Qu'est-ce que le remplacement valvulaire : aperçu, avantages et résultats attendus
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# What is Valve Replacement?
Valve replacement is a surgical procedure in which a diseased or damaged valve, usually within the heart, is replaced with a new, artificial valve. This surgery can be done either through open-heart surgery or through a minimally invasive procedure known as transcatheter aortic valve replacement (TAVR). Valve replacement surgery is usually required when a valve becomes blocked (stenosed) or loses the ability to open properly (regurgitating) due to disease.
The heart is an organ composed of four different valves, all of which facilitate the circulation of blood throughout the organs of the body. The aortic valve regulates the flow of oxygenated blood from the left ventricle into the aorta. The mitral valve regulates the flow of deoxygenated blood from the left atrium into the left ventricle. The tricuspid valve regulates the flow of deoxygenated blood from the right atrium into the right ventricle, and the pulmonary valve regulates the flow of oxygenated blood from the right ventricle into the pulmonary artery.
Valve replacement surgery is an important procedure for restoring the effective functioning of these valves in cases where they are blocked or unable to open properly due to disease. When a valve is diseased or damaged, it can lead to a number of medical problems, including heart failure, arrhythmia, and stroke. Valve replacement surgery is a treatment that can effectively address these problems and help patients to live longer, healthier lives.
## Overview of Valve Replacement Surgery
Valve replacement surgery involves replacing a damaged or defective heart valve with an artificial (also known as “prosthetic” or “mechanical”) valve. The new valve is usually made of metal alloy or plastic and is designed to open and close properly, allowing blood to flow through the heart in a normal fashion.
The type of valve that is implanted during valve replacement surgery is dependent on the age and medical condition of the patient. Metal alloy and plastic valves are the two main types of valves that are used. Metal alloy valves are usually preferred in younger patients due to their durability, while plastic valves are preferred for older patients due to their flexibility.
Valve replacement surgery can be performed using open-heart surgery, known as conventional valve replacement, or with a minimally invasive procedure known as transcatheter aortic valve replacement (TAVR). In conventional valve replacement surgery, the patient’s chest is opened and a needle is then used to stitch the artificial valve into place where the diseased valve used to be. TAVR is a minimally invasive procedure in which a balloon catheter is used to deliver the prosthetic valve.
## Benefits of Valve Replacement Surgery
Valve replacement surgery is beneficial for restoring normal heart function and reducing the symptoms of heart disease. Many of these benefits are experienced shortly after the surgery and can improve over time with appropriate follow-up care.
Valve replacement surgery can allow patients to live longer, healthier lives. Studies have shown that heart valve replacement surgery successfully relieves symptoms of heart disease, decreases the risk of further heart damage, and can increase survival rates by up to 80%.
The procedure is also much less invasive than other open-heart surgeries, and many patients require only local anesthesia and minimal blood loss. Recent advances in valve replacement technology have also made it possible to perform the surgery using a minimally invasive procedure, leading to fewer risks of infection and bleeding and a quicker and easier recovery.
## Expected Results of Valve Replacement Surgery
Most patients experience a significant improvement of symptoms shortly after valve replacement surgery. Many patients are able to resume their normal activities within two to three weeks after the surgery.
The rate of recovery varies from patient to patient, depending on factors such as age, overall health, and the type of procedure that was used. On average, patients usually regain their peak physical activity and confidence after 3 to 6 months following surgery.
Valve replacement surgery typically lasts 10 to 15 years, depending on the patient’s activity level. Patients will need to follow up with their doctors regularly after surgery to monitor the functioning of their new valve. Regular check-ups are also important to ensure that the valve is functioning properly and to detect any signs of wear and tear.
Conclusion
Valve replacement surgery is a procedure that can be used to replace a damaged or defective heart valve with an artificial valve. The surgery is beneficial for restoring normal heart function, reducing symptoms of heart disease, and reducing the risk of further heart damage. Most patients experience a significant improvement in symptoms after the surgery and are able to resume their normal activities within two to three weeks. The success of the surgery also varies from patient to patient, depending on factors such as age, overall health, and the type of procedure that was used. For best results, it is important to follow up with doctors regularly to ensure the newly-implanted valve is functioning properly.
Valve replacement is a surgical procedure in which a diseased or damaged valve, usually within the heart, is replaced with a new, artificial valve. This surgery can be done either through open-heart surgery or through a minimally invasive procedure known as transcatheter aortic valve replacement (TAVR). Valve replacement surgery is usually required when a valve becomes blocked (stenosed) or loses the ability to open properly (regurgitating) due to disease.
The heart is an organ composed of four different valves, all of which facilitate the circulation of blood throughout the organs of the body. The aortic valve regulates the flow of oxygenated blood from the left ventricle into the aorta. The mitral valve regulates the flow of deoxygenated blood from the left atrium into the left ventricle. The tricuspid valve regulates the flow of deoxygenated blood from the right atrium into the right ventricle, and the pulmonary valve regulates the flow of oxygenated blood from the right ventricle into the pulmonary artery.
