AVR and MVR (Valve Repair / Replacement) Treatment Cost in India

An aortic valve replacement is usually done where a damaged valve is replaced by an artificial valve. Whereas mitral valve replacement surgery involves replacing the damaged valve with a mechanical, man-made valve built out of man-made materials. Aortic and mitral valve replacement surgeries can be of two types depending on the types of material chosen to repair or replace the faulty valves in the heart chambers:

Mechanical valves: These are made of carbon, plastic or metal. They are more sustainable but run the risk of blood clots. For this the patient will always require blood thinners and regular health checkups.

Biological valves: These valves have their origin in animals and they have a life of 10 to 20 years and are unlikely to require blood thinner medication.

Aortic valve disease treatment options are dependent on how severe the patient is and what is kind of signs and symptoms they notice. The types of aortic valve diseases and mitral valve diseases that require repair and replacements are:

• Aortic valve regurgitation: This is the flow of blood back through the aortic valve into the left ventricle whenever the ventricle relaxes rather than flowing in one way direction from ventricle to the aorta. Backflow is caused due to leaky or dysfunctional valves or due to an abnormal shape of the valve during birth or due to a bacterial infection.
• Mitral valve regurgitation: like the above here instead of leaving the heart chambers the blood goes back to the left atrium from the left ventricle due to a leaky or faulty mitral valve flap. Rheumatic fever, bacterial infection or total calcium buildup can cause trouble.
• In the condition of aortic valve stenosis, the valve grows narrow and obstructed which makes it hard for the heart to pump blood back into the aorta. Congenital heart disease causes the closure flaps of the valves to thicken or get swollen. These are some of the effects of rheumatic heart disease.
• Congenital heart disease: This can result in valve regurgitation or stenosis.

In many fortunate cases, such conditions only require some monitoring from their healthcare provider but in some, if left untreated it can result in heart attack, heart failure or stroke and result in sudden cardiac arrest and subsequent death.

Symptoms usually include chest pain, heart murmur, general fatigue and compromise on overall fitness.

Your doctor can evaluate and conduct a physical examination of your signs and symptoms. Your doctor will probably detect a heart murmur during a physical test because that can mean that there is a heart valve condition. The doctor may suggest multiple diagnostic tests for your condition which will include:

•          Echocardiography
•          Electrocardiogram
•          Chest X-Ray
•          Cardiac MRI
•           Stress tests
•          Cardiac catheterization

Heart valve disease treatment depends on how severe your condition is, if you're experiencing signs and symptoms and if your condition is getting worse. Traditional open surgery is the method that is used for performing aortic valve repair or mitral valve repair by opening the chest bone (referred to as sternotomy). The surgeon again gets the bones wired back together to prevent any shift and aid in recovery.

The patient is put on a heart-lung machine or a cardiopulmonary bypass to keep the blood movement continuous all throughout the procedure. The procedure can comprise of the following methodologies for correcting the problem:

• To patch up holes or tears present in the valve flaps or   perforated cusps tissues can be inserted to close the   valve
• Right at the roots of the valve some amount of support is provided
• The fused valve cups are separated.
• Some reshaping and tissue removal may be done to help closure of the valve tightly.
• The annulus or the ring around the valve is tightened to   implant an artificial ring that is called an annuloplasty
• Some cords can be replaced in mitral valves to help the structural support and separate the leaflets of valves that have fused.

Assisted surgical techniques may also be used in mitral valve repair robots. The surgeon is able to view the heart in 3D on a monitor in one remote console.

Robotic arms are used for the duplication of specific maneuvers which are used in open-heart surgeries.

Balloon valvuloplasty is a less invasive surgery employed to repair aortic valves that are unable to open properly due to aortic valve stenosis. In this process, cardiac catheterization is used. The patient can be released from the hospital more speedily compared to traditional heart surgery.

In a mitral valve catheterization process a clip is also advanced. This clip after reaching the mitral valve reshapes it. This technique is useful for those patients who are not great candidates for surgery or who have severe regurgitation symptom troubles.

The cardiac catheterization technique for aortic valve replacement is useful for treating infants and children. In the case of adults, the valves tend to grow narrow after some time and hence among adults this surgery is only chosen for those individuals who are not fit for surgery or waiting for a valve replacement. Again, later another surgery is required to repair the problem.

A catheter procedure can also be used for performing aortic valve repair and mitral valve repair with the insertion of a device or plug for fixing a leaking valve.

In an aortic and mitral valve replacement procedure, the surgeon will replace the valve with a mechanical valve made from the human heart or may originate from other animal’s cardiac system like that of a pig or cow. Another biological replacement can be using a pulmonary valve from the patient’s body.

It is important to know which kind of valve is most suitable since most of the biological valve insertion means being on blood-thinning medications forever to prevent any blood clot. Since these degenerates with time, they require replacement again.

Even these surgeries are performed through traditional open-heart surgeries mostly but minimally invasive options are also available where smaller incisions are used. But minimally invasive is not considered much since situations and medical conditions may not allow the problem to be addressed properly.

Another non-surgical approach includes transcatheter aortic valve replacement or implantation. Through the blood vessel of the leg or a small incision through the chest, the surgeon accesses the heart of the patient. A hollow tube or catheter is guided via the veins up to the aortic or mitral valve. Once the correct location is reached a balloon-expandable aortic valve replacement is implanted in the location. This procedure is specifically helpful for people who are on the high or intermediate risk of undergoing aortic valve replacement surgery. This option can also be considered if the patient had an existing biological tissue valve that was used for aortic valve replacement and currently not functioning well.

Before jumping into the options of surgery, it is important for the patient to understand whether common medication and regular and stringent medical monitoring can keep them safe. There are many conditions where a little bit of extra caution and control from their healthcare provider can actually reduce the risk of cardiac arrest. If all other options fail (noninvasive ones) then one can think of surgeries

Your doctor and medical team will clarify what to expect before, during and after the procedure and the potential risk of the operation before and after surgery to have your mitral valve reparaturated or replaced.

You will also be addressing questions about fixing the mitral valve or replacing the mitral valve. Discuss all questions you may have about the procedure with your physician and care team.

Preparation for the AVR and MVR surgeries include discussion of the medical history of the patient with the healthcare provider in detail. If patients have undergone previous cardiac surgery, then that must be disclosed and the kind of medications they have been prescribed. In case of AVR or MVR surgeries the surgical team needs to understand in detail about the procedure option they must choose depending on the condition of the patient. The team needs to understand whether a repair or a replacement of the valve is recommended for the patient. When biological valve replacement is considered, the kind of replacement (origin of the valve) has to be chosen correctly. As a patient one must clearly understand that why such selection is being made. They must be prepared to ask questions on the suitability of the valve that is being chosen for them for the replacement, its consequences and its longevity.

After the surgery is performed the patient is shifted to the recovery room where their vital signs like blood pressure, the heartbeat are monitored for a day. Most patients are released within 2 or 3 days.  Depending upon the instruction of doctor they can gradually return to their normal life. However, the regime will be underlined to take care of the lifestyle. One is expected to quit smoking, eat healthily and manage stress better.

The healthcare provider may recommend the patient to undergo a cardiac rehabilitation program for faster recovery and general improvement of health. Some exercise needs to be incorporated into the regime to bring about overall fitness and finally resuming a normal life.

AVR and MVR surgeries range at $5500 - $7500 in India which is lowest as compared to other countries.