Heart valve replacement surgeries are medical procedures done to treat the diseased heart valves. Heart valve disease implies a condition where at least one of the four heart valves is not functioning properly, thus, restricting the flow of blood through the heart.
The human heart has four valves, each with a set of flaps known as leaflets and cusps. Normally, these flaps open and close in a heartbeat but when the valves are compromised, these flaps do not open or close properly. This disrupts the flow of blood through the heart to the rest of the body.
Thus, in a heart valve surgery, the doctor repairs or replaces the valve, depending on the severity of the condition. Multiple surgical approaches can be used for valve replacement including open-heart surgeries, as well as minimally invasive procedures. However, the type of treatment depends on the condition of the patient, the age, general health, and the underlying problem.
Some common valve replacement procedures include:
Surgical Aortic Valve Replacement (SAVR): Surgical aortic valve replacement istraditional,open chest surgery that replacesdamaged valves and is recommended for patients whose condition is strong enough to manage this surgery and the recovery. A SAVR is preferred for patients with low-risk. In a SAVR procedure, an incision is made in the chest to reach the heart; once through, the heart is placed on a heart-lung bypass machine, while the damaged aortic valve is replaced with a new one. The heart is the restored and the incision is closed. SAVR has shown great results on patients who are suitable for the surgery. Though the recovery time post a SAVR procedure is long and approximately requires 5-7 days of hospitalization, plus at least 6 weeks of full recovery.
Benefits of choosing to a surgical aortic valve replacement are:
- Lower chances of a permanent pacemaker
- Matured method
- The long span of the valve
A SAVR procedure may involve certain risks such as:
- Blood clots
- Irregular heart rate
- Longer recovery time
- Acute kidney injury
- Blood transfusion
Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve Implantation (TAVI): TAVR or TAVIis a surgical method performed to repair a compromised, blocked or narrowed artery which was disrupting the blood and oxygen supply to the heart. This surgical procedure is recommended for patients who have a higher risk or are too sick or suffer from severe aortic stenosis, or too old for open-heart surgery. This breakthrough procedure is advanced than a standard valve replacement.
The Transcatheter Aortic Valve Replacement (TAVI/TAVR) procedure involves the implantation of the aortic valve via a catheter without removing the damaged, old valve. Instead, TAVI/TAVR wedges another valve into the aortic valve’s place (valve-within-valve). The approach is very similar to the placement of a stent – a stainless steel mesh – in the artery. In a TAVI/TAVR procedure, a small incision either through the upper chest or groin is made to place a small, hollow fine tube (sheath) that provides access to the aortic valve by placing a catheter mounted with a balloon. Once, the catheter is in place, the balloon is inflated at the termination point to push the plaque to the sides.
Once the compromised valve is opened, a completely collapsible valve (artificial, biological or a combination of the two) in replacement, on the site of the old valve is placed through the catheter. Once, the placement is made, the new valve expands and drives the old one out of the place, enabling the new tissue in the valve to become the primary medium of regulating blood flow in the heart. Post successful positioning, the balloon is deflated and removed.
Where a standard valve replacement surgery involves an open heart surgery by a sternotomy via a surgically opened chest, a TAVI/TAVR process is less invasive and involves small openings that do not harm the chest bones.
A TAVI/TAVR procedure can be performed in two ways:
Transfemoral Approach: In this, the doctor enters through the large artery in the groin, without any surgical incision in the chest.
Transapical Approach: In this one, the doctor enters through the large artery in the chest by making small incisions on the chest.
Even after 20 years of existence, TAVI/TAVR procedure is continually being studied and advanced upon with newer techniques and refinements in technology and procedure, enhanced devices, post-operation care, newer approaches, and more.
That said, a TAVI/TAVR treatment has both benefits and risks involved. Some of the benefits include:
- Reliable alternative to open-heart surgery
- High survival rate
- Less invasive
- Less damage or chances of infection
- Faster recovery period
Risks involved in a TAVI/TAVR procedure include:
- Abnormal heartbeat and rhythm
- Kidney disease
- Adjustment problems with replaced valve
Though uncommon, these risks are important to be aware of before evaluating all options of treatment. Even the doctor will conduct several tests such as an ultrasound, echocardiogram, cardiac CT scan, and cardiac catheterization to determine if a TAVI/TAVR or SAVR procedure is best suited to your condition.