Heart valve replacement surgery is a surgical procedure that replaces damaged heart valves with artificial or biological tissues, primarily to restore normal blood flow direction and rhythm of the heart. When native valves lose function due to stenosis, regurgitation, or infection, this treatment can effectively improve symptoms such as heart failure and dyspnea. The types of surgery include traditional open-heart surgery and minimally invasive transcatheter approaches, with the most suitable option chosen based on the patient's age, degree of valve damage, and overall health status.
Currently, there are three main types of valves:
Primarily used for severe valvular diseases such as aortic stenosis causing chest pain or dizziness, mitral regurgitation leading to pulmonary edema, etc. Suitable cases include:
The procedure usually requires general anesthesia. Open-heart surgery involves cutting the sternum, while minimally invasive approaches use catheter insertion through blood vessels. Postoperative management includes timely use of anticoagulants such as warfarin. Patients with mechanical valves need regular INR monitoring to maintain levels between 2-3. Biological valve patients may only require short-term anticoagulation, with specific dosages adjusted by hematologists based on coagulation function.
The surgery can immediately relieve symptoms like shortness of breath and fatigue, and reduce the risk of heart failure. Mechanical valves are suitable for younger patients due to their long-term durability, while biological valves reduce the risk of anticoagulation-related side effects. Compared to medication alone, surgery can improve five-year survival rates by 40-60% and restore daily activity capabilities.
Potential risks include: bleeding complications (annual bleeding rate of approximately 2-3% in mechanical valve patients), thromboembolism (about 1-2%), and infective endocarditis. Long-term complications may involve valve calcification or functional deterioration, requiring follow-up every 5-10 years. Anticoagulation therapy may cause skin bruising or internal bleeding.
Contraindications include uncontrolled sepsis, severe liver or kidney failure, or refusal of anticoagulation therapy. Preoperative assessment of cardiopulmonary function is essential, and strict adherence to anticoagulation monitoring postoperatively is required. Patients should avoid contact sports and inform dentists about artificial valve implantation to prevent infective endocarditis.
Interactions with anticoagulants are critical; non-steroidal anti-inflammatory drugs may increase bleeding risk. During radiotherapy or cardiac catheterization, anticoagulant doses should be adjusted. If coronary artery bypass grafting is performed simultaneously, coordination of anesthesia and postoperative care is necessary. Biological valve patients should avoid drugs that may suppress the immune system.
Long-term follow-up shows that five-year survival rates after aortic valve replacement range from 70-85%, and mitral valve replacement improves symptom severity scores by over 60%. The 2019 European Society of Cardiology guidelines state that patients with severe aortic stenosis who undergo surgery experience an average increase of 15% in left ventricular ejection fraction (LVEF). Biological valves in patients over 70 years old have a five-year success rate of up to 90%, but mechanical valves tend to perform more stably in younger patients.
Non-surgical options include transcatheter aortic valve replacement (TAVR), suitable for high-risk surgical patients; valve repair procedures that partially restore the native valve structure; and medication management that can temporarily alleviate symptoms but does not address structural damage. TAVR shortens hospital stay to 3-5 days but is limited to specific anatomical conditions.
Patients should regularly monitor blood coagulation indicators (such as INR for those on anticoagulants) and avoid vigorous impacts to prevent valve damage. Daily diet should reduce foods rich in vitamin K (like spinach and broccoli) to avoid affecting anticoagulant efficacy. Quitting smoking, controlling blood pressure and blood sugar are also important measures to prolong valve function.
What are the differences in anticoagulation therapy between patients with mechanical and biological valves?Patients with mechanical valves require lifelong anticoagulant therapy (such as warfarin) with regular blood tests to adjust doses; biological valve patients typically only need short-term anticoagulation. Physicians will evaluate the most suitable valve type and medication plan based on age, bleeding risk, and comorbidities. Patients must strictly follow medical advice to prevent thrombosis or bleeding complications.
What symptoms should prompt immediate medical attention during recovery?If chest pain, shortness of breath, edema, unexplained bleeding or vomiting blood, or black stools occur, these may indicate heart failure, embolism, or anticoagulant overdose, requiring immediate medical care. Early signs of valve stenosis or regurgitation such as persistent fatigue or dizziness should also prompt prompt re-evaluation.
What precautions should patients take during long flights or vigorous activities?Long flights may increase the risk of deep vein thrombosis; it is recommended to move limbs regularly, wear compression stockings, and follow medical advice regarding anticoagulants. Vigorous activities like basketball or wrestling may damage the chest; low-impact exercises such as swimming or brisk walking are preferable. All activities should be discussed with a cardiologist beforehand.
What is the typical lifespan of biological valves? Is reoperation necessary?Biological valves typically last about 10-15 years, depending on patient age and cardiac function. Children or young patients may require reoperation due to valve calcification, while older patients often can maintain function for life. Regular echocardiographic follow-up helps predict the need for future surgery.
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