Heart valve surgery is a reconstructive surgical procedure to treat a heart valve disease. In heart valve disease, at least one of the four heart valves that keep blood flowing in the correct direction through your heart doesn't function properly. These valves include mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps are called leaflets. These flaps open and close once during each heartbeat. When the valves don't open or close properly they disrupt the blood flow through the heart to the body. In heart valve surgery, the surgeon repairs or replaces the affected heart valves. The treatment depends on several factors that include the age, health, the condition of the heart valve that is affected and the severity of the patient's condition. There are two types of surgery namely Annuloplasty and Valvuloplasty. Heart valve surgery might be performed during an open heart surgery, which involves an incision in the chest. The surgeon may sometimes perform minimally invasive heart surgery, in which there is the use of smaller incisions than those used in open-heart surgery.
The risks associated with heart valve surgery are bleeding, heart attack, infection, valve dysfunction in replacement valve, irregular heart rhythm, stroke and it might even lead to the death of the patient.
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.
The cost of Heart Double Valve Replacement in Singapore starts from $52500. There many JCI certified hospitals in Singapore that offer Heart Double Valve Replacement
The cost of Heart Double Valve Replacement in Singapore may differ from one medical facility to the other. The Heart Double Valve Replacement package cost usually includes all the expenses related to pre and post surgery expenses of the patient. The Heart Double Valve Replacement procedure in Singapore includes the fees of the surgeon, hospitalization and anesthesia as well. Post-surgical complications, new findings and delayed recovery may have an impact on the total Heart Double Valve Replacement cost in Singapore.
Heart Double Valve Replacement in Singapore is offered by multiple hospitals across the country. Some of the most renowned hospitals for Heart Double Valve Replacement in Singapore include the following:
While the speed of recovery may vary from patient to patient, they are still required to stay for about 21 days after discharge. This is important to ensure that the surgery was successful. During this time, control and follow-up tests take place to check for medical fitness.
Singapore is one of the most popular countries for Heart Double Valve Replacement in the world. The country offers the best cost of Heart Double Valve Replacement, best doctors, and advanced hospital infrastructure. However, there are other countries as mentioned below that are popular for Heart Double Valve Replacement as well:
|Saudi Arabia||USD 33000|
|South Korea||USD 70000|
|United Arab Emirates||USD 45000|
Apart from the cost of Heart Double Valve Replacement, the patient is also required to pay additionally for daily meals and guest house accommodation. The extra charges may start from USD 50 per person.
There are many cities that offer Heart Double Valve Replacement in Singapore, including the following:
After the Heart Double Valve Replacement takes place, the average duration of stay at the hospital is about 5 days. This phase is important to ensure that the patient is recovering well and is clinically stable. During this time, several tests are performed before the patient is deemed suitable for discharge.
The average rating for Heart Double Valve Replacement hospitals in Singapore is 2.7. This rating is automatically calculated on the basis of several parameters such as the infrastructure of the hospital, quality of services, nursing support and other services.
There are more than 6 hospitals that offer Heart Double Valve Replacement in Singapore. The above listed hospitals are approved to perform the surgery and have proper infrastructure to handle Heart Double Valve Replacement patients. Apart from good services, the hospitals are known to follow all standard and legal guidelines as dictated by the local medical affairs body or organization.
The hospitals in Singapore are all apprised and then given accredition by Joint Commission International, the premier accredition agency in the world. When it comes to healthcare quality and patient safety, the hospitals in Singapore are assessed by the Joint Commission International or JCI. The Organisation management of top hospitals of Singapore is checked by Joint Commission International and is a sign of the healthcare providers commitment to providing quality healthcare. The Joint Commission International keeps really stringent assessment measures before giving any hospital in Singapore the accredition.
The popular multi specialty hospital groups in Singapore are as follows
The popular multispecialty hospitals in Singapore give the best medical treatment and it is no wonder that these hospitals are truly international in the form of the diverse patient population that frequents them. The high benchmark of the popular multispecialty hospitals in Singapore is due the wide coverage in terms of the specialties covered by these hospitals and the quality of specialists operating in the hospitals. It is the really short waiting duration to get the best of medical treatment that makes Singapore multispecialty hospitals your best bet.
Healthcare in Singapore is identified with world class healthcare infrastructure and this gives you a strong reason to opt for treatment in Singapore. The highest quality of comprehensive care and high precision of clinical outcomes are aimed for by healthcare professionals and healthcare providers in Singapore. The high service levels with which patients are being treated in the hospitals in Singapore is the reason for its popularity as a medical tourism destination. The access to absolutely excellent healthcare and ease of travel has ensured that Singapore remain on top of the map in terms of popular medical tourism destinations.
It is important to know that with immense practical knowledge in their specialisation and being thorough professionals, doctors in Singapore are among the chosen few. It can be safely concluded that Singapore has good quality of doctors on the basis of their focus on precision and efficiency of treatment. The doctors in Singapore deal with patients from various nationalities and have immense experience with innumerable international patients. The presence of sharp skills and being educated from the best of the educational institutions means that the doctors in Singapore are most sought after by the patients.
We bring to you the list of documents needed for your medical travel to Singapore:
Kindly create a checklist of documents as you prepare your journey to Singapore for your medical travel. The documents that you need to carry for your medical treatment to Singapore will be consisting of your financial standing, your travel related documents and the ones that are related to your medical condition. Your travel documents should be aligned well with your visa requirements as someone who is traveling for medical purposes so that your treatment, stay in Singapore and your journey back to your home country is seamless.
The popular procedures available in Singapore are as follows.
It is their advanced education and training which ensures that the healthcare providers in Singapore are leaders in executing complex cardiology procedures. The Orthopaedic surgery procedures are synonymous with excellence as they are performed with precision and efficiency in the hospitals in Singapore. Singapore has long been famous for cosmetic surgery procedures some of which are:
The major hospitals in Singapore ensure that the stay is comfortable not just for the patient but even the people accompanying them by providing a number of additional facilities. Hospitals in Singapore are constantly putting efforts in making your travel and transfer seamless by providing you facilities such as:
It is pertinent to note that hospitals in Singapore are always seeking to make your medical travel to Singapore easy by enabling private payment gateways and the wide availability of private insurance. Patient centric care is ensured by the hospitals in Singapore in the form of health screening programmes, dietitians and pharmacies.
It is important that you check the visa requirements for your country as Singapore is a country with relaxed visa norms for many countries. Here are the requirement documents for a Singapore medical visa.
Please check the required visa fee from your country for Singapore medical visa. The medical visa processing time from Singapore is 5 working days and this excludes the day of visa submission (delays due to incomplete applications or during peak periods is not ruled out). Your financials must be in order for you to get a Singapore medical visa and you must submit your original bank statement to ensure this.
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