Heart Valve Surgery

What is heart valve surgery?

Heart valve surgery is an operation that fixes or replaces one or more of the four valves in your heart. Your valves, located between your heart’s four chambers, keep your blood moving the right way. Valves act like doors that open and close with each heartbeat, letting blood flow in and out of the chambers. When valves are working right, your blood should flow through your heart in one direction each time your heart beats.

Your four heart valves are:

• Tricuspid, between your right upper and lower chambers.
• Pulmonary, between your right ventricle (lower chamber) and your pulmonary artery.
• Mitral, between your left upper and lower chambers.
• Aortic, between your left ventricle (lower chamber) and your aorta.

Some of the blood may go back to the chamber or room it just left. Other times, a valve may become narrow, which may prevent blood from moving forward. This is a problem because it keeps your heart from working efficiently. Although heart valve surgery may make you feel fearful, it helps your heart work better. And if your heart’s working better, you’ll feel better, too.

Types of heart valve surgery

The type of heart valve surgery you have will depend on several factors. Your provider will consider:

• Your heart’s structure.
• Your age.
• Other medical conditions you may have.
• Your lifestyle.

Tests will tell your healthcare provider the location, type and extent of your valve disease. Your heart valve issue may have started at birth, or you may have developed a leak, stiffness or narrowing in your valve. The test results help determine the best type of procedure for you.

Your cardiac surgeon can combine valve surgery with other heart surgeries. Examples include surgeries that involve more than one valve procedure and combining heart valve surgery with:

• Bypass surgery.
• Aortic aneurysm surgery.
• Surgery to treat atrial fibrillation.

Heart valve repair surgery

A repair surgery fixes the damaged or faulty valve while preserving much of your own tissue. Surgeons repair mitral valves more than the other valves, but repair surgery can also treat problems with the aortic and tricuspid valves.

Heart valve replacement surgery

Heart valve replacement surgery removes the faulty valve and replaces it with a biological (pig, cow or human tissue) or mechanical (metal or carbon) valve. All valve replacements are biocompatible. That means your immune system won’t reject your new valve. Replacement options include the Ross procedure and minimally invasive procedures like TAVR.

Can a heart valve repair itself?

No, a heart valve can’t repair itself. Valve disease doesn’t go away. It gets worse with time. As the disease gets worse, you’ll have more symptoms and your overall health will suffer. These changes often happen slowly, but they can also occur very quickly.

Depending on the type and extent of valve disease you have, medication may help with symptoms for the short term. Surgery is the only effective long-term solution. Your healthcare provider will help determine when it’s time for surgery.

When is heart valve surgery necessary?

You’ll most likely need heart valve surgery if medicine doesn’t help anymore for symptoms like:

• Chest pain.
• Difficulty breathing.
• Fainting.

How should I prepare for heart valve surgery?

You may have tests the day before your surgery. These may include:

• Chest X-ray.
• Echocardiogram.
• Electrocardiogram (EKG).
• CT (computed tomography) scan.
• Cardiac catheterization.
• Blood tests.

Check with your healthcare provider about which medications you can take before surgery. Don’t eat or drink anything after midnight the day of your surgery.

On the day of your procedure, wear loose, comfortable clothes and shoes that are easy to put on. If you wear a bra, you may want to bring one that’s easy to put on without raising your arms. The person who brings you to the hospital can hold on to these items for you during surgery.

Before your surgery, a healthcare provider will shave and clean the area where your surgeon will be working.

What happens during valve surgery on your heart?

During heart valve surgery, a provider will:

1. Give you medicine through an IV in your arm or hand so you can sleep deeply and painlessly.
2. Use the smallest incision they can for your surgery.
3. Set up a machine to take over for your heart and lungs during surgery.
4. Repair or replace your heart valve.
5. Restart your heart.
6. Close your chest.

Heart valve surgery options include:

• Traditional or open-heart surgery: An incision (6 to 8 inches) through your breastbone.
• Minimally invasive heart valve surgery: A smaller incision (3 to 4 inches or smaller). Techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery.
• Transcatheter: Your provider will put a catheter into a larger artery, like your femoral artery in your groin, and do the work without cutting your chest.

How long does this procedure take?

Open-heart surgery for a heart valve replacement can take two to five hours. Repairs or minimally invasive procedures may take less time.

What happens after heart valve surgery?

After surgery, your healthcare team may move you to an intensive care unit (ICU) where they can monitor you closely. After that, you’ll be in a regular room. You may be in the hospital for five to seven days.

Machines connected to you will monitor your blood pressure and heart rate. You may have tubes coming out of your chest to drain fluids.

