Heart Valve Replacement in Turkey

AVR/MVR in Turkey

As the age of an individual increase, the valves in the heart thicken and become stiffer. This may pave way for a heart valve disease.  Additionally, certain risk factors such as high cholesterol, high blood pressure, and history of rheumatic fever, heart attack, and infective endocarditis (IE) increases the risk of heart valve disease. On the other hand, some babies are born with two flaps in the aortic valve instead of three. This congenital disorder, along with heart valve disease, may warrant the need for heart valve replacement.

In aortic valve replacement and mitral valve replacement surgery, the concerned defected or damaged valve is replaced with a mechanical or a tissue valve. This restores the normal functioning of the valve.

Heart Valve Replacement Cost in Turkey

Valve Replacement in Turkey is conducted by a team of highly experienced and skilled surgeons. Turkey is one of the leading medical tourism destinations in the world because it houses some of the best hospitals in the world. Additionally, the country is centrally located and can be accessed from any part of the world. This is the reason why many patients from abroad prefer to visit Turkey for valve replacement, among other cardiac procedures.

Treatment and Cost

21

Total Days
In Country

2 No. Travelers

7 Day in Hospital

14 Days Outside Hospital

Treatment cost starts from

USD 15000

Hospitals

About the Heart Double Valve Replacement

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.


About the ailment

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.

Causes of Heart Valve Disease

Some of the causes of heart valve disease include the following:

  • Cardiac stenosis or narrowing
  • High blood pressure and heart failure, which enlarges the heart and arteries and contribute to valvular diseases
  • Atherosclerosis
  • Scar tissue formation and damage due to heart attack or any injury to the heart
  • Strep throat or rheumatic fever can give rises to valve problems
  • Infection due to germs entering bloodstream can affect heart valves and one such infection is infective endocarditis
  • Lupus-like autoimmune diseases can affect the aorta and mitral valve
  • Carcinoid syndrome
  • Diet medicines such as fenfluramine and phentermine can at times give rise to valve diseases
  • Marfan syndrome
  • Metabolic disorders such as Fabry disease or high blood cholesterol
  • Radiation therapy to the chest can give rise to heart valve diseases.

Symptoms of Double Valve Replacement

Some of the symptoms of valvular heart disease include the following:

  • Fluid retention in the lower limbs
  • Chest pain
  • Fatigue and light-headedness
  • Dizziness and shortness in breath
  • Cyanosis

About heart valve replacement

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:

  • A bovine valve is usually derived from the tissues of a cow and is connected to the heart with the help of silicone rubber
  • A porcine valve has its origin rooted from a pig tissue and is implanted in the heart with or without the frame like a stent
  • A homograft or an allograft is usually collected from the human donor’s heart

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.

How is Heart Double Valve Replacement performed?

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.

Recovery from Heart Double Valve Replacement

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.

Patient Stories

Frequently Asked Questions

What is the health care infrastructure of Turkey / Why should opt for Turkey as a destination for your medical treatment?
The healthcare infrastructure of Turkey comprises health centers, health posts, mother and child health and family planning centers, tuberculosis dispensaries, etc. Health centers are each staffed by a team consisting of a doctor, a nurse, a midwife, a health technician, and an administrator. Health posts report to health centers and are each staffed by a midwife. Health centers and health posts are the only settings providing preventive care, health promotion, and community-based health services. All other settings use specialists to provide just primary diagnostic and curative care. Turkey is turning out to be a preferred destination for medical treatment by many people across the world for its pace of development. The people are friendly and the administration is efficient. After the treatment in Turkey, one can even choose to unwind amidst its beauty.
What are the conditions of the hospitals in Turkey? Are they JCI certified? What is the quality of the support staff in the hospitals?
The Joint Commission International (JCI) is a global leader in health care accreditation. JCI accreditation is considered a gold standard in worldwide health care. It provides the most skilled and experienced healthcare professionals in the medical industry, as evaluators of the rigorous international standards in healthcare quality and patient safety. Here are a few JCI certified hospitals in Turkey :
  • Anadolu Medical Center
  • Hisar Intercontinental Hospital
  • Medipol Mega University Hospital
  • NP Istanbul Brain Hospital
  • Neolife Oncology Center
  • Liv Hospital
  • Medicana Healthcare Group
  • Kadikoy Florence Nightingale Hospital
  • Istanbul Memorial Hospital
  • Memorial Antalya Hospital
  • Taksim Hospital
  • Dunyagoz Hospitals Group, Istanbul, Turkey
  • Medical Park Hospitals Group
  • Medical Park Göztepe Hospital Complex
  • Acibadem Maslak Hospital
  • German Hospital Taksim
  • Medical Park Bahçelievler Hospital
  • Göktürk Florence Nightingale Medical Center
  • International Hospital
  • Aydinlar Dental Group
Are the doctors/surgeons in Turkey of the best quality?
Doctors in Turkey are highly educated and well trained. This is one of the reasons why many people flock to Turkey for medical treatment. The doctors are skilled and can converse fluently in English and other foreign languages.
What is the process for obtaining a medical visa in Turkey?
At present, there are two types of medical visas available for your visit to Turkey:
  1. Medical Visa, which can be obtained from the Consulate of Turkey
  2. Online Visa (eVisa), which can be obtained in advance of arrival via the government of Turkey’s online visa system.
Visitors must obtain a medical visa for traveling to Turkey unless they come from visa-exempt countries and territories or citizens of those countries, which are eligible to apply for an e-Visa online. How To Acquire Online Medical Visas (e-Visa or electronic visa) :
  1. Simply visit www.evisa.gov.tr and apply on the platform by selecting your country and the type of passport or identity card. The platform is self-explanatory and will guide you throughout every step.
  2. Once you are done filling the form, save and download the form for future references.
  3. The applicant must visit the nearby Turkish embassy in his/her country to get the approval of the Consulate.
  4. Once the visa is approved, the travel dates can be scheduled accordingly.
What support services does MediGence provide in Turkey?
MediGence has been praised on a global scale for the list of services they provide. Apart from the listed services, the staff and the guides are adorned for their customer interaction, impromptu assistance, and various other assistance related guidance throughout the tour. Thus, the list of services provided by MediGence are:
  • Insurance query related guidance
  • In-detail guidance till completion of the medical tour
  • Visa Assistance
  • Free airport to hospital transfer
  • On-Ground Support
  • Teleconsultations
  • Accommodations Assistance
  • Rehabilitation and recovery services
Which are the best cities in Turkey for medical treatment?
The capital of Turkey is Istanbul. Istanbul is easily accessible and the preferred location for medical treatment. Other cities with good hospitals are Izmit and Bursa.

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