Valve Replacement Surgery

Valve replacement surgery Valve replacement surgery is a critical intervention for managing severe valve diseases that cannot be adequately treated with medical therapy or less invasive procedures. The aortic, tricuspid, and mitral valves may require replacement due to various pathological conditions. Here are the clinical indications for the replacement of each valve: Aortic Valve Replacement 1. Aortic Stenosis: o o Severe Symptomatic Aortic Stenosis: Symptoms include angina, syncope, and heart failure. Once symptoms appear, prognosis without surgery is poor. Asymptomatic Severe Aortic Stenosis: Replacement may be indicated if there is evidence of left ventricular dysfunction (ejection fraction < 50%), or if the patient is undergoing other cardiac surgery. 2. Aortic Regurgitation: o o Severe Symptomatic Aortic Regurgitation: Patients typically present with symptoms of heart failure such as dyspnea, orthopnea, and fatigue. Asymptomatic Severe Aortic Regurgitation: Indications include left ventricular dilation or dysfunction (ejection fraction < 50%), or if the patient is undergoing another cardiac surgery. 3. Endocarditis: o Infective Endocarditis: Valve replacement is indicated when there is severe valve destruction, persistent infection despite antibiotics, or recurrent embolization. 4. Aortic Valve Dysfunction: o Bicuspid Aortic Valve Disease: Progressive stenosis or regurgitation in bicuspid aortic valves may necessitate replacement, especially in younger patients with severe disease. Mitral Valve Replacement 1. Mitral Stenosis: o o Severe Symptomatic Mitral Stenosis: Symptoms include dyspnea, hemoptysis, and atrial fibrillation. Percutaneous mitral balloon valvotomy is preferred for suitable candidates, but replacement is indicated for those unsuitable for this procedure. Asymptomatic Severe Mitral Stenosis: Indications include pulmonary hypertension or new-onset atrial fibrillation. 2. Mitral Regurgitation: o o Severe Symptomatic Mitral Regurgitation: Symptoms of heart failure such as dyspnea and fatigue. Replacement is indicated if mitral valve repair is not feasible. Asymptomatic Severe Mitral Regurgitation: Indications include left ventricular dysfunction (ejection fraction < 60%) or significant left ventricular dilation (end-systolic dimension > 40 mm). 3. Endocarditis: o Infective Endocarditis: Valve replacement is indicated when there is severe regurgitation, persistent infection, or large vegetations causing embolic events. 4. Mitral Valve Prolapse: o Severe Regurgitation with Symptoms or Left Ventricular Dysfunction: Replacement is indicated when repair is not possible. Tricuspid Valve Replacement 1. Tricuspid Regurgitation: o Severe Symptomatic Tricuspid Regurgitation: Symptoms include right-sided heart failure such as ascites, edema, and fatigue. o Indications include severe regurgitation refractory to medical therapy, particularly in patients undergoing left-sided valve surgery. Asymptomatic Severe Tricuspid Regurgitation: Indicated if there is progressive right ventricular dilation or dysfunction, or if the patient is undergoing left-sided valve surgery. 2. Tricuspid Stenosis: o Severe Symptomatic Tricuspid Stenosis: Rare, but symptoms include fatigue and hepatic congestion. Replacement is indicated when there is significant obstruction and symptoms. 3. Endocarditis: o Infective Endocarditis: Commonly associated with intravenous drug use, valve replacement is indicated for severe tricuspid regurgitation, persistent infection, or recurrent septic emboli. General Indications Across Valve Types    Refractory Symptoms: Despite optimal medical management, patients with severe valve disease and persistent symptoms of heart failure or other complications. Structural Valve Deterioration: Degeneration of previously implanted bioprosthetic valves. Concurrent Cardiac Surgery: Indication for replacement of another valve during procedures for coronary artery disease, aneurysm, or other heart valves. In conclusion, valve replacement is essential for managing severe symptomatic valve diseases, preventing further cardiac complications, and improving patient survival and quality of life. The decision for valve replacement is based on a comprehensive evaluation of symptoms, valve dysfunction severity, and associated cardiac conditions. Rationale for Prophylactic Antibiotics Prophylactic antibiotics play a crucial role in preventing infectious complications in patients with valvular heart disease (VHD) undergoing surgery. These patients are at increased risk for developing infections such as infective endocarditis (IE), which can lead to severe morbidity and mortality. The use of prophylactic antibiotics aims to reduce this risk by targeting potential pathogens before they can establish an infection.