Frequently Asked Questions
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Your heart has four valves: the mitral valve and the aortic valve on the left side of your heart and the tricuspid valve and the pulmonic valve on the right side of your heart. In order for blood to move properly through your heart, each of these valves must open and close properly as the heart beats. The valves are composed of tissue (usually referred to as leaflets or cusps). This tissue comes together to close the valve which prevents blood from improperly mixing in the heart’s four chambers (right and left atrium and right and left ventricle).

You may notice that the beating of your heart makes a “dub-dub, dub-dub” sound. This sound corresponds to the opening and closing of the valves in your heart. The first “dub” sound is softer than the second and is called diastole. In diastole, the mitral and tricuspid valves are opened so that the ventricles can fill with blood. In addition, the aortic and pulmonic valves are closed to prevent blood leaking from the ventricles. The second “dub” which is much louder is called systole. In systole, the mitral and tricuspid valves close while the aortic and pulmonic valves open. The ventricles then contract. Blood from the left ventricle is pumped through the aortic valve to the rest of the body, whereas blood from the right ventricle goes through the pulmonic valve and to the lungs.

The average human heart beats 100,000 times per day. Over the life of an average 70-year-old, that means over 2.5 billion beats. In other words, your heart valves are opening and closing frequently.

Your heart is about the size of your fist, so the heart valves are quite small: anywhere from between the size of a nickel to the size of a quarter and slightly larger.

There are different reasons why one or more of your heart valves may not work properly. The ultimate effect of a diseased heart valve is that it interrupts proper blood flow through the heart. Causes may include things such as:

• Endocarditis — an infection of the valve tissue.
• Rheumatic fever — a specific type of infection more prevalent in developing countries where the valve tissue becomes inflamed and/or fused together.
• Calcification — over time, calcium in your body can build up on the tissue of your valve making it difficult for them to move properly.
• Congenital defects — a condition you are born with such as having only two leaflets on the aortic valve rather than three.
• Ischemia — also known as coronary artery disease when the heart’s own blood vessels become clogged and can no longer deliver the proper amount of blood.
• Degenerative disease — a progressive process that represents slow degeneration from mitral valve prolapse (improper leaflet movement). Over time, the attachments of the valve thin out or rupture and the leaflets become floppy and redundant.
• Other causes

There are different methods for treating valvular heart disease, and you should discuss your options with your physician. In some cases, no action may be needed and a “wait and see” approach may be used. Your doctor may also prescribe various types of medications that may improve your symptoms. If the disease has progressed, however, your doctor may determine that valve repair or replacement is appropriate. What procedure is appropriate is a decision that your doctor will make in consultation with you. This is dependent upon such things as which valve or valves need to be addressed, your specific medical conditions, and other factors. In general, there are two options to treat valvular heart disease: one is to repair your native valve; the other is to replace your native valve with a prosthetic valve. There is more than one approach to valve repair and replacement, including “minimal incision,” which involves a smaller incision than the traditional “open chest” approach. Lastly, for patients with severe symptomatic native aortic valve stenosis who are deemed inoperable for heart surgery, there is  transcatheter aortic valve replacement.

In some cases, it may be possible to repair your valve. Repair is most commonly performed on the mitral and tricuspid valves. The goal of the repair procedure is to fix your native valve so that it can open and close properly thus restoring normal blood flow through the heart. An implantable device which is usually ring-shaped with a metal core may be placed directly above your valve and tied in place with sutures. This procedure is called ring annuloplasty. The ring helps your valve maintain its proper shape so that no blood leaks out as the heart contracts and relaxes. A ring annuloplasty can be performed in a variety of ways including using either an open chest or minimal incision surgical approach.

If your heart valve cannot be repaired, your doctor may decide to replace your native valve with a prosthetic valve. The aortic valve is the most commonly replaced heart valve. The prosthetic valves are usually one of two types: a mechanical valve or a tissue valve. A mechanical valve is made from synthetic (manmade) materials. A tissue valve is usually made from either the tissue from a pig’s aorta or the tissue from the pericardium (sac surrounding the heart) of a cow.

Today there are two approaches that physicians can choose from to replace the aortic valve. The most common is called surgical aortic valve replacement. In this procedure, your physician will crack your breast bone, stop your heart from beating, and open the heart to remove the diseased aortic valve. A new aortic valve is then sewn into place. The second approach is intended for patients who are deemed inoperable for surgical valve replacement, and this procedure is called transcatheter aortic valve replacement (TAVR). TAVR is a procedure that allows replacement of the aortic valve without needing to crack the breast bone or stop the heart from beating.  Instead, the prosthetic valve is compressed, inserted into a blood vessel located in your leg, and advanced to the heart with the help of an x-ray machine. Once positioned within the patient’s native diseased valve, the prosthetic aortic valve is expanded and replaces the function of the old one.

