Heart valve surgery

Date Updated: 11/30/2021

Overview

Heart valve surgery is a procedure to treat heart valve disease. Heart valve disease involves at least one of the four heart valves not working properly. Heart valves keep blood flowing in the correct direction through the heart.

The four heart valves are the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps — called leaflets for the mitral and tricuspid valves and cusps for the aortic and pulmonary valves. These flaps should open and close once during each heartbeat. Valves that don't open or close properly disrupt blood flow through the heart to the body.

In heart valve surgery, a surgeon repairs or replaces the damaged or diseased heart valve or valves. Many surgical approaches can be used to repair or replace heart valves, including open-heart surgery or minimally invasive heart surgery.

The type of heart valve surgery needed depends on various factors, including your age, your health, and the type and severity of heart valve disease.

Why it's done

Heart valve surgery is done to treat heart valve disease. There are two basic types of heart valve problems:

A narrowing of a valve (stenosis)
A leak in a valve that allows blood to flow backward (regurgitation)

You might need heart valve surgery if you have heart valve disease that is affecting your heart's ability to pump blood.

If you don't have signs or symptoms, or your condition is mild, your doctor might suggest regular monitoring of the heart valve disease. Lifestyle changes and medications might help manage symptoms.

Sometimes, doctors recommend heart valve surgery even for those who don't have symptoms. If you need heart surgery for another condition, doctors might perform heart valve repair or replacement at the same time. Together, you and your doctor should discuss whether heart valve surgery is right for you and if minimally invasive heart surgery is an option.

Eventually, your valve might need to be repaired or replaced. In some cases, doctors recommend heart valve repair or replacement even if you're not having symptoms. If you need heart surgery for another condition, doctors might repair or replace the affected heart valve at the same time.

Your doctor will discuss with you whether heart valve repair or replacement is more appropriate for your condition. Doctors often recommend heart valve repair when possible, as it preserves your heart valve and might preserve heart function. But sometimes valve replacement is necessary and the best option.

Doctors might also evaluate if you're a candidate for minimally invasive heart surgery. Your doctor will discuss the benefits and risks of each procedure.

If you need heart valve surgery, if possible, choose a medical center that has performed many heart valve surgeries.

Risks

Possible heart valve surgery risks include:

Bleeding
Heart attack
Infection
Valve dysfunction affecting replaced valves
Irregular heart rhythm (arrhythmia)
Stroke
Death

How you prepare

Your doctor and treatment team will discuss your heart valve surgery with you and answer any questions. Before being admitted to the hospital for heart valve surgery, talk to your family about your hospital stay and discuss help you'll need when you return home.

Food and medications

Before you have heart valve surgery, talk to your doctor about:

When you can take your regular medications and whether you can take them before your surgery
Allergies or reactions you've had to medications
When you should stop eating or drinking the night before the surgery

Clothing and personal items

If you're having heart valve surgery, your treatment team might recommend that you bring several items to the hospital, including:

A list of your medications
Eyeglasses, hearing aids or dentures
Personal care items, such as a brush, a comb, shaving equipment and a toothbrush
Loose, comfortable clothing
A copy of your advance directive
Items that help you relax, such as portable music players or books

During heart valve surgery, don't wear:

Jewelry
Eyeglasses
Contact lenses
Dentures
Nail polish

You may need to have your body hair shaved where the incisions will be made. A special soap might be used to wash your skin to help prevent infection.

What you can expect

During the procedure

You'll receive anesthetics to put you in a sleep-like state during the procedure. You'll be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.

Heart valve surgery can be performed using standard open-heart surgery, which involves cutting your chest through your breastbone. Minimally invasive heart surgery involves smaller incisions than those used in open-heart surgery.

Minimally invasive heart surgery includes surgery performed using long instruments inserted through one or more small incisions in the chest (thoracoscopic surgery), surgery performed through a small incision in the chest, or surgery performed by a surgeon using the assistance of a robot (robot-assisted heart surgery).

Minimally invasive heart surgery might involve a shorter hospital stay, quicker recovery and less pain than you'd have with open-heart surgery. Minimally invasive heart surgery ideally should be performed at medical centers with medical teams experienced in performing these types of procedures.

Heart valve repair

Your doctor may often recommend heart valve repair when possible, as it saves the heart valve and may preserve heart function. Heart valve repair surgery may include:

Patching holes in a valve
Reconnecting valve flaps (leaflets or cusps)
Removing excess valve tissue so that the leaflets or cusps can close tightly
Replacing cords that support the valve to repair the structural support
Separating valve flaps that have fused
Tightening or reinforcing the ring around the valve (annulus)

Some heart valve repair procedures are done using a long, thin tube (catheter) and clips, plugs or other devices.

Doctors might treat a valve with a narrowed valve opening with a catheter procedure called balloon valvuloplasty. A doctor inserts a thin, flexible tube (catheter) with a balloon on the tip into an artery in your arm or groin and guides it to the affected valve.

The balloon is inflated, which expands the opening of the heart valve. Doctors then deflate the balloon and remove the catheter and balloon.

Heart valve replacement

If your heart valve can't be repaired and a catheter-based procedure isn't an option, the valve might need to be replaced. To replace a heart valve, your doctor removes the heart valve and replaces it with a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).

Biological valves often eventually need to be replaced, as they break down over time. If you have a mechanical valve, you'll need to take blood-thinning medications for the rest of your life to prevent blood clots. Doctors will discuss with you the risks and benefits of each type of valve.

A minimally invasive catheter procedure might be used to replace certain heart valves. For example, a catheter procedure might be performed to insert a replacement valve into a biological replacement valve in the heart that is no longer working properly.

After the procedure

After your heart valve surgery, you'll generally spend a day or more in the intensive care unit (ICU). You'll receive fluids and medications through an IV. Other tubes drain urine from the bladder and fluid and blood from the chest. You might be given oxygen through a mask or nasal prongs in your nose.

After you complete your stay in the ICU, you'll likely be moved to another hospital room for several days. How long you'll stay in the hospital depends on your condition and surgery.

After heart valve surgery, your treatment team will monitor your condition and watch for signs of infection at the incision sites. The team will check your blood pressure, breathing and heart rate. The team will also work with you to manage any pain you have after surgery.

You'll likely be asked to walk regularly to gradually increase your activity, and to cough and to do breathing exercises as you recover.

You'll be given instructions to follow during your recovery, such as:

Watching for signs of infection in your incisions
Taking your medications
Properly caring for incisions
Managing pain and other side effects after your surgery

Results

After heart valve surgery, your doctor will tell you when you can return to activities.

You'll need to attend regular follow-up appointments with your doctor. You might have several tests to evaluate and monitor your condition.

Your doctor may recommend making healthy lifestyle changes to keep your heart working well. Examples of heart-healthy lifestyle changes are:

Eating a healthy diet
Getting regular exercise
Managing stress
Avoiding tobacco use