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Heart valve replacement surgery: How to choose between mechanical or bioprosthetic valves?
Heart valve replacement surgery is an important medical procedure. When a patient's mitral valve becomes diseased, doctors will consider replacing it. These changes usually involve leaking of the valve (called mitral regurgitation) or narrowing of the valve (called mitral stenosis). The function of the mitral valve is to prevent blood from flowing from the ventricles to the atria when the heart contracts. However, as you age or develop disease, your mitral valve may develop a number of problems.
Currently available mitral valve replacement options include traditional open-heart surgery and minimally invasive heart surgery (MICS).
Normal anatomy and physiology of the mitral valve
Under normal circumstances, the mitral valve is located between the left atrium and the left ventricle and consists of two leaflets, which are responsible for regulating blood flow. The valve closes during systole to prevent blood from flowing back. The normal mitral valve area ranges from 5.0 to 11.4 square centimeters, and the structure of each leaflet is complex, involving the fusion of multiple layers of tissue.
Mitral Stenosis and Regurgitation
Mitral valve stenosis is often caused by rheumatic fever and is particularly common in developing countries. When the valve fails to open properly, pressure in the left atrium increases, potentially leading to enlargement of the heart and other health risks.
The most common causes of mitral regurgitation include myxomatous degeneration, ischemic heart disease, and congenital anomalies.
Types of Prosthetic Valves
There are currently two main types of prosthetic mitral valves: mechanical and bioprosthetic. Mechanical valves typically last 20 to 30 years, but users must take anticoagulant drugs throughout their lives, which increases the risk of bleeding. In contrast, bioprosthetic valves have a shorter lifespan of approximately 10 to 15 years and wear out more rapidly in younger patients.
Valve selection
Choosing the right valve type involves the patient's age, health status, and lifestyle. If the patient is younger than 65 years old, a mechanical valve is usually chosen; while patients over 70 years old tend to choose a bioprosthetic valve.
Surgical Procedure
Heart surgeons usually operate through an incision in the center of the chest, and the patient is placed on a heart-lung machine to maintain circulation during surgery. After surgery, patients usually need to be observed in the intensive care unit for a few days and gradually resume their daily activities.
Postoperative Recovery
The recovery phase after surgery may take some time, and patients need to gradually increase their activity under the guidance of a doctor. Some people may need to take anticoagulant medicines long-term to prevent blood clots from forming.
Potential complicationsLike other heart surgeries, valve replacement surgery carries the risk of bleeding, infection, and other complications. The patient's age and health status can affect the level of these risks.
Minimally invasive and transcatheter valve replacement techniques
With the improvement of medical technology, minimally invasive heart surgery and transcatheter valve replacement techniques have been developed to reduce surgical risks and recovery time, bringing new hope to many patients.
Valve repair and other alternatives
In some cases, repair of the valve is considered an alternative for mitral valve disease because of its favorable prognosis. For patients whose symptoms are not obvious or who are not suitable for surgery, medication can be considered to control the disease.
Choosing the right valve type not only affects the postoperative health status, but also affects the patient's quality of life and future medical needs.
With the continuous advancement of medical technology, the options for heart valve replacement and repair are becoming more and more diverse. What direction do you think heart valve surgery will develop in the future?
