Common Tests and Therapies

WHAT’S NEW IN VALVE REPLACEMENTS?

Transcatheter Aortic Valve Replacement (TAVR) is a newer, minimally invasive procedure for treating faulty aortic valves. This technique inserts a catheter into the groin artery or under the left breast and pushes it to the heart. The tip of the catheter has a deflated balloon with a folded replacement valve around it. Once the valve is in place, the balloon is inflated to expand the new valve so it fits snugly within the old valve. Then the balloon is deflated and removed along with the catheter.

Generally reserved for patients at high risk to undergo valve replacement surgery, these procedures tend to result in shorter hospital stays, ranging from three to five days, as opposed to five or more days for traditional heart valve surgery. Recovery time also tends to be shorter, from two to four weeks compared with six to eight weeks for traditional surgery.

Interventions and Surgeries

High-tech imaging and testing may reveal that one or more parts of your heart are in need of a surgical repair. This often feels like a big step, and a scary one. Although there is risk with any medical procedure, thanks to technological and medical advances, millions of people who have undergone heart procedures are living long, full lives. Here are some of the options your doctor may discuss with you:

Valve Surgery

Valve surgery involves a repair or replacement, and can prevent lasting damage to your heart and sudden death.

A heart with proper function has four valves that keep the blood flowing in one direction only. They open and close, causing the “heartbeat” sound. These are the two most common valve problems that may require surgery:

Stenosis, when the heart valve “doors” or “leaflets” thicken, stiffen, or become fused and prevent adequate blood flow through the valve. Surgery can open or replace the valve.
Regurgitation, when the leaflet doesn’t close properly, allowing blood to leak backward. Surgery repairs or replaces the faulty valve.

Considerations

Your doctor will consider a few factors to determine if heart valve repair or replacement surgery is necessary, including the severity of the valve disease; your age and general health; and whether you need heart surgery for other conditions, such as coronary artery bypass surgery, that can be done simultaneously.

How it Works

Valve Repair: Valve repair comes with fewer risks of complications and is therefore the preferred option over replacement. In this scenario, valve surgeons rebuild the valve so it works correctly.

Balloon Valve Repair: A balloon valvuloplasty is a less-invasive valve repair for stenosis. A surgeon inserts a catheter with a balloon at its tip through a blood vessel to the faulty valve in the heart. The doctor inflates the balloon to widen the valve’s opening. It is then deflated and removed along with the catheter. Balloon valvuloplasty patients typically have a shorter recovery time than surgery, but although effective at treating the symptoms of heart valve disease, it may not cure it. This also doesn’t work as well for adult patients with aortic valve stenosis.

Valve Replacement: If a repair is not an option, a surgeon may need to replace the valve. He or she will remove the damaged valve and replace it with either a biological valve constructed of human or animal tissue, or a mechanical valve made of plastic, carbon, or metal. There are trade-offs with each type: Biological valves generally last from 10 to 20 years, but then require replacement; mechanical valves generally don’t need replacement, but patients must take blood-thinning medications for life to prevent blood clots from forming on the valve.

Angioplasty

Angioplasty—with or without a stent—may be an option for patients who are unable to reduce the effects of plaque buildup in the arteries through medication and lifestyle changes alone. This simple, less invasive, nonsurgical procedure involves the insertion of a tiny “balloon” in the coronary artery that is inflated at the blockage site to compress the plaque and stretch open the artery.

Considerations

Often seen as a possible treatment short of coronary artery bypass surgery, angioplasty does not require the doctor to make an incision or put you under anesthesia. Recovery time is shorter. If stents are used, they may turn out to be a temporary solution and also carry risks of blood clots.

How it Works

Depending on your condition, one or more stents—small wire mesh tubes put over the balloon catheter—may be implanted to keep the artery open and reduce re-narrowing. When the balloon is inflated, the stent expands and locks in position to help keep the artery open. Stents coated with medicine to prevent the artery from re-narrowing may also be used.

The procedure is often performed using an artery in your arm or groin called the femoral artery. A local anesthetic is usually injected into the area where the balloon catheter is inserted, and the patient’s heart rate and rhythm are monitored through small electrode pads placed on the chest. The entire process usually takes anywhere from 30 minutes to several hours, depending on the type and amount of blockage.