Technological advances have produced greater precision and accuracy in diagnosing and treating heart valve disorders. Newer imaging techniques can scan the heart and identify specific problems affecting the cardiac valves and other structures. Newer, less invasive surgical techniques have also evolved that employ voice-activated computers, robotic devices to manipulate instruments inside the body, endoscopic ("keyhole") access to the heart, and space-age technology that minimizes extraneous movements.

Many of these advances are especially suited to heart valve surgery and can be used to repair an existing valve or replace it with a substitute valve prosthesis. The growing number of available surgical procedures allows patients to benefit from the specific surgical intervention that is best suited to their needs. Many of these new techniques also promote faster recovery from surgery. As with any cardiac procedure, a careful evaluation of the valve leaflets and surrounding tissue is performed before the surgeon selects the best operative technique for the patient.

What is the difference between heart valve repair surgery and heart valve replacement surgery?
A heart valve repair can be performed on a valve that is too narrow to allow sufficient blood to flow through the valve opening (stenosis) or on a valve that cannot close tightly enough to prevent back flow of blood (insufficiency). The mitral valve is especially suited to reparative techniques because its component parts — any of which may be the cause of the valve’s malfunction — often can be repaired.

Repair of a stenotic valve may involve cutting or separating the valve leaflets, or other components, to widen the valve opening. Repair of an insufficient valve may be achieved by narrowing or shortening the supporting structures to allow the valve to close tightly, or by inserting one of a variety of prosthetic rings to reshape a deformed valve.

The terms annuloplasty and valvuloplasty are often used to categorize the type of repair. An annuloplasty describes a procedure performed on the valve annulus, the ring of tissue that supports the valve leaflets. A valvuloplasty is a broad category that refers to reconstructing one or more components of the valve; the leaflets, annulus, chordae tendineae and/or papillary muscles that anchor the leaflets to the heart wall. For example, excess leaflet tissue can be removed or a dilated annulus can be made smaller with stitches.

In addition to the surgical procedures, percutaneous balloon valvuloplasty is a non-surgical treatment option that is performed for heart valve stenosis. This procedure is performed in the cardiac catheterization laboratory by cardiologists trained in adult and/or pediatric valve procedures. The cardiologist threads a balloon-tipped catheter through a large artery into the narrowed valve opening. The balloon is inflated, thereby enlarging the valve orifice.

 A heart valve replacement is performed when a diseased valve that cannot be repaired is removed and replaced with a substitute mechanical or biological valve. (See the tables for a description of commonly used mechanical and biological valves.)   Mechanical valves are constructed of durable materials such as Dacron, titanium, and pyrolytic carbon; they are very sturdy and can be expected to last a lifetime. Mechanical valves require the long-term use of anticoagulation medication to prevent formation of blood clots on the valve prosthesis.

Biological valves are made of tissue taken from pigs, cows or human donors. Often they do not require anticoagulation medication, but their durability is not as long lasting as mechanical valves. Biological valves are recommended for elderly patients, or for individuals with bleeding disorders, for patients with anticipated difficulty taking anticoagulation medication. Biological valves may be more suitable in women of childbearing age because the anticoagulant medication commonly taken for mechanical valves crosses the placental barrier and may affect the fetus. Many factors relating to the individual patient and to the specific valve problem are considered in selecting either a mechanical or biological valve.

Another biological valve substitute is an allograft, which refers to tissue from one person’s body that is placed in another person. Allografts (formerly known as homografts) are procured under sterile conditions in an operating room from cadavers that have no history of communicable disease, malignancy, diabetes, hypertension, hyperlipidemia, or previous open heart surgery. Allografts are assessed for proper function, measured, treated with antibiotic solution, and frozen in a bag surrounded by liquid nitrogen for long term storage. When needed for surgery, the appropriate size graft is selected, thawed and implanted.

Allografts have excellent hemodynamics.  (Their function resembles that of natural valves.) They rarely create blood clots and have a lower incidence of postoperative infection. They are especially suitable for young women and children, and they may be advantageous for patients with recurrent inflammation of the heart wall (called endocarditis). Tissue failure can occur (as with any biologic valve replacement surgery), but the onset is rarely sudden and does not progress rapidly, as compared with biologic (or mechanical) valves.

Another form of biologic valve replacement is accomplished with autografts. Autografts refer to tissue from the patient’s own body. Tissue is removed from one location and placed in another location. For example, a patient’s pulmonary valve may be removed and used to replace the patient’s diseased aortic valve. This a commonly known as the Ross Procedure. An allograft then is used to replace the excised pulmonary valve. This procedure may be performed when the surgeon decides that using the patient’s own tissue for the aortic surgery will achieve the most effective outcome. Because autografts are the patient’s own tissue, they do not have to be specially treated.

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