Double Valve Replacement (DVR) in Delhi, India

Replacement valves may be biological or mechanical. Mechanical valves are made from biocompatible carbon and polyester. These valves last about 10 to 20 years. However, they may cause blood clotting, so patients with mechanical valves are prescribed blood thinners for the rest of their lives. Hence, the chances of stroke are lowered.

Biological valves are also termed bioprosthetic valves. They are made up of human or animal tissue. These are further classified into three types:

• Allograft or homograft (taken from donor's heart)
• Porcine valve (taken from pigs)
• Bovine valve (taken from cows)

Double valve replacement is indicated in cases such as:

• Valve regurgitation: When the flaps of the valve fail to close tightly, they cause the blood to leak backwards. This condition thus requires to be treated to prevent damage or infection to the heart.
• Valve stenosis: Stenosis of the valve is a condition in which the flaps of the valve stiffen or become thick. In some cases, they may also fuse. This leads to the narrowing of the valve and thereby reduces blood flow throughout the body.

• Fatigue
• Dizziness
• Cyanosis
• Chest pain
• Lightheadedness
• Shortness of breath
• Fluid retention, especially in the lower limbs

Patients with double valve replacement need to meet some criteria before surgery. These include:

• Age of the patient
• Patient tolerance to the surgical procedure
• Ongoing medications
• In cases where the valve is irreparable
• Failed heart valve repair or replacement
• Development of complications such as infection, blood clots, and others

1) Those patients who are contraindicated for blood thinners

2) Severe medical co-morbidities 

• Advance cancer
• Severe lung cancer
• Patient with multi-organ failure 

Discussing any questions or doubts during the consultation with the doctor is essential. Inform the doctor in case of any medical history or condition, such as pregnancy, diabetes, allergies, and more. Also, inform them about ongoing medications since they may interact with the procedure. Some other points to consider for preparing for the surgery include:

• Quit smoking and drinking. These activities can largely interfere with the surgical procedure and, wound healing, post-op recovery
• A week to 5 days before the surgery, blood thinners need to be stopped to prevent uncontrolled bleeding during the procedure
• Shower and wash hair well before or on the day of surgery
• Prophylactic antibiotics may be prescribed for additional protection from infections
• On the day before surgery, avoid drinking or eating for at least 8-12 hours. Medicines can often be taken with little sips of water at the doctor's discretion
• Avoid wearing any jewellery and taking expensive items to the hospital on the day of surgery

This procedure is performed under general anaesthesia. Traditional surgery needs a large incision to be made from the neck to the xiphoid. With a minimally invasive procedure, short incisions are needed. Thus, the chances of infection are reduced.

A bypass machine is connected to the body to maintain the blood flow in the body throughout the procedure. Valves are then replaced. Once the surgery is completed, incisions are stitched or stapled, and dressings are placed.

In addition, drains are placed near the surgical area to prevent fluid accumulation at the surgical site. Post-operatively, patients are transferred to the ICU to monitor their vital signs.

Double valve replacement surgery comes with its own risks and complications since it is a major surgery. However, the chances of fatality are just 2%, which is quite an insignificant number. Some complications associated with the surgery include:

• Uncontrolled bleeding during or after treatment 
• Infection at the incision site
• Damage to the blood vessels
• Blood clots may cause stroke, heart attack, or lung problems
• Breathing problems
• Valve failure is also more common with replacement
• Infection in the new valve is called endocarditis, which is more common with valve replacement
• Pneumonia
• Arrhythmias or abnormal heart rhythms 
• Need for a permanent pacemaker
• Allergic reaction to anaesthetics or other medications

Patients are usually transferred to the ICU after the surgical procedure to monitor their vitals. 

IV fluids, painkillers, antibiotics, and other medications are injected at the hospital. Patients may also be given oxygen to help them breathe better. Drains are often attached to eliminate toxic waste/ excess fluid from the surgical site. The catheter is placed to drain urine from the bladder. All vital signs are monitored throughout the stay at the hospital.

After leaving the ICU, the patient is often moved to the regular room for a few days to ensure stability. Then, movement can be started with time and at the patient's comfort in the ICU or in the ward. Walking slowly within the hospital premises can be a starting point. Breathing exercises also help improve lung capacity and activity. Before discharge, speak to the doctor about precautions that need to be taken. Some standard instructions to be followed include:

• Avoid heavy lifting and vigorous exercises for a few weeks
• Take medicines on time as advised by the doctor
• Take a rest for a week or two
• Avoid taking any stress
• Avoid smoking and drinking
• Make lifestyle changes, including a healthier diet, exercise and a better mindset

If any symptoms are experienced, contact the doctor immediately.

Reviewed by Dr. Rajneesh Malhotra, Vice Chairman & Head - CTVS - Cardiac Sciences, Cardiac Surgery (CTVS), Robotic Surgery.