Valve Surgery – Repair, Replacement,
Each of the four heart valves—mitral, aortic, pulmonary, and tricuspid—plays an important role in regulating blood flow through the heart.
Healthy heart valves are needed for good heart functioning. If valves are leaky, narrowed, or floppy, surgery for heart valve repair, replacement, or transplant may be necessary.
Heart valve replacement with mechanical valves or ones made from tissue used to be the chief option for a diseased valve. While replacement is still a good treatment for some patients, heart valve repair is now often a better choice for many. Heart valve transplants also are appropriate for certain patients.
At the only hospital-based valve center in the Philadelphia area, the specialists of the Porter Institute for Valvular Heart Disease have broad knowledge and experience in valve surgery. We are committed to using the best techniques for superior patient results, so nearly all valve surgeries are performed as minimally invasive procedures to avoid cutting the breast bone and prevent putting the patient on a heart-lung machine during surgery.
When possible, our valve surgeons repair heart valves rather than replace them with mechanical or tissue valves. Saving a valve through surgical heart valve repair helps the heart function more efficiently. Heart valve repair also improves long-term survival and has a lower risk of causing blood clots or infection. Because there is no replacement valve, tissue rejection is avoided. So, too, is the need to take blood-thinning medication (especially important to women in their childbearing years).
Some of the most common heart valve repair procedures include:
- Mitral valve repair
The mitral heart valve may be abnormal from birth, or become abnormal due to aging or rheumatic heart disease, infection, or a left ventricular dysfunction. These conditions may cause mitral valve leakage (regurgitation), narrowing (stenosis), or a combination of both. At the Porter Institute for Valvular Heart Disease, more than 96% of patients with mitral valve regurgitation, or leakage, undergo successful heart valve repair, compared to a 44.3% national average. Most patients with mitral valve stenosis undergo valve replacement.
- Aortic valve repair
Aortic valve repair is used to correct some aortic heart valve disorders. It is an alternative to replacement. Aortic heart valve repair is performed less often and is more technically difficult than mitral heart valve repair.
Patients needing heart valve replacement choose between mechanical or tissue valves. That decision may depend upon health condition, age, lifestyle, and other factors:
- Mechanical heart valve replacement
These valves are designed to replicate the function of natural valves. In patients with leaky valves, mechanical replacements prevent regurgitation of blood as it pumps through the chambers of the heart. Mechanical valves are stress-tested to last 200 years. These valves can be heard clicking as they function. All mechanical heart valves require lifelong treatment with a blood thinner, such as warfarin. This blood-thinning, or anticoagulation, therapy requires monitoring with monthly blood tests. Currently, the Porter Institute for Valvular Heart Disease is participating in a large, national multi-center research study evaluating the effects of maintaining the newest generation of mechanical valves without anticoagulation therapy.
- Tissue heart valve replacement
Valves created from animal tissue are usually made from cow or pig heart valves or pericardial tissue. The tissue is treated to prevent rejection and calcification, which can stiffen the valve. Tissue valves are quiet. Patients with tissue valves do not need to take blood thinners. Because they are biological, tissue valves wear out. Tissue valves last an average of 15 years before they need replacement.
Some patients may be able to receive valve transplants using human or animal valves:
- Transplant with human heart valves
Homograft heart valves, from human aortas, are also known as human tissue or cadaver heart valves. The benefit of using these valves as transplants is that they pose little or no risk of rejection and patients do not need to take blood thinners. It is believed that the Porter Institute for Valvular Heart Disease has the largest homograft bank on the East Coast.
- Transplant with stentless porcine (pig) heart valves
These aortic heart valve substitutes are also true heart valve transplants. Unlike human heart valves, stentless porcine valves are preserved in gluteraldyhyde and are not living. They have a "heavy" feel which often limits their applicability to large hearts. Longevity for all tissue heart valves remains under investigation, but they can function for 15 to 20 years.
For all valve surgeries, patients at the Porter Institute for Valvular Heart Disease benefit from leading-edge technology and equipment. Our team is specially trained and highly experienced in many advanced surgical techniques, including:
- Heart valve repair and reconstruction
For expertise on valve surgery, contact the specialists at Abington’s Pilla Heart Center and Porter Institute for Valvular Heart Disease.