Heart replacement surgery is a specialized surgery which is performed to replace the damaged or diseased cardiac valve. While performing the surgery, the damaged or diseased valve is replaced with a biological or synthetic valve, depending on the condition of a patient. This surgery is considered an incredibly complex procedure having symptoms such as breathlessness and chest pain. The cardiac valve includes aortic, mitral, tricuspid, and pulmonic and any of these valves may get damaged during a person’s lifetime because of a number of reasons. Generally, Pulmonic and tricuspid valve are rarely replaced or repaired and mitral valve, on the other hand, often needs treatment. Narrowing of the valve or leakage of a valve is the reason why a patient asks for the valve replacement surgery as it restricts the flow of the blood from one chamber of the heart to another.
Being one of the leading reasons for heart valve replacement surgery, aortic valve stenosis is also a serious cardiac disorder. India, with the availability of the latest cardiac treatment technology and sophisticated catheterization labs, has secured the number one position in the list of countries with the best cardiac care. The low cost for heart valve replacement surgery in India is actually the major reason why hundreds of patients travel to India from all over the world. India has a strong brigade of skilled and experienced cardiac surgeons who have treated more than thousands of patients with aortic valve stenosis.
There are four types of valves in the human heart – the mitral, aortic, tricuspid, and pulmonary valve. The mitral and the tricuspid valve are present between the upper and the lower chambers of the heart. On the other hand, the aortic and the pulmonary valve are present in the two arteries that leave the heart.
Most often, it is the mitral and the aortic valve that undergoes certain pathologic changes due to degenerative valve diseases, rheumatic heart diseases, or infective endocarditis. This may result in problems associated with the valve opening and closure.
These dysfunctions can be treated with either valve repair or valve replacement surgery. Aortic valve replacement or mitral valve replacement is carried out when just one of the valve is diseased or damaged. However, when both the valves are diseased or damaged, a double valve replacement surgery is conducted.
The heart valves present in the heart are responsible for permitting the flow of nutrient-laden blood through the heart chambers. After allowing the ushering of blood, each valve is expected to close completely. The diseased or damaged valves are not able to open and close properly, thus allowing the mixing and backflow of blood (regurgitation).
A double valve replacement surgery mainly aims at correcting the problem of valvular heart disease and involves both aortic valve replacement and mitral valve replacement. The mitral valve is situated between the left atrium and the left ventricle while the aortic valve is located in between the aorta and the left ventricle.
Some of the causes of heart valve disease include the following:
Some of the symptoms of valvular heart disease include the following:
Double valve replacement surgery is a complicated procedure as compared to single valve replacement surgery. Aortic valve replacement and mitral valve replacement involves the replacement of just one valve but during double valve replacement surgery, both the diseased valves are removed at the same time and replaced with a synthetic (mechanical) or a biological valve.
In the case of mechanical valves, the components used are not of organic or natural origin. They are created from a combination of polyester and carbon material that the human body can tolerate and accept. Blood-thinning medications are given to patients who get mechanical valves to prevent blood clot formation.
Bioprosthetic valves or the biologic valves are either created from animal or human tissues and can be of the following types:
The choice of a particular type of valve depends on the age, overall fitness, and the ability to metabolize anticoagulant medications. The only problem associated with a bioprosthetic valve is that it may not last a lifetime and one may have to undergo a replacement again later.
For the purpose of hemodynamic monitoring, the peripheral arterial and venous access are installed. The patient is anaesthetized in a supine position with a single lumen endotracheal tube.
In the jugular vein, two percutaneous sheath introducers are placed for central venous pressure monitoring and drug administration. Another similar one is placed in the same right jugular vein for the purpose of introducing endocavitary pacemaker leads if required. External defibrillator pads are placed on the patient’s back and on the anterior left chest.
TEE or transesophageal echocardiography probe is used for an assessment of cardiac function, percutaneous venous cannulation guidance, and valve assessment. The skin is sterilized with iodine solution and an aseptic strip is applied on areas exposed. The double valve replacement procedure is very similar to isolated aortic valve replacement or mitral valve replacement, which is conducted via a single access right anterolateral minithoracotomy.
Before systemic heparinization, the venous introducer sheath is positioned in the femoral vein to prevent any unwanted bleeding. In the third intercostal space, an incision of 6 to 8 cms is made. Minithoractomy is made and in the 3rd and 5th intercostals spaces, two auxiliary working ports are placed. The first is for video assistance and the second is for gas insufflation, cardiotomy vent, and pericardial stay sutures. The pericardium is opened upwards and downwards after removal of the pericardial fat, which is 3 to 4 cm above the phrenic nerve. The pericardium is retracted using silk sutures.
