Treatment
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Treatment
 

Heart Valve Disease
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Heart Valve Disease – Overview

The Condition – Overview
– Aortic Stenosis
– Aortic Regurgitation
– Mitral Regurgitation
– Tricuspid Valve Disease
– Bicuspid Aortic Valve
– Endocarditis
– Related Illnesses
Symptoms
Diagnosis
Pre-Treatment
Treatment
After Care
Materials
Patient Stories
Know Your Heart

Heart Valve Disease: Understanding Treatment Options

Heart valve disease is a common and serious condition that affects over 1.5 million people in the UK. Despite its seriousness, it is highly treatable. With timely intervention, many individuals can return to a high quality of life, often symptom-free.

Treatment Options for Heart Valve Disease

Treatment for heart valve disease depends on the severity of the condition. Effective management typically involves either valve repair or replacement. Advances in medical technology have significantly improved treatment outcomes, with less invasive procedures now available.

  1. Valve Repair or Replacement: Traditional surgical procedures for valve repair or replacement have been successful for many decades. These procedures involve either repairing the damaged valve or replacing it with a prosthetic valve.
  2. Transcatheter Aortic Valve Implantation (TAVI): A less invasive option that has gained prominence in recent years is Transcatheter Aortic Valve Implantation (TAVI). This procedure is often recommended for patients who are considered high-risk for traditional surgery. TAVI involves inserting a new valve through a catheter, typically inserted through a blood vessel in the groin or chest, avoiding the need for open-heart surgery.

Multidisciplinary Team (MDT) Approach

A Multidisciplinary Team (MDT) will review your case to determine the most appropriate treatment pathway. The MDT typically includes cardiologists, cardiothoracic surgeons, and other healthcare professionals who collaborate to ensure a comprehensive approach to your care.

  • Personalised Treatment Plan: Your doctor will discuss the treatment options with you and recommend the most suitable approach based on your specific condition and overall health.

Advancements in heart valve disease treatments continue to improve outcomes and quality of life. If you have concerns or symptoms of heart valve disease, consult with your healthcare provider to explore the best options for you.

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 ageing. 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 healthcare provider may decide that the diseased valve(s) need 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.

Mechanical Heart Valves are known for their durability and longevity, often lasting for the patient’s lifetime. These valves are a popular choice due to their robustness and long-term effectiveness in replacing diseased heart valves.

Key Considerations:

  1. Anticoagulant Therapy: A major consideration with mechanical valves is the need for lifelong anticoagulant medication, such as Warfarin. This medication helps prevent blood clots from forming around the valve, reducing the risk of complications such as strokes or heart attacks. Regular monitoring is essential:
    • International Normalised Ratio (INR): Patients must regularly measure their INR levels to ensure they remain within a safe range. This helps balance the risk of clotting with the risk of bleeding.
  2. Audible Ticking Noise: Some patients report hearing a ticking sound from the mechanical valve. This is a normal occurrence and results from the valve’s operation. While it may be noticeable, it typically does not affect valve function or overall health.
  3. Activity Restrictions: Patients with mechanical valves are generally advised to avoid extreme sports or activities that could lead to falls or injuries. Such activities may pose a risk of damage to the valve or complications related to anticoagulant therapy.

While mechanical valves offer excellent durability, the need for ongoing anticoagulation and the potential for noise are important factors to consider. Your clinician will discuss these aspects with you to ensure you are well-informed and prepared for managing your valve replacement.

Tissue valves are made from natural animal tissues, such as those from pigs or cows. They are commonly used to replace damaged heart valves and offer several benefits:

  • Durability: Tissue valves typically last between 10 and 20 years. While they do not require long-term anticoagulant medication, the valve may eventually need replacement.
  • Medication: Unlike mechanical valves, tissue valves generally do not require lifelong anticoagulant therapy, which can be advantageous for many patients.
  • Suitability: Tissue valves are often recommended for older patients or those with active lifestyles due to their reduced need for medication and the potential for fewer complications related to blood thinners.

However, the lifespan of a tissue valve means that patients might require another valve replacement procedure later in life.

Human Donor Valves:

Human donor valves are less commonly used but may be considered in specific situations, such as for patients with endocarditis. These valves are obtained from deceased human donors and offer:

  • Durability: Similar to tissue valves, human donor valves generally last between 10 and 20 years. This often necessitates another surgery in the future as the valve wears out.
  • Considerations: Donor valves are typically chosen for their compatibility in certain medical scenarios, such as treating endocarditis, where they may provide a better outcome compared to other valve types.

Both tissue and human donor valves offer valuable options for heart valve replacement, each with its own set of advantages and considerations. Your healthcare provider will help determine the best choice based on your individual health needs and lifestyle.

Open-heart valve surgery (also known as sternotomy) has been a highly effective method for repairing and replacing heart valves for over 50 years. This technique is most commonly used for the mitral and tricuspid valves.

