Heart valve disease is a very treatable condition if patients suffering from symptoms such as breathlessness, tight chest and dizziness are diagnosed early. So it is important that if you have any of the symptoms or are over 65 years, you ask your GP for a quick stethoscope check. With treatment, people can return to a good quality of life with their friends and family.
Treatment for heart valve disease varies according to how severe the disease, but ultimately the effective ways of overcoming the disease are valve repair or replacement. Great progress has been made recently in less invasive procedures.
A diseased valve can either be repaired or replaced by a surgical procedure which has been proven to be very successful over many decades. More recently, a less invasive procedure called TAVI has become available for those who are considered to be at too high-risk for surgery.
A Multidisciplinary Team will meet to discuss your case and decide on the best treatment pathway for you. Your doctor will be able to advise which is the most appropriate in your case.
When one (or more) valve(s) becomes stenotic (stiff), the heart must work harder to pump the blood through the valve. Some reasons why heart valves become narrow and stiff include infection (such as rheumatic fever or staphylococcus infections) and aging. If one or more valves become leaky, blood leaks backwards, which means less blood is pumped in the right direction. Based on your symptoms and the overall condition of your heart, your health care provider may decide that the diseased valve(s) needs to be surgically repaired or replaced.
Traditionally, open heart surgery is used to repair or replace heart valves. This means that a large incision is made in the chest and the heart stopped for a time so that the surgeon can repair or replace the valve(s). Newer, less invasive techniques have been developed to replace or repair heart valves. Minimally invasive procedures make smaller incisions, and mean less pain afterward and shorter hospital stays.
The diseased valve may be repaired using a ring to support the damaged valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves may be made of plastic or tissue (made from animal valves or human valves taken from donors). There are pros and cons of each type, and you and your health care provider will talk about which is best for you.
The manufactured mechanical valve is the most durable and long-lasting type of valve replacement. This type of valve will last for the patient’s life.
A negative of this type of replacement is that the patient will have to take blood thinners (Wafarin), which prevents blood from clotting around the valve, for the rest of the patient’s life. Any clots which form around the valve have the potential to break off and travel through the blood stream causing strokes or heart attacks, warfarin reduces the risk of this. Patients taking Warfarin must measure their International Normalised Ratio (INR) to ensure that it remains within a normal range. Other mechanical valve patients also mention hearing a ticking noise from the mechanical valve. Extreme sports, or any activity that will cause a fall or injury, are not permitted if you have a mechanical valve as it may lead to a failure in said valve.
Tissue valves (bioprosthetic), created from animal tissues, are used to replace the damaged heart valve with a valve made from natural tissues. This valve lasts between 10 and 20 years and does not require any long-term use of medication. The life expectancy of the valve means there may be a need for another surgery later in the patient’s life. A tissue valve is sometimes suggested for older patients but is also a good pathway for those with an active lifestyle.
Human Donor of a valve is the least common method and is usually used for patients who contract endocarditis. A donated valve is expected to last 10-20 years so often leads to further surgery later.
If you have a regurgitation than a repair of your valve may be recommended rather than a replacement - depending on the level of damage caused to your valve.
For many, valve tightness can be relieved during a procedure called balloon valvuloplasty. It is done as part of a cardiac catheterization, which is less invasive than general surgery or open heart surgery.
In a balloon valvuloplasty, a small catheter holding an expandable balloon is threaded into the heart and placed into the tightened valve. Next, the balloon is expanded to stretch open the valve and separate the leaflets.
In some cases the valve cannot be successfully treated by balloon valvuloplasty, and a different surgical treatment is needed to open the valve and allow better blood flow.
A damaged valve can also be repaired using a ring to support the damaged valve, or the entire valve can be removed and replaced with an artificial valve. Artificial valves may be made of plastic or tissue. There are pros and cons of each type, and you, and your health care provider, should talk about which treatment is best for you.
Valves are replaced or repaired through the surgeries described below.
Open-heart valve (sternectomy) surgery has proven to be a very successful method of valve repair and replacement for more than 50 years. This method is most often used for the mitral or tricuspid valves. This procedure can last a few hours, patients usually remain in hospital for a few weeks and recovery can take around three months. Open-heart surgery requires a large incision made in the chest and the heart is stopped for a time so the surgeon can repair or replace the valve(s). The scar from open-heart surgery will be noticeable, especially for women.
Another less invasive approach is minimally invasive surgery. With minimally invasive valve disease surgery, the heart is accessed through a small incision on the right side of the chest which can be as small as five centimetres long. The surgeon then inserts a high-definition camera that will allow them the see the heart and using specialised tools they can then repair or replace the damaged valve.
Minimally invasive surgery involves a much shorter stay in hospital versus the traditional surgical treatment meaning the patient can expect a stay of only four to five days. The surgery also involves reduced discomfort, lower risk of infection and less scarring post procedure due to the small access points and recovery is much quicker as there are less life limitations involved post surgery.
While it is recommended that more complex valve repairs or those with co-morbidities such as previous lung surgery or radiotherapy or patients with circulation problems may be best receiving a more traditional sternectomy surgery, most mitral and aortic valve repairs can be done using the minimally invasive technique. Your surgeon will be the best person to decide the appropriate option for you.
Transcatheter aortic valve implantation (TAVI) is an alternative option for patients who may be at high risk for open heart surgery. This is a less invasive procedure than open heart-valve surgery.
In this procedure, the damaged heart valve would be replaced using a heart valve made of natural tissue obtained from the heart of a pig or cow. The new valve is delivered via catheter, thereby avoiding open heart-valve surgery. The procedure resembles a balloon angioplasty, in which a catheter - a long, flexible tube - is threaded through an artery and a balloon device on the end inflates to help open up a narrowing in an artery in the heart. Special imaging equipment is used to guide position and placement of the new valve. In the case of TAVI, the replacement valve collapses to a very small diameter and is crimped onto the balloon device. The surgeon positions the replacement valve inside the patient's natural aortic valve and inflates the balloon. This causes the replacement valve to expand, pushing the faulty valve aside. The replacement valve begins to function as soon as the balloon catheter deflates to permit the flow of blood. The catheterization procedure typically takes 1 to 2 hours, and patients are up and walking within 24 - 48 hours after the procedure. The typical hospital stay is 3 to 5 days.
Patients usually enjoy immediate benefit from the procedure in terms of improved blood circulation. Because the replacement valve is placed using minimally invasive techniques, patients usually experience a much more rapid recovery than they would from a traditional, open-heart valve replacement.
There are pros and cons to each type of surgical procedure and valve replacement, depending on age and lifestyle. You should discuss with your physicians which valve and surgery are most suitable for you.
Due to Patient Choice initiative, patients in the NHS have the right to choose where they are treated but you will need to be referred by your consultant cardiologist or GP.