Benefits and risks of heart valve replacement surgery

The article was professionally consulted by Dr., Doctor Tran Van Hung- Cardiologist - Cardiovascular Center - Vinmec Central Park International General Hospital

Heart valve replacement is extremely necessary for patients whose heart valves have been severely damaged, cannot be repaired or patients do not respond to drug treatment.
New heart valve replacement aims to help relieve symptoms for patients, prevent progression to chronic heart failure, arrhythmias and other complications in the future, and reduce the risk of early death for patients.
There are two types of artificial heart valves commonly used:
● Mechanical heart valves are made from materials such as silicon, titanium,... The durability of a mechanical heart valve is 20-30 years, even maybe even longer.
● Biological heart valves are valves made from animal tissues or from donors. This type of valve has the following characteristics: The service life of this valve is short, the maximum is 10-15 years. This type of valve also has a lower risk of thrombosis than a mechanical heart valve.
The health of patients after heart valve replacement surgery has improved a lot, they feel more comfortable, less anxious, and mentally excited, so they respond better to treatment. Patients can return to work after 6-8 weeks with light work. The time may be longer for heavy duty work. For some patients, they may have to switch to other jobs that are more suitable for their health.
However, your health can stay the same, get better or worse, depending on your condition, treatment method and whether you use the medicine properly according to the doctor's instructions or not, especially the Maintain hygiene to avoid complications of infective endocarditis after valve replacement.

It is difficult to predict exactly how long a person's life expectancy after heart valve replacement will be, because there are many factors, including: heart disease status, comorbidities, body's resistance, diet, etc. care, exercise and diet.
However, with good follow-up and care after surgery by taking medications as indicated, regular check-ups, proper nutrition and good treatment of comorbidities, the patient can completely live a long life. like a normal person.
In children, valve replacement surgery often has to be done more than once, because the replacement valve does not grow with the child. As the child matures, there will be many choices about the type of valve as well as the surgical procedure. Biological valves of animal origin have a lifespan of 10-20 years before they need to be replaced, but most of these valves are indicated for older people who have had heart damage. As for young adults, they are often replaced by mechanical valves, made of alloy material, this valve has the advantage of a longer valve life than biological valves, but the biggest disadvantage is that it is easy to form blood clots, so Patients must take anticoagulants regularly.

Is it dangerous to replace the heart valve is a concern of many patients when it is necessary to perform surgery. In fact, in the process of performing heart valve replacement surgery, the patient may still be at risk of some risks, however, this will be minimized if the preparation and control process is minimal. Preoperative examination and good intraoperative handling.
Some complications during heart valve replacement surgery may occur:
Reactions to anesthetics: Some patients may have reactions to increased heart rate, increased blood pressure when using anesthetics during surgery .
● Bleeding in surgery: The patient may bleed during surgery, if the blood loss is too much, a blood transfusion will be required.
● Injury during surgery: Surgery can unintentionally cause other damage to the patient's body.

If the patient after heart valve replacement has a lifestyle, scientific, moderate, good health and treatment compliance, there are still some factors that can affect the life expectancy of the patient after heart valve replacement. when replacing the heart valve, it is:
4.1. Thrombosis People who have a mechanical valve replacement have a higher risk of forming a blood clot, also known as a thrombus, than with a biological valve. Blood clots can block vessels (eg, extremity vessels, cerebral vessels, etc.), which are especially dangerous if they jam the heart valves (common with mechanical valve replacement) or tear the leaflets (common with replacements). biological valve), atrial fibrillation increases the risk of stroke (caused by a blood clot traveling to the brain and blocking a blood vessel in the brain).
Thrombosis is the main fatal complication in patients with prosthetic heart valves, accounting for about 0.6-2.3% of patients each year.
Symptoms of thrombosis causing valve obstruction are patients with shortness of breath or fatigue that increases for a short time from a few days to a week.
This is particularly common in patients with abrupt cessation of anticoagulation, with a change in anticoagulation dose. Patients with these symptoms require early echocardiography for diagnosis. When thrombus is diagnosed with prosthetic valve occlusion and the thrombus size is small, fibrinolytic agents such as urokinase or streptokinase can be treated.
If the large thrombus size causes obstruction of the prosthetic, mobile valve or the patient is hemodynamically unstable, urgent surgery is needed to remove the thrombus or replace the valve. Patients undergoing reoperation due to prosthetic valve occlusion have a high mortality rate.

