Heart Valve Surgery

Heart valve repair or replacement is one of the most common open heart surgery done in present days. Commonest cause of heart valve disease is rheumatic heart diseases in childhood in our country. This cause damage to the heart valve by immunological mechanism after about 7-10years of original diseases process, However in western world this is not common and they have more problem with degenerative myxomatus or infective case of heart valve disease.
There are four valves in our heart guarding different chambers and great arteries, Out of these mitral and aortic valves are the commonest valve which get affected commonly and needs frequent treatment. Tricuspid valve gets secondarily affected by mitral or Aortic Valve disease.
Valve surgery could be repair or replacement, Aortic valve repair is not very common and less successful and therefore mostly replaced. However mitral valve can be repaired particularly in the early stage of rheumatic disease. Repair is done by suturing leaflets, recreating new supporting apparatus and putting a ring around the valve. Repair is always good and better for patient’s survival and life style. It is particularly important for children and females in child bearing age. However it is to be understood that patients with valve repair may need reoperation if repair fails in the long run.
When valve is too defective, narrow, calcified and unsuitable for repair (in advanced stage of rheumatic heart disease) we should not hesitate to replace the valve.
There are two types of heart valve
a) Bioprosthetic Valve (made of animal tissue) 
b) Mechanical Valve (made of Pyrolytic carbon, a special type of alloy).
Bioprosthetic valves last for on an average 15yrs. These are suitable for elderly patients (beyond 60 yrs). Bioprosthetic valves are not suitable for younger patients since they get calcified fast and degenerate. Advantage of bioprosthetic valve is that it does not need any anticoagulation.
Mechanical Valves are durable. They do not degenerate and last for life long. They need stringent anticoagulation (blood thinning medication) for life long. The dose of this medication needs to be optimum and patient needs regular interval checkup and blood test. If medications are correctly taken these patients can have normal life style and live long. Irregular medication and overdose of medication can lead valve blockage, bleeding or stroke. Valve replacement patients should avoid injury, infections and certain Vitamin ‘K’ containing food..
The success rate of valve surgery is high. Operation can relieve symptoms and prolong life. Mechanical heart valve do not fail. Blood clot, stroke bleeding can be a complication but if medications taken properly and regular checkup done these can mostly be avoided. There is always a risk of infection. Talk to your doctor if you have infection anywhere in the body or before surgical procedure. Clicking of mechanical heart valve may be heard.  This is normal.
Dr. Mrinalendu Das
MS, MCh, FIACS
Consultant Cardiothoracic Surgeon

RTIICS, Kolkata

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