In certain cases, it is possible to perform the repair of a heart valve instead of replacing it with a prosthesis.
This is a significant advantage since it avoids having to implant a valvular prosthesis in the heart. Although this is innocuous it is not living tissue, with all that this supposes.
The main benefit of the repair is that you do not need to take long-term anticoagulant medication unless there is another cause to do so. However, it should usually be taken during the first 3-6 months after surgery. In addition, as no device is implanted in the heart there is less risk of infection in the heart tissue (infective endocarditis). Nor is the anatomy of the heart altered, as opposed to valvular prostheses, which may occasionally worsen the contractility of the heart.
The risks presented by valvular repair do not differ from those of any cardiac surgery. However, it must be pointed out that in the case of reparation there is always the added risk that it can not be successfully performed. When this happens, there is finally the replacement of the valve, which causes the duration of surgery and extracorporeal circulation to be greater. This fact may negatively influence the postoperative period.
When repairing the damaged valve using various surgical techniques, the intention of the surgeon is to restore valvular function. Sometimes several techniques are combined with each other. The goal is to make the veils (valve doors) open and close normally.
Repair of the aortic valve is exceptional. In the case of ascending aortic aneurysms (see the section: Surgery of Aorta Artery ), you can keep the valve when it no failure (improper closing) as a result of the aortic aneurysm. In these cases, the valve is suspended inside the prosthesis that will replace the ascending aorta;
The mitral and tricuspid valves can often be repaired. Mitral valve repair is discussed more extensively in the relevant section (see the section: Mitral Valve Repair ).
The tricuspid valve is the valve that when it is sick is repaired more frequently. It is rare to have to replace it with a prosthesis. However, it should be noted that their isolated involvement is rare. Therefore, in most cases, the surgical treatment is performed when a left valve (mitral or aortic valve) has to be operated. There are exceptions in which only the tricuspid valve is operated, but it is not usual.
The most frequent lesion of the tricuspid valve is its insufficiency. This is caused by dilatation of the valve ring, ie it is as if the frame of a door (the valve ring) is dilated, and the doors (which would be the valves of the valve) no longer close well. The most frequent are that this dilation occurs as a consequence of a disease of the left valves. This is why the veins of the tricuspid valve are generally unaffected. Therefore, a repair will consist of repairing the dilated ring of the tricuspid valve. For this, an annuloplasty of the tricuspid valve is performed. This technique consists of puckering the valve ring to reduce its diameter and is similar to that of a non-dilated valve. In this way the mechanism that generates the tricuspid insufficiency is solved, reducing the orifice through which the blood passes, which before was too large.
Tricuspid annuloplasty can be performed with a type of prosthesis without valves; This is called a prosthetic ring that is sutured to the tricuspid valve annulus, and reduces the diameter of the valve ring to that of the implanted prosthetic ring. The other option is to crimp the ring by a continuous suture around the valve;
Tricuspid valvular repair is associated with a low rate of complications and does not usually lead to a significant increase in surgical time.