Heart Valve Replacement: Procedure, Recovery, Cost, Risk & Complication

Heart valve replacement surgery is performed for treating heart valve disease, a condition where at least one of the valves that is responsible for the flow of blood in the proper direction, fail to function normally. The four important valves are mitral valve, pulmonary valve, tricuspid valve and the aortic valve. Each of these four valves has flaps that open and close with every heart beat. In some cases, these flaps do not close or open properly, resulting in the disruption of the flow of blood from the heart to the body.

In a heart valve surgery, the doctor repairs or replaces the heart valves that has been affected. Surgical procedures like open heart surgery and minimally invasive heart surgery are used for repairing or replacing a heart valve.

One may require a valve replacement surgery in the following circumstances:

• Regurgitation, where a valve does not close properly allowing the blood to leak backwards
• Stenosis, where a valve does not open completely, blocking the forward flow of blood
• Defects in the valves resulting in severe heart symptoms such as shortness of breath, chest pain, fainting spells or a heart failure
• When test results indicate the changes in the heart valve have started to severely affect the function of the heart
• The valves have been damaged due to an infection
• A heart valve surgery in the past that is not functioning properly at present, or problems such as bleeding or blood clots

Pre Procedure

A heart valve replacement surgery requires the following pre-treatment preparations:

• The surgeon and his team will inform you about your condition and what to expect from the surgery. In case of any questions or concerns, you can clear your doubts by asking your doctor.
• A few preliminary tests may be required like a blood test or EKG, to make sure that the bodily functions are normal.
• Your past medical history and surgeries if any, allergies to any food or medicine, or any adverse reaction to anaesthesia previously must be informed in accurate details to your doctors and anaesthetist.
• Follow the instructions of your doctor regarding the medicines to take or avoid before the surgery and whether you must stop drinking or eating anything a few hours before the operation.
• You may be asked to bathe with an antiseptic soap, and an attendant may shave the hair from the chest and abdomen area, ensuring that your body is as clean as possible prior to the surgery.

During Procedure

The surgeon may perform the surgery either by open heart surgery or by minimally invasive heart surgery. The incisions made are smaller in the latter compared to the former. For replacing a heart valve, the doctor will remove the affected heart valve and replace it with a mechanical valve or a biological tissue valve (made from the heart tissue of a human).

A minimally invasive catheter procedure can also be conducted for replacing certain heart valves. It can be performed for inserting a replacement valve into a biological replacement valve in the heart that is not functioning properly.

During the surgery, the chest is opened up to reach the heart and the affected valve. The heart will be stopped temporarily and the responsibility of breathing and blood circulation is given to a heart-lung machine. Once the valve has been replaced, all the incisions made are sewn with the heart resuming its function.

Post Procedure

Once you have undergone the surgery, you may be required to stay in the ICU for 1-2 days so that your vital stats can be monitored. All fluids, nutrition and medications will be administered through the IV channel. There will be other tubes for draining your urine and fluid/blood from the chest and heart. You may require oxygen too initially.

You may have to spend a few more days in the hospital after coming out from the ICU. The incision sites will be monitored by your doctor to check for any signs of infection. Apart from that, your heart rate, blood pressure and breathing will also be monitored. You will also be advised to walk regularly and increase your activities gradually as a part of your recovery process. Breathing exercises are also recommended at this stage.

The risks of a valve replacement surgery depend on the general health condition of the patient. It has been found that younger people have a lower risk of getting any complications compared to older people and those with other health problems. The general complications that may occur are:

• Bleeding or infection in the process of the surgery, or complications that may be associated with the anaesthesia that was administered
• Blood clotting that is caused because of the new valve. If the replacement has been done with a mechanical valve, medicines are required to prevent clotting.
• Any infection around the replaced artificial valve
• Arrhythmia, where the heart rhythm is irregular
• If the new valve fails to function properly, though this is a rare case
• Stroke or a heart attack

You will be able to get back to your daily schedule after a heart valve replacement surgery like working, exercising and driving. Ensure that you take all you medications in time. Attending follow-up appointments is very important. You may also have to undergo several tests so that your condition can be evaluated and monitored. Incorporate healthy lifestyle changes like inclusion of physical activity, healthy diet, management of stress and avoiding the use of tobacco.

Participation in cardiac rehabilitation can also be suggested by your doctor. It is generally a programme of exercise and education that has been designed for improving your health and helping you to recover after undergoing a heart surgery.

The cost of a heart replacement surgery is approximately Rs. 2,70,000 – Rs. 5,00,000.