Can a heart valve be replaced laparoscopically?

Heart valve disease can cause severe heart failure complications, affecting quality of life, reducing the patient's ability to work even life expectancy. Heart valve surgery improves the quality of life for people with heart valve disease. After surgery most patients progress in a good direction, being able to do things that they were not able to do before surgery.

A normal heart has four chambers: the left atrium and the left ventricle are separated by the mitral valve, and the right atrium and right ventricle are separated by the tricuspid valve. Blood flows from the right ventricle through the pulmonary valve to the pulmonary artery, while blood flows from the left ventricle through the aortic valve to the aorta, into the great circulatory system throughout the body. The role of the valve leaflets is to help blood flow only in a certain direction by opening and closing rhythmically when the heart chambers contract or relax according to the pressure difference between the chambers of the heart.
Heart valve diseases (openness, stenosis) can be congenital (born with heart valve damage) or acquired (after infection with infective endocarditis, rheumatic heart disease, elderly people with valve degeneration) , due to coronary artery damage...). The valves in a pathological state interfere with the normal functioning of the heart, the heart needs to contract harder and harder to maintain blood flow to the organs, and therefore, the heart will gradually weaken. Slowly, the end result is heart failure.
The normal heart has 4 heart valves: mitral valve, tricuspid aortic valve, pulmonary valve. When the valve leaflet becomes thick and stiff, it limits the valve's ability to open, impeding blood flow. This phenomenon is called leaflet stenosis.
In case the valve leaflets do not close tightly due to dilation, degeneration, adhesions causing contraction or because the ligaments of the valve are too long...make the valve leaflets not close tightly, the blood flow then not only flows along the way. one-way that is ejected during valve closing. This phenomenon is called mitral regurgitation.
Diseases of the stenosis and regurgitation mentioned above can occur in all valves (mitral valve, tricuspid valve, aortic valve, pulmonary valve). Because of valve damage, the heart has to work harder, and to increase the heart's ability to contract, the heart has a compensatory mechanism, increasing conduction, increasing heart rate, or increasing myocardial cell growth. size, quantity (myocardial hypertrophy) or dilation of the chambers of the heart, increasing stroke volume to compensate for the volume overload. If this condition is prolonged and untreated, it will cause the heart chambers to dilate and fibrous cells to grow irreversibly. If permanent damage to the heart muscle reduces the heart's ability to contract, heart failure occurs.

Is it possible to replace the heart valve with laparoscopic surgery is a matter of concern to many people. Depending on the health status, the doctor has appropriate indications
2.1. When is the patient indicated for heart valve replacement surgery? Mitral stenosis
If the patient's dyspnea symptoms worsen (NYHA≥2) after optimal medical therapy. Patients with pulmonary hypertension (≥55mmHg) or atrial fibrillation. Mitral stenosis is tight and not suitable for dilatation. Mitral stenosis is associated with aortic regurgitation or stenosis. The mitral valve is calcified and has a lot of retraction or is associated with a combined mitral regurgitation. Mitral regurgitation
Severe mitral regurgitation, acute course. Patients with moderate to severe mitral regurgitation and clinical symptoms. Patients over 75 years of age, with coronary artery disease or renal dysfunction. Mitral regurgitation with atrial fibrillation. Heart failure with an ejection fraction EF < 50% even without clinical symptoms Patient has mitral valve prolapse causing severe mitral regurgitation. Aortic regurgitation
Severe aortic regurgitation, acute course. Aortic disease: when the diameter of the aortic root is ≥ 50mm regardless of the degree of valve regurgitation Chronic aortic regurgitation is accompanied by 1 or more of the following signs: Symptoms of congestive heart failure (NYHA ≥2) or have chest pain; left ventricular ejection fraction EF ≤ 50%; left ventricular end systolic diameter ≥ 55mm; left ventricular end-diastolic diameter ≥ 75mm; Ejection fraction decreases with exercise. Aortic stenosis
Patient has symptoms: chest pain, syncope, congestive heart failure (NYHA≥ 2) The patient is young and the transaortic pressure gradient >100 mmHg. Patients with aortic stenosis and an indication for coronary artery bypass grafting. Left ventricular systolic dysfunction. 2.2. Advantages of laparoscopic heart valve replacement If in the past, the classic surgical technique had to cut the sternum up to 15cm long, then replace the mitral valve and close the sternum with metal sutures, causing pain for the patient. Today, the technique of endoscopic surgery to replace the artificial heart valve has overcome the previous disadvantages. During the procedure, doctors only need to insert the endoscopic instrument through two small holes and only need a side incision about 3cm long to insert the artificial valve into the patient's body.
Advantages of laparoscopic surgery:
Less blood loss. Low risk of infection Less invasive and less painful The hospital stay is shorter, the patient can quickly recover and return to daily life. Ensure the aesthetics because the scar is small, difficult to recognize. 2.3. Medical conditions to perform laparoscopic heart valve replacement Most laparoscopic heart valve replacement surgeries are performed on adults. This surgical technique should not be performed on newborns, because this method not only makes a small incision but also requires accompanying equipment such as integration with the extracorporeal circulatory system. In adults, the line can be easily inserted into the blood vessels. While the blood vessels of the newborn are very small, and the equipment for the newborn (with a baby weighing only 2-3kg) is currently almost nonexistent. Therefore, in order to choose patients for less invasive surgery such as laparoscopic surgery, different aspects must be considered, in which, weight is a concern, newborns who want to undergo laparoscopic surgery to replace heart valves. must be 10 kg or more. At that time, the operation of the surgeon will also be easier. In addition, consider the laparoscopic method when ensuring the results are equal to the mid-sternal surgery, then we proceed with this method. Surgeons evaluate patients to determine which cases will be indicated for laparoscopic heart valve replacement. In order to perform this surgery, the equipment in the operating room must be very good, with a camera system to support, the surgeon needs to have experience from previous surgeries with long incisions. proficient, the technique of extracorporeal circulation must be good. Because the complex laparoscopic surgery procedure requires a lot of experience and training, patients often need to be transferred to large medical facilities for endoscopic valve replacement.

