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Treating Heart Valve disease

Treating Heart Valve disease

If diagnosed early, heart valve disease is treatable and you can live a full, happy life. Treatments for heart valve disease can include medicines and surgery.

 Medicines

It’s not possible to reverse heart valve disease with medicine alone. Sometimes medicines may be recommended instead of surgery if your symptoms are mild, or if valve repair or replacement is not possible.

Medicines may be prescribed to reduce symptoms, maintain the heart’s rhythm, or lower the risk of blood clotting and stroke.

Some medicines that could be prescribed include:

 

  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs)

These manage high blood pressure and in turn, help blood pump around the body.

  • Anti-arrhythmic medication

These help maintain or restore a normal heart rhythm.

  • Antibiotics

These help to prevent infection after surgery.

  • Anticoagulants

These can reduce the risk of blood clots because of poorly circulating blood around faulty heart valves. Anticoagulants are often prescribed for patients with a mechanical heart valve, and can help prevent stroke.

  • Beta-blocker

These work by slowing your heart rate and reducing blood pressure, and can help against heart damage.

  • Diuretics

These can help lower the burden on your heart by reducing fluid in the tissues and bloodstream.

  • Vasodilators

These can help open and relax the blood vessels, reducing the workload of your heart and reducing pressure on leaky valves.

 

Surgery

Depending on your symptoms and the overall condition of your heart, your doctor may decide to repair existing heart valves or replace them entirely. An affected valve could be repaired with a ring to support the damaged valve, or it may be replaced with an artificial valve.

Types of surgery for heart valve repair or replacement include:

  • Open heart surgery

This is a highly successful procedure that has traditionally been used to replace or repair heart valves. The procedure usually takes a few hours: a large opening is made in the chest, and the heart is temporarily stopped so that the surgeon can insert a new valve or repair an existing one. Patients usually stay in hospital for a week or more after surgery. The recovery period from this type of surgery is around two to three months, and it leaves a noticeable scar.

  • Minimally invasive valve disease surgery

This is where a camera is inserted through a small opening on the side of the chest, so the surgeon can see the heart and repair or replace the valve. It’s a procedure with a shorter hospital stay than open heart surgery, usually involving a stay of around 4 or 5 days. This form of surgery also involves less risk of infection and scarring, and faster recovery than open heart surgery. Most aortic and mitral valve surgery can be done using this technique, but open heart surgery may be more suitable for people who need more complex valve repairs, or those who have some other health conditions as well as heart valve disease.

  • Transcatheter aortic valve implantation (TAVI)

This is a procedure where a long, flexible tube is inserted through an artery. The tube has a replacement valve attached to one end. Imaging equipment is used to guide the tube, positioning the replacement valve inside the natural valve. Once it is in the right position the replacement valve expands into place, pushing the faulty valve away. The replacement valve starts to work immediately. This is less invasive than open heart surgery, and generally has a shorter recovery time. The procedure usually takes around 1 hour, with a typical hospital stay of 3 to 5 days. It can also be an option for patients where open heart surgery is too risky.

  • Transcatheter mitral valve repair (MitraClip™)

This is a procedure where a long, flexible tube is inserted through a vein in the groin. The tube has a specialized clip attached to one end. Imaging equipment is used to guide the tube, positioning the device inside the natural valve. Once it is in the right position the clip grasps the leaky valve leaflets and reduces the leakiness of the valve. This is less invasive than open heart surgery, and generally has a shorter recovery time. The procedure usually takes around 2 hours, with a typical hospital stay of 3 to 5 days. It can also be an option for patients where open heart surgery is too risky.

There are two types of artificial valves:

  1. Mechanical valves

These valves last for the rest your life. People with this type of replacement valve usually need to take anticoagulant medicine (warfarin) for the rest of their life to prevent blood from clotting around the valve.

  1. Tissue valves

These valves are made from animal tissues. People with this kind of replacement valve don’t need to take anticoagulant medicine long-term. These valves don’t last as long as mechanical valves, so another surgery may be needed later in life.

Shared decision making

Decisions about ongoing care for heart valve disease should be based on an individual’s needs. That’s why shared decision making is so important. Shared decision-making means you have all the information you need to make decisions about the management of your condition with your health care professionals and your family.

You should discuss with your doctors which valve and surgery is most suitable for you so a well thought out decision can be made. A multidisciplinary team (MDT) or ‘structural heart team’ will be available. This is a team of heart valve disease experts who all have different skills, and they will help make sure you receive care that considers your needs, as well as other factors in your life that affect your health and wellbeing.