Heart valve surgery

Valve replacement; Valve repair; Heart valve prosthesis; Mechanical valves; Prosthetic valves

Heart valve surgery is used to repair or replace diseased heart valves.

Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must also flow through a heart valve.

These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

There are 4 valves in your heart:

Aortic valve
Mitral valve
Tricuspid valve
Pulmonic valve

The aortic valve is the most common valve to be replaced. The mitral valve is the most common valve to be repaired. Only rarely is the tricuspid valve or the pulmonic valve repaired or replaced.

Description

Before your surgery, you will receive general anesthesia. You will be asleep and unable to feel pain.

In open heart surgery, the heart surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. You are connected to a heart-lung bypass machine. Your heart is stopped while you are connected to this machine. This machine does the work of your heart, providing oxygen and removing carbon dioxide.

Minimally invasive valve surgery is done through much smaller cuts than open surgery, or through a catheter inserted through the skin. Several different techniques are used:

Percutaneous surgery (through the skin)
Robot-assisted surgery
Robot-assisted surgery
Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a compute...

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If your surgeon can repair your mitral valve, you may have:

Ring annuloplasty. The surgeon repairs the ring-like part around the valve by sewing a ring of plastic, cloth, or tissue around the valve.
Valve repair. The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve. Valve repair is best for the mitral and tricuspid valves. The aortic valve is usually not repaired.

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one in place. The main types of new valves are:

Mechanical -- made of man-made materials, such as metal (stainless steel or titanium) or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
Biological -- made of human or animal tissue. These valves last 12 to 15 years, but you may not need to take blood thinners for life.

In some cases, surgeons can use your own pulmonic valve to replace the damaged aortic valve. The pulmonic valve is then replaced with an artificial valve (this is called the Ross Procedure). This procedure may be useful for people who do not want to take blood thinners for the rest of their life. However, the new aortic valve does not last very long and may need to be replaced again by either a mechanical or a biologic valve.

Why the Procedure Is Performed

You may need surgery if your valve does not work properly.

A valve that does not close all the way will allow blood to leak backwards. This is called regurgitation.
A valve that does not open fully will limit forward blood flow. This is called stenosis.

You may need heart valve surgery for these reasons:

Defects in your heart valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
Angina
Angina is a type of chest discomfort or pain due to poor blood flow through the blood vessels (coronary vessels) of the heart muscle (myocardium). T...

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Fainting spells
Fainting is a brief loss of consciousness due to a drop in blood flow to the brain. The episode most often lasts less than a couple of minutes and y...

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Tests show that the changes in your heart valve are beginning to seriously affect your heart function.
Your doctor wants to replace or repair your heart valve at the same time as you are having open heart surgery for another reason, such as a coronary artery bypass graft surgery.
Your heart valve has been damaged by infection (endocarditis).
Endocarditis
Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium). It is caused by a bacterial or, rarely, a fu...
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You have received a new heart valve in the past and it is not working well, or you have other problems such as blood clots, infection, or bleeding.

Some of the heart valve problems treated with surgery are:

Aortic insufficiency
Aortic stenosis
Congenital heart valve disease
Mitral regurgitation - acute
Mitral regurgitation - chronic
Mitral stenosis
Mitral valve prolapse
Pulmonary valve stenosis
Tricuspid regurgitation
Tricuspid valve stenosis

Risks

The risks of having heart surgery include:

Death
Heart attack
Heart failure
Bleeding requiring reoperation
Rupture of the heart
Irregular heartbeat (arrhythmia)
Arrhythmia
An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...
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Kidney failure
Post-pericardiotomy syndrome -- low fever and chest pain that can last for up to 6 months
Stroke or other temporary or permanent brain injury
Infection
Problems with the breastbone healing
Temporary confusion after surgery due to the heart-lung machine

It is very important to take steps to prevent valve infections. You may need to take antibiotics before dental work and other invasive procedures.

Before the Procedure

Your preparation for the procedure will depend on the type of valve surgery you are having:

Aortic valve surgery - minimally invasive
Aortic valve surgery - open
Mitral valve surgery - minimally invasive
Mitral valve surgery - open

After the Procedure

Your recovery after the procedure will depend on the type of valve surgery you are having:

Aortic valve surgery - minimally invasive
Aortic valve surgery - open
Mitral valve surgery - minimally invasive
Mitral valve surgery - open

The average hospital stay is 5 to 7 days. The nurse will tell you how to care for yourself at home. Complete recovery will take a few weeks to several months, depending on your health before surgery.

Outlook (Prognosis)

The success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.

Mechanical heart valves do not often fail. However, blood clots can develop on these valves. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare. Tissue valves last an average of 12 to 15 years, depending on the type of valve. Long-term use of blood thinning medicine is most often not needed with tissue valves.

There is always a risk for infection. Talk to your health care provider and surgeon before having any type of medical procedure.

The clicking of mechanical heart valves may be heard in the chest. This is normal.

Open References

References

Carabello BA, Kodali S. Valvular heart disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 60.

Herrmann HC, Reardon MJ. Transcatheter therapies for mitral and tricuspid valvular heart disease. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 78.

