The valves are responsible for delivering rich oxygenated blood to the heart chambers. In total, there are four heart valves performing the same operation. Each valve closes completely after pushing the blood in the following chamber. Hence the flow is maintained. The ill-conditioned heart valve is incapacitated to perform this operation. When the blood vessels narrow, the lesser amount of blood flows in the chambers causing the heart muscles to work harder. This condition is called stenosis. Weak valves cause disruptive flow of blood as the valve sometimes may close lightly. This causes the blood to flow backward which is termed as regurgitation.
Getting a valve replacement means to replace the faulty valves with either mechanical or biological alternatives. Replacing both the mitral and the aortic valves is called double valve replacement, or the entire left side of the heart. This type of surgery is not as common as the others and the mortality rate is slightly higher.
Figuring out the right candidate for the double valve replacement can be a little tricky as the procedure is a bit uncommon. Also, the factors involved in deciding who should get the replacement would vary from person to person. A general viewpoint may lead to patients having these symptoms.
Other factors that play an important role in deciding the candidature of double valve replacement are:
The factors affecting the cost of double valve replacement procedure may depend on:
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.
Different hospitals have different pricing policy when it comes to the cost of Heart Double Valve Replacement in Switzerland. The top hospitals for Heart Double Valve Replacement in Switzerland covers all the expenses related to the pre-surgery investigations of the candidate. The Heart Double Valve Replacement cost in Switzerland includes the cost of anesthesia, medicines, hospitalization and the surgeon's fee. There are many things that may increase the cost of Heart Double Valve Replacement in Switzerland, including prolonged hospital stay and complications after the procedure.
After Heart Double Valve Replacement in Switzerland, the patient is supposed to stay in guest house for another 21 days. This duration of stay is recommended to complete all the necessary follow-ups and control tests to ensure that the surgery was successful.
Switzerland is undoubtedly one of the best countries for Heart Double Valve Replacement in the world. It offers the best medical expertise and good patient experience at an affordable cost. 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|
There are certain expenses additional to the Heart Double Valve Replacement cost that the patient may have to pay for. These are the chanrges for daily meals and hotel stay outside the hospital. The per day cost in this case may start from USD 50 per person.
Heart Double Valve Replacement in Switzerland is offered in almost all metropolitan cities, including the following:
The patient is supposed to stay at the hospital for about 5 days after Heart Double Valve Replacement for monitoring and care. During the recovery, the patient is carefully monitored and control tests are performed to see that everything is okay. If required, physiotherapy sessions are also planned during recovery in hospital.
There are more than 2 hospitals that offer Heart Double Valve Replacement in Switzerland. The above mentioned hospitals have the required infrastructure and a dedicated unit where patients can be treated. Also, these hospitals follow the necessary guidelines as required by the medical associations for the treatment of Heart Double Valve Replacement patients.
Switzerland is one of the leading medical tourism destinations with top hospitals, such as:
The country has more than 500 hospitals and boasts of some of the biggest private hospitals in the world. Around 12 hospitals are accredited and they adhere to international standards. A rising number of hospitals have developed centers of competence for outpatient diagnostic and therapy. Swiss hospitals deliver up to 70 percent of all out-patient services in a given region. Equipped with modern equipment and the latest medical technologies, the multispecialty hospitals in Switzerland are backed by the modern infrastructure to provide world-class treatment.
In Switzerland, healthcare providers are obliged by law to sign contracts on quality of care based on international standards. Healthcare accreditation is based on the model of the International Standards Organization. Standard EN 45001 acts as a benchmark for the accreditation of healthcare providers. The quality of test results is decided after the assessment of the accepted values and requirements. Healthcare standards act as a quality framework to effectively evaluate, control, and improve the standards of quality healthcare.
Switzerland is one of the most popular medical tourism destinations in the world because of several reasons like its highly qualified trained staff, traditional values of quality, and research-focus. Switzerland has modern infrastructure and exceptional research institutes that offer medical care of the highest quality. Switzerland has received worldwide recognition for its contribution to medical innovation and new treatments. Several renowned research institutes have come up with medical breakthroughs and new treatments.The Swiss are well known for their excellence in medical innovation and new treatments. Several world-famous research institutes have contributed to medical breakthroughs and new treatments. High level of privacy, quality treatment, and a wide spectrum of treatment specialties are some of the other factors that lead to Switzerland’s popularity in medical tourism.
Hospitals in Switzerland generally accept health insurance but always connect with your insurance company to check whether the treatment you want to undergo is covered at the hospital in the country. In case of an approved insurance provider, the hospital can start cashless treatment once it receives the Guarantee of Payment from the insurance. It is important to note that there are many things that are not covered under insurance like cosmetic surgery, pregnancy and abortion, and diagnostic tests. If a treatment is not covered under a health insurance plan in Switzerland, you can initially pay for the treatment and apply for reimbursement after you are back in your country.
Some of the popular procedures available in Switzerland are:
The reasons for the popularity of these procedures are world-class clinics and hospitals, superior technology, and well-trained doctors. A lot of people visit Switzerland for cosmetic surgery performed by highly trained surgeons with high precision and accuracy. IVF is performed with great perfection and safety under the supervision of highly trained fertility experts who are regarded ‘artists’ due to their deep skills in fertility treatment and personalized care.
The top-ranked cities that are most preferred by medical tourists in Switzerland are Basel, Geneva, Lausanne, Lugano, Zurich, Lucerne, Bern. With highly trained and qualified doctors and a large pool of multispecialty hospitals, Switzerland offers a great medical travel experience. A large number of medical tourists visit Zurich and Geneva every year because of several reasons like the availability of reasonably-priced hotel rooms, better transportation systems, and connectivity through airlines. A large number of hospitals, scenic value, rich culture, availability of translators, and safety of tourists also contribute to the popularity of these cities in medical tourism.
The vaccines recommended by WHO and CDC are:
Make sure you have MMR and other routine vaccinations as some parts of Switzerland have routine disease outbreaks. The factors that decide the type of vaccine and the dosage are immunization history, traveler's age, and current medical conditions. Before a trip to Switzerland, you should get pre-exposure vaccination against rabies and yellow fever.
Anyone traveling to Switzerland to seek treatment needs to have Schengen Visa. You are allowed to stay for a maximum of 90 days in Switzerland if you hold this visa. In case you have to stay for more than 90 days, you need to apply for a National Visa for Medical Treatment. Below documents are required for applying for a medical visa:
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