Heart Valve Replacement Surgery in Delhi, India

Heart valve surgery is a procedure for the treatment of heart valve disease. This takes place when one of the four heart halves that are responsible for pumping blood in the right direction is not functioning properly. Basically, our heart is a pump that comprises muscle tissue. It consists of four chambers responsible for the pumping. The upper chambers are known as atria, and the lower ones are referred to as ventricles. In between each of these chambers are valves which ensure the blood is flowing through the heart and into the right directions

• Pulmonary valve: This is present between the right ventricle and pulmonary artery
• Tricuspid valve: Present between right atrium and right ventricle
• Mitral valve: This one can be found between the left ventricle and the left atrium
• Aortic valve: This one is located between the aorta and left ventricle

Each valve consists of flaps that are known as leaflets for tricuspid and mitral valves and cusps in the case of pulmonary and aortic valves. These valves close and open with every heartbeat. At times, the valves are not able to close and open properly, which in turn affects the blood flow from your heart to the body.

In cases where any of the valves are diseased or damaged, they demand medical intervention. A heart valve surgery, therefore, includes a surgeon repairing or replacing the affected heart valves. In fact, the mitral valve and aortic valve are the two most commonly replaced valves. There are fairly uncommon cases of tricuspid and pulmonary valve replacement. This comprises many surgical procedures to repair the heart and includes minimally invasive heart surgery and open heart surgery.

In many cases, heart valve disease can develop before your birth or be acquired during the span of your life. Further, in many cases, the causes remain unknown. Common causes affecting the heart’s valves include:

• Congenital Valve Disease – This particular form impacts the pulmonic or aortic valve. They include valves of the wrong size or malformed leaflets. In many cases, the leaflets are not attached correctly.
• Bicuspid Aortic Valve Disease – This one affects the aortic valve. Unlike a normal valve with three cusps or leaflets, this one only has two. With the absence of the third leaflet, the valve becomes stiff and finds it difficult to close and open properly. It can also become leafy and create resistance in close contact.
• Acquired Valve Disease – This one involves problems that were acquired over one’s life. It includes changes in the valve structure due to some kind of infection or disease like rheumatic fever or endocarditis.
• Rheumatic Fever – This is a result of bacterial infection, which is left untreated. This was more prevalent earlier before antibiotics came into the scene to treat it during the 1950s. The infection initiates at a younger age and leads to inflammation of the valves. However, one is not able to see the symptoms until 20-40 years later.
• Endocarditis – This is caused when bacteria enter the bloodstream and start attacking the valves. As a result, holes and growths begin to occur in the valve and also lead to scarring. This causes leaky valves. The germs that are the major cause of Endocarditis can enter the bloodstream during surgery, dental procedures, severe infections and other IV drug usage.

There are many other conditions that can affect the valves. They have papillary muscles or chordae tendineae (CT) that can tear or simply stretch. Another case can be the dilating of the annulus of the valve. Then there are also chances of stiffness of the leaflets, and they can also be calcified.

There is another condition called mitral valve prolapse that can lead to the mitral valve leaflets flopping back to the heart’s contraction. This also impacts the tissues, and they become abnormal, thereby causing a leakage.

Further other causes include heart attack, coronary artery disease, syphilis, coronary artery disease, connective tissue diseases and high blood pressure. Other lesser reasons include radiation, tumour or some type of drug abuse.

Here are some of the most common symptoms of heart valve repair or replacement. 

• Shortness of Breath: This is most noticeable when you are engrossed in daily activities or lie down on the bed. You are required to keep a few pillows under your head to breathe easier.
• Dizziness or Weakness: You feel dizzy when carrying out everyday activities and have generally low energy all the time. There can also be cases when you pass out suddenly.
• Discomfort in Chest: You may feel a certain discomfort or pressure on your chest. It can worsen when you are out in the cold or a breezy environment.
• Constant Palpitations: It is a red sign if you have constant episodes of palpitations, which include an increased heart rate and irregular heartbeat, a flop feeling in the chest or skipped beats.
• Swollen Ankles, Abdomen or Feet: This condition is often referred to as pulmonary Edema. You can experience swelling in your belly, which causes you to feel bloated
• Sudden Weight Gain: A sudden increase in your weight without any possible indulgences or change in diet.

