Valvular Heart Disease Treatment

Valvular Heart Disease Treatment: The Precision Medicine Logic of Repair and Replacement and Recommendations for Authoritative Hospitals

Heart valves act as “valves” in the heart’s blood circulation, regulating unidirectional blood flow and ensuring the efficient operation of the heart’s pumping function. When valves develop stenosis, regurgitation, or prolapse due to congenital defects, rheumatic fever, degenerative changes, infections, or other factors, valvular heart disease occurs. If left untreated, it may lead to heart failure, arrhythmia, or even sudden death. In the modern medical system, the treatment of valvular heart disease is centered on the core logic of “precisely adapting to lesion types and maximizing the preservation of cardiac function,” covering multiple approaches such as conservative drug therapy, surgical treatment, and interventional therapy. Understanding its treatment logic and selecting an authoritative medical institution are crucial for improving treatment outcomes and prognosis.

I. Core Logic Analysis of Valvular Heart Disease Treatment

The essence of valvular heart disease treatment is to “correct abnormal valve function and restore normal cardiac hemodynamics.” Its logical system runs through the entire process of etiological assessment, disease staging, treatment plan selection, and postoperative rehabilitation, focusing on the principle of “repair first, individualized adaptation.”

(I) Treatment Decision-Making Logic: Why Choose Repair/Replacement/Drug Therapy?

The treatment decision for valvular heart disease is comprehensively judged based on “valve lesion type, severity, cardiac function status, and the patient’s overall condition,” following the principle of “stepwise treatment”:

• Drug Therapy Logic: Applicable to patients with mild valvular lesions (no obvious symptoms and normal cardiac function) or severe lesions but unable to tolerate surgery (e.g., advanced age, complicated with severe liver and kidney insufficiency). Its core role is “symptomatic support and delaying disease progression”—reducing cardiac load with diuretics, improving ventricular remodeling with angiotensin-converting enzyme inhibitors/receptor blockers, controlling arrhythmia with antiarrhythmic drugs, and treating underlying diseases such as rheumatic fever and infective endocarditis to prevent further deterioration of lesions. However, drugs cannot reverse structural damage to the valves and can only serve as adjuvant or palliative treatment.
• Valve Repair Surgery Logic: Preferentially applicable to patients with mild structural damage to the valves and eligible for repair, especially young and middle-aged individuals with single-valve lesions (e.g., isolated mitral valve prolapse, mild aortic stenosis). The core logic is “retaining native valve function and reducing postoperative complications”—restoring the valve’s sealing and opening/closing functions through procedures such as leaflet repair, annuloplasty, and chordae tendineae repair. Compared with replacement surgery, repair surgery offers advantages such as shorter postoperative anticoagulation duration (usually 3-6 months), lower infection risk, and less impact on cardiac function, with a significantly higher 10-year survival rate. It is the preferred option for eligible patients.
• Valve Replacement Surgery Logic: Applicable to patients with severe valve stenosis/regurgitation that cannot be repaired (e.g., severe valve calcification, leaflet tear) or recurrence after repair surgery. The core logic is “replacing the diseased valve with an artificial valve to rebuild the blood flow barrier”—selecting mechanical valves or biological valves based on factors such as the patient’s age, heart size, and comorbidities: Mechanical valves have high durability (service life > 20 years) but require lifelong anticoagulant therapy (e.g., warfarin), making them suitable for young and middle-aged patients; Biological valves have good biocompatibility and only require short-term anticoagulation (3-6 months) without long-term medication, but have lower durability (service life 10-15 years), making them more suitable for elderly patients (over 65 years old), those with high bleeding risk, or those unwilling to take long-term anticoagulants.

