Frequently Asked Questions About Valve Replacement Surgery

What is heart valve replacement or repair surgery? Valvular heart disease can be treated with heart valve repair or replacement surgery. Heart valves that are damaged or diseased may not function properly. Valvular stenosis and valvular insufficiency (regurgitation) are two conditions that can lead to heart valve dysfunction. When one (or more) of the heart's valves becomes stenotic (stiff), the heart muscle must work harder to pump blood through the valve. Infection (such as rheumatic fever or staphylococcus infections) and congenital heart defects (structural heart problems) are two causes of stenotic heart valves. When one or more valves fail (leak), blood leaks backwards, resulting in less blood being pumped in the proper direction. Based on the child's symptoms and overall heart condition, The doctor may decide that the diseased valve(s) should be repaired or replaced surgically.

Traditionally, valve replacement surgery success rate has required open-heart surgery, in which the chest is opened in the operating room and the heart is temporarily stopped so that the surgeon can repair or replace the valve(s). The breastbone, or sternum, is cut in half and spread apart to open the chest. Once the heart has been exposed, large tubes are inserted into it so that blood can be pumped through the body by a cardiopulmonary bypass machine (heart-lung machine) during the surgery. Because the heart is stopped and kept still while the surgeon performs the valve surgery, a bypass machine is required to pump blood.

How valve replacement surgery is done?

A review of basic heart anatomy and valve function follows to help you understand how valvular heart disease affects the heart.
The heart is a muscle-tissue pump. The heart is composed of four pumping chambers: two upper chambers known as atria and two lower chambers known as ventricles. The right atrium pumps blood into the right ventricle, which then sends blood to the lungs, where wastes like carbon dioxide are expelled and oxygen and other nutrients are absorbed.
Blood flows back into the left atrium from the lungs, is pumped into the left ventricle, and then is pumped through the aorta to the rest of the well as the coronary arteries. When the atria contract, the ventricles relax to allow blood to flow from the atria. When blood from the atria enters the ventricles, the atria relax and the ventricles pump the blood to the lungs and the rest of the body.

What are the reasons for, and risks associated with, heart valve repair or replacement surgery?

  • Valve repair or replacement surgery is used to repair or replace one or more diseased heart valves.
  • There could be other reasons why the doctor recommends heart valve repair or replacement surgery for the child.
The following are some of the potential risks associated with heart valve repair or replacement surgery:

  • Bleeding during or following surgery
  • Blood clots that can lead to a heart attack, stroke, or lung disease
  • Infection at the site of the incision
  • Pneumonia
  • Breathing difficulties
  • Arrhythmias are irregular heartbeats.
  • Other risks may exist depending on the child's specific medical condition. Before the procedure, make sure to discuss any concerns with his or her doctor.
What is causing my heart valve replacement surgery and pacemaker ? 

Is it an ischemic condition, a degenerative condition, rheumatic disease, an infection, heart muscle dysfunction, or something else? Is it Barlow's Disease if it is degenerative? The type of disease you have determines the level of expertise required to treat it. To maximise the likelihood of a repair for Barlow's Disease, Infections, and Rheumatic Disease, you will generally need a highly experienced repair team. 

How long does valve replacement surgery last? 

It is not sufficient to inquire about your surgeon's overall repair rate. You'll need to know his or her success rate for the specific problem you're dealing with. A surgeon may be successful in repairing 90% of all valves, but only 50% of Barlow valves may be repaired. You should proceed with a repair only if the surgeon believes he or she can guarantee a successful outcome, especially if you are asymptomatic.

what happens after valve replacement surgery?

A hospital stay is required for heart valve repair or replacement surgery. Depending on the child's condition, the procedure may differ.

In general, heart valve repair or replacement proceeds as follows:

  • The child will be asked to take off any jewellery or other objects that could interfere with the procedure and to put on a gown.
  • Prior to the procedure, the child will be asked to empty his or her bladder.
  • An IV line will be inserted into the child's arm or hand.
  • The child will be lying on his or her back on the operating table.
  • During the procedure, the anesthesiologist will continuously monitor the child's heart rate, blood pressure, breathing, and blood oxygen After the child has been sedated, a breathing tube will be inserted through his or her throat into the lungs and connected to a ventilator, which will breathe for the child during the surgery.
  • Additional catheters will be inserted in the child's neck, top of the leg (groyne), or wrist to monitor the child's heart and blood pressure and to collect blood samples. To drain urine, a catheter will be inserted into the child's bladder.
  • An antiseptic solution will be used to clean the skin around the surgical site.
  • From just below the Adam's apple to the end of the breastbone, the doctor will make an incision (cut) down the centre of the chest.
  • The sternum (breastbone) will be split in two.with a special operating instrument. The doctor will separate and spread apart the two halves of the breastbone to expose the heart.
  • The heart must be stopped to allow the doctor to perform the delicate procedure of valve repair or replacement. A cardiopulmonary bypass machine pumps blood through the body via tubes inserted into the heart.
  • The heart will be stopped by injecting it with a cold solution once the blood has been completely diverted into the bypass machine for pumping.
  • In the case of a valve replacement, the doctor will perform the procedure after the heart has stopped by removing the diseased valve and inserting the artificial valve. In the case of a valve The procedure used to repair the valve will depend on the type of valve problem present, such as separation of fused valve leaflets, repair of torn leaflets, and/or reshaping of valve parts to ensure better function.
  • The blood circulating through the bypass machine will be allowed to reenter the heart after the procedure is completed, and the tubes to the machine will be removed.
  • Temporary pacing wires may be inserted into the heart. If necessary, these wires can be connected to a temporary pacemaker to help the heart rhythm during the initial recovery period.
  • Small wires will be used to sew the sternum back together.
  • The sternum skin will be sewn back together. Sutures or surgical staples will be used to close the incision.
  • Tubes will be inserted into the child's chest in order to drain blood and other fluids from the area around the heart. To drain fluids away from the heart, these tubes will be connected to a suction device.
  • To drain stomach fluids, a tube will be inserted through the child's mouth or nose into the stomach.
  • A bandage or dressing will be placed on the wound.

What happens during valve replacement surgery?

Following surgery, the child will be transferred to the cardiovascular intensive care unit (CVICU) where he or she will be closely monitored for several days. The child will be hooked up to monitors that will display his or her electrocardiogram (ECG or EKG) trace, blood pressure, other pressure readings, breathing rate, and oxygen level at all times. A hospital stay of several days or longer is usually required for heart valve repair or replacement surgery.

The child will most likely have a tube in his or her throat so that a ventilator (breathing machine) can assist breathing until the child is stable enough to breathe on his or her own. As the child awakens from anaesthesia, he or she becomes more alert. When the child is able to breathe independently, the breathing machine will be adjusted to allow the child to do more of the breathing. The breathing tube will be removed once the child is awake enough to breathe completely on his or her own and is able to cough. The stomach tube will almost certainly be removed at this time as well.
A nurse will assist the child in coughing and taking deep breaths every two hours after the breathing tube is removed. This will be painful due to soreness, but it is critical to do so to prevent mucus from collecting in the lungs and possibly causing pneumonia.
Pain medication is given to children who are in pain. A nurse will demonstrate to the child how to tightly hug a pillow. Against their chest while coughing to help ease the discomfort.