Your heart has four valves, which are thin membranes that open and close to allow blood to flow properly. In a healthy heart, these valves work seamlessly. But in people with heart valve disease, heart valves may leak or allow too much or too little blood to flow. If you have a diseased heart valve and your provider recommends valve surgery, your heart is in good hands at Central Maine Heart & Vascular Institute. In addition to traditional open surgery, we offer three minimally invasive procedures for the treatment of valvular disorders.
About Heart Valve Surgery: Your heart’s four valves (tricuspid valve, pulmonary valve, mitral valve and aortic valve) manage the flow of blood through your heart. A diseased heart valve may allow regurgitation, which means it allows blood to leak back through the valve in the wrong direction. Or it may be afflicted with stenosis, which means the valve doesn’t open as well as it should, blocking blood flow. And when the mitral valve prolapses, that means it doesn’t close tightly.
If you have a diseased heart valve, your cardiologist may recommend heart valve replacement or repair. During valve surgery, your surgical team stops your heart with medication and uses a heart-lung machine to oxygenate and circulate your blood. Your surgeon removes the damaged valve and sews a new valve in place. The replacement valve may come from an organ donor, but more often a mechanical valve, made of plastic and metal, is used.
Sometimes diseased valves can be repaired – for example, if calcium deposits on the valve can be removed, the valve may be surgically reshaped, allowing it to close more effectively. If the valve opening is too big, it sometimes can be tightened with stitches. We offer both open-chest valve surgery, which requires a large incision through the breastbone, and minimally invasive surgery, which can be accomplished through small incisions in the chest.
Benefits of Minimally Invasive Surgery: Open-chest valve surgery has been used successfully in the surgical treatment of various heart-circulatory problems for decades. However, minimally invasive surgical treatment is now a preferable option for many patients. These surgeries are performed with high-tech thin instruments, miniature cameras and hybrid techniques.
Minimally invasive valve surgeries for adults are performed in surgical suites featuring sophisticated diagnostics, leading-edge technologies and state-of-the-art imaging capabilities. This environment combines the capabilities of an operating room and cardiac catheterization lab. Minimally invasive valve surgery techniques offer several advantages compared to open-chest procedures. They include:
- Faster recovery – Patients can usually return to work or other activities within two or three weeks, which is much quicker than open-chest heart valve surgery.
- Shorter hospital stay – Hospitalization time can be reduced by as much at 50%.
- Fewer complications – Because the breastbone (sternum) is not cut during minimally invasive surgery, chances for post-surgical complications and infection go down.
- Less pain – Decreased trauma to tissue and muscle results in less pain than open-heart procedures.
- Less blood loss – Because incisions are smaller, patients lose less blood and are less likely to require a transfusion.
- Less scarring – Only a few tiny scars and/or a two-inch scar remain after minimally invasive valve surgery.
CMH offers conventional open chest surgery for patients requiring such procedures.
CMHVI offers three types of minimally invasive valve surgery
Minimally Invasive Aortic Valve Surgery: Aortic valve surgery is approached from the right upper chest through an incision between the second and third rib near the breastbone (sternum). Using specialized surgical equipment and cameras, the surgeon performs the surgery much as they would through a much larger incision through the breastbone (sternum). During valve surgery, your surgical team stops your heart with medication and uses a heart-lung machine to oxygenate and circulate your blood. Your surgeon may repair the valve or replace it, depending on the type of valve disease you have. In an aortic valve replacement procedure, your aortic valve is removed and replaced with a mechanical valve or a valve from a cow or pig.
Minimally Invasive Mitral Valve Surgery: The mitral valve is a valve in the heart located between the left atrium and the left ventricle. It allows blood to flow from the left atrium into the left ventricle, but not in the reverse direction. The mitral valve has two flaps (cusps). It is also known as the bicuspid valve. Mitral valve surgery can replace or repair mitral valve damage due to two types of mitral valve disease:
- Mitral valve stenosis: This occurs when the flaps of the mitral valve stiffen, thicken or stick together. When this happens, the valve opening gets smaller and less blood can flow from the left atrium to the left ventricle.
