The normal heart has four valves that control blood flow through the chambers of the heart. Valves open to allow blood to flow through, then close tightly to prevent blood from leaking backward. If a valve is damaged, blood flow changes. Valve damage can be due to a birth defect, infection, rheumatic heart disease and aging.

Heart valve surgery is performed to improve blood flow through the heart by relieving obstruction or reducing the leakage of abnormal heart valves. Heart valve surgery can involve repair or replacement of a diseased valve. It may be recommended if you have symptoms of valve disease that worsen. The most common valve problems are stenosis (narrowing) and regurgitation (backflow of blood). Types of stenosis include mitral valve stenosis, aortic stenosis and pulmonary valve stenosis.

Heart valve replacement and repair

In valve replacement surgery, the surgeon removes the diseased valve and replaces it with a new one made from plastic, metal or tissue. In valve repair surgery, also called valvuloplasty, the surgeon repairs the defective valve by sewing the edges together. For many patients, heart valve repair is preferable to replacement because the individual’s own tissues are used. When a valve is severely damaged or malformed, replacement may be necessary.

Balloon valvuloplasty is a nonsurgical, minimally invasive option for some patients who have stenosis of a valve. This procedure involves a physician threading a catheter containing a balloon into the patient’s groin and up to the heart. The balloon is inserted into the valve and stretches it opened. The balloon and catheter are then removed.

Heart valve surgery types

If your doctor determines that you need heart valve surgery, you may have: 

  • Balloon valvuloplasty – This is a surgical procedure that opens a narrowed heart valve, without need for open heart surgery
  • Mitral valve repair – This surgery repairs a diseased or defective mitral valve. The surgery may be open heart or minimally invasive, depending on your age, health condition and other factors. 
  • Mitral valve replacement – This procedure involves removing your mitral valve and replacing it with a mechanical valve or a tissue (animal or human cadaver) valve. 
  • Aortic valve replacement – This procedure involves removing your aortic valve and replacing it with a mechanical valve or a tissue (animal or human cadaver) valve. 
  • Transcatheter aortic valve replacement (TAVR) – This is a less invasive valve replacement option for some qualified patients.

Heart valve repair

When possible, your cardiologist may recommend heart valve repair as a treatment option, since it preserves your heart valve and can preserve heart function. Depending on your situation, heart valve repair may include one or more of the following: 

  • Patching holes in your valve 
  • Reconnecting valve flaps (leaflets or cusps) 
  • Reinforcing or tightening the ring around the valve (annulus) 
  • Removing extra valve tissue so that the flaps can close securely 
  • Replacing cords that support the valve to improve structural support 
  • Separating valve flaps that have fused together

In some cases, your cardiothoracic surgeon may be able to perform heart valve repair using minimally invasive techniques. These may include using a catheter (long, thin tube) inserted through a small incision and threaded through an artery.

Heart valve replacement

If your heart valve has too much damage to be repaired or you aren’t able to undergo a catheter-based procedure for some reason, your cardiologist may recommend you undergo a heart valve replacement. During this procedure, your cardiothoracic surgeon removes the damaged heart valve and replaces it with a mechanical valve or a biologic valve made from human, pig or cow tissue. When possible, minimally invasive surgical techniques are used to replace heart valves.

It’s important to note that biological valves break down over time and will likely need to be replaced again. If you receive a mechanical valve replacement, you’ll likely need to take blood thinners for the rest of your life to reduce your chance of developing blood clots. Your cardiologist will discuss your options in detail with you and recommend the treatment option that is best for your health and situation.

What to expect during heart valve surgery

Preparing for your procedure

Prior to your heart valve surgery, you’ll meet with your physician to discuss your medical history, medications you take and any questions you have. Tests you may have before heart valve surgery include: 

  • Chest X-ray – a radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine 
  • Blood tests – studies to detect enzymes that leak into the blood when the heart has been damaged and to detect infection and antibodies 
  • Electrocardiogram (EKG/ECG) – a test that records the electrical activity of the heart 
  • Urine tests

If you use tobacco, you’ll be instructed to quit at least two weeks before surgery. Tobacco use can interfere with the blood’s ability to clot properly. Your physician can prescribe a nicotine-replacement product to help you stop tobacco use.

As in the case of most surgeries, your physician will ask you not to eat or drink a certain number of hours beforehand, often nothing after midnight the night before.

The area where your incision will be made is shaved and cleaned prior to surgery to reduce risk of infection. You’ll be given anesthesia.

During your procedure

You’re connected to monitoring equipment (electrocardiogram) to check your heart’s activity during the procedure. You also have an intravenous line in your arm to provide anesthesia throughout the procedure. A mechanical respirator breathes for you during the surgery, via a tube inserted in your windpipe. Another tube, inserted in your nose and through your throat, prevents air and liquid from pooling in your stomach. Still another tube, a catheter, is inserted into your bladder.

Heart valve surgeries require the use of a heart-lung machine. This keeps blood flowing during the procedure. The machine takes over this function for your body, and your body takes over again when the procedure is completed.

The surgeon makes an incision in your chest to access your valve. The repair or replacement is made, your heart is restarted and the heart-lung machine is disconnected. Traditional valve surgery takes several hours.

If you have robotic heart surgery or minimally invasive surgery, the incision is much smaller, the procedure is faster, and the hospital stay and recovery time are shorter.

Recovery after your heart valve replacement

If you have traditional heart valve surgery, you may remain in the hospital for as long as a week or two.

Your medical team will help you get up and about one or two days after surgery. You may feel stiff and sore, but it’s important to breathe deeply and cough to clear fluids from your lungs. You’ll be allowed to eat normally in most cases.

If you have valve replacement surgery, you may need to take medication to prevent blood clots from forming on the new valve. You also may hear a mechanical valve clicking in your chest. This is normal.

If your job involves primarily sitting at a desk, you usually can return to work in four to six weeks.

Why Ohio State is the best hospital for heart valve replacement or repair

We have a team approach to heart valve surgery, which means both a cardiologist and a cardiac surgeon evaluate a patient. When appropriate, other clinicians become involved, such as an imaging specialist, an interventional cardiologist and an anesthesiologist. This integrated approach means that each patient’s heart valve disease is treated individually, with that particular patient’s needs — and physical condition — in mind.

In addition, we offer both minimally invasive surgery and robotic heart surgery, which result in smaller incisions, reduced hospital stays and shorter recovery times. Open-heart surgery is also available if that is determined to be the best treatment option.

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