The heart is a pump made of muscle tissue. The heart has four pumping chambers: two upper chambers, called atria, and two lower chambers, called ventricles. To keep the blood flowing forward during its journey through the heart, there are valves between each of the heart's pumping chambers:
- Tricuspid valve, located between the right atrium and the right ventricle
- Pulmonary valve, located between the right ventricle and the pulmonary artery
- Mitral valve, located between the left atrium and the left ventricle
- Aortic valve, located between the left ventricle and the aorta
Heart valve repair or replacement surgery may be done when valves are damaged or diseased and do not work the way they should. Conditions that may cause heart valve dysfunction are valve stenosis (stiffness) and valve regurgitation (leaky valve).
When one or more valves become stenotic (stiff), the heart must work harder to pump blood through the valve. Some reasons why heart valves become narrow and stiff include infection and aging. If one or more valves become leaky, blood leaks backwards, which means less blood is pumped in the right direction.
The diseased valve may be repaired using a ring to support the damaged valve, or the entire valve may be removed and replaced by an artificial valve.
Traditionally, open-heart surgery is used to repair or replace heart valves. This means that a large incision is made in the chest and the heart stopped for a time so that the surgeon can repair or replace the valve. Newer, less invasive techniques like TAVR have been developed to replace or repair heart valves. Minimally invasive procedures make smaller incisions, and mean less pain afterward and shorter hospital stays.
Surgical Aortic Valve Replacement (AVR)
Aortic valve replacement is a surgical procedure used to treat aortic valve disease, in which the leaky or stiff heart valve is removed and a new valve is sutured in its place.
Surgical AVR is an open-heart procedure, but the surgeon may determine that a smaller incision can be used. The surgeon removes the diseased aortic valve and replaces it with either a mechanical valve (made from man-made materials) or a biological valve (made from animal or human tissue). Surgical AVR has been performed for many years and has lengthened many patients’ lives.
Transcatheter Aortic Valve Replacement (TAVR)
If a cardiologist and cardiac surgeon determine that a patient is too high risk or too sick for surgery, and if medicine is not helping, TAVR may be an alternative. This less invasive procedure allows a new valve to be inserted within the diseased aortic valve while the heart is still beating.
TAVR uses a catheter to direct a new valve to the site of the poorly functioning valve. Unlike conventional valve replacement, valves replaced using this method are delivered with a stent. The new valve can be inserted in a number of ways, including transfemoral (upper leg), direct aortic (upper chest) and subclavian (upper chest).
Just like surgical AVR, TAVR has been shown to consistently lengthen patients’ lives and improve their quality of life. However, the TAVR procedure is not right for everyone.
Contact the Beverly and Jerome Fine Cardiac Valve Center to learn more or schedule an appointment.