15.06.2021
Heart valve replacement surgery is a very complex process that requires close attention and high precision. Fortunately, modern medicine allows us not only to perform operations on such an important organ, but also to do it with high efficiency and minimal risk for the patient. Not only older people, but also younger people may need heart valve replacement.
Anatomy of the heart and reasons for replacing its valve
Our heart has four valves - aortic, mitral, tricuspid and pulmonary valve. They ensure the correct passage of blood through the four chambers of the heart during the heartbeat.
Disturbances in structure and, as a consequence, functioning can occur at birth, as birth defects that will affect later life. Also, destruction of valve tissue can result from certain diseases, for example, rheumatic fever or infective endocarditis.
Unfortunately, like the rest of the body, heart valves are also subject to aging. Regardless of the reason, the valve can either weaken (begin to let blood flow in the opposite direction), or vice versa - heal and become more rigid. This will cause the valve to not open completely. Incomplete, incorrect opening of the valve is called "stenosis". When the valve is weakened or stretched, it is called regurgitation or regurgitation.
Mitral valve: new life!
Details Published on November 10, 2020
In the cardiac surgery departments of the V.P. Polyakov widely use various techniques for mitral valve reconstruction.
Mitral valve reconstruction is considered worldwide to be the optimal surgical treatment for mitral valve dysfunction for any etiology of the disease.
Why is the function of the mitral valve impaired?
The most common causes of mitral valve dysfunction are: • Connective tissue dysplasia (CTD) • Coronary heart disease (CHD) • Chronic rheumatic heart disease • Infective endocarditis
Why reconstruction and not prosthetics?
The main advantages of mitral valve reconstruction over replacement:
Preservation of heart function!
By restoring the valve's original structure, surgeons can better preserve the heart's natural shape and function.
Freedom from taking medications throughout your life!
Patients who have had a mitral valve replacement must take blood thinners for the rest of their lives. These medications often cause a variety of adverse side effects and are best avoided if possible. In contrast, such drugs are not required in patients who have had valve function restored.
Longer service life!
A number of scientific studies have shown that 15 years after heart valve reconstruction in 82–87% of patients, its function is not impaired. For prosthetics, this figure is 72–82%.
In addition, biological prosthetic heart valves made from animal tissues are subject to degradation after 10–15 years (or even earlier!) (they fail due to changes in the structure of the valve leaflets). In such a situation, a repeat operation to replace the heart valve is necessary. Risk of surgery! The average mortality rate during mitral valve reconstruction surgery ranges from 1 to 2%, compared with 5 to 7% for replacement (Society for American Thoracic Surgeons 2021 Harvest 1 Executive Summary). As the head of the cardiac surgery department No. 11 of the Regional Clinical Children's Hospital named after V.P. explains. Polyakova Dmitry Valerievich Kuznetsov , timely surgical intervention allows you to preserve your own valve, restoring its function to almost all patients with STD or IHD! With infective endocarditis, this figure is somewhat lower and is about 40%, it all depends on the extent of destruction of the valve structures by the infectious process. Most often, patients are admitted with an advanced pathological process, when infectious agents have destroyed most of the valve structures. In such a situation, only its replacement is possible. And earlier diagnosis of infective endocarditis in the initial stages of the disease at the prehospital stage, when the structures of the mitral valve have not yet been destroyed, can increase the chances of restoring the valve structure without replacing it in patients. Patients with chronic rheumatic heart disease are the most difficult in terms of prospects for mitral valve reconstruction, since the pathological process in them, as a rule, lasts for years and proceeds unnoticed by the patients. And they come to the attention of cardiac surgeons with already greatly altered structures of the mitral valve, so it is almost impossible to restore it. But even in such situations, 10–20% of patients manage to undergo valve reconstruction without replacing it!
Important!
Employees of the cardiac surgery departments of the V.P. Polyakov Regional Clinical Children's Hospital constantly evaluate not only the immediate, but also the separate results of reconstructive operations on the mitral valve in their patients. After 5–10 years, in 90% of patients the function of the reconstructed valves is not significantly impaired and does not require repeated surgical intervention.
