Your operation involves repairing or replacing a damaged valve in your heart with a mechanical valve (made from synthetic materials) or a tissue valve (usually bovine or porcine in origin).
Heart valves open and close to allow the blood to flow in and out of the four chambers of the heart in the right direction. If they are damaged (through infection or disease) they will either not open properly or not close tightly enough and leak. Both problems mean the heart has to pump harder. A repair of your valve or a new valve relieves the strain on the heart and aims to ease symptoms such as breathlessness and chest pain.
The severity of the valve disease is based on physical examination and the echocardiographic findings. The indications for intervention are based on the following:
- the presence or absence of symptoms,
- the severity of valvular dysfunction,
- the response of the heart to he presence of valvular disease (dilatation, hypertrophy, failure),
- the effect on the pulmonary or systemic circulation, and
- the changes in heart rhythm.
All patients with heart valve disease are assigned to one of the new 4-stage.
- A (at risk)
- B (progressive)
- C (asymptomatic severe)
- D (symptomatic severe)
The operation typically requires a hospital stay of 5-7 seven days and is done under general anaesthesia. This means you will be asleep during the procedure. Once the anaesthetic has taken effect, your surgeon will make a cut (traditionally about 25cm long, mini sternotomy about 10-12cm long), down the middle of your breastbone and open the ribcage to reach the heart. The heart is slowed or stopped (using medication) and blood is re-routed to a heart-lung machine. This takes over the pumping action of the heart and lungs, adding oxygen to the blood and maintaining the circulation.
Your surgeon will open the heart chamber and repair your valve or alternatively sew in a new replacement. Blood is then redirected back to your heart and the heart is restarted. The breastbone is re-joined using wires and your chest is closed using dissolvable sutures, stitches or staples. The operation usually takes about 2-3 hours.
Tricuspid valve repairs
The preferred treatment for mitral valve disease is to repair the damaged valve; it is important choose a surgeon who has specialist expertise in performing this procedure. The advantages of repairing the valve are significant and include improved life expectancy, avoidance of long-term anticoagulation (use of blood thinners), and better preservation of natural heart function.
We use various techniques to achieve a successful tricuspid valve repair. Sometimes we perform more complex reconstruction of the valve leaflets and need to use sutures (GoreTex neochords) to provide additional support to the valve.
After fixing a leaflet, a special ring is implanted around the valve to provide additional support. This is called an annuloplasty ring and it reinforces the annulus of the valve. The annulus is the frame of the valve and has a similar role to a door frame in supporting a door. The rings are specially designed for the tricuspid valves to help “restore” the base of the valve.
Biological valves for tricuspid vale replacement
There are a variety of biological valves which can be used for tricuspid valve replacement. Most are made from cow or pig tissue. The main advantage of this type of valve is that it is associated with a low risk of blood clot formation which if occurs, can cause the valve to malfunction or cause a stroke. The key disadvantage is that these valves have a limited durability as compared with mechanical valves. In other words, they will wear out given enough time.
Mechanical valves for tricuspid valve replacement
There are a number of excellent mechanical prostheses available today. All perform equally well. The principle advantage of mechanical valves is their excellent durability, made from carbonised metal they simply do not wear out! Their main disadvantage is that blood cells are likely to form clots on the surface of the metal. If this happens the valve will not function normally. Patients with these valves must therefore take anticoagulants (blood thinners) for life. There is also a small but definite risk of blood clots causing stroke, even when taking anticoagulants.
Links:These, like any other published guidelines & evidence, do not and should not override the individual responsibility of healthcare professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient’s guardian or carer.
- ACS Evidence – Valves: Peer review evidence base library.
- 2021 European Guidelines on the Management of Heart Disease
- 2020 AHA/ACC Guidelines for the management of patients with valvular heart disease
- Echocardiographic approach to the decision-making process for tricuspid valve repair. Roshanali F, Saidi B, Mandegar MH, Yousefnia MA, Alaeddini F. J Thorac Cardiovasc Surg. 2010 Jun;139(6):1483-7.
- Which patient undergoing mitral valve surgery should also have the tricuspid repair? Bianchi G, Solinas M, Bevilacqua S, Glauber M. Interact Cardiovasc Thorac Surg. 2009 Dec;9(6):1009-20.
- Long-term outcomes of tricuspid valve replacement in the current era. Filsoufi F, Anyanwu AC, Salzberg SP, Frankel T, Cohn LH, Adams DH. Ann Thorac Surg. 2005 Sep;80(3):845-50.
- The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Rogers JH, Bolling SF. Circulation. 2009 May 26;119(20):2718-25. Review.