CABG with Valve replacement
Heart valve repair or replacement surgery is a treatment option for valvular heart disease. When heart valves become damaged or diseased, they may not function properly. Conditions which may cause heart valve dysfunction are valvular stenosis and valvular insufficiency (regurgitation).
When one (or more) valve(s) becomes stenotic (stiff), the heart muscle must work harder to pump the blood through the valve. Some reasons why heart valves become stenotic include infection (such as rheumatic fever or staphylococcus infections) and aging. If one or more valves become insufficient (leaky), blood leaks backwards, which means that less amount of blood is pumped in the proper direction. Based on your symptoms and overall condition of your heart, your doctor may decide that the diseased valve(s) needs to be surgically repaired or replaced.
Highly invasive procedure
Traditionally, repair or replacement of heart valves has involved open-heart surgery, which means that the chest is opened in the operating room and the heart stopped for a time so that the surgeon may repair or replace the valve(s). In order to open the chest, the breastbone, or sternum, is cut in half and spread apart. Once the heart is exposed, large tubes are inserted into the heart so that the blood can be pumped through the body during the surgery by a cardiopulmonary bypass machine (heart-lung machine). The bypass machine is necessary to pump blood because the heart is stopped and kept still while the surgeon performs the valve repair or replacement procedure.
Minimally invasive procedures (MIP)
Newer, less invasive techniques have been developed to replace or repair heart valves. Minimally invasive procedures make smaller incisions which means less pain in the post-surgery period and shorter hospital stay. Balloon valvuloplasty is one such procedure. It is used to treat some cases of valve stenosis, and is done as part of a catheterization procedure, rather than as part of open heart surgery. In this procedure your doctor inserts a long, thin tube (catheter) with a balloon in the tip into your arm or groin and guides it to your heart. Your doctor inserts the balloon in the valve and inflates the balloon to open or stretch the valve. The balloon is then deflated and removed. You may need additional procedures over time to treat the narrowed valve.
Transcatheter aortic valve replacement, or TAVR, is a new alternative for some cases of aortic valve stenosis. This hybrid procedure typically is done by a cardiac surgeon and an interventional cardiologist.
The diseased valve may be repaired using a ring to support a person’s own valve, or the entire valve may be removed and replaced by an artificial valve. Artificial valves may be mechanical (made of metal or plastic) or tissue (made from animal valves or human valves taken from cadavers).
Other related procedures that may be used to assess the heart include resting and exercise electrocardiogram (ECG), Holter monitor, signal-averaged ECG, cardiac catheterization, chest X-ray, computed tomography (CT scan) of the chest, echocardiography, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and ultrafast CT scan. Please see these procedures for additional information.
Heart valve repair or replacement follows this process:
- An intravenous (IV) line will be started in your arm or hand. Additional catheters will be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.
- A catheter will be inserted into your bladder to drain urine.
- The doctor will make an incision (cut) down the center of the chest from just below the Adam’s apple to just above the navel.
- The sternum (breastbone) will be divided in half with a special operating instrument. The doctor will separates the two halves of the breastbone and spread them apart to expose the heart.
In order to perform the valve repair or replacement, the heart must be stopped to allow the doctor to perform the very delicate procedure. Tubes will be inserted into the heart so that the blood can be pumped through your body by a cardiopulmonary bypass machine.
- Once the blood has been completely diverted into the bypass machine for pumping, the heart will be stopped by injecting it with a cold solution.
- When the heart has stopped, the doctor will perform the procedure by removing the diseased valve and putting in the artificial valve, in the case of a valve replacement. For a valve repair, the procedure performed will depend on the type of valve problem that exists, for example, separation of fused valve leaflets, repair of torn leaflets, and/or the reshaping of valve parts to ensure better function.
- Once the procedure has been completed, the blood circulating through the bypass machine will be allowed to reenter your heart and the tubes to the machine removed. Your heart will be shocked with small paddles to restart its electrical activity.
- Once your heart is beating again, the doctor will observe the heart to assess the function of the heart and the valves.
- Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period.
- The sternum will be rejoined and sewn together with small wires.
- The skin over the sternum will be sewn back together. The incision will be closed with sutures or surgical staples.
- Tubes will be inserted into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to drain fluids away from the heart.
A tube will be inserted through your mouth or nose into your stomach to drain stomach fluids.
The Estimate Includes:
1. Bed charges
2. Clinical Lab Charges
3. Professional Charges
4. Nursing Charges
5. Dietary Charges for the patient and an attendant
6. Operation Theatre charges
7. Anesthetist charges
8. Procedure charges
9. Meet & Greet at the Airport.
The Estimate Excludes:
1. Stay outside the hospital, cost of the same is not included in the above estimate and is payable on actual.
2. Any outpatient consultations and medicines which are required during the follow-up will not be a part of the estimate.
3. The estimate cost is for the number of days indicated above, if situation demands to extend stay in hospital, the additional days stay would be charged accordingly.
4. Cost for additional or multiple implants will be charged at actual.
5. Special Investigations referred by other departments or if situation demands any additional investigation would be charged accordingly.