Hospitalization time
For heart valve replacement surgery, patients usually need to stay in the hospital for about 1 week. You may be admitted to the hospital the day before the procedure because some tests and physical examination will be needed. The patient will see the doctors involved in both the surgery and the subsequent hospital stay, including the primary care physician, the surgeon, the anesthesiologist and resuscitator, the nurses, who will provide care. patients during and after surgery and can discuss their condition with the treating doctors.
Tests you need to do before surgery may include: complete blood count tests, liver function tests, kidney function, clotting status, blood type, electrocardiogram, echocardiogram and scan Cardiopulmonary X-ray,... You will be examined by other specialties such as maxillofacial, ENT, ear, nose and throat to ensure there is no potential or chronic infection that may affect the outcome after surgery.
The day of surgery
About an hour before surgery, the patient will be sedated to help you feel more relaxed and less anxious. The patient will be placed on a pushchair to take you to the operating room. During the surgery, the anesthesiologist will put the patient into a very deep sleep, feel no pain during the procedure, and wake up with no memory of the last surgery. Laparoscopic valve replacement surgery is usually very carefully prepared and precisely timed.
Immediately after surgery
After surgery, the patient is transferred to the recovery room to be closely monitored for developments immediately after surgery.
Usually, patients after laparoscopic heart valve replacement surgery will begin to wake up gradually after about 2 hours from the end of surgery, but there are also cases of later recovery, depending on the ability to accumulate and dig drug elimination from the patient's body. Some patients recounted: when awake, they can hear or open their eyes but still can't move their arms or legs, this is also very normal, patients do not need to worry. This condition will not last until the patient's brain is completely free from the inhibition caused by the anesthetic and can command the body to function normally.
In the recovery room
Most patients often feel pain at the incision site with varying degrees of pain but usually not much pain. Patients need to have a comfortable lying position, gentle hand movement will reduce pain. In the case of severe pain, the doctor will prescribe pain medication and this pain usually rarely lasts more than 3 days.
After surgery, the patient will find that he has many drains and monitors next to him. These devices help doctors and nurses monitor the patient's vital signs, the amount of fluid drained to ensure the patient's postoperative process is safe and effective. The arm is placed on an intravenous line to infuse drugs and fluids into the patient's body and monitor blood pressure. There is one or two drains in the chest to drain the remaining fluid from the incision area into a bottle for monitoring. Small patches (electrodes) are placed on the patient's chest to monitor the heart rate. There are also tiny electrodes that are threaded under the incision to control the heart rate if needed.
An endotracheal tube (a flexible plastic tube) is placed from your mouth to your windpipe (your airway) to connect to a ventilator. It does not cause pain but makes the patient unable to speak. During this time, the nurses will help you and understand what the patient needs to do. In general, the above tubes and monitoring devices will be removed when the patient is stable and can be transferred to the postoperative care room, the process in the recovery room usually lasts about 24 hours after surgery.
What can help the patient recover better?
Practicing deep breathing and coughing will help the patient recover faster. Coughing reduces congestion in the lungs, reducing the risk of superinfection pneumonia. Most patients are afraid of pain, so they do not dare to cough after surgery, the patient will cough more easily if the pillow is under the back. Changing your lying position regularly, constantly turning over also helps the recovery process better, avoids stagnation of fluid in the lungs and avoids pressure ulcers.
When sleeping, the patient should lie on his side and often turn over during sleep, change position every few hours if possible because if the patient only lies on his back for a long time and does not roll over, it will be easy to become congested. fluid accumulation in the lungs, not good for the patient's lungs.
When the endotracheal tube is removed, the patient will be able to eat liquid foods such as soup, porridge. Depending on the patient's digestive system, it may take longer or slower to switch from liquid to normal food.
About 2 days after surgery, the patient can sit up or walk with help around the room. After that, you can walk short distances in the hallway, even take a few stairs, and take longer walks when you are about to leave the hospital and go home.
About body hygiene
After surgery, the patient can wipe himself. A few days after the drain is removed, the patient can take a shower or shower and wash their hair, both using warm water and doing it quickly to avoid colds, do not use soap to bathe the incision area.
How will the incision heal?
Immediately after surgery, bandage the incision with the right length, thickness, and breathability, and this helps the incision to dry faster and heal faster. One week after surgery, sutures can be removed.
Discharge from hospital
On average, the hospital stay after laparoscopic heart valve replacement surgery is about 5-7 days. If the sick person has to take a bus, train or plane, they should reserve a seat in front of other passengers. If necessary, a stroller can be rented in advance to transport the patient.
Hopefully the above information will help readers better understand laparoscopic heart valve replacement surgery, when to have surgery, and what to keep in mind when having heart valve replacement surgery. If you have any questions, you can contact Dr. Vinmec for examination and support.