Heart Valve Disease
The aortic valve—one of the four heart valves—is essential for blood to flow from the heart to the rest of the body. Aortic stenosis is a progressive and debilitating disease that occurs when the aortic valve no longer opens well due to build-up of calcium deposits on the valve leaflets. If aortic stenosis becomes severe, patients often experience progressive weakness, shortness of breath, chest pain, and fainting or near-fainting spells. Advanced aortic valve stenosis, if untreated, often leads to death with mortality rates rivaling those of some aggressive cancers.
The standard approach to correct aortic valve stenosis has been surgical aortic valve replacement, whereby a cardiac surgeon removes the diseased valve and implants an artificial valve via open heart surgery. Open heart surgery for valve replacement is effective, but can be a high-risk option for some individuals with multiple medical problems. Additionally, it is not an option for some patients due to presence of severe medical conditions, advanced age and frailty.
Transcatheter Aortic Valve Replacement (TAVR)
TAVR is a minimally invasive treatment for some forms of aortic valve stenosis. Offered to patients at Overlake Medical Center, the TAVR procedure allows for insertion of an artificial valve using a catheter advanced to the heart through the groin artery. Patients who have TAVR typically have a small incision in the groin and are walking within 12 hours of the procedure. Additionally, there are other minimally invasive methods to access the heart for catheter based delivery of the artificial valve. TAVR was approved by the Food and Drug Administration (FDA) in 2011 after large clinical trials found it to be a very effective option for patients with symptomatic, severe aortic stenosis who are unable to have standard open heart surgery, or are high risk for open heart surgery.
Minimally Invasive Mitral Valve Repair & Replacement
The minimally invasive mitral valve repair/replacement procedure uses a minimally invasive direct vision approach to treat the narrowing or leaking of the heart's mitral valve.
The mitral valve is the inflow valve on the left side of the heart, which allows blood to flow from the left atrium into the heart's main pumping chamber. A correctly functioning mitral valve then closes to keep blood from regurgitating back into the lungs when the heart contracts to pump blood through the body.
The procedure is performed under direct vision by creating a 5 to 6 cm incision between the fourth or fifth ribs and using a wound retractor to improve visibility. This approach means patients experience a shorter hospital stay, which lowers the overall cost of care, and allows a return to full activity in three to four weeks compared to three to four months for standard surgery.
Heart Valve Program
The Heart Valve program at Overlake Medical Center & Clinics is a collaborative effort with Kaiser Permanente physicians. It is a community-based program that leverages the multidisciplinary expertise of our providers to offer an array of catheter based and surgical options for patients with valve disease.
The program focuses on state-of-the-art valve technologies that increase treatment options. The Heart Valve program, the first to offer TAVR on the Eastside of the Seattle/Puget Sound region, began in 2012 via collaboration between multiple experts across cardiovascular specialties at Overlake Clinics and Kaiser Permanente. This collaboration has culminated in a cohesive team that is committed to the delivery of safe and effective care to patients suffering from advanced valve disease.
Heart Valve Repair Procedures
During a heart valve repair operation, your heart valve may need to be resized (an annuloplasty procedure). In addition, extra valve tissue may need to be removed, holes in the leaflet repaired, or support structures called chords replaced. Valve repair may include all of the following procedures:
- The heart valve is resized by removing excess tissue.
- Support is added to the heart valve by adding tissue or a band or ring around the opening of the valve.
- Damaged leaflet tissue is repaired.
- Calcium deposits are removed.
- The cords that control the leaflets of your valve are repaired or replaced.
Valves are essential to your heart's pumping action. The four valves direct blood to move between your heart's four chambers.
If heart valve repair is the best option for you, your surgeon may perform an operation called an annuloplasty procedure.
Through disease or age, the tissue that supports the heart valve's leaflets (the annulus) can weaken and lose shape. To repair this condition, a device called an annuloplasty ring or band is sewn around the base of the heart valve to reshape it and give it support.
An annuloplasty band or ring is made of durable plastic, metal or fabric and may be flexible or rigid. These rings and bands are designed to hold the natural shape, motion and flexibility of the annulus.
