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Revolutionizing Valvular Heart Surgery: Safer, More Efficient Cardiac Care

By Dr. Rajneesh Malhotra in Cardiac Sciences , Cardiac Surgery (CTVS)

Nov 06 , 2024 | 2 min read

In the last decade, we have witnessed ground-breaking transformation in healthcare, including cardiac care. The developments aided by technology are fascinating for cardiac surgeons to improve and cure heart ailments in all dimensions and plan customised and targeted treatment. Advancements have enabled cardiac surgeons to focus on better patient management to extend their life span from combining innovations to leading a quality life. Doctors treating heart patients with the latest methodologies have given very satisfying outcomes, as they reduce morbidity and mortality significantly and enable patients to fend for themselves in every possible manner.

The Prevalence of Valvular Heart Disease in India

Valvular heart disease, especially rheumatic heart disease, affects millions of Indians even today. The patients affected by rheumatic heart disease are younger in their productive years. At the same time, degenerative heart disease affects the elderly population.

In the 1950s, the life expectancy of an average Indian was 40–50 years, whereas now it has become 73 years, according to the latest estimates. As the Indians have started living longer, more and more people have started suffering from degenerative heart disease involving heart valves, aortic stenosis being the commonest, affecting every fourth individual above the age of seventy years.

Advanced Stages of Rheumatic Valvular Disease and Surgical Solutions

Although in younger patients suffering from rheumatic heart disease involving mainly mitral and aortic valves, every attempt is made to repair these valves, most of the time, patients present to us in a very advanced stage when valves are severely damaged, calcified or degenerated. In the advanced stage, the only option for the cardiac surgeons is to replace these valves with an artificial heart valve. Traditionally, we replace these valves with mechanical heart valves made of metal, carbon, pyrrhotite and other artificial materials. It is mandatory to give anticoagulation with vital vitamin K+ antagonists like Acitrom or Warfarin to prevent thrombus formation in these mechanical valves. Many of these younger patients cannot take these vitamin K antagonists because of their lifestyles and other reasons.

Bioprosthetic valves are the other alternative for valve replacement, and they do not require anticoagulation. However, these first- and second-generation bioprosthetic heart valves will also degenerate in 10–12 years, requiring another valvular intervention.

The Rise of Current-Generation Bioprosthetic Heart Valves

We have current-generation bioprosthetic heart valves with a life expectancy of almost 20 years and are future-ready, thus enabling surgeons to manage patients for their lifetimes. Current-generation bioprosthetic valves can be implemented in younger patients, and percutaneous interventions can be the next intervention after 20 years or so without open heart surgery.

Minimally Invasive and Robotic Valve Replacement: A New Standard

Minimally Invasive, Robotic Valve Replacement has become the standard of care where valve replacement can be done without opening the sternum with minimum invasion, enabling patients to get back to their work and life with minimum pain and morbidity and in a much faster duration. Most of these patients are back to work and thus lifestyles in two to three weeks times compared to 2-3 months in traditional sternotomy open heart surgery. For degenerative heart disease, transcatheter therapies have revolutionised the treatment, where valvular intervention can be done without open heart surgery.

Technology has revolutionised current-generation valvular interventions, making treatment faster, safer, less painful, and longer-lasting for our patients.