TREATMENTS AND PROCEDURES FOR HEART VALVE DISEASE

An estimated 25,000 people in the U.S. die from heart valve disease each year, even though faulty heart valves can often be repaired or replaced.¹ If you notice the symptoms of heart valve disease, talk to your doctor.

Globally, heart valve disease is on the increase for two reasons:²

• Degenerative valve disease occurs as the population ages in developed countries
• There is not adequate treatment of rheumatic heart disease in the developing world

Because heart valve disease occurs more often as people age, the number of people needing heart valve replacement is rising over time. Researchers estimate that more than 800,000 heart valve procedures will be performed annually, worldwide, by 2050.^2,3

MEDICATIONS FOR HEART VALVE DISEASE

Your doctor may prescribe medication to treat your symptoms and help avoid further damage to the heart valves. Common medications include:

• Diuretics—to help remove excess fluid from the body
• Antiarrhythmic medications—to help ensure a stable heart rhythm
• Vasodilators and angiotensin-converting enzyme (ACE) inhibitors—to relax the muscle in blood vessel walls, which allows the vessels to widen and enables more blood flow
• Beta blockers—to treat high blood pressure and slow the heartbeat
• Blood thinners (anticoagulants)—to reduce the risk of clots forming in the blood

Be sure to take any medications as directed, and talk to your doctor if you have questions.

HEART VALVE REPAIR

For many people, a surgical procedure can repair a heart valve. Your doctor may use one of the following techniques to repair your heart valve.

Valvuloplasty: This is done to open a stiff (stenotic) heart valve. During the procedure your doctor inserts a small, narrow tube (a catheter) into a blood vessel in the upper thigh (the groin area) and advances it through the blood vessel and into the heart. When the catheter reaches the stiff valve, the doctor inflates a balloon at the tip of the catheter until the flaps (leaflets) of the valve are pushed opened. The doctor then deflates the balloon and removes the catheter.

Commissurotomy: This is a type of open-heart surgery to repair mitral valve stenosis. To open the valve, the surgeon removes calcium deposits and other scar tissue from the mitral valve leaflets. The surgeon may also cut parts of the valve structure to ensure that the valve opens and closes properly.

Annuloplasty: This is performed to repair the tissue at a heart valve’s base, or annulus. Sometimes the annulus becomes widened and dilated, allowing blood to leak backward through the valve (regurgitation). The surgeon sews a ring (or band) to the existing annulus of the valve. Doctors may perform annuloplasty alone or in combination with other techniques to repair a heart valve.

Another type of mitral valve repair is described farther down on this page.

HEART VALVE REPLACEMENT

There are several ways to replace a heart valve.

• Surgical valve replacement with open-heart surgery—in which the surgeons make an incision through the breastbone (sternum) to gain full access to the heart.
• Minimally invasive valve replacement surgery—which requires smaller incisions between the ribs.
• Transcatheter valve replacement or valve repair—which is the least invasive option of the three. The device is delivered via a small tube (a catheter) inserted through a small incision in the upper thigh or via an alternative access approach e.g. transapical, subclavian etc.

SURGICAL VALVE REPLACEMENT

Often doctors recommend surgery to remove the damaged valve and implant an artificial (prosthetic) valve in its place. Because it is performed often, heart valve replacement is a common procedure at most major hospitals.

There are two types of prosthetic valves used for replacement: tissue valves and mechanical valves. Both are designed to mimic the function of a natural, healthy heart valve. A valve’s hemodynamic performance is important, affecting your quality of life after the surgery. (“Hemodynamic” is a term doctors use to describe how efficiently blood flows through the valve.)

Your doctor will make the choice about which valve is right for you based on your:

• Health conditions (in addition to your heart issues)
• Medications
• Age
• Lifestyle

Tissue Heart Valves

Tissue heart valves are made from animal or human tissues. The tissue typically comes from a porcine (pig) heart valve or bovine (cow) cardiac tissue, though it can also come from a human donor. Once the tissue is removed from the animal or human donor, it is chemically treated to preserve the tissue.

Tissue valves may not last as long as mechanical heart valves. Mechanical valves are designed to last a lifetime, but having one requires that you take a blood thinner, called anticoagulation medication, daily.

Mechanical Heart Valves

A mechanical valve is carefully designed to mimic a natural heart valve. Like your own natural heart valve, it opens and closes with each heartbeat, permitting proper blood flow through the heart. Mechanical valves are designed to last a lifetime, but having one requires that you take a daily blood thinner called anticoagulation medication.

TRANSCATHETER VALVE REPAIR OR REPLACEMENT

Because a significant number of patients are not good candidates for open-heart surgery for valve replacement or valve repair, a transcatheter procedure may be an option for them.

A transcatheter procedure is not open-heart surgery. Instead, the surgeon usually accesses your heart by making a small incision in a blood vessel in your thigh, near the groin area. The replacement valve or repair device is collapsed so it is very thin. It is inserted into a hollow tube (a catheter) that is advanced up to your heart through the blood vessel. Your doctor uses imaging techniques to guide the catheter through your blood vessels, to your heart, and into your valve.

Transcatheter procedures include:

• Mitral valve repair for the mitral valve
• Aortic valve replacement for the aortic valve

Sometimes during these procedures the patient is fully asleep, under general anesthesia

More commonly the procedure uses intravenous (IV) sedatives and pain medicines. Patients also receive local anesthetic at the site where the catheter is inserted, so typically there is no pain during the procedure.

TALK OVER YOUR OPTIONS

Talk to your doctor about which option is right for you. Then participate in taking care of your heart by following all of your doctor’s instructions.

References

<sup>1. American Heart Association. Under-recognized heart valve disease kills estimated 25,000 each year. https://newsarchive.heart.org/under-recognized-heart-valve-disease-kills-estimated-25000-each-year/. Accessed August 18, 2018.
2. CardioPulse Articles. Eur Heart J. 2015;36:325–332. doi.org/10.1093/eurheartj/ehu483.
3. Huygens SA, Goossens LM, van Erkelens JA, et al. How much does a heart valve implantation cost and what are the health care costs afterwards? Open Heart. 2018;5:e000672. doi.org/10.1136/openhrt-2017-000672.</sup>

The information provided is not intended for medical diagnosis or treatment as a substitute for professional advice. Consult with a physician or qualified healthcare provider for appropriate medical advices.