An annuloplasty ring or band may also have a marker that makes it possible to see it on an X-ray.
A flexible annuloplasty ring or band is used to help restore the shape of your heart valve.
Many patients feel physically better following heart valve repair surgery because they are no longer impacted by the symptoms of their valve disease.
Often a leaking mitral valve is associated with a broken chord. These chords hold the leaflet in the proper position. This can be repaired by replacing the broken chord with a Teflon suture. This procedure is called artificial chord replacement (ACR).
Benefits and Risks of Heart Valve Repair
Depending on your condition, you should begin to feel the effects of your heart valve repair soon after surgery.
- Benefits: Most patients feel the results of valve repair surgery immediately. Others notice a gradual improvement over several weeks following their surgery. Your doctor will help you evaluate your progress and recommend programs and activities to help restore your strength and energy.
- Risks: There are obviously risks associated with heart surgery. They can vary from patient to patient. Talk with your surgeon to learn more about the benefits and risks of heart valve repair surgery.
What Is Heart Valve Replacement?
During a heart valve replacement procedure, the surgeon removes your diseased heart valve and replaces it with what's called a prosthetic or artificial heart valve. This artificial valve works much like a normal heart valve.
An artificial heart valve is either a mechanical or a tissue valve. Mechanical heart valves are made of a strong material such as titanium or carbon. Tissue heart valves are obtained either from human donors or from animal tissue.
After receiving your new heart valve, you will likely begin noticing an immediate improvement in how you feel. Complete recovery may take approximately six to 12 weeks. Most heart valve patients resume a normal, healthy lifestyle.
Benefits and Risks of Heart Valve Replacement
Heart valve replacement surgery is generally considered safe, and you should feel some benefits of your new heart valve almost immediately. However, risks and complications are possible. You need to know about them so you can alert your doctor if you notice symptoms.
- Benefits: Over time, you should be able to engage in your normal activities again. Each patient recovers at his or her own pace. Recovery depends on your overall strength. The effects of your old, damaged valve on your body will gradually fade as your new heart valve begins to help your heart function more efficiently.
- Risks: There are obviously risks associated with heart surgery. They can vary from patient to patient. Talk with your surgeon to learn more about the benefits and risks of heart valve replacement surgery.
Questions & Answers About Heart Valve Replacement
Should I get a mechanical valve or a tissue valve?
There are advantages and disadvantages with either choice. Your doctor can provide more details. A mechanical valve lasts longer than a tissue valve, but you will have to be on blood-thinning medication for the rest of your life to reduce the risk of clots. The main advantage of a tissue valve is that it does not typically require this.
You and your doctor together will decide which option is best for you.
How long will my heart valve last?
Mechanical valves in some patients have lasted as long as 25 years without problems. So, it is possible that your new artificial valve could last for the rest of your life. But in some cases, a valve has to be replaced within a matter of years or months, for a number of reasons.
Mechanical valves are more resistant to the constant demands on them, such as opening and closing each time your heart beats. The materials used in mechanical valves stand up well to this wear and tear.
Tissue valves don't tend to last as long as mechanical valves. They can tear and leak over time. Tissue valves usually have to be replaced after about 10 to 15 years, or more often in pediatric patients who may have outgrown their valves.
Fortunately, tissue valves wear out slowly so you and your doctor have time to plan for a new operation, if it is necessary.
Will my new valve need special care?
Let your other doctors and your dentist know that you've had heart valve surgery. Ask whether you should take antibiotics before surgical or dental procedures to help prevent valve infections.
Will a mechanical heart valve set off airport security?
No. Airport security systems have no effect on replacement valves. They are not likely to activate airport security alarms, depending on the sensitivity of the security settings. Learn more on the Transportation Safety Administration website.
Is it safe to have an X-ray after heart valve replacement?
All replacement heart valves are completely safe with X-ray examinations.
Is it safe to have a magnetic resonance imaging (MRI) scan after a heart valve replacement?
Our replacement heart valves have been tested and found to be safe during a magnetic resonance imaging (MRI) scan. Contact Medtronic LifeLine CardioVascular Technical Support for more detailed information.