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Heart Valve Surgery
Minimal invasive techniques have been developed in the last 30 years due to the fact that heart valve surgery, that is, heart valve repair and replacement surgery, is performed by making a 35-40 cm incision in the bone of faith in the old routine open heart surgery and the complications are high and bone union is delayed. The practice of entering the heart, removing the heart valve and replacing it with a new valve for 50-60 years has provided great experience and allowed the development of new types of heart valves. Today, the successful application of minimally invasive (armpit minithoracotomy) techniques and advanced bileaflet (double-leaflet) metal and biological heart valves have greatly increased the success rate in these surgeries. The surgeries performed extend life by as high as 30-40 years.
Advantages of Heart Valve Surgery
All heart valve repair and replacement surgeries can be performed with minimally invasive (right armpit) techniques.
We have demonstrated the many benefits of this technique, which we first started in 1997 and published international scientific studies in 1999, 2001 and 2014. Among these benefits; The patient's early return to daily life. It is especially preferred by physically working patients. Other benefits include patients being discharged early, not having to protect their chest, being able to sleep on their side, having a very low risk of infection, and being able to drive a vehicle.
Advantages After Heart Valve Surgery
The benefits during the hospital period are; Complications such as bleeding and infection are few, the intensive care period does not exceed 24 hours, and the hospital stay is 4-5 days. The only disadvantage for the patient is that the early pain is slightly more than that of routine heart surgery. The reason is that the outer membrane of the lung is sensitive to pain. But after 8-10 hours, there is no pain. In heart surgery performed with this technique, the chest is entered through a right armpit minithoracotomy and the heart valve is accessed by connecting it to the heart-lung pump. Heart valves that are not excessively calcified can be repaired, or the valve can be removed and replaced with a metal or biological valve.
Its application, especially in patients without lung problems, not only reduces complications but also reduces the risk of heart surgery in case a second surgery is required later in life. Patients with valve repair can easily undergo open heart surgery when valve replacement is required after 15-20 years. This is another advantage that extends life.
What is a Heart Valve?
The heart consists of 4 chambers: the upper part, consisting of the right and left atria, and the lower part, consisting of the right and left ventricles. While the right side of the heart deals with dirty blood, the left side deals with clean blood. There are 4 valves in the heart. The valve between the left atrium and left ventricle of the heart mitral valvevalve between the right atrium and right ventricle tricuspid valve It is called. Valve through which blood passes from the right ventricle to the lungs to be cleared pulmonary valve The valve through which the cleaned blood spreads from the left ventricle to the body aortic valvetruck. The most important function of these valves in the heart is to ensure that blood flows in the right direction and does not leak back. The most common heart valve diseases include heart valve stenosis and heart valve failure. The heart valve surgery process should be evaluated.
Article Content
Complaints of Heart Valve Patients
Diagnosis of Heart Valve Diseases
Causes of Heart Valve Diseases
Symptoms of Heart Valve Diseases
Stenosis in the Heart Valve
Heart Valve Insufficiency
Treatment Methods of Heart Valve Diseases
Heart Valve Repair
Heart Valve Replacement
Things to Consider After Heart Valve Surgery
1. Complaints of Heart Valve Patients
- Shortness of breath
- Palpitation
- arrhythmia
- Don't get tired easily
- In the future, edema, swelling and fluid accumulation in the legs and abdomen
- sudden fainting
2. Diagnosis of Heart Valve Diseases
The examination that should be performed in the definitive diagnosis of heart valve diseases is ultrasound, that is, echocardiography, of the heart. Afterwards, an opinion is made about having heart valve surgery.
3. Causes of Heart Valve Diseases
- Rheumatic heart valve disease, which is the most common disease and the most common cause, occurs especially in people who have had a lot of throat infections at a young age. The valves most commonly affected are the mitral valve, aortic and tricuspid valves. Defect of this heart valve may cause stenosis or complete melting due to calcification, causing failure. Sometimes it causes both stenosis and insufficiency. As a result of these situations, heart valve surgery can be used as a treatment method.
- Congenital causes are among the causes of the disease.
