Open Heart Surgery
Whilst the patient is on the heart/lung bypass machine and the heart stopped surgeon can open the heart. The malfunctioning valve is cut out and an artificial one sewn in place. The mitral valve can occasionally be repaired rather than replaced.
These are substantial operations with a recovery period lasting several weeks so there has been an effort to develop techniques for replacing heart valves minimally invasively-
Minimally Invasive Valve Procedures
The procedures take approximately 1-2 hours to perform often using local anaesthetic and sedation. The patient can go home the following day.
1)Aortic Valve-TAVR Procedure
The aortic valve can be replaced minimally invasively. A balloon with a compressed artificial aortic valve is introduced into the artery at the top of the leg and passed around to the heart. When in position the balloon is expanded leaving the valve in place.
This is currently only being used for higher risk patients as the long term durability of the valves is not known. However clinical trials are ongoing to assess whether it is suitable for all patients.
Currently this procedure is only used for narrow aortic valves “aortic stenosis” but there are clinical trials to see if it is also suitable for leaking aortic valves “aortic Regurgitation”.
2) Mitral Valve
A narrow mitral valve “mitral stenosis” can be opened up minimally invasively with a balloon in many cases.
A leaking mitral valve “mitral regurgitation” can sometimes be repaired minimally invasively with a clip “mitraclip”. The clip is introduced into the vein at the top of the leg and then passed along the vein to the mitral valve where it is used to clip the valve in the middle to reduce the leak.