Valve replacement surgery is an important procedure for restoring the effective functioning of these valves in cases where they are blocked or unable to open properly due to disease. When a valve is diseased or damaged, it can lead to a number of medical problems, including heart failure, arrhythmia, and stroke. Valve replacement surgery is a treatment that can effectively address these problems and help patients to live longer, healthier lives.
## Overview of Valve Replacement Surgery
Valve replacement surgery involves replacing a damaged or defective heart valve with an artificial (also known as “prosthetic” or “mechanical”) valve. The new valve is usually made of metal alloy or plastic and is designed to open and close properly, allowing blood to flow through the heart in a normal fashion.
The type of valve that is implanted during valve replacement surgery is dependent on the age and medical condition of the patient. Metal alloy and plastic valves are the two main types of valves that are used. Metal alloy valves are usually preferred in younger patients due to their durability, while plastic valves are preferred for older patients due to their flexibility.
Valve replacement surgery can be performed using open-heart surgery, known as conventional valve replacement, or with a minimally invasive procedure known as transcatheter aortic valve replacement (TAVR). In conventional valve replacement surgery, the patient’s chest is opened and a needle is then used to stitch the artificial valve into place where the diseased valve used to be. TAVR is a minimally invasive procedure in which a balloon catheter is used to deliver the prosthetic valve.
## Benefits of Valve Replacement Surgery
Valve replacement surgery is beneficial for restoring normal heart function and reducing the symptoms of heart disease. Many of these benefits are experienced shortly after the surgery and can improve over time with appropriate follow-up care.
Valve replacement surgery can allow patients to live longer, healthier lives. Studies have shown that heart valve replacement surgery successfully relieves symptoms of heart disease, decreases the risk of further heart damage, and can increase survival rates by up to 80%.
The procedure is also much less invasive than other open-heart surgeries, and many patients require only local anesthesia and minimal blood loss. Recent advances in valve replacement technology have also made it possible to perform the surgery using a minimally invasive procedure, leading to fewer risks of infection and bleeding and a quicker and easier recovery.
## Expected Results of Valve Replacement Surgery
Most patients experience a significant improvement of symptoms shortly after valve replacement surgery. Many patients are able to resume their normal activities within two to three weeks after the surgery.
The rate of recovery varies from patient to patient, depending on factors such as age, overall health, and the type of procedure that was used. On average, patients usually regain their peak physical activity and confidence after 3 to 6 months following surgery.
Valve replacement surgery typically lasts 10 to 15 years, depending on the patient’s activity level. Patients will need to follow up with their doctors regularly after surgery to monitor the functioning of their new valve. Regular check-ups are also important to ensure that the valve is functioning properly and to detect any signs of wear and tear.
Conclusion
Valve replacement surgery is a procedure that can be used to replace a damaged or defective heart valve with an artificial valve. The surgery is beneficial for restoring normal heart function, reducing symptoms of heart disease, and reducing the risk of further heart damage. Most patients experience a significant improvement in symptoms after the surgery and are able to resume their normal activities within two to three weeks. The success of the surgery also varies from patient to patient, depending on factors such as age, overall health, and the type of procedure that was used. For best results, it is important to follow up with doctors regularly to ensure the newly-implanted valve is functioning properly.
Définition et aperçu
Un remplacement valvulaire, comme le terme l'indique, est une intervention chirurgicale qui consiste à remplacer une ou plusieurs des valves du cœur pour traiter des maladies telles que la sténose et la régurgitation.
Le cœur possède quatre valves différentes, appelées (1) tricuspide, qui se trouve entre l'oreillette droite et le ventricule droit, (2) mitrale, qui relie le ventricule gauche à l'oreillette gauche, (3) pulmonaire, qui aide le le flux sanguin du ventricule droit vers les poumons et (4) l'aorte, qui achemine le sang oxygéné du cœur vers les autres vaisseaux sanguins du corps. Leur travail peut être classé en deux : s'ouvrir pour laisser passer le sang à travers la chambre vide et se fermer au bon moment pour éviter les fuites et empêcher le sang de refluer.
Dans les cas où les valves deviennent malades, les médecins peuvent choisir de prescrire des médicaments et des changements de mode de vie, de réparer les valves affectées ou de les remplacer. La dernière option n'est envisagée que lorsque tous les autres choix n'ont pas réussi à corriger la condition et si ses avantages l'emportent largement sur les risques et les complications.
Lors du remplacement des valves, des matériaux mécaniques et biologiques sont pris en compte, mais le choix dépend toujours de la durabilité, des performances, des besoins en médicaments, des risques et des complications. En fin de compte, le but ultime est de rétablir la santé et la vitalité du patient et d'améliorer sa qualité de vie.
Qui devrait subir et résultats attendus
Une chirurgie de remplacement valvulaire est effectuée lorsque les conditions qui affectent l'une des valves sont considérées comme graves ou ne peuvent pas être corrigées à l'aide d'autres méthodes non invasives ou peu invasives. Ces conditions incluent :
Sténose - Cela fait référence à la constriction ou au rétrécissement des valves augmentant le risque d'obstruction du flux sanguin. Cette condition peut être causée par une anomalie congénitale telle qu'une valve bicuspide (deux volets de la valve sont fusionnés), l'accumulation de dépôts de calcium, des infections, des rhumatismes fièvre, et la détérioration de la valve due à l'âge.
