How are heart valve diseases treated with surgery?

The recommended treatment method in surgeries for heart valves is to try to repair the problematic valve by preserving the patient's own valve tissue as much as possible (heart valve repair surgery). Thanks to the preservation of his own valve tissue, the patient's need for long-term anticoagulant treatment is eliminated. Thus, the patient is protected from possible complications of anticoagulant therapy. If it is not possible to repair the patient's valve problem during the evaluation during the surgery, the diseased valve tissue is cut and removed and a prosthetic valve is sutured in its place (heart valve replacement surgery).

What are heart valve prostheses, what is the difference from each other?

Currently, there are two types of prosthetic heart valves (mechanical and biological). Both types of prosthetic heart valves have advantages and disadvantages over each other. The long-term durability and thrombogenic (clotting) properties of the valve are two important problems of prosthetic heart valves. Mechanical heart valves are very durable but have high clotting properties. If an infection in any part of the body does not hold the valve in a patient with a mechanical valve, if a clot does not develop that prevents the valve from working, or if the patient's own tissues do not impair the operation of the valve by advancing to the valve, there is no need for re-operation. However, these patients have to use anticoagulant (preventing blood clotting) drugs for the rest of their lives. Patients using anticoagulant drugs are kept under close follow-up to ensure that the blood is fluid at the desired level. There is a risk of drug-induced bleeding or clotting on the prosthetic valve, especially in elderly patients and patients who are not compliant with medication. Bioprosthetic valves are generally obtained from bovine pericardium or pig heart valves. The use of caps from human donors is extremely rare. The main advantages of bioprosthetic heart valves are the much lower risk of clot formation in the valve tissue. Long-term use of anticoagulant drugs is generally not required in these patients, but durability of bioprosthetic heart valves is a serious problem. Structural deterioration occurs in bioprosthetic heart valves within 10-15 years. Patients may need to be operated again in the future.

When the valve needs to be replaced, how is it decided which type of prosthetic valve to be placed?

Before the planned operation, the patient and their relatives are informed in detail and the right type of prosthetic valve is chosen jointly. In general, bioprosthetic valves are preferred as much as possible in patients who are inconvenient to use anticoagulant drugs after surgery or are over 70 years old. In younger patients, mechanical prosthetic valves are considered in the foreground.