(II) Implementation Logic of Core Treatment Methods

1. Surgical Treatment (Traditional Gold Standard)

• Preoperative Evaluation Logic: Through echocardiography (assessing valve morphology, function, heart size, and ventricular wall thickness), electrocardiogram, chest CT, cardiac catheterization, etc., clarify the valve lesion type, severity, and whether there are complications such as coronary artery disease and pulmonary hypertension, to accurately determine if the patient is suitable for surgery and the surgical approach (repair/replacement).
• Surgical Operation Logic:
• Valve Repair Surgery: For mitral valve prolapse, restore normal valve opening and closing through procedures such as “chordae tendineae repair/transfer, leaflet plasty, and annuloplasty”; For mild aortic stenosis, relieve stenosis through “valvulotomy” to preserve valve function.
• Valve Replacement Surgery: Under general anesthesia and cardiopulmonary bypass support, resect the diseased valve and accurately suture the artificial valve to the annulus to ensure tight fit and avoid postoperative paravalvular leakage. Traditional open-chest surgery provides a clear surgical field and is suitable for complex valvular lesions (e.g., multiple valve lesions, combined cardiac structural abnormalities).
• Postoperative Management Logic: After surgery, the patient is transferred to the intensive care unit for 24-48 hours of monitoring, focusing on heart rate, blood pressure, cardiac output, and bleeding; Patients with mechanical valve replacement require lifelong monitoring of coagulation function (maintaining INR 2.0-3.0) to avoid thrombosis or bleeding risks; Patients with biological valve replacement require short-term postoperative anticoagulation and prevention of infective endocarditis (e.g., prophylactic antibiotics before tooth extraction or surgery).

2. Interventional Treatment (Minimally Invasive Emerging Option)

• Transcatheter Aortic Valve Replacement (TAVR): Applicable to high-risk/very high-risk patients with aortic stenosis (e.g., advanced age, complicated with lung disease, unable to tolerate open-chest surgery). The core logic is “minimally invasive implantation of an artificial valve via blood vessels”—through femoral artery or apical puncture, deliver the compressed artificial valve to the aortic valve position via a catheter, which replaces the diseased valve after deployment. It does not require open-chest surgery, has minimal trauma (3-5 mm puncture site), and rapid recovery (discharge in 3-5 days after surgery). In recent years, the indication of TAVR has expanded to intermediate and low-risk patients, becoming an important option for aortic stenosis treatment.
• Transcatheter Mitral Valve Repair (MitraClip): Applicable to high-risk patients with severe mitral regurgitation (e.g., complicated with heart failure, renal insufficiency). A specialized clip is delivered to the mitral valve position via a catheter to grasp the prolapsed leaflets, reducing regurgitation without valve resection. The surgery has low risk and can quickly improve patients’ symptoms.

3. Auxiliary Logic of Drug Therapy

Drug therapy runs through the entire course of valvular heart disease treatment, with core roles including: controlling symptoms before surgery (e.g., diuretics to relieve edema, beta-blockers to control heart rate) to create conditions for surgery; assisting recovery after surgery (e.g., improving ventricular remodeling, preventing infection, controlling anticoagulation); and delaying disease progression and improving quality of life for patients unable to undergo surgery. It should be noted that drug therapy cannot replace surgery. If a patient’s valvular lesion progresses to moderate or above with symptoms such as chest tightness, shortness of breath, or decreased exercise capacity, surgical indications should be evaluated promptly.

(III) Postoperative Rehabilitation and Long-Term Management Logic

The success of valvular heart disease treatment relies not only on surgical outcomes but also on long-term scientific management, with the core logic of “protecting cardiac function, preventing complications, and extending survival cycle”:

• Lifestyle Management: Avoid strenuous exercise (e.g., running, weightlifting) within 3 months after surgery, and gradually resume mild exercise such as walking and tai chi; Follow a low-salt, low-fat, and low-sugar diet, control fluid intake (to avoid increasing cardiac load); Quit smoking and limit alcohol consumption, and prevent respiratory infections (infections may induce endocarditis).
• Medication Adherence: Patients with mechanical valve replacement need to take anticoagulants for life, and must not discontinue or adjust the dosage without authorization. At the same time, avoid foods that affect coagulation function (e.g., spinach, animal liver); Regularly recheck coagulation function, liver and kidney function, and adjust medication based on results.
• Regular Reexamination: Reexamine echocardiography and electrocardiogram at 1 month, 3 months, 6 months, and 1 year after surgery to evaluate artificial valve function, heart size, and ventricular function recovery; If symptoms such as chest tightness, shortness of breath, fever, or difficulty breathing occur, seek medical attention promptly to rule out complications such as paravalvular leakage and infective endocarditis.

