Sometimes your doctor may tell you that you have a small leak in one of your heart valves. It's normal to feel a little scared and worried when you hear something like this. But don't worry, today we'll talk about this condition and the special surgery that is performed for it, Aortic Valve Repair. What exactly is this? How is it done? What are the pros and cons? We'll talk about all this very simply, in a way that you can understand.
What is Aortic Valve Repair?
Simply put, this is a type of heart surgery. This surgery is done to make the "door" between the main blood vessel (aorta) that carries blood from our heart to the rest of the body and the heart work properly. We call this door the aortic valve. To be precise, this is a valve. This valve opens and closes every time the heart beats, controlling the flow of blood.
Imagine what happens if you can't close a door in your house properly? Similarly, when this valve is damaged, it doesn't open or close properly. In some people, this valve starts to leak. Medically, we call this aortic regurgitation . What happens in this case is that because the valve doesn't close completely, some of the blood that should go to the body leaks back into the heart. What happens then? The heart has to work harder to pump the amount of blood the body needs. When this happens over time, the heart can be damaged.
It is only when the valve leaks severely and symptoms appear that doctors recommend surgery to repair or replace the valve.
In most cases, the valve is replaced with a new one. However, some patients may benefit greatly from having their valve repaired. Surgeons make this decision on a case-by-case basis. Your doctor will consider many factors, including the shape of your valve and the extent of damage, to determine whether a valve repair or replacement is best for you.
What happens before the surgery?
The most important thing when preparing for surgery is the tests that are done beforehand. The surgeon wants to make sure that your valve is actually in a state where it can be repaired. If some parts are severely damaged, it may be better to replace the valve with a new one rather than repair it. There are several key tests that you will need to have done to help you with this.
| Test | Simply put... |
|---|---|
| Transesophageal Echocardiogram (TEE) | Passing a small camera through the esophagus to obtain very clear, close-up images of the heart and valves. |
| Cardiac Catheterization | A test to check for blockages in the blood vessels leading to the heart. |
| Chest X-ray | Checking the general condition of the heart and lungs. |
| CT scan | Obtaining detailed 3D images of the heart and major blood vessels. |
| E.C.G. (EKG/ECG) | Recording the electrical activity of the heart. |
| Blood and urine tests | Checking the overall health of the body and the functioning of organs such as the kidneys. |
Your doctor will give you clear instructions on how to prepare for surgery. It is very important to follow those instructions exactly. If there is something you do not understand, ask again. These instructions may include things like:
- The time to stop eating and drinking before surgery.
- What medications do you usually need to temporarily stop taking?
- Time to come to the hospital for surgery.
- Things to bring to the hospital and things to leave at home.
How is the surgery done?
This surgery is usually done as open-heart surgery , which means a single long incision is made in the middle of the chest. However, in some cases, it can also be done as minimally invasive surgery , which involves only a few small incisions in the chest. Your surgeon will explain to you which method is best for you.
Here are the steps in which the surgery usually takes place:
1. First, you will be given anesthesia to put you into a deep sleep so that you will not feel any pain during the surgery.
2. Next, the surgeon makes an incision or several incisions in the chest to reach the heart. This may be a six-inch incision (sternotomy) made through the middle of the breastbone (sternum). Or it may be a two- to four-inch incision that is made without opening the chest completely.
3. You will then be connected to a heart-lung machine (`(heart-lung machine)`) . This machine will do the work of your heart and lungs during the surgery.
4. Now comes the important part. The surgeon will repair the valve according to your needs. This can be done using various techniques. For example, they can perform an annuloplasty, which strengthens the ring around the valve and makes it close tightly. Or they can change the shape of the valve leaflets, or graft tissue to replace torn areas or holes.
5. While the valve is being repaired, if there are other problems, such as aneurysms (bulging of the walls of the main blood vessel), they are also repaired during this surgery.
6. After all necessary repairs are completed, the surgeon will close the incisions. You will then be transferred to a special unit to recover.
What are the benefits and risks of this surgery?
As with any surgery, there are benefits and risks. It's important to discuss these openly with your doctor.
| Benefits | Risks |
|---|---|
| Being able to preserve one's own valve: This is the biggest advantage. This avoids the risks associated with inserting an artificial valve. | Reoperation required: Reoperation or valve replacement may be necessary if the repaired valve leaks again, becomes infected (endocarditis), or does not work as expected. |
| No need for blood thinners: In most cases, you will not need to take blood thinners (anticoagulants) for the rest of your life. | Abnormal heartbeat: irregular heartbeat (arrhythmia). |
| Restoration of heart function. | Common surgical risks include bleeding, anesthesia allergy, heart attack, stroke, and heart failure. |
Not everyone is at the same risk. People with other health problems, such as severe heart disease, may be at slightly higher risk before surgery. So talk to your doctor about your risks and understand them.
How long does it take to recover?
You will need to stay in the hospital for 3 to 7 days after surgery. It may take about 4 to 8 weeks to fully recover and return to normal activities. If you had minimally invasive surgery, your recovery time may be shorter.
It is normal to feel tired for a few weeks. So take it slow and listen to your body. Don't try to do too much at once. Your doctor will tell you when you can drive or go to work. Participating in a cardiac rehabilitation program (`(Cardiac Rehab)`) can help you recover safely and get used to a healthy lifestyle.
When to see a doctor immediately
After you go home after surgery, you should seek medical advice immediately if you develop any symptoms of a complication. Watch out for these symptoms:
- Chest pain or tightness.
- Pus or fluid draining from the surgical incision, swelling, or redness.
- Fever or feeling cold.
- Feeling like your heart is beating fast (`(Heart palpitations)`).
- Swelling of the legs or feet (edema).
- Weight gain of more than 1.5 kg within a week.
If you have any of these symptoms, call your doctor immediately. If necessary, go to the Emergency Department (ETU) of the nearest hospital.
Aortic valve repair is not as common a surgery as aortic valve replacement. Since this is a highly specialized surgery, it is best to choose a hospital with experienced surgeons who frequently perform this type of surgery.
Take-Home Message
- Aortic valve repair is a specialized surgery that repairs a leaky heart valve.
- The biggest advantage of this is that you get to preserve your natural valve, so you can avoid having to take blood-thinning medication for the rest of your life.
- It takes time to recover. It is very important to follow the doctor's instructions exactly and to participate in cardiac rehabilitation programs.
- Talk openly with your doctor about any questions or fears you have about the surgery.
- Be aware of the warning signs that may occur after surgery. If any such signs appear, seek medical advice immediately.
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