Some patients are born with defective heart valves that affect blood flow through the heart. In addition, infection, rheumatic fever and the aging process can damage healthy heart valves. Cardiac surgeons at The George Washington University Hospital are recognized nationally for their expertise in valvular surgery. They perform innovative minimally invasive valve repair and replacement procedures using advanced surgical techniques, valve devices and prostheses.
Minimally Invasive Procedures
Like traditional bypass surgery, conventional valve surgery requires a major incision in the chest and separation of the breastbone. During a minimally invasive procedure, however, surgeons leave the breastbone intact and access the heart through a small incision under the breast.
This approach can’t be used in all patients, but those who undergo minimally invasive surgery usually have shorter hospital stays, quicker recoveries and less scarring. The technique can also be used to treat a patient who has both a valve defect and a tumor in the heart or a hole in the wall that divides the heart.
The Aortic Valve
The aorta is the main artery that carries blood out of the heart through the aortic valve. When a person has aortic stenosis, his or her aortic valve does not open fully, decreasing blood flow from the heart to the body. Severe forms of aortic stenosis can prevent sufficient blood from reaching the brain and other organs.
Transcatheter aortic valve replacement (TAVR) is catheter-delivered aortic heart valve replacement for high-risk patients who have aortic stenosis and are not candidates for traditional aortic valve surgery. Because TAVR is performed while the heart is beating, there is no need for a heart-lung machine. A TAVR valve is made of biological material and is supported with a metal stent. Learn more about TAVR>
The Mitral Valve
The mitral valve is a heart valve between the left atrium (upper chamber of the left heart) and the left ventricle (lower chamber of the left heart). Consisting of two flaps, or leaflets, it acts as a doorway for the blood to go from the left atrium to the left ventricle every time the heart beats. The mitral valve opens during diastole (the part of cardiac cycle when the heart relaxes) and allows oxygen rich blood from the lungs to flow from the left atrium to the left ventricle that gets filled with this oxygen rich blood in preparation to pump it to the rest of the body. When the left ventricle starts to contract during systole (the part of cardiac cycle when the heart pumps out the blood), the mitral valve closes so that the blood does not go backwards into the left atrium and the lungs.
Any disease that affects the mitral valve leaflets can cause a leaky mitral valve. The most common cause is myxomatous degeneration of the mitral valve. In this process, the mitral valve leaflets, which are normally very thin and pliable, become thickened. Other causes include dysfunction of the left ventricle from coronary heart disease or enlargement and infections that weaken the valve.
Symptoms of a defective mitral valve can include:
- Shortness of breath after exertion that develops over the course of months or years
- Irregular heart rhythm
- High pulmonary (lung) artery pressures
Mitral Valve Repair and Replacement
Mitral valve repair is typically recommended for leaky mitral valves. Most leaky valves can be repaired using the patient’s own tissues. Depending on the damage, a surgeon can either tighten the valve by sewing a ring around it or rebuild one or both of the flaps that open and close the valve.
For the mitral valves that cannot be repaired, replacement with an artificial valve is another option. Two types of mitral valve prosthesis are used:
Bioprosthetic valves (Biological valves)
- These are either bovine (cow) tissue or porcine (pig) tissue valves. The advantage of tissue valves is that they do not require patients to be on long term anticoagulation (blood thinning medications such as warfarin), reducing the risks patients face with blood thinning medications. The disadvantage is their functional deterioration (structural valve deterioration) can lead to the valve not functioning properly and the patient requiring another operation to replace the malfunctioning artificial biological valve.
Mechanical valves (metal valves)
- These are artificial valves that are made of a metal. The advantage of a mechanical valve is that, typically, these valves last for the patients’ life time. The disadvantage of these valves is that they have a tendency to form clots and patients need to stay on life-long anticoagulation medication (blood thinners).
How Mitral Valve Repair Works
Farzad Najam, MD, serves as the Director of Cardiac Surgery and Clinical Professor of Surgery at The George Washington University Hospital. In this video, he discusses mitral valve issues and the advanced methods GW Hospital offers to repair these issues.