II. Recommendations for Authoritative Hospitals for Valvular Heart Disease Treatment in China

The core criteria for selecting authoritative hospitals for valvular heart disease treatment are “cardiac surgery/interventional department strength, ability to handle complex cases, surgical success rate, and complication control rate.” The following are top domestic institutions (data sources: 2022 Fudan Edition Hospital Rankings, official hospital disclosures):

1. Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences

• Core Advantages: National Center for Cardiovascular Diseases, a global leader in valvular heart disease treatment. It performs over 5,000 valve surgeries annually (with repair surgeries accounting for more than 40%), ranks first in China in TAVR procedures for 5 consecutive years, and has a success rate of over 98% for complex multiple valve lesions;
• Featured Technologies: Pioneered minimally invasive valve repair, robot-assisted valve surgery, and transcatheter mitral valve repair (MitraClip) in China, and is at the international advanced level in the precise treatment of congenital valvular heart disease and rheumatic valvular heart disease;
• Address: No. 167 Beilishi Road, Xicheng District, Beijing.

2. Beijing Anzhen Hospital, Capital Medical University

• Core Advantages: Top cardiovascular specialist hospital in China, performing over 4,500 valve surgeries annually with a valve repair rate of 35%, a TAVR success rate of 99%, and a perioperative mortality rate of less than 1%;
• Featured Technologies: Rich experience in TAVR for bicuspid aortic valve, minimally invasive repair of mitral valve prolapse, and emergency valve replacement for infective endocarditis, with an established multidisciplinary team (MDT) for valvular heart disease;
• Address: No. 2 Anzhen Road, Chaoyang District, Beijing.

3. Zhongshan Hospital, Fudan University

• Core Advantages: One of the birthplaces of cardiac surgery in China, with a long history of valvular heart disease treatment. It performs over 3,000 valve surgeries annually, leads in the treatment of complex valvular heart disease (e.g., valvular heart disease combined with coronary artery disease, heart failure), and has a 10-year survival rate of over 85%;
• Featured Technologies: Pioneered transapical TAVR and biological valve re-replacement surgery in China, and is at the domestic leading level in precise and personalized valve repair;
• Address: No. 180 Fenglin Road, Xuhui District, Shanghai.

4. West China Hospital, Sichuan University

• Core Advantages: Cardiovascular disease diagnosis and treatment center in Western China, performing over 2,500 valve surgeries annually, covering the treatment of valvular heart disease in adults and children, with a sound postoperative rehabilitation system and low complication rate;
• Featured Technologies: Mature minimally invasive small-incision valve replacement/repair surgery, with rich experience in the combined treatment of rheumatic multiple valve disease and corrective surgery for congenital valve defects;
• Address: No. 37 Guoxue Lane, Wuhou District, Chengdu.

5. Guangdong Provincial People’s Hospital

• Core Advantages: Benchmark hospital for valvular heart disease treatment in South China, performing over 2,000 valve surgeries annually, ranking first in South China in TAVR procedures, with a long-term patency rate of over 90% for valve repair surgeries;
• Featured Technologies: Leading in China in interventional treatment of elderly high-risk valvular heart disease and comprehensive treatment of valvular heart disease combined with pulmonary hypertension, and conducting clinical research on new biological valves;
• Address: No. 106 Zhongshan Second Road, Yuexiu District, Guangzhou.

III. Conclusion: Precise Adaptation and Scientific Treatment

The logical essence of valvular heart disease treatment is to “select the optimal plan based on lesion type and individual patient conditions”—prioritizing repair when feasible, precisely selecting valve type for replacement, and preferring minimally invasive interventional therapy for high-risk patients. For patients, early detection and timely medical attention are key: Regular physical examinations with echocardiography can screen for valvular lesions. If relevant symptoms occur, seek medical advice from the cardiovascular department of an authoritative hospital as soon as possible to formulate an individualized treatment plan by professional doctors.

With the advancement of medical technology, the treatment of valvular heart disease has evolved from traditional open-chest surgery to “minimally invasive, precise, and individualized” approaches. The proportion of repair surgeries continues to increase, and the indication of interventional therapy is expanding, providing patients with more safe and effective treatment options. By strictly following medical advice and conducting long-term management after surgery, most patients can resume normal life and work, achieving high-quality survival.