Misshapen or damaged heart valves often need repair. That repair can be done with a procedure called annuloplasty. An annuloplasty can reshape or reinforce the ring (annulus) that surrounds a valve in the heart.
The heart is made up of a series of valves, chambers, arteries, and veins that rhythmically pump and move blood through it and into the body. It’s a well-timed machine that keeps us active, alert, and alive.
Sometimes, parts of the heart can become misshapen or stretched. The heart valves are particularly vulnerable to this. The valves are flaps that open and close to allow blood to flow into the heart but keep any blood from flowing backward.
Here, we will look at why an annuloplasty may be needed, how the procedure is performed, and what the outlook is for people who have one.
The heart’s four valves open and close to move blood through the heart’s chambers. When they’re open, blood comes in and the valves shut. With the next beat, blood is expelled as the heart pumps. This is done over and over, thousands of times each day.
Sometimes, however, those valves can become stretched or misshapen. This can occur from disease or natural changes to the valves.
If this happens, valves cannot effectively keep blood from flowing in the wrong direction or “
A leak may make the heart pump less effectively. This can lead to symptoms like weakness, fatigue, and shortness of breath. Without proper treatment, the risk of blood clots, heart failure, and cardiac arrest can increase.
That’s when annuloplasty may be needed. During this procedure, a surgeon will implant an annuloplasty ring. This ring acts as support or reinforcement for the valve. The ring is made of either metal, plastic, or mesh.
By implanting this ring, the valve will be able to close more effectively, and the risk of blood flowing backward decreases.
Annuloplasty options
An annuloplasty is a surgical procedure. There are a few options for this surgery:
- Open heart: During open heart surgery, some doctors may also do other procedures, like an aneurysm repair, while also performing an annuloplasty.
- Minimally invasive: If a surgeon opts for the less invasive option, they can make smaller incisions and use lighted instruments inside the body to make the valve repairs.
- Transcatheter procedure: A doctor guides a thin, flexible tube (catheter) through the femoral artery (in the groin) to the affected valve to perform an annuloplasty. This procedure is still in clinical trials.
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People with an enlarged heart may also need an annuloplasty. The stretching of the muscles may prevent the valve flaps from properly closing and opening.
There are four types of annuloplasty:
- Mitral valve annuloplasty: repair of the mitral valve
- Aortic valve annuloplasty: repair of the aortic valve
- Pulmonary valve annuloplasty: repair of the pulmonary valve
- Tricuspid valve annuloplasty: repair of the tricuspid valve, which has three flaps
The type of valve repair you need will depend on which valve is misshapen or damaged. You may need more than one repair.
Before the procedure, your surgeon will likely ask you to fast starting the night before surgery. You may also need to stop taking certain medications, such as blood thinners, for several days before the surgery. This is because blood thinners increase bleeding risks.
There are two ways to perform an annuloplasty: open heart or minimally invasive. These procedures are outlined below.
You’ll be under general anesthesia no matter which procedure you have. This means you’ll be asleep during the surgery and won’t be aware of what’s happening.
During an open heart annuloplasty, your surgeon will:
- make a large incision in the chest near the heart
- locate the affected heart valve and place or sew the annuloplasty ring around the heart valve
- close the incision using stitches or surgical glue
During a minimally invasive surgery, your surgeon will:
- make several small incisions in the chest near the heart
- insert small, flexible tubes with cameras or tools through the incisions
- use the tools and camera to place or sew the annuloplasty ring around the affected heart valve
- retract the tools and camera, and then close the incisions with surgical glue or stitches
Over time, the heart muscle will grow around the ring, and it will act as any other part of the heart.
Immediately after the surgery, you will rest in a recovery area of the hospital or surgical suite. Nurses and other healthcare professionals will monitor your recovery.
People who have a minimally invasive procedure may be able to return home in 3 to 5 days, as long as there are no complications.
People who have open heart procedures will need to stay longer, often up to 7 days. If there are any complications with recovery, they will need to stay in the hospital for a longer time frame.
Once you’re released from the hospital, you’ll have a set of instructions to follow. Your doctor will discuss these with you before and after your surgery. These instructions will include details on how long you need to limit physical activity and strenuous work, and when you can resume some daily activities.
You will have follow-up appointments with your surgeon or doctor after your surgery. During these visits, they’ll look at the incisions to make sure they’re healing properly. They may also order an imaging exam, such as an echocardiogram, to see how well your new ring is working.
Most people will only need one annuloplasty in their lifetime for an impaired valve. The procedure is very effective. In fact, annuloplasty is performed in almost all cases of mitral and tricuspid valve repair.
One 2020 study found that the estimated survival rate 1 year after the surgery was as high as
People with an annuloplasty ring will undergo lifelong follow-up exams with a cardiologist to monitor the ring’s placement and success. One 2021 study found that people who had the surgery could develop complications, including blood clots, years after the surgery.
As with any surgery, annuloplasty can have risks. These are primarily related to recovery and the possibility of infection after the procedure.
Risks of an annuloplasty include:
- ring malfunction
- irregular heartbeat
- blood clots
- bleeding
- stroke
- infection
If you notice any redness or swelling around the incision sites, seek medical attention. You may have an infection and need antibiotics before it worsens.
Likewise, if you have symptoms like shortness of breath, chest pain, or weakness, seek emergency medical attention. These could be symptoms of a blood clot.
Annuloplasty is a common procedure that’s used to repair faulty or damaged heart valves.
Without the procedure, a heart valve may not seal properly and blood can leak backward. Over time, this can cause symptoms like shortness of breath, irregular heartbeat, and swollen feet or ankles. Blood clots are possible and can be fatal.
Annuloplasty is usually a very successful procedure. People who have the surgery rarely need additional repair on the affected valve.