Heart valve surgery is a surgical procedure performed with the aim of repairing or replacing a damaged heart valve. The heart valve must be repaired if it has an abnormality that causes it to not function properly. Conditions that can cause heart valves to experience dysfunction are stiffness (stenosis) or leakage (regurgitation).
The heart has 4 valves that function to regulate blood flow when the organ is pumping blood, and serves as a barrier to heart space. Among others are:
- Tricuspid valve. The tricuspid valve is the valve that forms the boundary between the right atrium (foyer) and the right ventricle (chamber) of the heart.
- Mitral valve. The mitral valve is the valve that forms the boundary between the left atrium and the left ventricle of the heart.
- Pulmonary valve. Pulmonary valve or valve of the lungs is a valve that regulates blood flow from the right ventricle to the arteries of the lungs.
- Aortic valve. Aortic valve is a valve that regulates blood flow from the left ventricle to the aortic vessels, and continues throughout the body.
Heart valve disease is caused by heart valves not closing or opening properly, so that blood flow to the heart becomes disrupted. In heart valve surgery, valves that have abnormalities can be repaired or replaced. After this operation, the patient needs to be hospitalized at the hospital.
Heart Valve Surgery Techniques
Heart valve surgery is usually done with 2 techniques, namely repairing the heart valve that has an abnormality or replace it. Repairing the heart valve is done in two ways, namely closing the valve that has a leak, or repairing and widening the valve opening that is experiencing narrowing or stiffness. One method that can be done to overcome heart valve leakage is annuloplasty, which strengthens the heart valve muscles and closes the leak by using a heart valve ring. Meanwhile, to widen the opening of the heart valve, valvuloplasty can be done, which is to widen the valve opening with the help of a special balloon.
If heart valve abnormalities can no longer be corrected by overcoming leakage or widening openings, doctors can recommend patients to undergo heart valve replacement. In this procedure, the heart valve that has an abnormality will be replaced with a new one. The new heart valve to be installed can be a prosthetic valve made of plastic or metal, or it can also be a biological valve taken from human or animal tissue.
Indications for Heart Valve Surgery
Patients will be recommended to undergo heart valve surgery if they experience heart valve abnormalities that cause symptoms, such as:
- Chest pain.
- Heart beat.
- Hard to breathe.
- Get tired quickly.
- Lips and fingertips turn blue (cyanosis).
- Edema, which is swelling in the legs or abdomen due to fluid buildup.
- Drastic weight gain due to fluid buildup.
If these symptoms occur, the doctor will examine the patient's general health condition and examine the patient's heart condition, to find abnormalities in the heart valve and determine whether or not a heart valve operation should be performed.
Warning Heart Valve Operation
Heart valve surgery is a fairly complicated medical procedure. There are several conditions that need to be watched before undergoing heart valve surgery, because it is feared to cause complications. These conditions include:
- Not long ago had a heart attack.
- Suffering from cardiomyopathy.
- There is a lump or blood clot in the heart.
- Has severe pulmonary hypertension in the lungs.
- Has a left ventricular heart muscle weakness that causes a reduced volume of pumped blood.
- Suffers from end-stage kidney failure.
Preparation for Heart Valve Surgery
Before undergoing heart valve surgery, the doctor will explain to the patient and his family, related to the details of the surgical procedure along with the side effects and preparations that will be undertaken. Patients will be asked to be accompanied by family, from before surgery to undergoing recovery through hospitalization at the hospital. The patient's family will also be directed by the doctor regarding the postoperative recovery process, along with steps to help the patient's recovery.
The doctor will conduct a general health examination of the patient before performing heart valve surgery. In addition, patients will undergo blood tests to see the ability of blood clotting. If the patient is pregnant or plans to become pregnant, has an allergy to latex, anesthetics, or other drugs to be used during surgery, it must be notified to the doctor. Likewise if the patient has a device attached to the heart, for example a pacemaker.
Patients will be asked to fast 8 hours before undergoing surgery, usually starting at midnight if the operation is done in the morning. Patients will also be asked to stop smoking before the operation. If the patient takes blood-thinning drugs, such as aspirin, will be asked to stop taking the drug for a while.
Heart Valve Surgical Procedure
In the preoperative stage, the patient will be asked to change his clothes first and wear special surgical clothes. Patients will also be asked to remove their jewelry, both metal and non-metal. Patients also need to urinate before surgery. To collect urine that comes out during surgery, the patient will be fitted with a catheter.
