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Heart Valve Replacement

Overview :

After cutting through and separating the breast-bone and ribs, surgeons place the patient on a cardiopulmonary bypass machine, which will perform the functions of the heart and lungs during the operation. They then open the heart and locate the faulty valve. Slicing around the edges of the valve, they loosen it from the tendons that connect it to the rest of the heart and withdraw it. The new valve is inserted and sutured into place. The patient is then taken off the bypass machine and the chest is closed. The surgery takes three to five hours and is covered by most insurance plans.

There are three types of replacement valves. One class is made from animal tissue, usually a pig's aortic valve. Another is mechanical and is made of metal and plastic. The third, includes human valves that have been removed from an organ donor or that, rarely, are the patient's own pulmonic valve.

There is no single ideal replacement valve. The choice between an animal valve or a mechanical valve depends largely on the age of the patient. Because valves obtained from animals have a life expectancy of 7-15 years, they usually are given to older patients. Mechanical valves are used in younger patients because they are more durable. Because mechanical valves are made of foreign material, however, blood clots can form on their surface. Therefore, patients who receive these valves must take anticoagulants the rest of their lives.

Donor or pulmonic valves are given only to those patients who will deteriorate rapidly because of a narrowing of the passageway between the aorta and the left ventrical (aortic stenosis). These valves are limited in their use because of the small supply available from donors and the strain that could be caused by removing and transferring a patient's own pulmonic valve.

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