Serious complications, sometimes leading to reintervention or death, may be associated with heart valve repair or replacement. It is important to discuss your particular situation with your doctor to understand the possible risks, benefits, and complications that could occur.

You should discuss this option with your doctor as there are advantages and disadvantages to both. A mechanical valve may last longer than a tissue valve (which can wear out over time). However, patients with mechanical valves are required to be on anticoagulants (blood thinners) for life. Blood thinners are needed with mechanical valves to reduce the risk of clot formation. If these clots are big enough, they could cause such adverse events as strokes. Being on blood thinners may require you to limit your physical activity in order to reduce the risk of bleeding events. You may also need to modify your diet and make other lifestyle changes. It is important to discuss these issues with your doctor. Tissue valves do not require you to be on blood thinners for the rest of your life. However, they can wear out over time which may require surgery for a new valve.

The results of valve repair or replacement vary for each individual. Most individuals feel relief from symptoms immediately, while other patients begin to notice an improvement in their symptoms in the weeks following the procedure. Minimal incision surgery often results in a faster return to normal activity. Your doctor can help you in evaluating your progress and physical health following valve repair or replacement.

If you have a valve repaired or replaced, the normal recovery period is four to six weeks. Typically during this time you will begin to restore muscle tone and return to normal energy and activity levels. Your ability to return to your normal daily activities depends on several factors, including the type of valve repair or replacement you’ve had, how you personally feel, how well your incision is healing, and the advice of your doctor. Regardless of the type of procedure you and your doctor have selected and the pace of your recovery, a supervised cardiac rehabilitation program is always helpful in helping you regain lost energy and overall good health.

As with any medical procedure, you may be required to take medications following your heart valve repair or replacement. Discuss with your doctor which (if any) medications you may need.

Anticoagulants, or blood thinners, decrease the blood’s natural ability to clot. If you must take anticoagulant drugs, you will need a prothrombin time test (commonly called a pro-time test) every two to four weeks. A pro-time test measures the level of certain clotting factors that indicate the blood’s ability to clot. This test result helps your doctor determine the amount of anticoagulant you need. The pro-time test should be done at the same lab every time because results may vary from one lab to another. It may take a while to establish the right dosage of this drug for you, but consistency and working with your doctor are important. Home testing may also be available, so check with your physician about this option.

While taking anticoagulants, you should avoid large amounts of foods high in vitamin K, such as leafy greens, since they may interfere with your anticoagulant. Alcohol may also alter its effect. Even simple over-the-counter drugs such as aspirin, laxatives, vitamins, and cough medications can make your anticoagulant more or less active than usual. Consult your doctor before eating these foods or taking any of these drugs.

Other things that may affect your response to anticoagulants include irregular eating habits, crash dieting or binge eating, stress, significantly increased or reduced exercise, and travel. Try to find a routine of daily activities and stay with it. Consult your doctor if you anticipate any major changes in your activities. Notify your doctor IMMEDIATELY if you experience a momentary loss of consciousness or speech because it may mean that your anticoagulant dosage is too low. Notify your doctor IMMEDIATELY if you experience any of these symptoms, which can indicate that your anticoagulant dosage is too high:

• Bleeding from a cut that does not stop by itself
• Nosebleeds
• Bleeding gums from brushing
• Red or black, tarry stools
• Any unusual symptoms such as pain, swelling, or discomfort

Be sure your dentist and doctors know that you have had heart valve repair or replacement. Ask your dentist and doctor about taking antibiotics before dental or surgical procedures to help prevent valve infection. Always follow your doctor’s instructions carefully.

Although the amount of metal in these devices is very small, airport metal detectors can be very sensitive, so it is possible they could cause an airport metal detector to go off. Be sure to carry your identification card with you at all times.

If you received an Edwards heart valve repair or replacement product, you may request a replacement card by contacting Edwards Lifesciences.

Most Edwards heart valves and annuloplasty rings are safe and compatible during magnetic resonance imaging (MRI) procedures. Information is not available on annuloplasty rings made of stainless steel before 1984. Please have your doctor or imaging center visit www.edwardsmri.com or contact our Technical Services Department for details on specific product model numbers.

U.S. and Canada 800.822.9837
Outside the U.S. 1.949.250.2500 ext. 5030
Fax 1.949.250.2625
tech_support@edwards.com
Mail:
Technical Services
Edwards Lifesciences LLC
PO Box 11150
Santa Ana, CA 92711-1150 USA