Heart Valve Replacement

What is Heart Valve Replacement?

Heart Valve Replacement is a procedure which is performed using Open Heart Surgery approach where the damaged and diseased heart valves are either replaced by grafts from your own tissues or they are replaced by artificial heart valves.

Where can I get a Heart Valve Replacement?

Country	Cost with MedSolution
France	$33,137 (inquire)

Cost of procedure performed in the US: $70,000 (both valves).

All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

Types of artificial valves used for Heart Valve Replacement?

• Mechanical Valves - These valves are also called prosthetic valves. These valves are made of immunologically inert material that does not react with the bodies own tissues. These valves are similar in structure and function as your own heart valves permitting proper flow of blood through the heart chambers. The mechanical valves have an un-limited life span. Mechanical valves are resistant to the flow of blood and are prone to blood clot formation on the leaflets. As a result if you undergo Heart Valve Replacement with mechanical valves, then you will have to be on blood thinning medication for the rest of your life.
• Tissue Valves - These valves are also called biological valves, bio-synthetic or bio-prosthetic valves. Tissue valves are usually made from animal tissue i.e. pig tissue (porcine) or cow tissue (bovine) with fine mesh sewn around it to provide support and stability. The most important advantage of tissue valves is that after Heart Valve Replacement you do not have to be on blood thinning medication as there is no danger of clot formation.
• Homograft Valves - Homograft or allograft valves are obtained from human donors which are frozen under sterile conditions and used for qualified candidates. These valves are not as durable as mechanical or tissue valves. However, the biggest advantage of using these valves is that after Heart Valve Replacement surgery, you do not have to use any blood thinning medication as there is no danger of clot formation.

Why have Heart Valve Replacement?

Heart valves are gates that direct the flow of blood from the atria to the ventricles and from the ventricles to the pulmonary artery or aorta. Your heart has four valves: mitral valve, tricuspid valve, aortic valve and the pulmonary valve. Any of these valves may malfunction because of a birth defect, infection, disease, or trauma. When the malfunction is so severe that it interferes with blood flow, you will have heart palpitations, fainting spells, and / or difficulty breathing which can progressively worsen and cause death unless you under go timely Heart Valve Replacement surgery.

Who is an ideal candidate for Heart Valve Replacement?

Two major problems occur whenever any of the heart valves are diseased or damaged; the heart valves either get thickened and stenosed (narrowed) or they become leaky and incompetent due to loosening of the leaflets. The following are major causes of diseased heart valves and indications for Heart Valve Replacement surgery:

• Congenital Heart Valve Diseases
  • Bicuspid aortic valves
  • Stenotic (narrowed) or leaky valves
  • Myxomatous valve disease - e.g. Marfan's syndrome
• Acquired Heart Valve Disease
  • Calcification
  • Infection
    • Rheumatic valve disease
    • Infective endocarditis
  • Coronary artery disease
  • Heart attack
  • Cardiomyopathy (heart muscle disease)
  • Syphilis
  • Hypertension
  • Aortic aneurysm
  • Connective tissue diseases
  • Tumors
  • Dilatation of valve annulus

What does the procedure for Heart Valve Replacement involve?

Heart Valve Replacement is performed either as Open Heart Surgery using the heart-lung bypass machine or Beating Heart Surgery procedure where heart-lung bypass machine is not used. The surgery will be performed under general anesthesia in a hospital setting. The surgery may take 3 - 5 hours. After cutting through the skin and the breast bone, the heart is opened and the damaged valve is located. The valve is loosened and disengaged from the surrounding tissue that connects it to the heart, the new valve is inserted and sutured into place. You will then be taken off the cardio-pulmonary bypass machine and the chest will be closed with sutures thorough the bone and all the overlying tissue structures. After the Heart Valve Replacement surgery you will spend a couple of days in the ICU (Intensive Care Unit) under observation for post-operative complications, to monitor your breathing and circulation closely. Neurological assessment will be conducted to make sure that you have not suffered a stroke during the Heart Valve Replacement surgery.

How to prepare for Heart Valve Replacement Surgery?

The preparation for Heart Valve Replacement surgery is same as Open Heart Surgery procedure for any other indication. Before your Heart Valve Replacement surgery, you will have a complete and through evaluation by your physician, cardiac surgeon and anesthesiologist. All the routine pre-operative tests like blood and urine examination, x-ray chest, Electrocardiogram, Echocardiogram, Cardiac Catheterization , and Coronary Angiogram will be performed. Please make sure to inform your doctor about all the prescription and non-prescription medication including vitamin, mineral and herbal supplements that you might be taking. You will be instructed to eat a balanced diet, do some exercises to clear your lungs and quit smoking completely before the Heart Valve Replacement surgery . Also, plan on staying in the hospital for 5 days or so and arrange for someone to help you around the house for the next couple of weeks after Heart Valve Replacement surgery . Do not eat or drink anything for at least 12 hours before the surgery and get a good night's sleep. You will be instructed to shower both on the evening before and the morning of surgery with a special antibacterial soap to prevent infection during and following Heart Valve Replacement surgery.

