Mitral valve replacement through catheterization in Israel

The most common and popular minimally invasive intervention in modern cardiac surgery in Israel is mitral valve replacement. During catheterization, the damaged valve is replaced or reconstructed with a biological (tissue) or artificial graft.

The human heart is a rather complex four-chambered organ: its right part (atrium and ventricle) is responsible for sending venous blood to the lungs, and the two left chambers receive oxygenated blood from the lungs and pump it into the arteries.
To ensure that blood moves along this route in only one direction, there are four sequentially opening valves between the chambers. However, they can have pathology, both due to congenital defects and due to a number of diseases: rheumatic fever, infection, due to age-related changes. Most often, the mitral valve, located between the left atrium and the ventricle, is affected. Depending on the severity of the pathology, the patient may be recommended surgical treatment: reconstruction or complete replacement of the heart valve. The cost of heart valve replacement surgery ranges from $34,000 to $42,000.

Life after valve replacement

The lifespan after surgery directly depends on the individual characteristics of the patient’s body and on whether the patient complies with the necessary rules or not.
Having a valve replacement procedure not only improves a person's overall well-being, but also minimizes the likelihood of death due to heart failure. Only 0.2% of people die after surgery, so the prognosis can confidently be called favorable. Patients need to avoid stress and psycho-emotional stress in every possible way.

Diet after surgery

Many patients forget about general recommendations as soon as the rehabilitation period passes.

In fact, a certain diet must be followed throughout your life. It means:

• caffeine withdrawal;
• giving up alcohol and nicotine;
• refusal of unhealthy foods (fried, fatty, floury);
• inclusion of fruits, vegetables, herbs in the diet;
• consumption of cereals, lean meat and fish.

After surgery you need to give up coffee

Such nutrition increases the patient’s life expectancy, since it partially eliminates the risk of blood clots. People with a biological prosthesis are also not recommended to indulge in junk food, alcoholic drinks and cigarettes.

Gymnastics

For the first year after surgery, the person will need to see the doctor monthly. It is the specialist who, if necessary, can prescribe a course of therapeutic exercises. You should not resort to performing any strenuous exercises. As an alternative, you can do the simplest exercises, or better yet, do therapeutic walking.

In the second postoperative year, you will need to visit a specialist every 6 months, and all subsequent times – once every 12 months.

The patient is prohibited from engaging in heavy work or participating in various sports competitions. The patient needs to spend at least 1-2 hours in the air every day.

• The most effective methods of aortic valve replacement

The patient needs to spend 1-2 hours in the fresh air every day

After open surgery, a scar or a noticeable scar remains on the chest, which plastic surgery (in particular, laser correction) can help remove. Such procedures must be agreed upon with the attending physician.

Valve replacement is a procedure that significantly increases the patient's chances of living a normal life. It can restore a person’s efficiency, cheerfulness and activity.

Other recommendations

There are a few other mandatory tips that patients undergoing valve replacement surgery must follow.

1. If you experience symptoms of cardiac problems (chest pain, a feeling of interruptions in the heart), signs of circulatory problems (swelling in the legs, shortness of breath) and other unexpected symptoms, you should immediately consult a doctor.
2. Patients who have had a biological valve installed are not recommended to take calcium supplements. In their diet, it is advisable for them not to overuse products containing it: milk and dairy products, sesame seeds, nuts (almonds, Brazilian), sunflower seeds, soy.
3. All doctors, including the dentist, need to warn the patient that he has an artificial valve installed.

Following the necessary recommendations will help the patient maintain excellent health for a long time and live a full life.

Who needs such an operation

In a situation where the valve ceases to fulfill its purpose, a disruption occurs in the direction of blood flow. As a result, the heart muscle begins to wear out extremely quickly and gradually leads to heart failure. This, in turn, does not allow the blood to circulate well and provide the human body with the necessary amount of oxygen and nutrition. These problems will eventually lead to irreversible processes throughout the body and even to the death of the patient. The only way out of this situation can be heart surgery.

Important! The main reasons why a doctor recommends surgical intervention is a severe organic pathology that can develop into a heart defect.

