Heart Valve Surgery

Overview

Heart valve surgery 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. When valves are working right, your blood should flow through your heart in one direction each time your heart beats.

Valves act like doors that open and close with each heartbeat, letting blood flow in and out of the chambers. When a valve isn’t working right, 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.

Your four heart valves are:

  • Tricuspid: Lets oxygen-poor blood flow from your right atrium (upper chamber) to your right ventricle (lower chamber).
  • Pulmonary: Lets oxygen-poor blood move from your right ventricle (lower chamber) to your pulmonary artery, which takes blood to your lungs to get oxygen.
  • Mitral: Lets oxygen-rich blood coming back from your lungs move from your left atrium (upper chamber) to your left ventricle (lower chamber).
  • Aortic: Lets oxygen-rich blood move from your left ventricle (lower chamber) to your aorta, which sends blood to your entire body.

Types of heart valve surgery

The two types of heart valve surgery options are:

  • Valve repair surgery to fix the damaged or faulty valve, while preserving much of the person’s own tissue. The mitral valve is the most commonly repaired valve, but repair surgery can treat problems with the aortic and tricuspid valves.
  • Valve replacement surgery to remove the faulty valve and replace it with a biological (pig, cow or human tissue) or mechanical (metal or carbon) valve. All valve replacements are biocompatible, which means your immune system won’t reject your new valve.

You’ll have tests so your healthcare provider can find out the location, type and extent of your valve disease. The test results help determine the best type of procedure for you. Other factors your doctor will consider are:

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

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

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, you may be able to take medication for the short term. Surgery is the only effective long-term solution, and your healthcare provider will help determine when it’s time to pursue that option.

When is heart valve surgery necessary?

You may have been born with a valve problem or developed a leak, stiffness or narrowing in your valve.

You’ll most likely need treatment for heart valve disease if you’re having symptoms like:

Note: While medication can help improve your symptoms and quality of life, surgery is the only effective long-term option. Ask your healthcare provider when you should start considering heart valve surgery.

Procedure Details

What happens before heart valve surgery?

You may have a chest X-ray, echocardiogram and electrocardiogram (EKG) the day before your surgery. Other tests may include a CT scan, heart cath and lab tests.

  • A healthcare provider will shave and clean the area where your surgeon will be working.
  • Don’t eat or drink anything after midnight the day of your surgery.
  • Check with your healthcare provider about which medications you can take before surgery.

Bring 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 brought you to the hospital can hold on to these items for you during surgery.

What happens during heart valve surgery?

  1. You’ll receive medicine through an IV in your arm or hand so you can sleep deeply and painlessly.
  2. Your healthcare provider will use the smallest incision they can for your surgery.
  3. Your surgeon may have a machine take over for your heart and lungs during surgery.
  4. Depending on which surgery you’re having, your provider will repair or replace your heart valve.

Heart valve surgery options include:

  • Traditional or open heart surgery: An incision (6-8 inches) through your breastbone.
  • Minimally invasive heart valve surgery: A smaller incision (3-4 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, such as your femoral artery in your groin, and do the work without making a cut in your chest.

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.

Risks / Benefits

What are the advantages 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. valve replacement are:

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

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

The benefits of minimally invasive surgery include:

  • Lower risk of infection.
  • Less bleeding and trauma.
  • Shorter hospital stay.
  • Shorter recovery.

What are the risks or complications of heart valve surgery?

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

Risks are related to:

  • Your age.
  • Other medical conditions you have.
  • 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 a faulty valve that isn’t repaired. 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.

Recovery and Outlook

How long does it take to recover from heart valve surgery?

It takes about four to eight weeks to recover from heart valve surgery. But your recovery 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.

You can expect to get tired 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.

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 the person's overall health.

When to Call the Doctor

When should I see my healthcare provider?

Contact your doctor 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 five pounds, which may mean you’re retaining fluid.

Frequently Asked Questions

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’s based on your individual needs. It 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 valve repair or replacement lasts depends on several things:

  • Age.
  • Whether you have heart valve repair or replacement.
  • The type of valve you have placed (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. Currently, warfarin is the only approved blood thinner for mechanical heart valves.

If you have a mechanical heart valve, you’ll need to take this medication for the rest of your life.

If you have valve repair or a biological valve replacement, you may need to take this medication for several weeks after surgery, or maybe not at all.

You may need to take an anticoagulant for a condition not related to your heart valves. This medication also treats:

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

A note from Cleveland Clinic

After talking with you, your surgeon will choose the best option for your heart valve surgery. Once you know what type of surgery you’ll have, you can rally your family and friends to help. You may not be allowed to bend and lift after surgery for a while. Ask people to help you with housework and meal preparation so you can focus on recovering. You can also prepare and freeze meals before your surgery so you can just reheat them while you heal.

Last reviewed by a Cleveland Clinic medical professional on 05/01/2022.

References

  • American Heart Association. Multiple heart valve pages. Accessed 5/3/2022.
  • Lund K, Sibilitz KL, Berg SK, et al. Physical activity increases survival after heart valve surgery. (https://pubmed.ncbi.nlm.nih.gov/27056969/) Heart. 2016 Sep 1;102(17):1388-95. Accessed 5/3/2022.
  • National Heart, Lung, and Blood Institute. How the Heart Works. (https://www.nhlbi.nih.gov/health-topics/how-heart-works) Accessed 5/3/2022.
  • National Institutes of Health, National Library of Medicine. Heart valve surgery. (https://medlineplus.gov/ency/article/002954.htm) Accessed 5/3/2022.

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