In a standard way, two aortic purse strings are placed for direct arterial cannulation after the aorta has been exposed. The operation is continued with venous cannulation under the guidance of TEE. A guidewire in moved through the venous introducer and positioned in the superior vena cava.
With the central cannulation of the ascending aorta, arterial inflow is established. The cannula has an obturator and an advanced tip to aid aortic insertion within the thorax. With cannula rings, the tip is secured and with two tourniquets the cannula is secured. They allow maximum space to work during thoracotomy access.
Carbon dioxide flow keeps running and when the heart gets arrested, the aorta is opened in an oblique way with an incision like a hockey stick, k which is further extended to the non-coronary sinus Valsalva. After this, aortotomy is made far away from the cross-clamp and from the main pulmonary artery trunk; for the closure of aortotomy, enough aortic tissue must be kept. Now the problematic valve is excised. The annulus size is measured and calibrated with a sizer and then prosthesis is implanted. The aortic prosthesis is lowered and made to remain above the final plane of implantation.
Now focus shifts to the left atrium. It gets dissected in a Sondergaard’s plane, and with the help of one single silk suspension stitch and an atrial retractor, the mitral valve is exposed. If now required the left atriotomy can be further extended behind upwardly behind the superior vena cava or along the inferior vena cava downwardly. In right minithoracotomy the visualization of the mitral valve is very good and allows valve and subvalvular repairs easily.
The procedure starts with synthetic braided sutures being placed in the mitral annulus whose diameters are measured using suitable valve sizes. For the mitral valve, reductive annuloplasty is performed. The sutures are passed and the retractor is removed and then attention is again diverted towards the aortic valve prosthesis. This is lowered into the annular plane and thereafter knotted.
For the assessment of the results of the repair, the atrial retractor is again positioned in the left atrium. To estimate the competence of the valve, a water probe is applied with an implanted open mitral ring. After successful completion, the left atrium is closed leaving behind the ventricular vent via the mitral valve in the left ventricle. Aortic cross-clamp is removed and aortotomy suture is further knotted. The aortic vent is positioned in the ascending aorta. A polypropylene purse-string suture is hand-knotted after aortic vent is removed. After confirmation by the TEE, the procedure moves to the final stage where the aortic cannula is removed and a percutaneous cannula is also withdrawn with the femoral vein temporarily placed under compression, the skin incision is closed with a single silk stitch.
After the surgery, the patient is shifted to ICU for close monitoring for several days. Blood pressure, ECG tracing, breathing rate, and oxygen levels are closely studied. You may require staying in the hospital for several days after heart valve replacement surgery. With the help of the ventilator, breathing is assisted via a tube inserted in the throat. The breathing machine will be further adjusted as the patient keeps growing stable and once the patient is able to breathe and cough on their own, the tube is removed. Along with this, the stomach tube is also removed.
In every two hours, a nurse would help the patient take deep breaths and cough. This feels sore but is vital to prevent accumulation of mucus in the lungs and prevent pneumonia. The patient is taught to hug a pillow tightly while coughing to ease out any discomfort. The patient must express discomfort felt at coughing and medications are suggested accordingly. Slowly fluid intake is initiated and you can gradually increase your daily activities such as walking around the room. After a few days, the patient is shifted to the recovery room where the rest of the recovery takes place before discharge.
Notify your doctor if you feel swelling and redness around incision area, fevers and chills, or pain in the area of the incision. You should rest and keep the surgical area as clean as possible at home.
Heart valve replacement surgery is advised to the patients with a severe condition where they start experiencing the signs and symptoms of valve dysfunction. Rheumatic Heart Disease is the prime cause of valve problems in India. The procedure of heart valve surgery is fairly common and has been performed across all the major multispecialty hospitals. India is globally renowned for its quality approach for cardiac care services comprising some of the highly trained and experienced cardiac surgeons in the world.
The success rate of the heart valve replacement surgery in India is high as compared to the western countries. So, a patient can be assured that they can live a healthy life following valve replacement surgery in India. With the best cardiac care, India’s top hospitals are known for their genuine service and around the clock availability. Additionally, English speaking staff and state-of-the-art rehabilitation facility make the country the most preferred destination in the world wherein thousands of patients with aortic valve stenosis can get back to their normal lives in no time.
