisions in your chest for the instruments to be inserted.
A heart-lung machine may not be needed for minimally invasive surgery. Instead, your doctor will use medications or a mechanical device to slow your heart rate enough for the surgery.
These two types of valves are primarily used for replacements:
Mechanical valves are manufactured using cloth, metal or ceramic materials. A mechanical valve will last longer than a biological valve, but you will need to take blood thinners for the rest of your life.
Biologic valves may be of human or animal origin. Typically, these valves last about 15 years, but generally don’t require blood thinners to be taken for life.
As with any surgery, there are risks involved including adverse reactions to anesthesia, bleeding, blood clots, infection, and breathing problems. Older patients may have an increased risk for irregular heart rates (requiring medication or a pacemaker to control); damage to other organs, nerves or bones; or heart attack, stroke or death.
The benefits of minimally invasive heart valve surgery may include:
Less bleeding during the surgery, which minimizes the need for blood transfusions
Lower infection risks
Smaller incisions and scars
Shorter hospital stay
Faster recovery time
You should discuss the benefits and risks of the surgery with your physician. You can lessen the risks by taking these steps before any surgery:
Try to lose some weight before surgery if you are overweight.
Talk to your family and visitors about not visiting if they aren’t feeling well (coughing, sneezing, running a fever or have digestive symptoms).
Remind everyone to wash their hands before touching you.
To learn more about minimally invasive valve surgery, visit the National Heart, Lung and Blood Institute at www.nlm.nih.gov.
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