Τhe Cardiovascular Surgery Clinics of Mediterraneo Hospital offers the full range of surgical treatment for cardiac valve diseases. In this sector, during the last years, a lot of new surgical methods were developed.
Range of treatment – Heart valve surgery in adults
- Replacement of mitral and aortic valve with biological and mechanical valves.
- Replacement of aortic valve using minimally invasive technique.
- Replacement of aortic valve with homograft in endocarditis.
- Minimally invasive replacement or reconstruction of mitral valve.
- David procedure – reconstruction of aortic valve, with maintaining of aortic valve.
- Ross Procedure, with the use of the patient’s pulmonary valve, in aortic position.
- Replacement or reconstruction of tricuspid valve.
Selection of cardiac valve prosthesis
The decision for the selection of prosthetic cardiac valves is done after obtaining the patient’s consent, taking in consideration his condition (age, athletic activities, coexisting diseases, etc).
Mechanical cardiac valve prosthesis
The modern cardiac valves with double flaps (see Image 1), which are used by us, offer the ideal flow profile and they are characterized by their endurance, for lifetime. As disadvantage, it should be taken in consideration the lifetime intake of anticoagulants, for avoiding clot formation.
Image 1: Mechanical cardiac valve
Biological cardiac valve prosthesis
Concerning the endurance, the tissue valve (image 2) cannot be compared with the mechanical valves and for this reason, in a period of 10 – 20 years, they should be replaced because of degeneration. An advantage of these valves is the low percentage of clot formation. For this reason, the treatment with Sintrom is necessary only for 2 months after the intervention.
Image 2: Biological cardiac valve
Cardiac valve reconstructions
A variation of the replacement of the aortic valve, with biological prosthesis, is the “Ross Procedure”. The pulmonary valve of the patient is placed in the site of aortic valve, while in the site of the pulmonary valve a pulmonary valve from a donor (homograft) is placed (image 3). This is done regularly in younger patients, who would like to avoid the use of anticoagulants. Υet, it should be taken in consideration that in the future, a new procedure will be needed for the replacement of the valve. However, the endurance of the “new” aortic valve is bigger in comparison with the endurance of the conventional biological prosthesis.
Image 3: The result of Ross Procedure. The new aortic valve is composed of the patient’s former pulmonary valve and the pulmonary valve of the donor has been implanted in the site of the pulmonary (yellow color).
David procedure – Reconstruction of aortic valve
The morphologically intact aortic valve is sutured to the prosthesis which replaces the aortic root. The control with water injection confirms the fluid-tightness of the reconstructed valve.
The development of new techniques improves the surgical results, aiming to the improvement of the patient’s post-operative quality of life. New implants (the so-called hybrid prostheses), to which a conventional vascular prosthesis is connected, which has replaced the thoracic aorta, are used for the replacement of the ascending aorta, of the aortic arch and the descending aorta. In this way, additional surgical procedures can be avoided in many patients.
Reconstruction of mitral valve
For the last years, the emphasis concerning the mitral valve surgery is given to the successful reconstruction of this valve, while in the previous decades the replacement of the mitral valve, which is applied rarely, consisted the biggest part of the procedures of the mitral valve. The advantages are related with the maintenance of the geometry of the left ventricle, the best functional results and also with the small tendency of the reconstructed valve to form clots, a fact that makes needless the long-term medication with anticoagulants.
The diseases of the tricuspid valve are met frequently in combination with diseases of the left cardiac ventricle. In a 25 percent of the patients, who undergo reconstruction of the mitral valve because of ischemic insufficiency, the reconstruction of tricuspid valve is also needed.
The tricuspid valve insufficiency develops as a progressive, continuous condition.
When the ring (annulus) of the tricuspid valve is dilated quite a lot, the related clinical semiology appears.
The grade of severity of tricuspid valve insufficiency is related with the survival of the patients. So, high-grade insufficiency is combined with high mortality, no matter the functional performance of the left ventricle and the pressure of the pulmonary artery. For the reconstruction of the tricuspid valve, we use special rings (Edwards MC3), which are sutured on the natural ring (annulus) of the above mentioned valve.