4.2. Bleeding In patients on long-term anticoagulants (vitamin K antagonists), the risk of bleeding is 1%. Close monitoring of the INR (International Normalized Ratio) will reduce the risk of bleeding.
4.3. Deterioration of the valve Mechanical valves are generally very durable and rarely fail.
Biological valves have an increased rate of degeneration over time. The onset of valve degeneration is usually in the 7th or 8th year after surgery. Biological valves will degenerate from 50 - 60% at year 10 and 70 - 90% at year 15.
4.4. Infective endocarditis The incidence of infectious endocarditis on prosthetic valves is approximately 0.5% per year, even in patients with correct antibiotic prophylaxis.
Infective endocarditis on prosthetic valves is a serious condition with a high mortality rate (from 30 to 50%).
Diagnosis of infective endocarditis is usually based on positive blood cultures and on echocardiography with evidence of prosthetic valve infection, such as vesicles, paravalvular abscesses, or newly emerging paravalvular regurgitation. .
Medical therapy alone may be possible if infective endocarditis develops late after valve replacement (more than 6 months postoperatively).
Surgery should only be done in the following cases: failure of medical therapy, hemodynamic compromise due to large regurgitation, large warts, and new flow in the heart.
4.5. Proximal annulus regurgitation is typically caused by infection, thread removal, fibrosis, and calcification of the natural annulus, resulting in the artificial annulus not pressing firmly against the patient's natural annulus.
Mild proximal annular regurgitation: Usually benign, only a very small number of patients (<1%) need reoperation, due to the fact that proximal regurgitation increases after 1-2 days. year of follow-up.
4.6. Poor control of comorbidities Patients with severe heart disease requiring heart valve replacement often have many other chronic diseases, such as high blood pressure, diabetes,... Therefore, if not controlled, If the co-morbidities are well controlled, the patient's condition can be in jeopardy.

With endoscopic valve replacement, the hospital stay is usually shorter than with open surgery. After open-heart surgery, you will stay in the hospital for 5-7 days and it will take 6-12 weeks for your breastbone to heal completely. During the recovery period after a valve replacement, the patient should avoid lifting heavy objects and doing activities that put pressure on the chest area. At the same time, in order to quickly recover and avoid risks after heart valve replacement, it is necessary to pay attention to the following issues:
● Keep mentally stable, avoid stress and anxiety, do not fall into a state of anxiety and depression.
● To prevent blood clots from forming, it is necessary to take anticoagulants as prescribed by the doctor and periodically monitor the blood clotting index INR in order to adjust the medicine in time. Use the right type of medicine, in the right dose, as prescribed by your doctor.
● Prevent infective endocarditis: Take care of your teeth regularly, visit your teeth every 6 months and brush your teeth with toothpaste twice a day. Avoid piercings and tattoos, and do not inject any medication without a prescription.
● Periodic medical examination: Patients should have regular check-ups after surgery, at least within the first 3 months. Then maintain periodic inspection at least 2 times/year.
● Diet: Should reduce salt, reduce fat, increase fiber. Limit dark green vegetables such as cauliflower, kale, spinach, scallions, sprouts, milk, plums... because they are rich in vitamin K, which will reduce the effectiveness of anticoagulants. thrombosis.
● Patients need to notify the doctor when they have the following symptoms: Angina (a feeling of squeezing, squeezing in the chest); Shortness of breath, cold sweat, dizziness, nausea; High fever, unusual weight gain, ankle edema, hemorrhage, arrhythmia, unusual tiredness, signs of bleeding (e.g., bruising on the skin, nosebleeds, bleeding gums), ...
Exercise regularly but avoid overdoing it.

Percutaneous aortic valve replacement was first used in patients with tight aortic stenosis who were refused surgery by surgeons due to the high risk of surgery in 2002 and was performed by Dr. Interventional cardiologist Dr. Alain Cribier. This technique has been officially and routinely applied for about 10 years now. Vinmec is the first hospital in Vietnam to perform this technique independently.
Cardiovascular Center - Vinmec Times City International General Hospital has now made a mark, affirming the leading position in the North by mastering many complex cardiovascular intervention techniques:
● Replacing the aortic valve TAVI
High-tech Mitra Clip - transcatheter mitral regurgitation
Aortic stent graft
ICD implantation
Cardiac resynchronization therapy CRT
Coronary angiography and stenting.
In particular, Vinmec is the only place in Vietnam that has a Hybrid operating room equipped with advanced equipment such as DSA angiography machine, anesthesia machine with integrated hemodynamic monitoring software closely. (PiCCO system, entropy,...).
Therefore, the Hybrid operating room can meet the requirements of surgery and angioplasty, coronary stenting, aortic stent graft, open heart surgery, congenital heart diseases and heart valve replacement surgery with advanced technology. Modern, least invasive, safest technique, helping patients recover soon.
The hospital has a team of "cardiology team" that work in unison and support, Cardiology surgeons are always accompanies during the procedure.
List of doctors at Cardiovascular Center, Vinmec Times City Hospital who perform heart valve replacement techniques include:
● Master - Doctor Nguyen Xuan Thanh: a member of Hanoi Heart Association and Cardiology Association Vietnam. Currently, the doctor is working at the Department of Cardiology - Vinmec Times City International General Hospital.
To register for examination and treatment at Vinmec International General Hospital, you can contact HERE or contact hotline 0243 9743 556 for support.