Your heart valve repair doctor will have a thorough discussion, perform a physical examination and carry out certain tests before recommending a heart valve repair or replacement surgery.

The physical examination involves listening to the sound that your heart makes as the valves open and close. A heart murmur is the kind of swishing sound made by the bloodstream as it passes through a leaky valve or stenotic. Similarly, an irregular rhythm signifies an enlarged heart. In fact, if your heart is retaining fluid and not able to pump the way it should, the doctor can figure that out by listening to the lungs.  This is followed by a thorough examination of the body that helps assess the circulation and functioning of other organs.

The tests conducted by heart valve specialists include:

Transoesophageal Echocardiography (TEE): A specialised cardiac imaging technique that involves inserting a probe into the oesophagus to obtain clear images of the heart's structure and function, making it especially valuable for assessing heart valve conditions.

Echocardiography: Often referred to as an "echo," it is a non-invasive and widely used imaging test that uses sound waves to create real-time images of the heart to help diagnose and monitor various heart conditions, including heart valve problems.

Cardiac Catheterization (Angiogram): Commonly referred to as an “angiogram”, it involves using a thin, flexible tube (catheter) to inject a contrast dye through blood vessels to the heart, which allows specialists to visualise the coronary arteries and identify abnormalities.

Based on the outcomes of these tests, the progress of the valve disease is diagnosed, and a further treatment method is recommended.

Based on the dynamics of the case, a heart valve specialist can recommend either heart valve repair or replacement. 

Heart Valve Repair

In cases where possible, the doctor suggests heart valve repair as it allows the preservation of the valve and proper heart function. It includes:

• The surgeon patched a hole in the diseased valve
• Followed by reconnecting the valve cusps
• Removal of any excess oil between the valves so they can close tightly
• Replacing the cords to support valve repair for structural support
• Separation of the fused valves
• Tightening of the ring around the valve, also known as the annulus

Heart Valve Replacement

In cases where repairing the heart valve is not possible at all, doctors recommend heart valve replacement. It involves removing the heart valve and replacing it with a mechanical one or one made from the tissue of a human, pig or cow’s heart.

These biological tissue valves also require to be eventually replaced because they tend to degenerate over the years. On the other hand, a mechanical valve requires blood-thinning medicines for all your life to avoid blood clots.

The pros and cons of each type of valve replacement are discussed with the patient before making a decision. A minimal invasion is carried out during this surgery using a catheter process.

With a diseased valve condition, every step needs to be carefully planned. That is why we at Max Healthcare make it easier for the patients to make the decision. The exceptional row of doctors takes each case differently and provides treatment methods after thoroughly studying the history and the present condition of the patient. This ensures that the surgery is not the only focus but a comfortable post-treatment plan as well.

You will be under anaesthesia and connected to a heart-lung bypass machine that allows constant movement of the blood throughout the procedure. This surgery can be performed during open-heart surgery that includes a cut or incision in the heart. In many cases, surgeons also perform minimally invasive surgery that includes smaller incisions. This involves using long instruments that are inserted through small incisions in the chest or using robotic arms. This surgery usually comes with a shorter stay and quicker recovery.

Preparing for heart valve surgery is a crucial step to ensure a successful procedure and a smoother recovery. Here are some important steps to consider when preparing for heart valve surgery:

Consultation and Education: Schedule a consultation with your cardiac surgeon to discuss the surgery, its goals, and the risks and benefits. Ask questions and seek clarification about what to expect.

Medical Evaluation: Patients are required to undergo a comprehensive medical evaluation, which may include blood tests, imaging studies, and other diagnostic tests.

Cardiac Rehabilitation: In some cases, patients are required to participate in a cardiac rehabilitation program before surgery to help improve their physical fitness and overall health.

Medications: In some cases, heart specialists may ask the patient to adjust or discontinue certain medications, such as blood thinners, in the days leading up to the surgery.

