What is Heart Valve Surgery

Heart valve surgery is a procedure to treat heart valve disease. Heart valve disease involves at least one of the four heart valves not working properly. Heart valves keep blood flowing in the correct direction through your heart.

What is a Heart Valve Replacement Operation?

Heart valve surgery or valve replacement surgery in cardiac surgery is a very common procedure.

Almost as equal but if not pretty close to coronary artery bypass surgery. So the other most common type of valve that will be used for replacement is what we call tissue or valve prosthesis. The most common tissues are cow tissue, made of the heart sac of the cow, or pig valve, and sometimes a combination of both.

Now there’s other options where we can use a cadaver valve or we can actually use a valve in another part of your heart and transfer it there. But those are the specific indications for that and it’s usually not the most common procedure.

So if we restrict ourselves to mechanical and the tissue valve that’s usually the discussion you’ll have with your heart surgeons. We already mentioned that the mechanical valve you will have to go on blood thinners because they tend to clot.

There are some risks associated with that for the rest of your life the other option is to take the tissue valve, you don’t necessarily need the blood thinner. You can just be on aspirin, but they wear out with time.

And the younger you are when you get them, the faster they wear. So there’s specific indications again, but if you’re an elderly, probably a good option. So the most common valve that usually gets replaced is the aortic valve, and the most common reason is because it wears out.

This is the aorta there where the red blood comes out of the heart, and the valve is right there. The role of the valve is to prevent the blood when the heart ejects or pumps. When it relaxes, the valve closes and it prevents the blood going back into the heart.

Typically the way we replace that valve is we make a cut in that pipe, and already by that time you’re on cardiopulmonary bypass so you’re connected to a machine that takes the blood away from your heart and your lungs.

The machine does the work, and we stop the heart, and it allows us to open, do our work so through that pipe here we go and take that valve out. And we’ll put either a tissue valve or a mechanical valve and then we close and we fill the heart back with blood, and then we restart the heart, and we’re done.

If you think that you need valve replacement surgery or valve interventions, the first step again is discuss this with your family doctor. He can then refer you to the appropriate person typically the cardiologist or the surgical team.

Most commonly it would a team that’s assessing you, your options will be reviewed, and recommendation based on your lifestyle and your comorbidities. Local Cardiologist.

Presenter: Dr. Guy Fradet, Cardiothoracic Surgeon, Kelowna, BC

Local Practitioners: Cardiothoracic Surgeon

CABG - Coronary Artery Bypass Graft Surgery

The term that you usually hear about coronary bypass surgery is CABG, which is the acronym for coronary artery bypass graft.

And what that refers to is basically on the heart there is a big blood pipe where the oxygenated blood or the red blood comes out the heart goes to your brain and your arm. And there’s a valve that prevents once the blood comes out to go back into the heart. Just above that valve there’s two main arteries, conduits, that bring that red blood that is rich in oxygen and food to the heart muscle itself.

As you get older those arteries and the one on your body get hardened, and with time narrowing happens. Sometimes it happens faster depending on some risk factors which we can talk about but when the narrowing is enough a few things can happen.

The narrowing or the plaque can crack and then clot and then you have an acute sensations of the blood flow to the heart, that’s when you have a heart attack. Or, the decrease can be small enough that whenever you try to do exercise your heart is suffering and then you get the chest pain or the angina.

And in some people those things happen and they don’t feel it, typically diabetic patients
And there’s other ways, tests we can do to show that the heart is suffering although they can’t feel it so all those can be indications to do something about the blockage.

And there’s two things we can do, one is a catheter-based intervention with the blood and the other one is the CABG or the coronary artery bypass. The coronary artery bypass typically doesn’t deal with the blockage, it bypasses it. So you’re rerouting blood from a site where blood flows properly into the main blood pipe. Or another area of the body and you go and drop that flow beyond the blockage.

And we will use a conduit and the conduit will be typically a vein from your leg or an artery from your arm or an artery from inside your chest. And then we will go and reconnect that artery into that area that we just opened just beyond a bypass.

If you think that you do have angina and coronary artery disease you may be in the need in a coronary artery bypass surgery, the first step is for you to contact your family physicians and get the process initiated.

Presenter: Dr. Guy Fradet, Cardiothoracic Surgeon, Kelowna, BC

Local Practitioners: Cardiothoracic Surgeon

TAVI Catheter Valve Replacement

When we replace an aortic valve, we actually have to stop the heart and open and get access within the heart.

That’s usually done by cutting this blood pipe here and getting access to it. To do it with a catheter there’s two to options. We don’t open the heart, we don’t stop the heart, and a catheter is inserted, most commonly into your leg, in the artery of the leg and brought backward to the heart.

And to that blood pipe, and at the end of that catheter there’s a balloon, and then there’s a valve that has been crimped on a stent or a mesh of metal if you want. So the catheter’s coming up this blood pipe, turning around, and going back toward the heart. And then the valve is deployed this way.

Now let’s say that the arteries are too diseased you cannot access that, so we have the heart in your chest like that here. So what can be done is surgeons can go in between your ribs there and then open that, so without breaking the ribs.

So it’s a small incision, and then they make little sutures there to control. And then the catheter is brought into the heart this way, from the apex of the heart and now the valve is going to be deployed this way as opposed to backward.

And when all that is done and the ribs are closed and – similar, it’s the same – it’s usually a short stay procedure, one or two days. The advantages to doing that procedure as opposed to an open heart surgery, surgical replacement of the valve, one is you avoid the cutting of the chest.

Two is the recovery is usually much faster, maybe one day before you’re discharged home, the risk of bleeding is less. The risk of infection is less because the chest is not open. But there’s other risks like stroke, and also not knowing how long those valves last, that’s what’s being studied.

So it’s a compromise, right now within the study, it’s offered to people who are too high risk for surgery, or people that are at higher risk for surgery where then they’re given the options of the two basically.

So again if you have a valve problem it will be a discussion that will be initiated with your cardiologist and surgeons. It might be in your best interest rather than to have surgery, to have the transcatheter implantation.

Those physicians will then initiate a referral to a specialized centre because not all centres do that procedure. And then see if you could be a successful candidate for that.

Presenter: Dr. Guy Fradet, Cardiothoracic Surgeon, Kelowna, BC

Local Practitioners: Cardiothoracic Surgeon

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