Today, there are a wider range of options for treating heart valve disease than ever before. As a result, understanding which options are available to you and discussing each with your doctor will help ensure you make the decision that’s best for you.

Factors such as your age, medical condition, lifestyle, and medications you are taking will impact your doctor’s recommendation as well as your decision. In some cases, your heart valve may be repaired (instead of replaced) by a surgeon. In these cases, an annuloplasty ring or band may be used to strengthen the tissue of the mitral or tricuspid valve.

In other cases, such as with the aortic valve, surgical valve replacement may be required. In these cases, the diseased valve is surgically removed and replaced with a prosthetic heart valve.

 

The two primary types of prosthetic heart valves are:

• Mechanical Valves - Made with a highly durable form of carbon called “Pyrolite”
• Biological Valves - Made from animal tissue

Mechanical valves are highly durable and structural failures are extremely rare. The main drawback to these valves from a lifestyle perspective is that they require the patient to be on lifelong blood-thinning "anticoagulation" medication to prevent possible blood clots.

Bioprosthetic valves are fabricated from flexible, durable material taken from cows or pigs. Because they are made from actual biological tissue, the need for anticoagulation medication may not be required. Additionally, valves made from biological tissue usually have a shorter life span than mechanical valves. If a failure occurs, you may experience the same symptoms you had prior to the initial valve replacement surgery and will likely undergo an additional valve replacement surgery.

This information is intended to provide only a general overview. There are many additional details and considerations to discuss with your doctor.

Warning : This information should not be used as a substitute to consultation from a physician

When the valve disease is too serious to be controlled by medication, heart valve surgery may be recommended in order to avoid further damage to the heart. The aim of this surgery is to improve the health and quality of life of people with heart valve diseases. Depending on your condition, the surgeon will choose either to repair or to replace your heart valve.
 
BEFORE THE SURGERY

On the day of your surgery, a nurse or a patient educator will talk to you and your loved ones, to explain what you have to expect from the surgery.

Preparing for Surgery

•  You should inform the doctor of any medication you are taking, even aspirin, as you might be asked to stop taking it.
•  It is advisable to stop smoking as soon as possible: smoking constricts the coronary arteries, increases the risk of blood clotting, produces excess mucus in the lungs, raises the blood pressure and makes the heart beat faster.
•  You must not eat or drink anything after midnight the night before surgery.
•  To help prevent infection, all hair in the incision area will be shaved. You may also be asked to wash with an antibacterial soap the morning of surgery.
•  If you need dental work, it is advisable to have it done before surgery. This is because dental work can allow bacteria to enter the bloodstream, and cause infection around heart valves.

Knowing the Risks
 
As with every surgical procedure, heart valve surgery can involve risks, such as:

•  severe bleeding
•  infection
•  lung complications
•  excessive reaction to the anaesthetic
•  problems with your heart's rhythm
•  nerve injury
•  damage to bones and muscles
•  problems due to anticoagulant therapy
•  strokes, heart attacks, or death

If you experience some complications, you may require further treatment such as additional surgery to stop bleeding, or antibiotics to treat infections. Complications are not so common: about five percent of people having a heart valve replacement do not survive the surgery or die shortly afterwards. However, you should take into consideration that having no treatment could cause you much more severe problems than those associated with heart surgery.
 
SURGERY

You will receive a general anaesthetic, which will put you to sleep so you do not feel any pain during the surgery.
The surgeon will perform an incision in your chest to reach the heart inside the rib cage. To perform the surgery your heart must not be beating, so it will be stopped. A heart-lung machine will function throughout the surgery, supplying oxygen to your blood and pumping it back through your body. If the valve can be repaired, the surgeon will do this. If the valve must be replaced, it will be removed. A correctly-sized replacement valve will be selected, positioned in the location of the native valve, and sewn firmly into place. The surgeon will close the incision in your heart and aorta, restart the heart and then close all other incisions. The heart-lung machine will be removed and your heart will beat and pump by itself.
 
AFTER SURGERY

Your Hospital Recovery

Immediately after surgery, you will be taken into the intensive care area. You will be closely watched and will be given medication. When you wake up you may have the breathing tube still in place, some draining tubes coming out of your chest and some intravenous lines to give you medication through the bloodstream. Your heartbeat will be recorded and shown on monitors you will see around your bed. After this initial stage in intensive care, you will be transferred to a regular room where you will learn how to exercise in order to improve your movement and breathing potential.

