Valve Repair / Replacement What is it: repair and replacement difference, how to fix heart valve, benefits, symptoms, complications, minimally invasive techniques, percutaneous intervention

Valve Repair / Replacement - What it is

A valve is a structure in the body that allows fluid to move along the body. The main heart valves are the aortic, pulmonary, tricuspid and mitral valves. These valves work in coordinated movements, so that while the mitral and tricuspid valves open to allow blood to flow into the heart for example, the aortic and pulmonary valves remain closed. This ensures one-directional blood flow for proper blood circulation.

Valve repair or replacement is a major operation that is performed to treat patients with diseased valves that are no longer functioning correctly. Examples of dysfunctional valves are when they are stenotic (narrowed) or incompetent (leaky), causing blood to leak back into the heart when it should flow out of the heart. It is crucial that faulty valves are repaired because untreated valve disease can lead to heart disease and mortality.

Pathway of blood flow through the various chambers and valves in the heart.

To repair or replace damaged valves

Valve repair (also called valvuloplasty) is a procedure whereby the surgeon fixes a faulty valve. The mitral valve is the most commonly repaired valve, but the aortic and tricuspid valves may also undergo some of these repair techniques. During surgical repair of valve defects, such as mitral incompetency, the surgeon reconstructs the valve so that it can close properly, which can include:

Fixing holes in a valve
Reconnecting valve leaflets
Separating valve leaflets that have fused together
Removing excess valve tissue
Replacing chords supporting the valve
Strengthening and tightening the valve with a synthetic ring

It is important to note that valve repair is only suitable for selected patients. If the valve is severely damaged, replacement of the valve will be necessary. In valve replacement surgery, the patient’s heart valve is replaced by an artificial valve which can be made of metal (mechanical valve), or biologic animal tissue (bio-prosthetic valve). The following shows the advantages and disadvantages of mechanical and bio-prosthetic valves respectively:

Type of Valve	Advantage	Disadvantage
Mechanical valves	Can last for 30 years or more.	May cause blood clots and hence, patients with mechanical valves need to take lifelong anticoagulation medication.
Bio-prosthetic valves	Do not cause blood clots and hence, patients with bio-prosthetic valves do not need to take anticoagulation medication.	Only last an average of 10 years and need to be replaced when they wear out.

Your doctor will make recommendations based on the severity of your condition and medical history.

How is a valve repair or replacement done?

Valve repair surgery is typically done though open-heart surgery.

Traditionally, heart valve surgery is conducted through open-heart surgery via a median sternotomy, which involves splitting the sternum (breastbone). As such, the patient will be given general anaesthesia before the surgeon cuts open the chest. The patient will then be connected to the heart-lung bypass machine which performs the heart’s pumping functions.

A Transesophageal Echocardiogram (TEE) is conducted to monitor the functions of the patient’s valves both before and after the procedure. An echo probe will be inserted down the oesophagus which is behind the heart and thus should not interfere with the surgery.

One or more plastic chest drains may be left in the chest to drain any excess fluid. Pacing wires may be left in the heart temporarily to control the heart rhythm when necessary. The breastbone is then wired together and wounds are closed with absorbable sutures.

Minimally invasive valve repair or replacement techniques

In suitable patients, minimally invasive heart surgery for valve repair or replacement may be an option. These involve smaller surgical incisions and can potentially lead to a faster recovery.

Percutaneous transcatheter valve repair or replacement techniques

In patients not suitable for open-heart surgery, percutaneous transcatheter valve repair or replacement techniques may be an alternative. These involve small needle punctures and incisions to insert wires and catheter-based instruments. Some of these treatments include:

TricValve®
TriClip™
MitraClip
Transcatheter Aortic Valve Implantation (TAVI)

Who will need a valve repair or replacement?

Valve repair or replacement can help improve various symptoms caused by diseased valves such as:

Chest pain (angina)
Breathlessness
Dizziness or fainting
Swelling at the legs or abdomen
Palpitations

What are the advantages of valve repair compared to valve replacement?

Compared to valve replacement, valve repair is associated with:

Lower risk of infection
Decreased need for life-long blood thinning medication
Preserved heart muscle strength
Reduced risk of stroke and increased long-term survival

Possible complications of valve repair or replacement

Heart valve repair or replacement is a major surgery and in some cases, might result in certain complications, including:

Abnormal heart rhythms (arrhythmias): Up to 30% of patients might experience a rapid irregular rhythm called atrial fibrillation (AF), but this is usually controlled with medications.
Chest discomfort or breathlessness: This could be a temporary or permanent side effect that occurs after the surgery.
Dysfunction of repaired or replaced valves: The repaired or replaced valve(s) might not be effective. In these cases, additional procedures might be needed.

The risks associated with valve repair or replacement procedure varies according to each patient’s specific conditions and medical history. Please discuss any concerns you might have with your surgeon beforehand and provide him/her with all the necessary information.