Procedure Details:

  • Surgical Approach: The surgery involves making a large incision in the chest (sternotomy) to access the heart. During the procedure, the heart is temporarily stopped to allow the surgeon to repair or replace the affected valve(s).
  • Duration and Hospital Stay: The surgery typically lasts several hours. After the operation, patients usually stay in the hospital for more than a week. Full recovery can take around three months.
  • Scar and Recovery: The incision will leave a noticeable scar on the chest, which may be more apparent in women. The recovery period involves managing pain, gradually resuming activities, and attending follow-up appointments to monitor healing and valve function.

Open-heart valve surgery remains a reliable and effective option for many patients, offering long-term benefits despite the need for a significant recovery period and a visible scar.

Minimally invasive valve surgery is an advanced approach that offers a less invasive alternative to traditional open-heart surgery. This technique involves accessing the heart through a small incision on the right side of the chest, which can be as small as five centimetres.

Procedure Details:

  • Access and Visualisation: The surgeon makes a small incision and inserts a high-definition camera, allowing for a clear view of the heart. Specialised tools are then used to repair or replace the damaged valve.
  • Hospital Stay and Recovery: This method typically results in a much shorter hospital stay, usually around four to five days, compared to the longer stay required for traditional surgery. The reduced incision size leads to less postoperative discomfort, lower risk of infection, and minimal scarring.
  • Benefits: Patients experience a quicker recovery time with fewer lifestyle restrictions after the procedure. The smaller access points contribute to reduced pain and a faster return to normal activities.

Considerations:

  • Complex Cases: While minimally invasive surgery is suitable for many mitral and aortic valve repairs, more complex cases or patients with certain co-morbidities (such as previous lung surgery, radiotherapy, or circulation issues) might benefit more from traditional open-heart surgery (sternotomy). Your surgeon will evaluate your situation and determine the most appropriate surgical option for you.

Minimally invasive valve surgery offers a promising option for many patients, combining effective treatment with a less traumatic recovery experience. Discuss with your healthcare provider to understand if this approach is suitable for your condition.

Transcatheter Aortic Valve Implantation (TAVI): A Less Invasive Option

Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive procedure designed for patients who are at high risk for traditional open-heart surgery. TAVI offers a less invasive alternative to conventional valve replacement methods.

Procedure Overview:

  • Valve Replacement: During the TAVI procedure, the damaged aortic valve is replaced with a new valve made from natural tissue, typically sourced from a pig or cow. The replacement valve is delivered via a catheter, which avoids the need for open-heart surgery.
  • Catheterisation Technique: The process is similar to a balloon angioplasty. A catheter (a long, flexible tube) is threaded through an artery, and a balloon device on the catheter is inflated to help position the new valve. Special imaging techniques are used to guide the catheter and ensure proper placement of the new valve.
  • Valve Deployment: The replacement valve is collapsed to a small diameter and crimped onto the balloon device. The surgeon positions the new valve inside the patient’s existing aortic valve and inflates the balloon. This expands the replacement valve and pushes the faulty valve aside. Once the balloon deflates, the new valve starts functioning, allowing normal blood flow.

Procedure Details:

  • Duration and Recovery: The TAVI procedure typically takes 1 to 2 hours. Patients often start walking within 24 to 48 hours after the procedure, with a typical hospital stay ranging from 2 to 5 days.
  • Benefits: Most patients experience immediate improvement in blood circulation. The minimally invasive nature of TAVI usually results in a quicker recovery compared to traditional open-heart valve replacement, with reduced discomfort and a faster return to daily activities.

TAVI provides a valuable treatment option for patients who may not be suitable candidates for traditional surgery, offering effective results with a less invasive approach.

Scientists from the London School of Hygiene and Tropical Medicine are currently running a clinical trial to improve outcomes for TAVI patients. Click here to find out more information.

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.

Tips for family, friends and carers

  • Learn the facts before they have their surgical procedure so that they’ll know what to expect.
  • For further information on heart valve disease, please see our Heart valve disease fact sheet here.

Treatment
QUICK LINKS

Treatment
 

Heart Valve Disease
QUICK LINKS

Heart Valve Disease – Overview

The Condition – Overview
– Aortic Stenosis
– Aortic Regurgitation
– Mitral Regurgitation
– Tricuspid Valve Disease
– Bicuspid Aortic Valve
– Endocarditis
– Related Illnesses
Symptoms
Diagnosis
Pre-Treatment
Treatment
After Care
Materials
Patient Stories
Know Your Heart

Patient Story: Phillip

After beginning to feel breathless in 2018, Phillip Warlow was diagnosed with aortic stenosis in April 2019. With his condition deteriorating, Phillip required early intervention and received a tissue valve at Morriston Hospital, Swansea. Since being treated, Phillip is back enjoying life with his grandson, welcomed a new granddaughter into the world and now supports Heart Valve Voice to raise awareness of the disease.

Read Phillip’s story in full…