1. Birth defects, which today are most often diagnosed in childhood.
2. Adhesions or seals between valve petals. Quite often, such patients undergo a surgical operation known as commissurotomy, but sometimes, due to individual characteristics, this manipulation cannot be performed. It is in this case that the valve is replaced.
3. Wrinkling of valve leaflets or tendon strands. This may be a consequence of rheumatic carditis, which usually develops due to a streptococcal infection in the body.
4. Myocardial fibrosis is a disease in which the valves become covered with connective tissue. This pathology usually develops as a consequence of complications of certain inflammatory heart diseases.
5. Calcification. Calcium salts accumulate on the valves. Most often this happens as a consequence of metabolic disorders or hormonal imbalances. Quite often this is a hereditary pathology. In addition, cardiac rheumatism also has such consequences.
6. Aortic stenosis, which developed as a complication after previous coronary artery bypass grafting.

Reviews from doctors

Professor Ran Kornovsky, Director of the Institute of Invasive Cardiology at Beilinson Hospital: “I am very pleased that we were able to perform valve replacement surgery quickly and gracefully, with minimal harm to the patient. To date, less than 20 such procedures have been registered worldwide and none in Israel. In this way, we continue to build on the already extensive experience we have acquired in the field of heart valve replacement through catheterization and other varied and complex procedures.”

Professor Alik Sagi, Director of the Institute of Echocardiography (Echography) and the Valve Diseases Clinic at Beilinson Hospital: “This is a real revolution. Repeated surgical interventions on the heart in patients who have previously undergone similar operations are associated with a long and difficult recovery process, sometimes stretching for several months. Two days after our procedure, the patient was already moving around the department, and we observed a significant improvement in her clinical condition.

Types of heart valve replacement surgeries

The operation is performed on an open heart with the patient connected to the artificial circulation system. Currently, innovative minimally invasive techniques have been introduced in advanced clinics such as the Almazov Center, where heart valve replacement is carried out under local anesthesia without dissecting the chest.

Read more about the types of prostheses

The prosthesis is selected individually, depending on the diagnosis, the patient’s condition, and the presence of comorbid pathology. The shape of the implant depends on which heart valve is affected. Prostheses are made either from artificial materials (mechanical) or from tissues of animal origin (biological). The patient is often interested in which option is better to choose. Let's try to figure it out.

Characteristic features of mechanical products:

• Made from plastic, carbon, metals.
• They are highly durable and have a 15-20 year warranty.
• Recommended for young patients.
• Increase the risk of blood clots.
• In the postoperative period, lifelong use of anticoagulants is required.

Biological prostheses can be described as follows:

• My Heart Valve Replacement Story

• They are xenografts and allografts.
• Relatively short-lived, requiring replacement after 8-12 years.
• It is advisable to implant in people of older age groups, with a risk of blood clots, and allergies to anticoagulants.
• There is no need to prescribe antithrombotic drugs.

Among cardiac surgeons, the popularity of the Ross operation is increasing - replacing the aortic valve with a pulmonary valve (autograft), and the pulmonary valve with a prosthesis made of biomaterials.

Patient preparation

During hospitalization, the clinic’s doctors will ask the patient to take with him all the extracts, examination data, ask about existing diseases, taking medications, and then prescribe additional tests on the eve of the operation.

Preparing for heart valve replacement has two goals:

• Identification of possible risks during and after prosthetics.
• Planning the course of surgical intervention and rehabilitation procedures.

The effectiveness of treatment depends on this. It is important to inform specialists even of minor points, in the patient’s opinion.

The doctor needs to know the following:

• heart valve condition;
• degree of severity of disorders in the myocardium;
• changes in heart function;
• the patient has a tendency to bleed;
• danger of respiratory and allergic complications;
• features of the liver, endocrine and excretory systems;
• history of bad habits;
• taking medications and biological supplements.

It is usually recommended to undergo a laboratory examination (general clinical tests and biochemistry), instrumental diagnostics (x-ray, ultrasound, functional methods), and obtain consultations with specialized specialists (including an anesthesiologist, even if a minimally invasive intervention without general anesthesia is planned). On the eve of prosthetics, the patient will be asked not to smoke, eat or drink.

Technique of the operation

The technique for performing prosthetics is almost the same when replacing different valves. The order of the stages of the operation is strictly observed. Access to the heart is carried out by dissecting the sternum or ribs along the lateral lines.

A longitudinal incision is made to open the pericardium. The artificial blood circulation machine is connected. Procedures are carried out to cool the heart and prevent air embolism. Temporary electrodes are sutured to the myocardium, and drainage is left in the pericardial cavity and mediastinum.

