Heart Valve Surgery: Repair, Replacement & Minimally Invasive Options | Dr. Manoj Pradhan

Duration: 3:16 514 transcript words EN summary

Video summary

Dr. Manoj Pradhan introduces the two primary approaches to heart valve surgery: replacement and repair. In a replacement procedure, a severely damaged natural valve is removed and substituted with an artificial one, whereas a repair involves fixing the existing valve to restore its function without removing it. Traditionally, these operations required stopping the heart using a heart-lung machine and accessing the chest through a large incision known as a sternotomy. However, significant advances have allowed for minimally invasive techniques that utilize small incisions on the right side of the chest, which can be performed either with robotic assistance or by hand. The choice between a mechanical valve and a tissue valve largely depends on the patient's age and specific medical circumstances. For younger patients who are expected to live a long time, mechanical valves are generally preferred due to their durability, though they require lifelong blood-thinning medication. In contrast, tissue valves are recommended for older patients, typically those over 60 or 65 years old, because they do not necessitate blood thinners, reducing the risk of bleeding complications. Special considerations also apply to women of childbearing age, who often receive tissue valves to avoid the risks associated with anticoagulation during pregnancy. For elderly patients specifically, such as those over 75 or 80 years old requiring aortic valve replacement, a non-surgical option called TAVI or TAVR is now available. This procedure involves inserting a new valve through a small cut in the groin area rather than opening the chest, and it takes place in a catheter laboratory instead of an operating theater. This innovative method ensures a significantly quicker recovery time compared to traditional open-heart surgery. Consequently, Dr. Pradhan advocates for a minimally invasive approach whenever feasible, allowing most patients to return home within three or four days, with younger individuals recovering even faster than older ones.

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Hello. I'm Dr. Manoj Pradhan, senior consultant cardiothoracic surgeon in Manipal Hospitals. And today now I'm going to talk to you about heart valve surgery. So, what are the advances in heart valve surgery that we are looking at? Primarily, it is two types of operations. One is a replacement, which means that your old valve is so bad that it needs to be excised or taken out and replaced with an artificial The other type of procedure is where your old valve is actually not so bad and it can be repaired successfully to give you a good result. Now, this operation is necessarily done using the heart-lung machine and on a still heart, which means that the heart is stopped when you do this operation. But, the newer techniques that have come, it can be done totally endoscopically, as we call it, which means through small incisions, one or two small incisions on the right side of the chest, and we can generally take care of these valves. So, that is something which can either be a robotic surgery or a non-robotic surgery. Either way, even for a robotic surgery, you need to make a small incision to introduce a new valve. When we do that, generally my patients would go home by the third or fourth day, depending on how old they are. The younger the patient, the more likely they are to run back home pretty soon, and their recovery in general is very short. So, as far as possible for all valve replacements or repairs, I do them with a minimally invasive approach. Patients who require a standard surgery, which means that it's a central incision or a sternotomy incision, are the ones who have had previous surgeries or who are very ill, in which case we offer a standard sternotomy so that we have more vision and we can do things quicker. Other than this, what I would suggest is that if we do a minimally invasive surgery, the valve that we use depends on the age of the patient and the requirement, which means that if you have a younger patient, we use a mechanical valve except when we have lady who is likely to have pregnancies, in which case we use a tissue valve. I will be showing these valves to you later on in the talk. If you have a patient who's older than 60 years or 65 years, we use what we call as tissue valves. The reason why we use tissue valves is that they do not require any blood thinners to be given. And then if you have patients who are 75 plus or 80 plus who need an aortic valve replacement, it is nowadays done non-surgically using what we call as a TAVI valve. It is a TAVI procedure or TAVR procedure, which is done with a small cut in the groin and the entire thing is done in the catheter lab, not in the operation theater, because it can be done remotely, ensuring a quicker recovery. Thank you. >> [music]