How is open heart valve replacement surgery performed?
If you have been scheduled for surgery on one of your heart valves, you should go to the hospital at least one day before the operation. During this time, the medical staff will carry out all the necessary procedures (CT, ECG) and collect the necessary tests. You will also have time to meet and talk with your doctor. He will tell you all the details of the upcoming operation and also answer any questions you may have.
It's normal to feel nervous before heart surgery, so don't be afraid to express your concerns to your doctor. Be sure to describe exactly what medications you take on an ongoing basis, this may be important.
About an hour before surgery you will be given the first pain medications. The operation itself is performed under general anesthesia, which guarantees deep sleep and absence of pain. As a rule, surgery lasts 3-3.5 hours.
Your relatives may be in a special room waiting for you. When the surgery is completed, the doctor will tell them the results. For all people, depending on age, body weight and gender, anesthesia takes place over different periods of time, which is usually limited to a few hours.
Operation technique
The patient is given general anesthesia. After opening the chest, the patient is connected to a heart-lung machine. Mitral valve replacement involves opening the left atrium, and aortic valve replacement involves opening the aortic wall. The doctor removes the affected valve and sews in a new one. The duration of the operation is 3 - 6 hours.
If such surgery is contraindicated for the patient, aortic heart valve replacement can be performed endovascularly or minimally invasive surgery can be used.
The first hours after heart surgery
Typically, after heart surgery, a person spends about a week in the hospital. During this time you will be in the intensive care unit (ICU). Family members will be allowed into your room approximately 60 minutes after surgery. Subsequent visits can be arranged in accordance with the rules of the medical institution.
When you wake up, you will be connected to many tubes, catheters and electrodes. Specifically, you will have a breathing tube in your mouth, which will interfere with your ability to speak. Don't worry, there will be a nurse nearby who will understand what you need.
The breathing tube will be removed a couple of hours after surgery. Also, thin tubes will be connected to your arms or neck, through which medications and nutrients will be introduced into your body. These tubes are needed to take blood samples and monitor your blood pressure. Thin wires may protrude from the chest. They are attached to the heart and, if necessary, allow you to quickly connect a temporary pacemaker. There will also be several tubes coming out of your chest that pump out fluid from the tissues surrounding the heart. A tube in the bladder is needed to remove urine, and various electrodes taped to the chest are used to monitor the heart rhythm.
After surgery, you may experience discomfort and soreness in your chest muscles where the incision was made. Don't worry, the wound is stitched up securely, there is no danger. You will be given painkillers for the first few days. As you recover, the need for them will disappear.
Good afternoon dear friends! If you have had heart valve surgery, then this topic is for you. It is known that a radical method of treating patients with acquired heart defects is surgical correction of valvular lesions. Acquired defects often arise due to rheumatism, an infectious process on the heart valves, or age-related calcification of the valves (usually aortic or mitral). The bicuspid aortic valve (found in 1-2% of the population; normally it is tricuspid) wears out faster and often calcifies at 50–60 years of age. Clinically, heart disease is manifested by shortness of breath, fatigue, and palpitations during exercise. If you have complaints, you must consult a doctor for examination. It is important to understand that surgery improves the quality of life. Heart valve replacement surgery is performed under artificial circulation. The goal of valve surgery is to normalize blood flow to the heart. The affected valve is replaced with an artificial one. In the human body, the lifespan of an artificial valve depends on many factors, including the patient’s lifestyle. To maintain health, patients who have undergone surgery to correct valvular heart disease must undergo regular medical examinations and lead a healthy lifestyle. If your condition is satisfactory and there are no complications, you should visit a cardiologist once or twice a year. If the patient’s well-being changes, his follow-up schedule changes, and examinations are carried out depending on his condition. After heart valve surgery, it is necessary to take medications prescribed by your doctor in strict accordance with the recommendations received, and it is important to follow a certain diet. Stopping medications