Progress of the procedure

The person is given general anesthesia. The cardiac surgeon removes the affected valves, installs artificial ones in their place, then connects the myocardium, starts the organ’s work, and sutures the covering tissue.

• Mechanism of development, diagnosis and treatment of aortic calcification

A self-expanding artificial biovalve is passed by a catheter through an artery or vein (depending on which valve needs “repair”) to the required part of the heart, melts under the influence of body temperature, and is put into operation immediately after transportation.

It is also possible to replace the valve using a mini-access - an incision up to two and a half centimeters in the fifth intercostal space to the left of the sternum. An artificial valve is inserted to the apex of the heart.

It is important to know! A huge advantage of such techniques is not only the absence of the need to open the heart cavity, but also the ability not to resort to connecting a heart-lung machine.

Suspected complications

When replacing a heart valve, adverse consequences can occur both during the procedure and in the postoperative period. The attending physician will definitely inform the patient about possible complications. In the operating room, the patient’s condition is completely controlled by a team of doctors.

During rehabilitation, a person should immediately seek help in the following situations:

• the color of urine or feces has changed;
• shortness of breath appeared;
• have problems with hearing or vision;
• numbness of the limbs is felt;
• inexplicable fatigue sets in;
• there is swelling and hyperemia of the sutures;
• an increase in body temperature is recorded.

A negative consequence may be associated with the proliferation of fibrinous tissue, bleeding due to taking anticoagulants, the formation of blood clots, hemolysis of red blood cells, and the addition of an infection. Careful preoperative preparation and adherence to medical recommendations will help avoid dangerous conditions.

Rehabilitation

On average, the duration of hospitalization in the clinic takes 7–10 days, including the first days after prosthetics in the intensive care unit. But even a successful result requires a recovery period of up to 3-6 months.

A few simple tips that will make your rehabilitation easier:

• take all medications prescribed by your doctor;
• eat easily digestible carbohydrates;
• regularly check your sugar and cholesterol levels;
• give up baths and saunas for at least a year;
• perform measured physical activity.

Sometimes, even with very good health indicators, depression awaits a person in the postoperative period. Therefore, it is important that the person recovering is under the supervision of an experienced specialist and has psychological support.

About the purpose of disability and prognosis

Non-working group II is determined for a period of one year after completion of the operation to restore the myocardium. In the future, transfer to group 3 is possible.

When establishing disability, cognitive deviations (decreased mental abilities) are taken into account individually.

How long do you live with an artificial valve? The average life expectancy in this case is approximately 20 years. However, theoretically, the valve’s lifespan is much longer (up to 300 years, according to doctors).

Rehabilitation period

After replacing the mitral valve using catheterization, the patient is transferred to the intensive care unit. Within a few hours he can get out of bed and walk independently. The average length of hospital stay after surgery is about 5-7 days. To prevent the formation of thrombosis, regardless of the type of transplant, a course of blood thinning drugs is prescribed. It is recommended to avoid intense physical activity and stress for a month.

An individual cardiac rehabilitation program is developed for each patient, including a course of physical activity aimed at stabilizing the functioning of the cardiovascular system, the formation of a dietary menu, and psychological support.

In our clinic you are guaranteed high-quality medical care and individual solutions for creating treatment programs for cardiovascular diseases for each patient.

After aortic valve replacement surgery

Once the operation is completed, the patient is sent to the intensive care unit. Here he is brought out of anesthesia and vital functions are monitored:

• The heart rate is determined.
• Breathing and blood pressure are monitored.
• The oxygen level in the blood is checked.

• A tube is inserted into the mouth and lungs to provide additional ventilation.
• A drain is installed to drain fluid from the chest.
• The patient has a catheter placed in the bladder to drain urine.
• Pain medications, fluids, and electrolytes are injected directly into a vein.

After aortic valve replacement, the patient usually spends 5-7 days in the hospital if there are no complications.

Diagnostics

At the clinic, the patient undergoes a number of diagnostic tests, including:

• chest x-ray;
• electrocardiography;
• echocardiography;
• angiography;
• transthoracic echocardiography;
• 24-hour Holter ECG monitor;
• advanced biochemical analyses.

If necessary, an additional examination program is prescribed. After receiving the diagnostic results and collecting an anamnesis, the attending physician decides on the procedure for performing the operation to replace the mitral heart valve.