Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

60  Chapter 2 • Cardiovascular Care

Valve Replacement

Valve Treatments Valve treatments are used to prevent HF in patients with valvular stenosis or insufficiency accompanied by severe, unmanageable symptoms. Depending on the patient’s condition, they may undergo one of three types of valve surgery. Types of valve surgery include valvuloplasty (valvular repair), commissurotomy (separation of the adherent, thickened leaflets of the mitral valve), and valve replacement (with a mechanical or prosthetic valve). When valve surgery is not an option, percutaneous balloon valvuloplasty is used to enlarge the orifice of a stenotic heart valve, improving valvular function. Although valve surgery carries a low risk of mortality, it can cause serious complications. Hemorrhage, for instance, may result from unligated vessels, anticoagulant therapy, or coagulopathy resulting from cardiopulmonary bypass during surgery. Stroke may result from thrombus formation caused by turbulent blood flow through the prosthetic valve or from poor cerebral perfusion during cardiopulmonary bypass. With valve replacement, bacterial endocarditis can develop within days of implantation or months later. Valve dysfunction or failure may occur as the prosthetic device wears out.

With valve replacement, the natural heart valve is excised, and a prosthetic valve is sutured in place.

Prosthetic tissue valve

Sutures placed through valve’s rings

Sutures placed through valve’s rings

Valve orifice

Sutures placed around the annulus to

anchor the prosthetic valve

PLACEMENT OF PROSTHETIC VALVE

Prosthetic valve in place at the completion of the procedure

Sutures placed around the annulus to

anchor the prosthetic valve

F I N I S H E D V A L V E R E P L A C E M E N T

Types of Replacement Valves

Replacement valves can be mechanical or tissue.

Porcine heterograft valve (Carpentier-Edwards, tissue)

Bileaflet valve (St. Jude, mechanical)

Tilting-disk valve (Medtronic-Hall, mechanical)