The doctor. Xavier Ruyra is a specialist in Cardiovascular Surgery, Head of Service of the Hospital Universitari Germans Trias i Pujol of Badalona and of the Unit of Cardiac Surgery VidaalCor of CM Teknon. Within his specialty, he focuses his care activity on cardiac valve repair surgery, Ross Operation, bloodless heart surgery and new alternatives for aortic valve pathology in high-risk patients.
How can the heart valves be affected?
There are four heart valves in the heart and their function is to ensure that the flow of blood is done in the right direction and in the right way. Valves can be affected because they are not able to open properly (stenosis) or because they can not be closed properly (insufficiency). Currently, in Western countries and with the progressive aging of the population, the most frequent pathologies are stenosis of the aortic valve that requires valvular replacement and mitral insufficiency of degenerative origin, which affects 6.4% of people between 65 and 74 years old and to 9.3% of people over 75 years of age.
Why should patients with severe mitral regurgitation be operated?
When the mitral valve is unable to close properly, a large part of the volume of blood that ejects the heart in each beat is directed backwards, congesting the lungs and exerting a volume overload on the heart itself. That heart, in the attempt to adapt, is going to become large (dilation) and will lose contraction force. The patient will feel more fatigued, with difficulty breathing and may have complications such as arrhythmias or embolisms. It is very important to reestablish the normal functioning of the valve before the impact on the heart is important.
Is it better to repair the valve than to replace it with an artificial prosthesis?
Until a few years ago, all patients with severe mitral valve insufficiency who underwent surgery underwent replacement or replacement of the affected valve with an artificial prosthesis.. Today we know that the best option is not the replacement but the repair of that valve (plasty). The advantages are very significant: we preserve the architecture of the heart better and therefore its function, we avoid in many cases having to take anticoagulants like Sintrom® for life, we decrease the operative risk and we get a better and faster recovery. In addition, the associated complications are much lower. The advantages are so important that, at present, early surgery is recommended (even before having symptoms) of all patients with severe mitral regurgitation, if we can ensure an effective repair in more than 95% of cases and a lower surgical risk at 1%.
Can all valves with insufficiency be repaired?
The mitral valve is a very complex structure, with many anatomical elements that must interact with each other in a coordinated manner to achieve a perfect closure of the valve. It is essential to evaluate completely and individually each patient with mitral disease to have an exact idea of the reasons why this valve fails. Currently, echocardiography studies provide us with all the necessary information and are able to predict the reparability of the valve. Then we must refer the patient to surgeons with sufficient training, experience and skill to repair complex changes of the mitral valve. Today, we can repair with guarantees, almost 100% of mitral insufficiencies with very good results in the short, medium and long term, and with a very low risk.
How are mitral valves repaired with insufficiency?
Each patient will be different and we will have to individualize the surgery according to the cause, the anatomical findings and the type of dysfunction that have caused the insufficiency of the valve. We can trim the excess tissue, reconstruct the anatomy of the veils, replace the elongated or broken cords, reposition the elements of the mitral apparatus, etc.. In addition, we will always perform an annuloplasty with a prosthetic ring that remodels and stabilizes our repair.
What is the Ross Operation?
The Ross Operation (named after the surgeon who described it: Sir Donald Ross) is an excellent option for young patients with aortic valve involvement. It consists of using the patient's own pulmonary valve to replace the affected aortic valve. In the place of that pulmonary valve we will implant a cryopreserved tissue Bank homograft. With the Ross Operation we obtained a completely human valve replacement, very resistant to infection, with a high hemodynamic performance, and which does not require the patient to take anticoagulants.. The objective is always the same: to solve the patient's problem with the minimum risk and surgical aggression, to get him to recover quickly and well, to be able to re-establish his normal life soon, and to enjoy the best quality of life possible.