The heart valve surgery procedure will begin with making a skin incision in the chest area. Skin slices are made from the bottom of the neck to reach the chest. If the patient's chest has thick hair, the hair will be shaved before the operation is performed. The patient will undergo heart valve surgery in an unconscious state due to getting general anesthesia. After the patient is given anesthesia, the doctor will install a breathing apparatus and a transesophageal echocardiography (TEE) device through the esophagus to monitor the condition of the heart valves during surgery.
After the incision is made, the doctor will then divide the patient's breastbone so that he can access the heart from outside. The patient will be given medicine to stop the heart, then the patient's body will be connected to the heart lung machine (heart lung machine) so that blood stays, during the operation.
The doctor will then repair the heart valve. Heart valve repair methods performed by doctors in general can be in the form of:
- Closing the hole formed in the heart valve.
- Discarding the tissue that causes the heart valve cannot close completely.
- Reconnecting separate or incompletely formed heart valves.
- Separating the fused valve.
- Strengthen the tissue around the heart valve.
- Replacing the muscle tissue that strengthens the heart valves.
However, if the heart valve cannot be repaired, the doctor will perform a heart valve replacement. To make a heart valve replacement, doctors not only make incisions in the skin and open the breastbone. The doctor will also make an incision in a large artery (aorta), for access to replace the heart valve. After the aortic incision is made, the doctor will remove the damaged heart valve and replace it with a new valve. Once installed, the doctor will then close the aortic incision that has been made.
When the heart valve replacement or repair procedure is complete, the doctor will reactivate the patient's heart with a heart shock device. After the heart beats again, the doctor can install a pacemaker during the patient's recovery to keep the heart rate normal. The opened breast bone will be closed again with a special suture bone so that it can be reunited. The skin incision is also covered with ordinary sewing thread and a sterile dressing is placed to prevent infection. The patient will then be taken to the intensive care room to undergo recovery in the hospital.
After Heart Valve Surgery
Patients will undergo postoperative care and recovery in the ICU for several days. Generally the duration of hospitalization for the patient will be about 5-7 days before being allowed to go home and outpatient. During treatment at the ICU, patients will be monitored for their condition by doctors and officers through monitoring:
- Blood pressure
- Oxygen levels in the blood
- Respiratory rate
- Electrocardiography
During the period of hospitalization, the patient remains fitted with a breathing apparatus to maintain the respiratory rate of the patient, especially in the initial period of hospitalization after just undergoing surgery. Breathing apparatus is installed to maintain the breathing rate while the patient is still feeling the effects of anesthesia. If the anesthetic effect has diminished or disappeared, the doctor can remove the breathing apparatus and other officers will help the patient to practice breathing so that the patient avoids pneumonia.
Patients can feel pain in the operation due to incision and opening of the breastbone. To relieve the pain, patients will be given pain medication as needed. The patient can also feel discomfort when breathing when the breathing apparatus is removed, but that is only temporary. At the beginning of the recovery period the patient will find it difficult to eat and drink, so the patient's nutritional intake is done through an IV. After the patient starts to swallow comfortably, the doctor will arrange food that can be given to the patient, ranging from delicate to solid food if the patient can eat.
If the patient has recovered, the patient will be allowed to go home by the doctor to be picked up by the family. During the early outpatient recovery period, patients are not allowed to do heavy physical activity and drive a vehicle. The former area of operation must be kept dry and clean. Patients will need family assistance to carry out daily activities during the outpatient period. The doctor will arrange a patient control schedule for several weeks after surgery to monitor the patient's recovery process. Patients will also be asked to stop smoking to speed up wound healing.
Depending on the type of valve used in valve replacement surgery, especially if prosthetic valves are used, patients will be advised to take blood-thinning medication for life to prevent the formation of blood clots on artificial valves. If blood clots form, there is a risk of heart attack and stroke. The recommended blood thinning medication is warfarin.
Risk of Heart Valve Surgery
Heart valve surgery is safe to do. So far, it is known that the success rate of heart valve surgery is around 98%. However, keep in mind that heart valve surgery is a medical procedure that also has side effects. Side effects that can be experienced by patients, including:
- Bleeding.
- Infection.
- Blood clotting.
- Stroke.
- New heart valve disorders undergoing repair or replacement.
- Heart attack.
- Irregular heartbeat (arrhythmia).
- Pancreatitis.
- Pneumonia.
- Respiratory disorders.
- Dead.
To be aware of infections, patients and families must pay attention to the following symptoms:
- Fever.
- Shivering.
- Difficulty breathing.
- Pain in the operating area.
- Redness, swelling, bleeding, and discharge from the operating site.
- Nausea and vomiting.
- Heart rate increases or becomes irregular.
If symptoms of the infection appear, the patient or family should immediately contact a doctor in order to be treated.
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