Your provider will encourage you to eat, drink and walk as soon as you can after surgery. You can start with short walks around your room or down the hall and increase your distance little by little.

Your provider may sign you up for cardiac rehab, a carefully monitored exercise program.

What are the benefits of heart valve surgery?

Heart valve surgery can ease your symptoms, improve your life expectancy and help prevent death.

The potential advantages of heart valve repair vs. heart valve replacement surgery are:

• Lower risk of infection.
• Less need for lifelong anticoagulant (blood thinning) medication.

Valve surgeries, including heart valve repair and replacement, are the most common minimally invasive procedure.

The benefits of minimally invasive surgery include:

• Lower chance of infection.
• Less bleeding and trauma.
• Shorter hospital stay.
• Shorter recovery.
• Improved cosmesis (appearance) and smaller wounds.

What are the risks or complications of heart valve surgery?

Any surgery involves risks. Heart valve surgery risks may include:

• Heart attack.
• Heart failure.
• Abnormal heart rhythm — you may need a pacemaker.
• Stroke.
• Blood clots.
• Infection.
• Bleeding.

Risks are related to your age, other medical conditions you may have and how many procedures you have in a single operation. Your cardiologist and surgeon will talk to you about these risks before your surgery.

If you’ve had a valve fixed or replaced, you may be at a higher risk of getting infective endocarditis. But this can also happen with an unrepaired faulty valve. In certain cases, your healthcare provider may prescribe antibiotics to keep you from getting endocarditis from some types of dental work. You can reduce the risk of endocarditis yourself by taking good care of your teeth.

How long is recovery after heart valve replacement or repair?

Heart valve surgery recovery takes about four to eight weeks. But your recovery time may be shorter if you had minimally invasive surgery or surgery through a vein.

The way you feel after surgery depends on:

• Which valve was repaired or replaced.
• Your overall health before the surgery.
• Which method your provider used to get to your heart (large incision, small incision or through a vein).
• How the surgery went.
• How well you take care of yourself after surgery.

Caring for yourself after surgery

Recovery after heart valve surgery takes time. Be kind to yourself. Here are some tips:

• Go to your follow-up appointments during recovery so your provider can monitor your progress.
• Don’t take on more than you can handle. You can expect to tire easily for the first three weeks after surgery.
• Don’t drive for a few weeks after surgery.
• Don’t handle anything that weighs more than 15 pounds for the first six to eight weeks after surgery.
• Talk to your provider about when you can go back to work. It’s usually six to 12 weeks after surgery.

What is the survival rate following heart valve surgery?

A study found that people who were more physically active in the year after surgery had a lower risk of death than those who didn’t exercise much. The death rate ranges from 0.1% to 10% depending on the operation and a person's overall health.

When should I call my healthcare provider?

Contact your provider if:

• You have chest pain or pain near your incision.
• You feel depressed. This can happen after surgery and can make your recovery take longer.
• You have a fever, which can be a sign of infection.
• You gain more than 5 pounds, which may mean you’re retaining fluid.

Is surgery better for me than medication alone?

Medications often help during the first stages of valve disease, but they don't work as well as the disease gets worse. You don’t need to wait until your symptoms become unbearable before you have surgery. In some cases, it’s best to have surgery before symptoms start. The decision to have surgery is a major one that involves input from you, your cardiologist and your surgeon.

Is a heart valve replacement major surgery?

Yes, a heart valve replacement is considered major surgery. However, it may seem less intimidating if you have a minimally invasive type of surgery, which is common.

How long will my valve last?

The amount of time your heart valve replacement or repair lasts depends on several things:

• Age.
• Whether you have heart valve repair or replacement.
• The type of valve you receive (for heart valve replacement).

Mechanical valves rarely wear out, but they may need replacement if a blood clot, infection or tissue growth keeps them from working right. Biological valves may need to be replaced, especially if you’re younger.

Will I need to take blood-thinning medication (anticoagulants) after surgery?

The need for anticoagulant medication (blood thinners) after surgery depends on the type of surgery you have. The medication prevents blood clots from forming and causing problems with your heart valve.

• If you have a mechanical heart valve, you’ll need to take blood thinners for the rest of your life.
• If you have a heart valve repair or a biological valve replacement, you may need to take blood thinners for several weeks after surgery, or maybe not at all.

You may need to take an anticoagulant for a condition unrelated to your heart valves. This medication also treats:

• An irregular heartbeat.
• An enlarged heart.
• A weakened heart.
• People with a history of blood clots.

Can you lead a normal life after heart valve surgery?

Yes. Many people can return to the activities they did before they had surgery. Other medical conditions you have affect your life after surgery as well. Your life after surgery will most likely be different from those of other people you know. Everyone’s situation is different.