The average cost of heart valve replacement surgery in India is $9,500. Undoubtedly India offers the most efficient and pocket-friendly treatment for heart valve surgery in comparison to the other western countries. The point which is worth mentioning is that the cost can vary as per the diagnosis, condition of the patients, the hospital you have chosen, types of room along with the facility availed, and expertise of the surgeon.
While any minor problems do not affect that much and do not ask for surgery but mild ones need treatment with the help of heart valve repair surgery. Majority of people are living their life normally after having heart valve replacement surgery in India. The high success rate of procedure performed in India shows how successfully a patient is able to recover after the surgery.
After the surgery, the patient is usually advised to take a few medications for a few weeks. It should be noted that the duration of the medication could be reduced or lifted altogether depending on the condition and status of recovery of the patients. The patients should visit the doctor according to the schedule of follow up. During follow up visit, the doctor may perform a few tests to check for the healing of the tissue and then he would observe the functioning of the new valve. The recommended hospitals in India ensure a speedy recovery process by helping patients to return back to their normal routine.
Health is a major sector and one of the most concerned topics in India. In the past few decades, India has seen remarkable growth in the healthcare industry and boasts a volume of its excellent maintained healthcare providers which are renowned to carry out the procedure of heart valve replacement surgery with brilliance. With well-equipped infrastructure, modern amenities, and the best surgeons on board, the Indian cardiac hospitals deliver the most efficient cardiac treatment which you are looking for. Here is the list of some recommended hospitals in India for heart valve replacement surgery:
Silverline Hospital, Kochi, India
Fortis Hospitals Mulund, Mumbai, India
Fortis Escort Heart Institute, New Delhi
Fortis Hospitals Bangalore, Bangalore, India
Fortis Hospitals Mohali, Chandigarh, India
Sarvodaya Hospitals And Research Center, Faridabad, India
BGS Global Hospitals, Bangalore, India
Asian Heart Institute, Mumbai, India
Apollo Hospitals Indraprastha, New Delhi
Kokilaben Dhirubhai Ambani Hospitals, Mumbai, India
Wockhardt Hospitals South Mumbai, Mumbai, India
BLK Super Specialty Hospitals, New Delhi
Sevenhills Hospitals, Mumbai, India
India has a pool of qualified cardiac surgeons, working across some of the trusted hospitals in India. Having been trained from top medical institutes in India and abroad, Cardiologists in India hold thorough knowledge in cardiology and cardiac science. See the top Cardiologist in India for heart valve replacement surgery:
Dr. Naresh Trehan
Dr. Rajendra Patil
Dr. Vivek Jawali
Dr. Ashok Seth
Dr. NS Devananda
Dr. Nandkishore Kapadia
Dr. Sandeep Attawar
Dr. Sandeep Singh
Dr. Sameer R Rao
Dr. Ravi M N
Dr. Arunansu Dhole
Dr. Saifuddin Arsiwala
India is one of the top medical tourism destinations. Of all the specialties that India is famous for, cardiac surgery remains on top. There are thousands of patients who travel to India for a cardiac procedure and valve replacement surgery is one of them.
There are many reasons that make India an appropriate destination to get valve replacement surgery done. Some of the reasons include the following:
Heart valve replacement surgery cost in India depends on several factors. Some of these factors include the following:
Heart valve replacement surgery cost in India
The following two types of valves are used in India for heart valve replacement surgery:
Prosthetic Valve: It is also known as an artificial or mechanical valve. Mechanical valves are most commonly made of pyrolytic carbon. They are expected to last longer than biological valve and there is less risk of another surgery after a few years because it does not wear out that fast. There is a greater need for using blood-thinners in the case of mechanical valves.
Tissue Valve: It is also known as a biological, bovine valve, or bioprosthetic valve. This type of valve is derived from a pig’s heart and the sac around a cow’s heart. It costs more than a mechanical valve. Patients who get a biological valve have less need to take blood-thinning medicines and are able to recover faster as far as the valve’s functioning is concerned.
All metropolitan cities in India have well-equipped hospitals that can cater to the needs of a patient requiring cardiac surgery. With that said, New Delhi, Noida, Gurugram, Bangalore, Mumbai, Hyderabad, and Chennai are some of the best cities to get heart valve replacement surgery done in India.
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