or changing their dosage yourself is strictly prohibited. If you have a mechanical valve implanted, you will be prescribed medications - anticoagulants. They thin the blood to prevent clots from forming. The effect of anticoagulants must be closely monitored using a blood test called a coagulogram. It is important to prevent the development of infection in a patient with an artificial heart valve. Call your doctor immediately if you experience the following symptoms: – Sudden or gradually increasing shortness of breath. – Temporary blindness in one eye or a gray veil before the eyes. – Weakness or numbness in the face, legs, arms, or one side of the body, even if it was temporary. – Slurred speech, even for a short period of time. – Unusually rapid weight gain, fluid retention, swelling of the legs in the ankle area (to control, you need to weigh yourself every day). – Weakness, especially if accompanied by a fever that does not go away within a few days (doctors recommend taking your temperature twice a day for 2-3 weeks). – Chills or fever with a temperature above 40°C. – Unusual bleeding or bruising. – Dark or even black stools, dark urine, also pay attention to the presence of blood in the stool. – A burning sensation or change in urinary frequency. – Loss of consciousness, even for a short period of time. – A sudden change or absence of the normal sound or sensation in your heart valve as it opens and closes, or in your heart rhythm and rate. – Redness, swelling, discharge or discomfort in the incision area. A lifestyle with an artificial heart valve requires giving up bad habits. First of all, you should stop smoking, and it is better to do this even before surgery. Monitor your blood pressure levels. You should limit the amount of salt you consume, reduce the amount of animal fats, fried foods, smoked foods in favor of vegetables, lean meats and fish, all this will help you maintain your health for a long time and avoid new problems.
Postoperative period
After 1-2 days, depending on how the recovery goes, you will be able to sit up in bed. Then get up and move short distances with the help of others. After a few days you will be able to wash yourself, but under the supervision of a nurse. Once the air tube is removed, you can drink. You may not have an appetite, but adequate nutrition is essential for a speedy recovery. Your doctor will tell you when you can switch from liquid to solid foods.
Every day you will get better and better, however, fatigue and emotional downturns are possible. These are normal consequences of the operation. When the doctor is completely sure that you have recovered sufficiently, you will be discharged from the hospital to go home. It is advisable for one of your relatives to meet you and take you. As a last resort, take a taxi. Taking public transport or driving a week after open heart surgery is not a good idea. Please note that during the first days you should be under the supervision of loved ones or a caregiver.
Recovery after heart surgery
When you find yourself at home, try to quickly return to your usual sleep and wakefulness routine. It is advisable to find time for a short nap after lunch. You should weigh yourself regularly for several weeks and record your weight. You most likely lost weight while you were in the hospital. You will gain weight, but be sure to tell your doctor if you are gaining weight quickly. Accelerated weight gain may indicate that fluid is accumulating in the body, and this is dangerous!
The rest is normal rehabilitation. If your doctor allows it, take short walks, preferably accompanied by loved ones or a caregiver. You can also do low-intensity exercise on an exercise bike. Try to do a little more every day than you did yesterday. However, don't overdo it. If you are tired, rest, if you are rested, exercise.
Within six months you will feel better almost every day. Regarding daily activities, you should not lift or move objects weighing more than 2.5 kg. You can do simple housework, go to the movies, cafes, and attend social events. If you drive a car, you can move around in it. It will be useful to climb the stairs, but you need to start small, preferably under the supervision of loved ones.
Nutrition and medications during the rehabilitation period after heart surgery
During your stay at the facility, you will be given detailed information about the diet you will be following. In short, nutrition should be healthy. Most likely, you should limit salt, sugar, and try to reduce the amount of trans fats and saturated fatty acids.
In addition, you will have to change your drug therapy. You should only take medications that your doctor prescribes. Without consulting a specialist, do not take medications that were taken before surgery. If you have been prescribed anticoagulants, then approach this very responsibly. Don’t miss a dose, and if you still couldn’t drink it on time, consult your doctor. No need to take a double dose next time!
