Download Expository DRAFT

Feiling 1
Traci Feiling
Dr. Brown
English 010
November 8th, 2015
Heart Valve Surgery
According to the Texas Heart Institute, surgeons perform over 100,000 valve operations
each year. This means that over 100,000 patients have one or more of the four heart valves
repaired or replaced. There are multiple steps to the procedure, which depends on whether the
patient is having their valve repaired or replaced, how much damage there is to the valve, and
which method the surgeon and patient agreed to perform. There are also several statistics and
demographics, health factors, and complications and issues that may come with the surgery.
The heart has four chambers: the right atrium, the right ventricle, the left atrium, and the
left ventricle. On the right side of the heart, blood is pumped from the right atrium into the right
ventricle, then into the pulmonary artery. The tricuspid valve separates blood flow from the right
atrium and the right ventricle, and the pulmonary valve separates blood flow from the right
ventricle and the pulmonary artery. On the left side of the heart, blood is pumped from the left
atrium into the left ventricle, and then into the aorta. The mitral valve separates blood flow from
the left atrium and the left ventricle, and the aortic valve separates blood flow from the left
ventricle and the aorta. The valves, also known as cusps or leaflets (Texas Heart Institute), close
tightly to prevent the backwards flow of blood.
An article by the Texas Heart Institute states that in the United States surgeons perform
over 100,000 valve operations each year. Most of these surgeries are done to repair or replace the
mitral or aortic valves, which are located on the left side of the heart (Texas Heart Institute). The
Feiling 2
left side of the heart works harder than the right side (Texas Heart Institute). The surgeries are
also most often performed on elderly patients, since they are “more prone to hypertension,
diabetes, obesity, renal failure, and heart attack due to lifestyle upgrade” (Liu, He, & Shi).
However, another article stated that “the U.S. Census Bureau projects that the very elderly
population (age > 80) will grow from 5.8 million (1.8% of the population) in 2012 to 13 million
(3.2%) by 2050. Heart valves are well known to degenerate with aging, affecting up to 13.2%
patients age > 75 years” (Mao, Thongprayoon, Wu, Tejwani, Vela-Ortiz, Dearani, and Qian).
Health factors that may require the procedure are “congenital defects, narrowed, stiff
valves that obstruct the free flow of blood, loose, leaky valves that allow blood to flow the wrong
way through the heart, and infected valves” ("Heart Valve Replacement"). If patients have severe
valve damage, the valve will need to be replaced, and not repaired (Texas Heart Institute).
Replacement can also be used on any valve disease that is life-threatening, and some patients
may need two or more valves repaired or replaced (Texas Heart Institute). There are two kinds of
valves that can be used for replacement. Mechanical valves are strong and sturdy, last a long
time, and are made from materials such as plastic, carbon, or metal. (Texas Heart Institute).
Biological valves are made from animal tissue, commonly from a pig or cow, or human tissue
from a donated heart. Some valves can also be made from the patients own tissue (Texas Heart
Institute and "Heart Valve Replacement").
In the article titled “Heart Valve Replacement,” the authors state that prior to the
procedure, the surgeon may perform a physical exam, an echocardiogram - which is a test that
visualizes the heart using sound waves - an x-ray, an electrocardiogram, which records the
patient’s heart activity, and a cardiac catheterization. A cardiac catheterization is when the
surgeon inserts an instrument into the patient’s heart through an artery to detect any problems
Feiling 3
with their heart and blood supply. Patients are also encouraged to review medications with their
doctor, stop smoking at least two weeks prior to surgery, bathe the night before surgery to reduce
the amount of germs on their skin, eat a light meal the night before, and nothing after midnight
(Texas Heart Institute and "Heart Valve Replacement").
On the day of the surgery, the patients will have electrodes attached to their chest to
monitor their heart rhythm (Texas Heart Institute). An IV will be placed into the patient’s wrist,
and anesthesia will be given to the patient through the IV during the operation (Texas Heart
Institute). Anesthesia is given to block pain, and to keep patients asleep during the operation
("Heart Valve Replacement"). Once the patient is asleep, “a tube [is] inserted down [their]
windpipe and connected to a machine called a respirator, which will take over [their] breathing.
Another tube is inserted through [their] nose and down [their] throat, into [their] stomach. This
tube will stop liquid and air from collecting in [the patient’s] stomach, so [they] will not feel sick
and bloated when [they] wake up” (Texas Heart Institute). The surgeon will then “cut through
the skin and breastbone… the chest cavity is opened” ("Heart Valve Replacement"). The patient
is then hooked up to a heart-lung machine, which keeps blood flowing through the body while
the patient’s heart is stopped. (Texas Heart Institute). The patient’s heart is then stopped and
cooled, and a “cut is made into the heart or aorta, depending on which valve is being repaired or
replaced” (Texas Heart Institute). If the valve needs to be repaired, the surgeon will do that next.
If it needs to be replaced, the damaged valve is removed after the incision is made, and the
surgeon stitches the replacement valve into place ("Heart Valve Replacement"). The surgeon will
check the valve to make sure that it works properly, and then the cut in the heart is closed
("Heart Valve Replacement"). The heart is then restarted, and once the heart begins working
again, the patient is removed from the heart-lung machine ("Heart Valve Replacement"). The
Feiling 4
patient’s chest is closed with wire, and their skin is closed with sutures ("Heart Valve
Replacement"). The surgery can last anywhere from 2 to 5 hours, depending on how many
valves need to be repaired or replaced (Texas Heart Institute and “Heart Valve Replacement”).
The article “Heart Valve Replacement” states that the length of stay is anywhere from
two-to-five days, and the first day is spent in the Intensive Care Unit.
There are several complications that can occur after the valves are repaired or replaced. If
a valve was replaced with a mechanical valve, the patient will need to take blood-thinning
medicines for the rest of their lives, because blood tends to stick to the mechanical valves and
create blood clots (Texas Heart Institute). Biological valves are not as strong as mechanical
valves, and may need to be replaced every ten to fifteen years (Texas Heart Institute). Patients
will also have pain while recovering from surgery (“Heart Valve Replacement“). Patients will
need to alert their doctor if they experience a fever, swelling around the incision site, nausea,
vomiting, chest pain, or rapid heart rate (“Heart Valve Replacement”).
Heart valve surgeries are starting to increase the lives of the elderly (Mao,
Thongprayoon, Wu, Tejwani, Vela-Ortiz, Dearani, and Qian), and surgeons have several
different ways to perform the surgery. There are different reasons as to why a patient would need
the operation, several different complications that may arise after their surgery and different
statistics on the patients that undergo the procedure.
Feiling 5
Works Cited
“Heart Valve Replacement.” EBSCOhost. N.p., n.d. Web. 28 Oct. 2015
Liu, Weichao, Fei He, and Gongning Shi. “Succass Rates and Prognosis of Heart Valvuloplasty
and Valve Replacement Performed for Elderly Patients.” N.p., 30 July 2015. Web. 28
Oct. 2015.
Mao, Michael, Charat Thongprayoon, YiFan Wu, Vickram Tejwani, Myriam Vela-Ortiz, Joseph
Dearani, and Qi Qian. “Incidence, Severity, and Outcomes of Acute Kidney Injury in
Octogenarians following Heart Valve Replacement Surgery.“ N.p., n.d. Web. 28 Oct.
2015.
“Valve Repair or Replacement Surgery - Texas Heart Institute Heart Information Center.” Valve
Repair or Replacement Surgery - Texas Heart Institute Heart Information Center. Texas
Heart Institute, n.d. Web. 28 Oct. 2015