Heart Valve Surgery

Heart valve surgery is an operation that fixes or replaces a heart valve that isn’t working well. Your valves, located between your heart’s four chambers, keep your blood moving the right way. Valves open and close with each heartbeat. They let blood flow in and out of the chambers.

Surgery can fix heart valves that leak blood or are too narrow. It’s also an option if you were born without enough flaps on a valve or if an infection damaged your valve. You’ll most likely need heart valve surgery if medicine doesn’t help anymore for symptoms like chest pain, difficulty breathing and fainting.

Heart valve surgery is the only effective long-term solution for valve disease. A heart valve can’t repair itself, and valve disease doesn’t go away. As it gets worse, you’ll have more symptoms.

Although valve surgery may sound scary, it helps your heart work better. And if your heart’s working better, you’ll feel better, too. Thousands of people have heart valve surgery each year.

Types of this procedure

The type of valve surgery you’ll have will depend on several factors. Your surgeon will consider your heart’s structure, your age, your lifestyle and other conditions you have. Heart valve surgery types include:

• Balloon valvuloplasty: A healthcare provider stretches a narrow valve using a catheter they thread through a blood vessel. They inflate a balloon at the end of the catheter.
• 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: This removes the faulty valve and replaces it. The new valve can be biological (pig, cow or human tissue) or mechanical (metal or carbon). Replacement options include the Ross procedure and minimally invasive procedures like TAVR.

Tests will tell your healthcare provider the location, type and extent of your valve disease. The heart valve issue may have started at birth or developed later. The test results help your provider find the best type of procedure for you.

Your cardiac surgeon can also combine valve surgery with other heart surgeries.

How should I prepare for this procedure?

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

• Chest X-ray
• Echocardiogram
• Electrocardiogram (EKG)
• CT 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 drives you to and from the hospital can hold onto these items for you during surgery.

Before your surgery, a provider will shave and clean the area where your surgeon will be working. This may be in your chest or groin.

What happens during this procedure?

During heart valve surgery, a provider may:

• Provide anesthesia through an IV in your arm or hand so you can sleep deeply.
• Use the smallest cut they can for your surgery.
• Stop your heart and start a machine to take over for your heart and lungs during surgery.
• Repair or replace your heart valve.
• Restart your heart and disconnect the heart-lung machine.
• Close the cuts they made for the procedure.

Heart valve surgery options include:

• Traditional or open-heart surgery: A cut (6 to 8 inches or 15 to 20 centimeters) through your breastbone.
• Minimally invasive heart valve surgery: A smaller cut (3 to 4 inches or 8 to 10 cm or smaller). A surgeon may use 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. They’ll work without opening your chest.

How long does heart valve surgery take?

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

What are the potential benefits and risks of this procedure?

The heart valve surgery success rate is typically high. Fixing or replacing your valve can ease your symptoms and help you live longer.

A heart valve repair may provide a lower risk of infection and less need for lifelong anticoagulants (blood thinners).

Benefits of minimally invasive valve surgery include:

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

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 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 or other procedures. You can reduce the risk of this infection yourself by taking good care of your teeth.

What happens after heart valve surgery?

You may be in the hospital for an average of three to seven days. 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.

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 supervised exercise program.

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.

What is the recovery time?

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

Here are some tips for the recovery process:

• Go to your follow-up visits 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 lift things that weigh 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.

Survival rate

The survival rate after heart valve surgery varies. People who are more physically active in the year after surgery may have a lower risk of death than those who aren’t as active. But the operation you have and your health matter, too.

When should I call my healthcare provider?

Contact your provider if:

• You have chest pain or pain near your cut
• You have blood or pus coming out of your wound
• You feel depressed, which can happen after surgery and 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 are bad before you have surgery. In some cases, it’s best to have surgery before symptoms start.

How long will my valve last?

The amount of time your new or repaired heart valve lasts depends on your age and whether you have a repair or replacement. The type of replacement valve you receive also matters.

Mechanical valves rarely wear out. But you may need a new one if a blood clot, infection or tissue growth keeps it from working right. You may need a new biological valve in the future, especially if you’re younger.

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

The need for anticoagulants 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 receive 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 receive a biological valve, 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.