- Degeneration of heart valves due to aging is among the main causes
- Connective tissue diseases and disorders are also among the main causes of heart valve disease.
4. Symptoms of Heart Valve Diseases
Heart valve diseases are diseases that progress insidiously. The disease may not cause symptoms until it reaches a certain level. The main symptoms that occur due to stenosis or insufficiency in heart valve diseases are:
- Shortness of breath
- Palpitation
- arrhythmia
- Don't get tired easily
- In the future, edema, swelling and fluid accumulation in the legs and abdomen
- sudden fainting
5. Heart Valve Stenosis
Heart valve stenosis is a condition that occurs as a result of the narrowing of the opening in the valves, allowing less blood to pass than normal and causing the heart to work harder to send blood. Some structural defects seen in the leaflets of the valves can cause stenosis in the heart valve. As a result of insufficient blood passing through the valves, not enough blood can be sent to the body, and pooling may occur as a result of the pressure created by the remaining blood. These pools cause symptoms such as edema and swelling depending on where they occur. It is one of the reasons for heart valve surgery.
6. Heart Valve Failure
Heart valve insufficiency is a condition in which the valves cannot close completely and leak blood backwards. While not enough blood can be sent to the body as a result of blood leaking back, pooling may occur as a result of the pressure created by the accumulated blood. The function of each valve is different. However, especially when there is leakage and the valves cannot close completely, the symptoms are close to each other. Among these, palpitations, shortness of breath, not being able to breathe as you walk, called exertion dyspnea, not being able to make more effort, extreme fatigue, not being able to climb stairs, shortness of breath at night, waking up from bed at night, shortness of breath relieved by raising the pillow, a phenomenon called sleep dyspnea may occur. All these symptoms may occur in heart valve failure.
7. Treatment Methods of Heart Valve Diseases
Heart valve diseases must be treated because they can cause some heart problems such as heart enlargement and heart failure. Early diagnosis is very important in the treatment of heart valve diseases. However, it should not be forgotten that these diseases progress insidiously and sometimes do not cause symptoms. Therefore, it is extremely important to detect the disease at an early stage through examinations and apply the necessary treatment.
In the treatment of heart valve diseases, sometimes the valve is repaired with heart valve surgery and sometimes it is completely replaced with advanced techniques. This means that the heart valve is repaired or replaced with minimally invasive surgical techniques, with a small 4-centimeter incision on the side, under the arm, or, if the lungs are bad, with a small 4-5 centimeter incision in the front. The important thing is timely intervention, timely detection and preventing further damage to the heart.
8. Heart Valve Surgery Repair
Heart valve repair, in order to eliminate the problem in the patient's heart valve, if the condition of the valve is suitable, heart valve surgery should be preferred first. Because it is better for the patient to continue his life with his own valve than to have it replaced with an artificial heart valve. In cases where heart valve disorders are not severe, the heart valve can be repaired and treated.
In heart valve disease, some symptoms are required for the valve to be repaired. The most important of these are that the heart valve leaves are regular, there is no stenosis with heart valve leakage, there is no clot or roughness on the valve, the valve leaves can easily approach each other, or the valve leaves do not leak backwards when the stenosis can be opened. All these factors are evaluated. Repairing the valve, especially during surgery, is the first preferred method.
9. Heart Valve Surgery Replacement
Heart valve replacement is the replacement of the heart valve with biological or mechanical artificial valves, which is applied in cases where the patient's heart valve stenosis and insufficiency problems cannot be resolved by repair. In cases such as severe regurgitation or severe stenosis of the heart valves, sometimes both together, advanced calcification of the valve, clot in front of the valve, clot inside the heart, heart rhythm disturbance. heart valve surgery It may be necessary to replace the cover with . Mitral valve insufficiency, severe mitral valve stenosis, atrial fibrillation, and sudden rupture of the heart valve can be given as examples of these conditions.
10. Things to Consider After Heart Valve Surgery
One of the most important issues to consider after heart valve surgery is that patients use blood thinners regularly as recommended by the physician. While the use of blood thinners for biological valve replacement is 3 months, patients must use blood thinners for life in mechanical valve replacement. In addition, it is extremely important to protect the patient from infections. In cases such as surgical interventions that may be due to another disease, it is important for the patient to contact the heart doctor and take preventive measures against infection. However, regular physician checks should be performed to monitor the patient, heart and heart valve.
