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 your heart.

The four 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 open and close once during each heartbeat. Valves that don't open or close properly disrupt blood flow through your heart to your body.

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

Your treatment depends on several factors, including your age, your health, the condition of the affected heart valve and the severity of your condition.

Why it's done

There are two basic types of heart valve defects: a narrowing of a valve (stenosis) and a leak in a valve that allows blood to back up (regurgitation). You might need heart valve surgery if you have one of these defects and it's affecting your heart's ability to pump blood.

Your doctor will evaluate you to determine the most appropriate treatment for your condition. If you don't have signs or symptoms, or your condition is mild, your doctor might suggest monitoring over time. In that case, healthy lifestyle changes and medications might help manage symptoms.

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

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

Food and medications

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

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 surgery, don't wear:

  • Jewelry
  • Eyeglasses
  • Contact lenses
  • Dentures
  • Nail polish

You'll 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 preserves your 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 performed using a long, thin tube (catheter) and clips, plugs or other devices, and regular technology advances allow new procedures to be done.

Doctors might treat a valve with a narrowed opening with a catheter procedure called a balloon valvuloplasty. A doctor inserts a 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 is not feasible, 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 degenerate 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 be given fluids and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and fluid and blood from your 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 be moved to a progressive care unit for several days. The time you spend in the ICU and hospital will depend on your condition and surgery.

Your treatment team will monitor your condition and watch for signs of infection in your incision sites. Your 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.

Your treatment team will instruct you to walk regularly to gradually increase your activity, to cough and to do breathing exercises as you recover.

Your doctor will give you instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.

Results

After heart valve surgery, you might be able to return to daily activities, such as working, driving and exercise. Your doctor will discuss with you when you can return to activities. You'll generally need to take certain medications.

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 might instruct you on making healthy lifestyle changes — including physical activity, a healthy diet, stress management and avoiding tobacco use — to keep your heart working well.

Your doctor might recommend that you participate in cardiac rehabilitation — a program of education and exercise designed to help you recover after heart surgery and improve your overall and cardiovascular health.