Diet and Nutrition: Patients must maintain a healthy diet to support their body's nutritional needs and overall well-being and follow any dietary restrictions or fasting instructions provided.

Smoking Cessation: If you smoke, consider quitting before surgery. Smoking can increase the risk of complications and impair the healing process.

Mental and Emotional Preparation: Patients can seek emotional support from family members, friends, or a counsellor to help alleviate anxiety and can also consider joining a support group.

Postoperative care and recovery following heart valve surgery are crucial for a successful outcome and a return to a healthy, active life. Here are some essential aspects of postoperative care and recovery:

Hospital Stay: Patients are monitored in the intensive care unit (ICU) or a cardiac care unit (CCU) for a period of time, depending on their condition and the complexity of the surgery.

Pain Management: Pain management is a priority during the early stages of recovery. Medications will be provided to control pain and discomfort.

Monitoring: All vital signs are closely monitored, and Electrocardiograms (ECG or EKG) will be performed to assess the heart's rhythm.

Chest Tubes and Drains: Chest tubes may be inserted to drain excess fluid or air from the chest cavity. These tubes are removed as the patient’s condition stabilises.

Physical Activity and Mobilization: Early mobilisation through gentle exercises is essential for preventing complications such as blood clots and pneumonia. 

Breathing Exercises: Patients are encouraged to perform deep breathing exercises to prevent lung congestion and promote oxygenation.

Diet and Nutrition: Initially, the patient may receive nutrition through an intravenous (IV) line, gradually transitioning to a liquid diet and then to solid foods.

Wound Care: Incisions will need to be kept clean and monitored for signs of infection. Patients must follow the healthcare team's instructions for wound care.

Monitoring Heart Valve Function: Regular echocardiograms are performed to assess the function of the repaired or replaced heart valve.

Gradual Return to Normal Activities: The heart surgeon provides guidance on when to resume daily activities, such as driving and returning to work, depending on the rate of recovery.

Follow-Up Appointments: Patients must attend all scheduled follow-up appointments with their heart surgeon to monitor their progress and address any concerns.

The overall risk profile for heart valve surgery depends on various factors, including the patient's age, overall health, the type of valve surgery needed, and the experience of the surgical team. The team of cardiac surgeons and cardiologists at Max Hospitals carefully assess these risks and discuss them with patients before surgery. Here are some of the risks associated with heart valve surgery:

Bleeding: Bleeding during or after surgery is a common risk. Surgeons take precautions to minimise bleeding, but excessive bleeding may necessitate blood transfusions or additional procedures to control it.

Infection: Surgical sites can become infected, which may require antibiotic treatment or, in severe cases, further surgery to address the infection.

Blood Clots: Blood clots can form in the heart or blood vessels after surgery. These clots may travel to other parts of the body, potentially causing strokes or other complications.

Stroke: During surgery, there is a risk of dislodging plaque or blood clots, which can travel to the brain and cause a stroke. Surgeons take measures to reduce this risk.

Heart Rhythm Problems: Surgery can disrupt the heart's electrical system, leading to arrhythmias (irregular heart rhythms). These are usually temporary but may require treatment.

Kidney Problems: The use of anaesthesia and the changes in blood flow during surgery can stress the kidneys, potentially leading to acute kidney injury (AKI). This is usually temporary and resolves with appropriate care.

Pneumonia and Respiratory Complications: After surgery, patients are at risk of developing pneumonia or other respiratory problems due to reduced lung function or postoperative immobility.

Deep Vein Thrombosis (DVT): Immobility after surgery increases the risk of Deep Vein Thrombosis DVT, where blood clots form in the deep veins of the legs. These clots can be dangerous if they break free and travel to the lungs (pulmonary embolism).

Heart Attack: Although rare, heart attacks can occur during or after heart valve surgery due to changes in blood flow and other factors.

Prosthetic Valve Complications: For those who receive mechanical or biological (tissue) heart valves, there is a risk of complications, such as valve malfunction, blood clots forming on mechanical valves, or the need for future valve replacement.