Régurgitation - Cela signifie que les valves fuient le sang dans plus d'une direction ou que le sang retourne dans sa chambre précédente. Cela peut être dû à une malformation cardiaque ou à une infection.
Infectieux endocardite (IE) - Il s'agit d'une infection aiguë de la muqueuse du cœur due à des bactéries qui ont envahi la circulation sanguine et voyagé jusqu'au cœur, affectant les valves ou les vaisseaux sanguins.
Le remplacement valvulaire est rarement effectué chez les personnes qui ont un prolapsus de la valve mitrale. Au contraire, cette condition est traitée avec des médicaments tels que les bêta-bloquants ou la valve est réparée. Dans de nombreux cas, la condition est laissée seule car elle ne constitue pas une menace pour la santé de la personne et ne provoque aucun signe ou symptôme grave. Dans la majorité des cas, les chirurgiens optent pour des traitements moins invasifs comme les médicaments et la réparation valvulaire avant d'envisager de remplacer la valvule endommagée ou malade.
Si une personne atteinte d'une valvulopathie cardiaque grave ne subit pas de procédure de remplacement valvulaire pour quelque raison que ce soit, sa durée de vie peut être réduite jusqu'à 25% dans les cinq années suivant le diagnostic.
Comment fonctionne la procédure ?
Il existe différentes options chirurgicales pour le remplacement de la valve, et le chirurgien choisira en fonction de plusieurs facteurs, notamment l'état de santé général du patient, son âge, le résultat souhaité, la durabilité de la nouvelle valve et le besoin de médicaments par la suite.
Deux des méthodes les plus populaires sont appelées Ross, ou autogreffe pulmonaire, et remplacement ou implantation de valve aortique transcathéter (TAVR/TAVI).
Dans la procédure de Ross, la valve aortique problématique est remplacée par un matériau d'autogreffe. Puisqu'il est dérivé du corps du patient, le risque de rejet et de complications est considérablement réduit.
Pendant ce temps, la technique TAVR/TAVI est peu invasive car elle ne nécessite que de petites incisions dans la poitrine ou l'artère fémorale, après quoi un cathéter est enfilé dans la valve endommagée afin que la nouvelle puisse être calée, créant un meilleur chemin pour le sang. .
Dans de nombreux cas, cependant, la chirurgie de remplacement valvulaire standard qui implique l'ouverture du thorax (sternotomie) est toujours pratiquée, à moins que le patient ne souffre d'une affection sous-jacente susceptible d'affecter la procédure ou si la procédure est considérée comme ayant considérablement réduit la durée de vie du patient, en auquel cas, TAVR/TAVI est pris en compte. Les patients peuvent également choisir de subir d'autres procédures moins invasives telles que l'assistance robotique (où les bras robotiques sont contrôlés par les chirurgiens) ou endoscopique (où un tube avec une caméra est inséré dans l'une des petites incisions pour voir la valve malade en temps réel et utiliser les autres incisions pour opérer avec des instruments microchirurgicaux).
Au cours de la chirurgie de remplacement valvulaire, le patient est administré sous anesthésie générale et est connecté à une machine qui surveille les performances du cœur. Une machine cœur-poumon est également utilisée si la procédure nécessite un arrêt temporaire du cœur.
Risques et complications possibles
caillots sanguins et embolies ne sont pas tout à fait rares chez les personnes qui ont subi un remplacement valvulaire à l'aide d'une valve mécanique, de sorte qu'elles reçoivent généralement des anticoagulants avant et après la chirurgie. Leur réponse à long terme à ces médicaments est également surveillée. Un remplacement de valve ne garantit pas non plus que la condition ne se reproduira pas, bien que cela soit moins probable chez les personnes qui ont une valve mécanique car c'est la plus durable.
Des risques et complications chirurgicaux courants peuvent également être rencontrés, que la procédure soit invasive ou peu invasive. Ceux-ci comprennent des cicatrices sur le site de l'incision et certaines parties du cœur, des dommages aux muscles et aux tissus du cœur, une infection, des saignements, un arrêt cardiaque, des douleurs et des difficultés respiratoires. Les techniques mini-invasives, cependant, présentent moins de risques en raison d'un temps de récupération plus rapide, d'une exposition moindre des muscles cardiaques non affectés et d'incisions plus petites.
Les références
Fullerton DA, Harken AH. Cardiopathie acquise : valvulaire. Dans : Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Manuel de chirurgie. 19e éd. Philadelphie, Pennsylvanie : Elsevier Saunders ; 2012 : chap. 61.
Otto CM, Bonow RO. Cardiopathie valvulaire. Dans : Bonow RO, Mann DL, Zipes DP, Libby P, eds. La maladie cardiaque de Braunwald : un manuel de médecine cardiovasculaire. 9e éd. Philadelphie, Pennsylvanie : Elsevier Saunders ; 2011 : chap. 66.
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Very informative! Great post!
Really helpful information!