Breaking Barriers: The Evolution of Valve Treatments

Breaking Barriers: The Evolution of Valve Treatments

Heart valves are among the most important structures in the heart, directing the flow of blood through the four chambers systematically and periodically. Inefficient functioning or failing heart valves result in problems with the blood flow that may affect the heart and the rest of the body as well. While symptoms of malfunctioning valves may be non-existent or minor for a long while, they often lead to chest pain, dizziness, shortness of breath, fainting and swelling in the abdomen, ankles, and feet. There may also be some issues with the heartbeat rhythm.

Apollo Hospitals, Karnataka, has been a trailblazer in cardiac care since its inception, offering radical approaches to cure and manage a plethora of cardiac conditions and emergencies with supreme dexterity and state-of-the-art medical facilities.

Valve Disorders & Diseases

There are four heart valves which allow blood flow in specific directions around the heart. These are the aortic, mitral, pulmonary, and tricuspid valves. Valve problems are mainly caused by:

• Stenosis:A condition leading to thickening or stiffening of the heart valve flaps that prevents them from opening fully
• Regurgitation: A condition in which the heart valves don’t close completely, leading to a backward flow of blood
• Congenital Abnormalities: Issues with the heart valve structure present at birth

Untreated heart valves can lead to various issues with the heart, including strokes, blood clots, heart rhythm problems, and even heart failure. Advances in cardiovascular medicine have allowed cardiologists to repair or replace heart valves by employing various advanced techniques, including minimally invasive and robot-assisted surgery.

Advancements in Valve Repair Treatments

The first recorded instance of valve repair surgery was for treating aortic valve stenosis in which the valve was accessed through the aortic wall manually. Eventually, closed transventricular mitral commissurotomy procedure for valve repair came along which became the choice of treatment for mitral valve stenosis for many years until valvular prosthesis was developed. It became the foundational groundwork for most modern-generation surgical valves.

Innovations in heart valve repair techniques have been an influencing factor in the evolution of cardiovascular surgery. Continuous and passionate research efforts by cardiologists from all over the world have enabled overcoming the difficulty of replacing a faulty valvular structure with an artificial one. In the later part of the 20th century, donor grafts became an option, with valve tissue harvested from a deceased human donor (called an allograft) or from a pig or cow (called a xenograft).

Subsequently, an innovative technique called the Ross procedure was developed to replace the non-functioning aortic valve from the patient, replacing it with the patient’s own pulmonary valve. The pulmonary valve was then replaced with one from a donor. It became widely popular as it helps replace the failing aortic valve with the patient’s own pulmonary valve, which is less risky than other replacement options. This procedure helped restore normal life expectancy to young and middle-aged people with aortic stenosis, allowing patients to go without further intervention for up to 25 years after the initial surgery.

Advancing the Field: Advent of Minimally Invasive Surgery

In the past, narrowed or leaking mitral valve and aortic valve required open heart interventions, which often carried significant risks and extended recovery periods, especially for older patients or those with other health complications. The open heart surgery technique involves opening the chest and breastbone by making a large incision. Open heart surgeries tend to be more painful but may still be considered a treatment option for treating valvular diseases in people younger than 60.


Recent innovations have made it less invasive, and transcatheter procedures are becoming more common. Offering significantly improved outcomes, lesser risk of complications, and faster recovery times for patients, transcatheter procedures use a small catheter that is threaded into an artery through a small incision in the groyne or chest. The catheter is threaded through the artery to the diseased valve, where it is then used to remove the diseased valve and replace it. Pioneering efforts of various interventional cardiologists have led to the development of different minimally invasive techniques, among which TAVI and TMVR are the most prominent ones.

TAVR

Transcatheter Aortic Valve Implantation (TAVI), also known as Transcatheter Aortic Valve Replacement (TAVR), is a revolutionary procedure in cardiovascular surgery that offers minimally invasive treatment of severe aortic stenosis, a medical condition in which the aortic valve narrows down.

TMVR

Transcatheter Mitral Valve Replacement (TMVR) is another radical approach that is used to replace a damaged mitral valve without open heart surgery. This minimally invasive procedure uses a flexible, hollow tube (catheter) to reach the heart and replace the mitral valve through a blood vessel. It is used to treat mitral valve stenosis and mitral valve regurgitation.

Benefits of TAVI & TMVR

TAVI and TMVR offer significant improvements over traditional open heart surgery, especially for those patients who are considered high risk for open heart surgery. Here are the key advantages of these techniques:

• Minimally invasive: These procedures don’t involve making large incisions or stopping the heart for the procedure, therefore, being much less invasive.
• Quicker recovery: With minimal incision, patients require shorter hospital stays and experience faster recovery than the traditional method of surgery.
• Reduced risk: These procedures carry significantly lesser risk of complications, such as infections, strokes, and bleeding, compared to open-heart surgery.
• Enhanced quality of life: Patients have reported improvements in the symptoms and overall quality of life after the procedures.

Novel & Advanced Possibilities with AI & Robotic Surgery

New avenues of valve repair surgery have been developed, advancing from minimally invasive procedures to sophisticated robotic systems. Coupled with artificial intelligence (AI) and computed simulation tools, new possibilities for valve replacement surgery have opened up that aid cardiac surgeons in determining the best possible option for treatment. These tools are being used to plan an effective treatment and optimise the long-term use of replacement valves.

The advanced da Vinci® system is frequently employed for aortic and mitral valve replacement surgery, offering greater precision in valve repair. With a team of highly experienced surgeons directing the movements of the robotic arms, precise movements inside the heart can be made, which the human hand isn’t capable of performing. Thus, these robotic surgical tools offer a greater range of motion, allowing for more intricate movements.

Apollo Hospitals, Karnataka, for Heart Valve Replacement Surgery

With a commitment to providing world-class cardiac care, at Apollo Hospitals, Karnataka, we offer a comprehensive range of diagnostic, therapeutic, and rehabilitation care. In addition to patient care, our cardiac surgeons and consultants, with erudition and experience from some of the most well-reputed medical institutions around the world, are engaged in an ongoing medical research effort for the advancement of existing procedures. With our focus on patient safety and comfort, we are dedicated to ensuring that our patients receive the support they need at every stage of their treatment journey.