When it comes to dealing with heart valve disease, choosing the right healthcare provider for heart valve repair or replacement is of paramount importance. Max Hospitals stand out as a trusted choice for cardiac care, offering several compelling reasons why patients and their families should consider them for heart valve procedures:

Leading Cardiac Experts: Max Hospitals boast a team of highly skilled cardiac surgeons, interventional cardiologists, and specialised professionals with vast experience, ensuring the best possible outcomes for patients.

State-of-the-Art Facilities: Max Hospitals are equipped with cutting-edge technology and state-of-the-art cardiac care facilities, enabling precise diagnosis, minimally invasive procedures, and comprehensive postoperative care.

Comprehensive Diagnostic Services: Max Hospitals offers a wide range of diagnostic services, including advanced imaging techniques like echocardiography and cardiac catheterisation. These tools allow for accurate assessment and personalised treatment plans.

Multidisciplinary Approach: The teams at Max Hospitals follow a multidisciplinary approach to cardiac care, involving collaboration among cardiac surgeons, cardiologists, nurses, and rehabilitation specialists, ensuring every aspect of patient care is fully addressed.

Minimally Invasive Techniques: Max Hospitals are at the forefront of minimally invasive heart valve surgery. These techniques offer shorter recovery times, reduced pain, and smaller incisions compared to traditional open-heart surgery.

Proven Track Record: Max Hospitals has a track record of successful heart valve surgeries and excellent patient outcomes. The institution's commitment to quality care and patient safety is evident in its outcomes data.

Comprehensive Cardiac Rehabilitation: Max Hospitals provide comprehensive cardiac rehabilitation programs comprising supervised exercise, nutritional guidance, and emotional support aimed at optimising recovery and improving long-term heart health.

Patient-Centric Approach: Patient well-being and comfort are top priorities at Max Hospitals. The healthcare team is dedicated to providing compassionate and patient-centred healthcare services throughout the treatment journey.

International Patient Services: Max Hospitals offers international patient services, making it convenient for patients from around the world to access our renowned cardiac care from some of the most esteemed heart specialists in India.

With a strong focus on positive outcomes and a commitment to improving cardiac health, Max Hospitals has earned a reputation as a trusted leader in cardiac care. If you’d like to learn more about heart valve disease or treatment, book a consultation with a heart specialist at a Max hospital near you. 

1. Can heart valve disease be treated with medications alone?

Medications can help manage symptoms and slow the progression of valve disease. However, for severe cases, surgery may be necessary to repair or replace the affected valve.

2. How long does heart valve surgery typically take?

The duration of the surgery depends on factors such as the type of valve procedure, the patient's overall health, and surgical complexity. On an average, it can take several hours.

3. What is the recovery period after heart valve surgery?

Recovery varies from person to person but usually involves a hospital stay of 3-7 days. Full recovery may take several weeks to months, depending on the individual's overall health.

4. Can you live a normal life after a valve replacement?

Yes, individuals can lead a normal life after heart valve replacement surgery, with improved quality of life and carry out everyday activities. That said, adhering to prescribed medications and lifestyle recommendations is essential for long-term success.

5. Is it painful to get a heart valve replaced?

During heart valve replacement surgery, patients are typically under anaesthesia, which means they do not feel pain during the procedure. However, it is common to experience pain and discomfort in the chest and incision area in the days following surgery. 

6. Can a heart valve repair itself?

No, a heart valve cannot repair itself on its own. Once a heart valve is damaged or diseased, it typically requires medical intervention, either through heart valve repair or replacement surgery

7. What is the cost of aortic valve replacement in Delhi?

The cost of an aortic valve replacement surgery in Delhi, India, can vary widely depending on several factors, such as the type of valve used, the complexity of the procedure, and the patient's overall health.

8. Who is not eligible for heart valve replacement? 

Eligibility for heart valve replacement depends on individual factors, but those with advanced age, severe comorbidities, limited life expectancy, or unstable overall health may not be suitable candidates.

Reviewed by Dr. Dinesh Chandra - Principal Consultant-Cardiac Surgery (CTVS) on 13-Dec-2023

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