Valve surgery

"The incorporation of endoscopic techniques has allowed us to develop minimally invasive procedures (HeartPort), which offer the same results as the open technique and reduce surgical aggression. This facilitates a faster recovery and a reduction in hospital stay".

DR. REBECA MANRIQUE ANTÓN
SPECIALIST. CARDIAC SURGERY DEPARTMENT

Valve surgery is the technique used to treat conditions of the heart valves: valve stenosis (narrowing or closing of the valve) and valve failure, also called regurgitation (inadequate closure of the valve).

Valve surgery is open heart surgery, meaning that the heart's chambers or vessels are opened to access the valves. It is performed under general anesthesia, through an incision in the sternum.

There are currently two procedures for performing the operation: classic surgery and minimally invasive surgery, performed through the HeartPort technique.

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When is valve surgery indicated?

The artificial valves that are placed can be of three types:

Biological

Derived from animal tissues such as pork or bovine pericardium. Normally indicated in patients over 65 years old. They have a duration of between 15 and 20 years.

Mechanical

Made of very resistant materials such as pyrolite carbon and titanium. They need oral anticoagulation for life. Its duration is almost unlimited.

Homografts

They are biological and come from human donors, so their use is more limited. They are used in very specific cases.

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Learn how it is performed and different techniques of valve surgery (only in spanish)

Most frequent indications:

  • Aortic Stenosis
  • Mitral Stenosis
  • Aortic insufficiency
  • Mitral insufficiency

Do you have any of these diseases?

You may need to have valve surgery

How is valve surgery performed?

Classic surgery

The chambers or vessels of the heart are opened to access the valves and perform their repair or replacement.

  • Sternotomy. This is done through an incision in the sternum. A heart-lung machine performs the pumping and breathing functions during the surgery.
  • Repair or replacement. The heart vessel or chamber is opened by repairing it or replacing it with a valve prosthesis.

Percutaneous minimally invasive surgery

The use of techniques such as videothoracoscopy (camera introduced through the thorax) allows for minimally invasive surgery. Minimally invasive surgery facilitates rapid patient recovery and shortens hospital stay.

  • Intervention by HeartPort. The operation is performed through a main incision, between 5 and 8 centimeters, in the right breast fold. Extracorporeal circulation is performed through the vein and the femoral artery.
  • Percutaneous or transapical aortic valve. By means of a catheter introduced through the femoral artery or the tip of the left ventricle (mini incision in the left chest) a biological valve is introduced and placed in the aortic position.

Most patients will be admitted to the hospital the day before the procedure or, in some cases, the morning of the procedure itself. You will be asked to shower the night before in order to reduce the amount of germs on your skin.

After you are admitted to the hospital, you will be washed, disinfected with an antiseptic and, if necessary, shaved.

The risk of complications from anesthesia is less if the patient is fasting. That is why you will be asked not to eat or drink anything after midnight the day before the operation.

If you do eat or drink anything, it is important that you notify the anesthesiologist and the surgeon.

If you smoke, your doctor will ask you to stop smoking at least two weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing. 

Before the operation, you will have an electrocardiogram (ECG), blood and urine tests, and a chest X-ray, so that the surgeon has the latest information about your health status. You will be given a mild sedative before being taken to the operating room.

A heart-lung machine operated by a perfusionist or blood-flow specialist is used in all valve repair or replacement procedures. Before you are hooked up to this machine, you will be given a blood thinner (anticoagulant) to keep your blood from clotting.

After the patient is connected to the heart-lung machine, the heart is stopped and cooled. An incision is then made in the heart or aorta, depending on which valve needs to be repaired or replaced.

Once the surgeon has completed the repair or replacement, the heart is restarted and the patient is disconnected from the heart-lung machine.

After the operation, the patient will remain in the intensive care unit for one or two days, where the functioning of his or her heart will be constantly monitored.

The average postoperative stay is 5 to 8 days in the hospital, while full recovery from surgery can take from a few weeks to 2 months, depending on the patient's situation before the operation.

In some exceptional cases, a valve repair may not be effective and another intervention may be necessary.

Patients with a biological valve may need to have it replaced at 15 or 20 years of age. Mechanical valves can also fail, so patients should warn their doctors if they have symptoms of valve failure.

Patients who have a mechanical valve must take anticoagulants for the rest of their lives. Since these medications increase the risk of internal bleeding, these patients should always inform their doctor or dentist that they are taking a blood thinner. Even if you are not taking anticoagulants, you should always inform your physician and dentist that you have had valve surgery, because if you must have a surgical or dental procedure, you will need to take an antibiotic prior to the procedure.if bacteria get into a repaired or artificial valve, they can cause a serious condition called bacterial endocarditis.

Patients who have mechanical valves sometimes hear a slight 'click' in the chest. It's just the sound the new valve makes when it opens and closes, and it's not something to worry about. In fact, it is an indication that the new valve is working properly. 

Where do we do it?

IN NAVARRA AND MADRID

OUR MEDICAL TEAM

Specialists of the Department of Cardiac Surgery

The Cardiac Surgery Department of the Clinic is backed by its extensive experience of more than 50 years. It is a pioneer in the introduction of the most complex procedures and the most avant-garde techniques.

Our surgeons are specialists trained in international reference centers, which combine the application of the latest techniques with personalized treatment to our patients.

We also have a team of highly specialized nurses, both in surgical and clinical aspects.

Treatments we perform

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Why at the Clinica?

  • Pioneers in advanced procedures and techniques.
  • Implantation of the first total artificial heart in Spain in 2016.
  • Specialists trained in international centers of reference at national level.

Safer than ever to continue taking care of you

We update safety protocols weekly with the latest scientific evidence and the knowledge of the best international centers with which we collaborate.