Leon MB, Mack MJ. Transcatheter aortic valve replacement. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 74.

Pellikka PA, Nkomo VT. Tricuspid, pulmonic, and multivalvular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 77.

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021;143(5):e35-e71. PMID: 33332149 pubmed.ncbi.nlm.nih.gov/33332149/.

Rosengart TK, Aberle CM, Ryan C. Acquired heart disease: valvular. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 61.

Heart - section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart - section through the middle
illustration
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Heart valves - anterior view - illustration
There are four valves located in the heart. Each valve either consists of two or three folds of thin tissue. When closed, the valve prevents blood from flowing backwards to its previous location. When open the valve allows blood to flow freely. Valve problems can occur because of congenital abnormalities, infection, or other causes.
Heart valves - anterior view
illustration
Heart valves - superior view - illustration
There are four valves located in the heart. Each valve either consists of two or three folds of thin tissue. When closed, the valve prevents blood from flowing backwards to its previous location. When open the valve allows blood to flow freely. Valve problems can occur because of congenital abnormalities, infection, or other causes.
Heart valves - superior view
illustration
Heart valve surgery - Series
Presentation

<strong>Heart valve surgery - Series</strong><p>There are four valves in the heart aortic valve, mitral valve, tricuspid valve, and pulmonary valve. The valves are designed to control the direction of blood flow through the heart. The opening and closing of the heart valves produce the heart-beat sounds.</p>

<strong>Indications</strong><p>Heart valve replacement may be recommended for narrowing of the heart valve (stenosis) or leaking of the heart valve. Valve problems may be caused by infections (rheumatic fever) or birth defects and may cause heart failure (congestive heart failure) and infections (infective endocarditis). The surgery is done while the patient is in deep-sleep and pain-free (general anesthesia). An incision is made through the breast bone (sternum).</p>

<strong>Procedure, part 1</strong><p>Heart valve surgery is open-heart surgery. Tubes are used to re-route the blood away from the heart to a heart-lung bypass machine to keep the blood oxygenated and circulating while the heart is being operated on.</p>

<strong>Procedure, part 2</strong><p>Valves may be repaired or replaced. Replacement heart valves are either natural (biologic) or artificial (mechanical). Natural valves are from human donors (cadavers), modified natural valves are from animal donors (porcine, pigs) which are placed in synthetic rings, and artificial valves are made of metal or plastic. Natural valves rarely require life-long medication to prevent blood clot formation (anticoagulation), whereas artificial valves will require anticoagulation. The advantage of mechanical valves is that they last longer-thus, the tradeoff of lifelong anticoagulation in some cases is worth it to avoid a second valve replacement surgery.</p>

<strong>Procedure, part 3</strong><p>The ineffective mitral valve is removed and the heart valve replacement is sutured into place. </p>

<strong>Aftercare</strong><p>The rate of success of heart valve surgery is high and increasing. The operation provides symptom relief and prolongs life. The death rate varies depending on the heart valve and averages 2% to 5%. Approximately 2 out of 3 patients who received an artificial mitral valve are still alive 9 years after the surgery. Life-long anticoagulant therapy is necessary for patients with artificial heart valves. The clicking of the mechanical heart valve may be heard in the chest and is normal. The first 2 or 3 days following the operation are spent in an intensive care unit where heart functions can be monitored constantly. The average hospital stay is 3 weeks. A few weeks to several months should be allowed for complete recovery, depending on health before surgery.</p>

Heart - section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart - section through the middle
illustration
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Heart valves - anterior view - illustration
There are four valves located in the heart. Each valve either consists of two or three folds of thin tissue. When closed, the valve prevents blood from flowing backwards to its previous location. When open the valve allows blood to flow freely. Valve problems can occur because of congenital abnormalities, infection, or other causes.
Heart valves - anterior view
illustration
Heart valves - superior view - illustration
There are four valves located in the heart. Each valve either consists of two or three folds of thin tissue. When closed, the valve prevents blood from flowing backwards to its previous location. When open the valve allows blood to flow freely. Valve problems can occur because of congenital abnormalities, infection, or other causes.
Heart valves - superior view
illustration
Heart valve surgery - Series
Presentation

A Closer Look

Talking to your MD

Self Care

Tests for Heart valve surgery

Review Date: 5/13/2024

Reviewed By: Mary C. Mancini, MD, PhD, Cardiothoracic Surgeon, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Health Library

Heart valve surgery

Description

General anesthesia

Robot-assisted surgery

Aortic valve surgery - minimally invasi...

Aortic valve surgery - open

Mitral valve surgery - minimally invasi...

Mitral valve surgery - open

Why the Procedure Is Performed

Angina

Fainting spells

Endocarditis

Risks

Arrhythmia

Before the Procedure

After the Procedure

How to care for yourself at home

Outlook (Prognosis)

References

Heart - section through the middle - illustration

Heart - section through the middle

Heart - front view - illustration

Heart - front view

Heart valves - anterior view - illustration

Heart valves - anterior view

Heart valves - superior view - illustration

Heart valves - superior view

Heart valve surgery - Series