What to expect during the recovery period following Heart Valve Replacement surgery?

The initial few days following the Open Heart Surgery for Heart Valve Replacement can be crucial. There will be pain and discomfort which can be relieved by pain medication. Some of the common unpleasant experiences after Heart Valve Replacement surgery will be forgetfulness, mood swings, lack of energy, tiring easily, lack of appetite possibly even nausea or constipation, difficulty sleeping through the night or perhaps nightmares or vision changes. Your doctor will provide you a list of specific discharge instructions to follow for the first three weeks at home, after your Heart Valve Replacement surgery to help you return to a normal pace of life. Some of the post-operative Heart Valve Replacement surgery guidelines will include:

• Get plenty of rest and sleep, this will help you heal and recover.
• Avoid extreme temperatures i.e. very cold and very hot weather including wind chill factor and humidity.
• Do not perform strenuous activities like lifting, pushing, pulling, mopping, vacuuming, yard work, car washing, laundry etc.
• Eat a well balanced, low salt, low calorie, nutritious diet comprising of fruits, vegetables, dairy and protein.
• Avoid alcohol and limit your caffeine intake.
• Continue coughing and deep breathing exercises.
• Bathe or shower daily with warm water.
• Keep your incision clean, do not apply oils, lotions or creams over your incision.
• Avoid driving or going for long outings.
• Avoid sexual intercourse for at least 4 - 6 weeks after Heart Valve Replacement surgery .
• Avoid constipation, eat lots of fruits and vegetables and drink plenty of water to keep your stool soft.
• Follow the Cardiac Rehabilitation Program as outlined by your health care professional team to provide emotional support and information about the recovery process.
• Make long term lifestyle changes like regular walking, exercising, eat low fat, low calorie diet, quit smoking etc - in short make healthy lifestyle choices.

What is the outcome of Heart Valve Replacement surgery?

The morbidity and mortality rate following Heart Valve Replacement is minimal. Depending on the type of valve that you receive, a heart valve can last 7 - 10 years; if your heart valve wears out after that, you will need a second similar kind of procedure. The decision to use a mechanical or bio-prosthetic valve depends on you as well as on your surgeon. In younger patients and in women of childbearing age, surgeons prefer to use a bio-prosthetic valve as there is no need for long-term anticoagulation. Majority of patients who receive Heart Valve Replacement can return to their normal activity level in about 2 months. Above all, the quality of your life will improve immensely as you will no longer suffer from palpitations, breathlessness and fainting spells.

B . R . A . N . D . of Heart Valve Replacement surgery

Benefits of Heart Valve Replacement surgery

• Heart Valve Replacement surgery restores the function of your heart that may be compromised due to congenital or acquired defects in your heart. The heart malfunction can be very debilitating and result in palpitation, difficulty in breathing, chest pain, fatigue and fainting spells that can progressively worsen and may even result in death. Approximately 225,000 Heart Valve Replacement surgeries are performed world wide annually. If you follow your physicians guidelines about diet, exercise and use of your medications, chances are that you will be able to enjoy a good quality of life and your 'new' heart valve may last you a life time.

Risks of Heart Valve Replacement surgery

• Calcifcation and presence of vegetations on heart valves - Deposition of calcium and tiny blood clots can make them leaky (incompetent) or narrow (stenosis) them thus hampering their function.
• Thrombo-embolism - These vegetations and blood clots may break off from the surface of the heart valves and enter the general circulation. They can get lodged in any of the arteries of the body cause fainting spells, stroke, kidney failure, or loss of circulation to the legs.
• Infective endocarditis - These vegetations are ideal for bacteria to grow on and cause infection. Bacterial endocarditis can be treated with intravenous antibiotics.
• Stroke
• Heart attack
• Allergic reaction to anesthesia
• Hemorrhage (bleeding) due to post-operative anti-coagulation therapy.
• Heart valve prolapse

Alternatives to Heart Valve Replacement surgery

• Valvuloplasty or Balloon Valvotomy - Valvuloplasty is a procedure in which a small balloon is inserted and inflated to stretch and open a narrowed (stenosed) heart valve.
• Heart Valve Repair - This is a good alternative to Heart Valve Replacement surgery

Now or Never

• Heart Valve Replacement offers an improved quality of life and can restore your peace of mind. With the availability of heart valves that are hemodynamically durable and resilient, the long term results of Heart Valve Replacement are reliable and excellent and the majority of patients enjoy a good functional status of their heart..

Decision to have Heart Valve Replacement surgery

• If you decide to undergo Heart Valve Replacement surgery, you can be reassured that you will be cared for by the finest team of health care professionals who use the most sophisticated techniques and equipment available. With the options available for timely management of Heart Valve Disease, you can prevent further damage to your heart valves and soon enjoy a good quality of life.