- Mitral valve regurgitation: This occurs when the flaps of the mitral valve can no longer close completely and tightly. When this happens, blood leaks back into the left atrium from the left ventricle. Over time, this leakage, or regurgitation, can damage your heart muscle.
TAVR: When your aortic valve doesn’t work properly because of aortic stenosis, having surgery to repair or replace it may reduce symptoms and lower your risk of potentially fatal complications. Aortic valve replacement – done either through an open chest procedure or minimally invasive surgery – offer you an opportunity to feel better and live longer. However, the least invasive type of procedure currently available is TAVR. During TAVR, your surgeons insert a replacement valve into your own aortic valve without removing your damaged valve. Because the replacement valve is wedged into place – and because TAVR is less invasive than other repair or replacement procedures – TAVR offers a variety of advantages, including shorter recuperation time and a quick improvement in aortic stenosis symptoms.
About Aortic Stenosis: Aortic stenosis is one of the most common and serious valve disease problems. The aorta is the main artery carrying blood out of the heart. When blood leaves your heart, it flows through the aortic valve, into the aorta. In aortic stenosis, the aortic valve does not open fully. This decreases blood flow from the heart. As the aortic valve becomes narrower, the left ventricle must increase pressure to pump blood out through the valve. To do this extra work, the muscles in the ventricle walls become thicker, which can lead to chest pain. As the pressure continues to rise, blood may back up into the lungs. Severe forms of aortic stenosis prevent enough blood from reaching the brain and the rest of the body. Aortic stenosis may be present from birth (congenital), but it more commonly develops during aging as calcium or scarring damages the valve and restricts the amount of blood flowing through it.
Aortic Valve Repair or Replacement: When your aortic valve doesn’t work properly, having surgery to repair or replace it may reduce symptoms and lower your risk of potentially fatal complications. Aortic valve replacement – done either through an open chest procedure or minimally invasive surgery – offer you an opportunity to feel better and live longer. However, the least invasive type of procedure currently available is TAVR.
Benefits of TAVR: With traditional aortic valve replacement surgery, surgeons remove your valve and replace it with a mechanical aortic valve or an aortic valve from an animal. However, with TAVR, your surgeons insert a replacement valve into your own aortic valve without removing your damaged valve. Because the replacement valve is wedged into place, it is a less complicated procedure that can be done through a catheter inserted through an incision in your thigh, rather than through incisions in your chest.
TAVR offers a major advantage: With traditional valve replacement, your surgeons must stop your heart with medication and use a heart-lung machine to oxygenate and circulate your blood during surgery. But because TAVR is done via catheterization and does not require the removal of your existing heart valve, your surgeon can allow your heart to continue beating throughout the procedure. TAVR requires no heart stopping. This makes aortic valve repair a viable option for more patients, especially those at high-risk, either due to age, history of heart disease, frailty or other health issues.
TAVR often provides immediate relief of debilitating symptoms and helps patients live longer, more active lives. It can also allow for quicker recovery than traditional aortic valve replacement surgery. Other benefits of TAVR may include:
- Improvement in common symptoms of aortic stenosis, such as shortness of breath, chest pain and fatigue
- Less pain
- Less blood loss
- Lower risk of cardiac and respiratory complications
- Fewer days in the ICU
- Shorter hospital stays
- Faster return to normal activities
Our Team: CMHVI cardiac surgeons have expertise in all types of heart valve surgeries. They have extensive training and experience in performing valve repair and replacement surgery and are certified by the American Board of Surgery and the American Board of Thoracic Surgery. An experienced, dedicated technical-professional team supports them in their work. Our cardiac surgery program has been recognized by the Society of Thoracic Surgeons as one of the top cardiac programs in the United States.
For a referral to CMHVI’s cardiac surgery program, including minimally invasive valve surgery, speak with your primary care provider. CMHVIS’s cardiac surgeons can provide patients with an in-depth consultation about their cardiac issue.