The human heart has four valves. Each of the valves has a set of flaps called the leaflets and cusps. In a healthy heart, these four flaps open and close according to each heartbeat. However, when the valves are compromised due to several reasons, these flaps do not function properly. Hence, they restrict the blood flow through the heart to the rest of the body.
A condition where one or more of the four valves is not functioning properly is called a heart valve disease. The medical procedure performed to improve the functioning of the valves is called valve replacement surgery.
Valve replacement surgery is a very effective procedure to correct the functioning of the valves. In this procedure, the surgeon replaces or repairs the compromised valve and restores the blood flow to the body. There are multiple methods to perform valve replacement surgery. The type of procedure depends on the severity of the condition, the general health of the patient, the age of the patient, as well as the underlying problem.
Some of the most common valve replacement surgeries include:
Transcatheter Aortic Valve Replacement (TAVR) or Transcatheter Aortic Valve Implantation (TAVI): This is one of the most preferred valve replacement surgeries performed to repair a compromised valve.TAVR or TAVItreats a blocked or narrowed artery, which was the cause of blood and oxygen disrupting the blood and oxygen supply to the heart. A TAVR/TAVI is suitable for patients that have a higher degree of risk or have another underlying condition. Moreover, this procedure is recommended for patients that are too sick and hence, not considered fit for open-heart surgery. Patients suffering from aortic stenosis or too old are also advised to undergo a TAVR procedure for valve repair or replacement.
The Transcatheter Aortic Valve Replacement (TAVI/TAVR) is an advanced version of the standard valve replacement surgery and involves treating the diseased valve by implanting an aortic valve. This is a less invasive procedure as compared to the traditional valve replacement surgery. It involves small openings that do not harm the chest bones and leave fewer scars. The valve implantation is done via a catheter without removing the damaged, old valve. In a TAVI/TAVR method, the surgeon places a valve-within-a-valve, similar to that of placement of a stent – a stainless steel mesh – in the artery. The surgeon makes a small incision in the upper chest or groin and places a flexible, small, hollow fine tube (sheath) to gain access to the aortic valve and then inserts a catheter mounted with a balloon. After the catheter is in the right position, the balloon mounted on top is inflated at the termination point. This pushes the build-up of plaque to the sides and thus, freeing the flow of blood to and from the heart.
TAVI/TAVR treatment has several benefits. Some of the benefits include:
- Dependable substitute for open-heart surgery
- High survival rate
- Less invasive and involves fewer and smaller incisions
- Less damage or chances of infection
- Faster recovery period
- Fewer scars
Even though a TAVR/TAVI surgery is less risky compared to an open-heart valve replacement surgery, it involves a few risks. Risks of a TAVI/TAVR procedure include:
- Bleeding from the incision
- Abnormal heartbeat and rhythm
- Kidney disease
- Adjustment problems with new replaced valve
Surgical Aortic Valve Replacement (SAVR): SAVR is the traditional open-chest surgery to treat the diseased or compromised valve. Before the introduction of minimally-invasive techniques such as TAVR, SAVR was the most preferred option even for patients suffering from severe aortic stenosis.Surgical Aortic Valve Replacement isan open chest surgerywhich replaces the compromisedaortic valves. Because of the nature of the surgery, this procedure is suitable only for patients that are strong and healthy to manage the stress and recovery. It is the ideal surgery for patients that have a low-risk.
In a SAVR procedure, the surgeon makes an incision in the chest of the patient to successfully reach the heart. Once the access to the heart is obtained, the surgeon places the heart on a heart-lung bypass machine to keep the heart alive. In the meanwhile, the surgeon replaces the compromised or damaged aortic valve with a new one. Post successful replacement of the valve, the heart is restored to the body and the incision is closed. The patient is kept under observation to ensure the new valve is functioning properly and the heart functioning is not compromised. SAVR has been very successful for multiple patients that have sound health and no underlying medical condition. However, the risks and the recovery time involved in a SAVR procedure are very long. The patient is kept under observation for almost 5-7 days and then is asked to stay on rest and follow precautions for another 6 weeks for complete recovery.
Some advantages of a SAVR are:
- Lower chances of the patient requiring a permanent pacemaker
- More mature method than a TAVR/TAVI
- The replaced valve has a longer life
However, a SAVR is not ideal for many patients because of the several risks involved, such as:
- Blood clots
- Uneven heart rate
- Longer recovery time
- Acute kidney injury
- Blood transfusion issues
- More scars
Sutureless Valve Surgery: The most advanced method to treat a diseased valve is a sutureless valve surgery. It is the most minimally-invasive valve replacement surgery that does not place or tie sutures, thus limits the stress on the heart. Due to the lack of sutures, the surgery is referred to as the sutureless valve surgery. This form of valve replacement surgery is considered the safest method and is ideal for patients that face a high risk from open or less-invasive methods such as SAVR or TAVR/TAVI. Both SAVR and TAVR/TAVI cause a lot of stress, trauma and carry certain risks.
This form of valve replacement surgery ensures rapid deployment of aortic valves and is more advantageous over the traditional method since it reduces the cross-clamping and also cardiopulmonary bypass duration. With the help of sutureless valve method, a surgeon can execute complex cardiac interventions a lot of ease. This procedure also helps to maintain the hemodynamic outcomes and ensures low paravalvular leak rates. That said, even though this method has several advantages, it is not considered ideal for all patients. The applicability of the method depends on the general health, underlying condition, age and overall severity of the patient. Moreover, since the sutureless valve surgery is very new, the applicability of the procedure becomes even more restricted. Hence, only a few patients, with the ideal health conditions are considered fit for the surgery.
Key advantages of the sutureless valve replacement include:
- First-rate hemodynamic performance
- Low chances of structural valve degeneration (up to 15 years)
- Low chances of paravalvular leak rates
- Less surgical stress
- Fast recovery process
- Reduced duration of cross-clamp and cardiopulmonary bypass
- Easy and safe implantation and deployment
- Minimized operative time
- Simple and easy implantation of valves
- Fewer post-operative complications
Each valve replacement surgery method has its advantages and disadvantages. The applicability of the method depends on critical factors such as the general health of the patient, age, medical history, overall risk, and the underlying condition. It is important to discuss all procedures, recovery periods, precautions, risk, etc, involved in the chosen valve replacement surgery.