Cardiac valve surgery

If the valves of your heart fail

For the atriums and chambers of the heart to pump the blood always in the proper direction, the four cardiac valves serve as one-way flaps and prevent a return flow of the blood in the wrong direction. Each half of the heart has one atrioventricular valve and one semilunar valve. The atrioventricular valves are located between atrium and chamber and are called mitral or bicuspid valve (left heart) and tricuspid valve (right heart).
The semilunar valves located between chamber and outlet vessel are called aortic valve (left heart) and pulmonary valve (right heart). The cardiac valves consist of fine and highly elastic connective tissue. Each cardiac valve opens and closes about 120,000 times in just one day.

Heart with its 4 cardiac valves

For the optimal functioning of the heart's pumping performance each cardiac valve needs to properly open and close depending on the respective cardiac phase. If this is not the case, there is a valvular insufficiency. Basically, we distinguish between two types of valvular insufficiencies. In case of a narrowing (stenosis) there is not enough blood flowing through the valve and thus part of it is retained in the upstream heart section. If there is a leakage (insufficiency) of the cardiac valve, part of the blood that was pushed inside will flow back to behind the cardiac valve.

There are various causes for valvular insufficiencies. Congenital valvular insufficiencies, for instance, might be produced by the effects of harmful substances during pregnancy or owing to certain diseases the pregnant woman contracted in the course of pregnancy (e.g. German measles or diabetes mellitus). Moreover, certain genotype defects may lead to congenital valvular defects. Acquired valvular insufficiencies might develop, for example, after suffering a heart attack, after an inflammation of the heart muscle (myocarditis) or of the lining membrane of the heart (endocarditis), or due to calcifications or tumour formations. About 99% of the valvular heart diseases are acquired valvular insufficiencies.

When the one-way flap function of the valves is impaired such that a retention or a return of the blood occurs, our heart must do extra work to maintain the required blood flow. The increased burden on the heart's walls and the heart muscle may result in a cardiac insufficiency (weakness) and in cardiac dysrhythmia, which in severe cases might lead to cardiac failure. The reduced circulatory performance leads to excessive fluid accumulations (edemas) in the body tissues, which might lead to symptoms such as respiratory obstruction, leg swelling or liver enlargement.

A cardiac valve surgery can restore the valve function

If medication alone fails to sufficiently relieve the heart, and if it is not possible to apply cardiological catheterisation (e.g. burst stimulation of the flaps in case of stenosed cardiac valves), a cardiac valve surgery will be required to restore the valve function of the cardiac valves. This surgery should be performed as early as possible, before the heart muscle is affected by irreversible impairments.

Fundamentally, there are two different surgical methods. The cardiac valve reconstruction restores the functional performance of the cardiac valve concerned by different surgical techniques. A valve reconstruction is performed differently depending on whether there is a narrowing or a leakage . Reconstructive surgery is mostly provided when there is a leakage of the mitral and tricuspid valve.

The applications of the valve reconstruction are limited by the type of disease. If the cardiac valve concerned is severely deformed or calcified, a corrective intervention will be virtually impossible.

Where the cardiac valve cannot be reconstructed, a cardiac valve replacement is the only alternative to restore the valve function. The defective cardiac valve is first removed and then replaced by a biological or artificial cardiac valve.

Cardiac valve replacement: biological or mechanical?

Biological cardiac valve prostheses are human or animal cardiac valves, which are conditioned by elaborate processes. Mostly the biological prostheses used for that purpose come from the cardiac valves of pigs or from the pericardium of, e.g.,.cattle. The biological cardiac valve has the advantage that the patient needs to take special anticoagulants (such as, e.g., Marcumar®) for approx. 8 weeks only. After this period a particular prevention of blood clots is no longer required, normally a medication with ASS is sufficient. The disadvantage is that biological cardiac valves have a limited functional capability. After about 8 to 15 years, owing to a calcification of the valve leaflets, you have to reckon with the necessity to have the biological cardiac valve exchanged in another surgery. Accordingly, this type of cardiac valve replacement is mainly performed in older patients (over 70 years) or in patients who must not take anticoagulants.

Biological cardiac valve

Mechanical cardiac valve prostheses are cardiac valves manufactured from the extremely durable material carbon. They are practically free from wear and consist of a valve ring and two crescent-shaped wings or a tilting disc. The virtually unlimited functional capability of the mechanical valve prostheses - lab tests showed that a mechanical cardiac valve perfectly works for about 100 years - is the huge advantage of this type of prosthesis. The disadvantage is that mechanical valves may cause blood clots (thrombi) due to the exogenous materials. That is why patients with a mechanical cardiac valve must take anticoagulants (such as, e.g., Marcumar®) for the rest of their lives.
For the correct intake of the anticoagulants the patient must regularly determine the so-called INR value, which gives an indication of the reduction of the normal blood clotting. INR self-testing is easily performed and can quickly be learned in our hospital's training courses for patients. Contrary to the biological prostheses the mechanical cardiac valve prosthesis emits a soft clicking noise with every heartbeat, to which the patient usually grows accustomed rather quickly.

Mechanical cardiac valves

Safety thanks to the most advanced medical equipment

A cardiac valve surgery is performed under general anaesthesia using the heart-lung machine. The cardiac surgeon reconstructs or replaces the cardiac valve at the arrested heart, while the heart-lung machine is keeping up the entire circulatory system. The anaesthetist monitors the patient's condition throughout the surgery by means of the most advanced equipment for the monitoring of artificial respiration and circulatory system. On average a cardiac valve surgery in the Schüchtermann-Klinik takes between 2 and 3 hours.

Cardiac valve surgery: safe and successful

In Germany every year around 20,000 patients receive a cardiac valve surgery. Meanwhile, cardiac valve surgery is a routine intervention. If the heart muscle is not yet seriously impaired by the stress and if the patient has no additional severe heart disease, the operative risk will be very small.

After successful cardiac valve surgery the quality of life will considerably improve in most of the patients and their life expectancy after surgery will equal that of healthy persons. Even a cardiac insufficiency that has existed previously will frequently heal in the course of the first year after surgery. Nevertheless, the long-term success of a cardiac valve surgery depends primarily on how much the heart and other essential organs have already been affected by the cardiac valve disease.

For information on catheter-based heart valve replacement, click here.