Prof. Dr. Academic Statements from Yavuz Beşoğul About Heart Valve Surgery
Heart valve surgery involves the repair and replacement of the heart valve. Thanks to the experience in heart valve surgeries over the last 60 years, artificial valves have been developed and have contributed to the development of surgical techniques. The most preferred metallic heart valves today have a double-leaflet carbometal structure and are long-lasting, although they require anticoagulants. In addition, biological valves made from bovine or porcine pericardium have been developed for those who cannot use anticoagulants, such as the elderly or patients considering pregnancy. Generally, mitral and/or aortic heart valves and sometimes tricuspid valves are repaired or replaced. These surgeries have been performed with sternotomy for many years. Due to the complications of sternotomy, heart surgeries began to be performed with anterolateral thoracotomy in the world in the 1990s, and access incisions gradually became smaller.
From Past to Present
In 1997, we first started performing our surgeries by converting them to subaxillary incision in our country and contributed to the national and international literature in series. In fact, although there is no difference in the surgical technique, the entry technique has proven to be advantageous from bleeding to infection and early return to daily life. It reduces complications, especially in patients with diabetes, rib cage disorders, kidney failure and obesity. In addition, the small size of the incision and its location on the side are also important from a cosmetic perspective.
On the other hand, the entrance site of the surgery provides excellent visibility and access, especially in terms of the exposure of the mitral, tricuspid and aortic valve. This is another factor that reduces complications. Since the rib spacing is different in terms of aortic and mitral valves, performing aortic and mitral valve, i.e. double valve, surgery may prolong the time and disrupt the chest structure and cause the ribs to break, which creates postoperative respiratory problems.
Briefly; Aortic and mitral valve (double valve) surgery should not be performed with this technique. In such cases, a frontal incision, that is, ministernotomy, is more useful and there is no entry site complication.
Heart Valve Surgery Technical Explanation
The patient is placed on the left side of the chest under double lumen intubation and general anesthesia; That is, an anterolateral thoracotomy position is given with the chest on the right side. A vertical 6 cm incision is made on the intersection of the subaxillary line and the right breast line, pectoralis major and pectoralis minor. without cutting the muscles It is dissected and a retractor is placed, the thorax is entered through the 3rd intercostal space for the aortic valve, and the 4th intercostal space for the mitral valve, and right lung ventilation is turned off or, if not tolerated, the tidal volume is reduced. The pericardium opens and its leaves hang on the chest wall. Aorta, right and left atrium are clearly seen. After returning the aorta with the pedicle, it is suspended and the aorta, right auricle, and right atrium are easily cannulated.
Operation
The patient is connected to the heart-lung pump, extra-corporeal circulation is transferred, ventilation is stopped and an x-clamp is placed on the aorta. Cardiac arrest is achieved by applying cold blood cardioplegia and topical cold saline. For the aortic valve, an incision is made at the aortic root and the aortic valve is clearly observed. After the repair or replacement is made, the aotomy is closed. If the intervention is made through the 4th intercostal space, that is, for mitral valve surgery, the left atrium is opened and the image of the mitral valve is clear. After the repair or replacement is made, the left atrium is closed. The patient is warmed, the heart is defibrillated if necessary, and after starting, the pump flow is gradually reduced and stopped. The heart is easily decannulated. After bleeding control, a single chest drain is placed in the thorax (the location of the drain is important to avoid pain), the ribs are brought closer, and the muscles, subcutaneous and skin are closed properly. Postoperative follow-up is the same.
While this intervention technique can be applied to any patient, it is only In some cases it should not be preferred. These :
- Those with advanced lung problems
- Those over 75 years of age,
- Double valve replacement (Aortic and Mitral) required,
- It should never be applied to patients requiring aortic valve surgery for the second time.
It is also an ideal method for second and third mitral valve surgeries and/or tricuspid valve surgeries.
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