HCM Procedures

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Valve replacement is a surgical procedure that removes a faulty valve and replaces it with a mechanical or biological tissue valve.

Hypertrophic obstructive cardiomyopathy (HOCM) is often associated with abnormalities of the mitral valve. Many people with HOCM develop mitral regurgitation. This is because the leaflets of the mitral valve do not close properly. As a result blood leaks back into the left atrium. Severe mitral regurgitation can cause symptoms like shortness of breath, fatigue, exercise intolerance, and palpitations. It can also contribute to heart failure.

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For many HOCM patients, myectomy is enough to eliminate obstruction and most mitral regurgitation. But it is fairly common for patients to need surgery to repair or replace the mitral valve. When repair is possible - and it is in a majority of cases - it is preferable to replacement. Replacement is sometimes necessary.

Mitral valve replacement is often done at the same time as myectomy or other open heart procedures. Sometimes valve replacement can be done by itself with a minimally invasive procedure. This can mean a shorter time on heart-lung bypass, shorter hospital stay and quicker recovery. Your surgeon will talk with you about the options available, as well as their pros and cons.

TYPES OF REPLACEMENT SURGERY
A key choice for you will be whether to replace the valve with a mechanical valve or a biologic valve. Mechanical valves tend to last longer. But they require that you take anticoagulants for the rest of your life, to minimize the chance of stroke. Biologic valves (from human, pig, or cattle) do not require anticoagulants, but do not last as long. Typically they need replacement after 10 or 15 years. Whenever possible, doctors will preserve the cords supporting the valve to preserve the heart's function.

THE PROCEDURE
You will be anesthetized for the procedure. You will be connected to a heart-lung machine to take over the work of the heart and lungs during surgery. The length of the procedure varies, depending on which type of replacement surgery you are having.

AFTER THE PROCEDURE
You will spend one or more days in the ICU after the procedure. Then you will be transferred to a regular hospital room for monitoring for several days. How long you spend at the hospital will depend on the type of surgery you had and your condition. Before you are sent home, your doctor will discuss when you can return to normal activities. You will probably need to take medications and make some lifestyle changes after the surgery. You will need to attend regular follow-up appointments. Your doctor may recommend that you participate in cardiac rehabilitation to help you recover.

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