After heart valve surgery, you may need to undergo anticoagulation therapy, by means of what is known as a blood thinner. This therapy may last some months in the case of valve repair or replacement with a biological valve, or it may last longer: your surgeon will discuss this therapy with you, together with any other related medication needs.

The healing period lasts on average 2 to 3 weeks, but some people recover faster than others. During this time you should follow your doctor's advice and undergo some follow-up examinations. You will need to do some blood tests to check that you are receiving the correct dosage of anticoagulation medication.

You will be asked to help in checking and looking after your health by following the procedures taught in the hospital, exercising, and checking your temperature and the healing of the incision made during surgery.

Resuming Normal Life

After some time, you will recover and regain your strength. Your doctor will advise you on the do's and don'ts. You will be taught how to carry out certain movements, especially those involved in lifting weights and working. You will have to take care of yourself and lead a healthy lifestyle: doing some exercise regularly, eating "heart-healthy" food and, last but not least, you should stop smoking.

When to Call the Doctor

If the following signs or symptoms occur, call your doctor immediately:

• chest pain or tight pressure that does not disappear within a few minutes
•  sudden and increasing shortness of breath
•  temporary blindness or lack of vision in one eye
•  clumsiness, weakness or numbness in the face, arm or leg on one side of the body
•  loss of consciousness
•  any chills, sweating or fever above 100°F
•  unusual bleeding or bruising
•  unusually rapid gain in weight, fluid retention or swelling of ankles
•  redness, swelling or discharge around any incision

Warning : This information should not be used as a substitute to consultation from a physician

If your heart valves do not work properly and cannot be repaired, you may need to have a heart valve replacement.
You will undergo heart surgery, during which your diseased valve will be removed and replaced with a prosthetic heart valve.

There are different kinds of heart valve prostheses. They can be categorized according to the material they are made of:

•   Biological or tissue valves are made from animal tissue:

                    - bovine (cow) pericardium (sac surrounding the heart)
                    - porcine (pig) aortic valve,
                    - human valves from cadaver donors

•   Mechanical valves are constructed from synthetic material

 Tissue Valves

Tissue valves are all made from heterologous tissue, and can be categorized according to the origin of the tissue. The tissue can be:

•  Autologos: tissue coming from your own body
•  Homologous: tissue coming from another human being (cadaver donors)
•  Heterologous: tissue coming from another animal species

The most common tissue valves are made from animal tissue. The valves are usually made of:

•  Porcine material
•  Bovine material

A porcine valve is made from a pig's aortic heart valve. The valve may be left as it is, or in other cases, pieces from different valves may be sewn together to create a new one. A bovine pericardial valve is made from bovine pericardium (the membrane that surrounds the heart). Whenever the animal tissue is taken, it is treated in such a way as to strengthen and make it suitable for human use.

Tissue valves can be categorized according to the presence or absence of a support inside the valve; they can be stented if there is a plastic or metallic support inside, or stentless, if there is nothing to support the tissue.

Mechanical valves

The most common kind of mechanical valve used worldwide is the bileaflet valve.

A bileaflet valve is made of a rigid ring (housing) in which two semicircular discs (leaflets) are hinge-mounted. The housing is then surrounded by a soft tissue (sewing ring) which is sutured into the heart.
The leaflets are the mobile part of a valve: they open and close simultaneously at every heartbeat.

Selection Criteria of a Heart Valve Prosthesis

The criteria according to which your surgeon will choose between a biological or a mechanical valve will depend on his/her evaluation of the risks and the benefits of each of the two types, your age, your physical condition and your lifestyle. Both kinds of valves can offer you different advantages and disadvantages. The choice of the best valve is made with a view to a balance between the valve's characteristics and your medical condition.
Tissue valves usually have a low thrombo-embolic risk (the risk of blood clot formation), and do not require life-long anticoagulation therapy. However, as the valves are made of biological tissue, the risk of tissue deterioration is higher, and this would probably lead to the need of a further operation in order to replace the valve.

Mechanical Valves usually last for life, because they are made from non-biological material. However, in order to reduce the thrombo-embolic risk, they need to be coupled with an anticoagulation therapy. This entails constraints on diet and activity, and regular blood tests in order to make sure that you are always taking the correct dosage.

Warning : This information should not be used as a substitute to consultation from a physician

The INRange Heart Valve Program provides Sorin mechanical heart valve patients the opportunity to participate in their care from the moment they leave the hospital.
Patients can keep their medication levels in range of the target ratio by self-testing at anytime and from anywhere. INRange promotes consistent weekly blood testing to help patients maintain good health.