Heart Valve Replacement

What is heart valve replacement?

Heart valve replacement is a surgery or less invasive procedure that gives you a new heart valve. The valve may be biological (made from tissue) or mechanical (made from artificial parts).

This is a treatment for severe heart valve disease. You may need a new valve if your heart can’t pump blood well enough or you have symptoms like chest pain and fainting.

You have four valves in your heart. Surgeons can replace any of them. But the aortic valve is the one that’s most commonly replaced. Mitral valve replacements are also common. Tricuspid and pulmonary valve replacements are rare. 

Heart valve replacement can treat:

• Aortic valve disease
• Mitral valve disease
• Tricuspid valve disease
• Pulmonary valve disease
• Congenital heart disease

Types of replacement heart valves

A new heart valve is called a prosthetic valve or artificial valve. These fall into two main groups:

• Biological valves: These are also called tissue or bioprosthetic valves. They’re made of tissues from cows (bovine), pigs (porcine) or humans (homografts). They may have some artificial parts, too.
• Mechanical valves: These are made of metal or carbon. The bileaflet valve is the most common type. It’s made of two carbon flaps mounted in a ring covered with fabric. A mechanical valve is very durable and easy for your body to tolerate.

Each type of valve has pros and cons. For example, mechanical valves could last for life. But you’ll always need to take warfarin, a blood thinner, to prevent clots from forming on the valve. You’ll need regular blood tests to see how well you’re responding to the medicine. You may also hear a clicking noise from the valve flaps opening and closing.

If you receive a biological valve, you won’t have to take blood thinners for life unless you need them for another condition. But these valves eventually break down. They usually need to be replaced after 10 to 20 years. This means you’ll need another surgery down the road.

Your surgeon will share more about specific valve types and recommend the best one for you. They consider things like:

• Your age
• The risks of taking blood thinners
• The risks you’d face with another surgery later in life
• Your preferences

This is a decision you’ll make together.

Which surgery is best for valve replacement?

Surgeons can replace your valve with traditional (open-heart) surgery or a catheter-based procedure. It depends on the type of valve disease you have and other factors like your age, surgical risk, valve anatomy and heart function. Examples of traditional surgeries include:

• Surgical aortic valve replacement (SAVR)
• Ross procedure
• Mitral valve replacement surgery
• Tricuspid valve replacement surgery

Procedures using small cuts and tiny tubes (catheters) are becoming more common. This is especially the case for aortic valve replacement. Such procedures include:

• Transcatheter aortic valve replacement (TAVR)
• Transcatheter mitral valve replacement (TMVR)
• Transcatheter pulmonary valve replacement (TPVR)

Your surgeon will talk with you about the options in your situation and their benefits and risks. They’ll also explain what you can expect for recovery and follow-up care.

How should I prepare for heart valve replacement?

You’ll get instructions on how to prepare. These will include when to stop eating or taking any of your usual medicines. You may need to go in for some tests the day before your operation.

Wear comfortable clothes and shoes you can slip into. You’ll need someone to drive you to and from the hospital.

What happens during heart valve replacement?

The exact steps depend on the type of valve replacement you’re having. In general, your surgeon will:

1. Prepare your incision site: They’ll clean and shave the area.
2. Give you anesthesia: This medicine lets you sleep during the surgery. You won’t feel pain.
3. Make a cut (incision): The exact location and length vary by surgery type. The cut may be in the middle of your chest, between your ribs or in your groin area.
4. Connect you to a heart-lung machine: This takes over the work of your heart and lungs during valve replacement. You need this for open-heart surgery, but not for catheter-based procedures.
5. Remove and replace your valve: Your surgeon will remove the diseased valve. They’ll put a biological or mechanical valve in its place. For some procedures, your old valve stays in place. The new valve fits inside it.
6. Close your incision: Your surgeon will check to make sure your new valve is working right. They’ll close the incision and move you to recovery.

Valve replacement procedures and surgeries take anywhere from one to four hours. Catheter-based procedures are typically shorter than open surgeries.

What are the potential benefits and risks of heart valve replacement?

Heart valve replacement gives you a long-term solution to your valve issue. Also, it treats your symptoms and helps you live longer. Catheter-based procedures have several advantages over surgeries, including less time in the hospital, a faster recovery and a lower risk of infection. But surgery is sometimes necessary and more helpful depending on your condition.

Risks of heart valve replacement include:

• Infection
• Bleeding
• Heart failure
• Kidney failure
• Heart attack
• Abnormal heartbeat

Your healthcare provider will talk with you about the benefits and risks of your specific procedure or surgery.

What happens after heart valve replacement?

You’ll start your recovery in an intensive care unit (ICU). Providers will keep a close eye on you. Next, you’ll move to a regular room. Your care team will explain how long you need to stay in the hospital. Your provider may recommend you do cardiac rehab to help you get stronger after your valve replacement.

What is the recovery time?

Heart valve replacement recovery takes about one to three months for most people. Recovery is typically shorter for procedures than for surgeries.

Your provider will tell you what you can expect for recovery. In general:

• You may get tired easily for the first few weeks of your recovery.
• You’ll need to avoid driving for a while (your provider will tell you how long).
• You may have restrictions on physical activity, including lifting things.
• You’ll need several weeks or months to recover before returning to work.

Is a heart valve replacement major surgery?

Yes, a heart valve replacement is considered major surgery. You might wonder how much this will affect your life — including the time commitment and rehab. If you have a less invasive procedure, you’ll likely feel strong again sooner than if you have open-heart surgery. But every person is different. Your provider can tell you more.

When should I call my healthcare provider?

As you recover, call your provider if you have:

• A fever or chills
• An irregular pulse
• Pain, bruising or pus at your incision site
• Pain, redness/discoloration or swelling in your lower leg (possible sign of a blood clot)
• Sudden weight gain or swelling in your legs or feet

If you’re taking blood thinners, tell your provider if you fall — even if you think you’re fine. Also, let them know if you have excessive bleeding anywhere in your body, like your gums or nose.

Seek emergency care if you have signs of a heart attack or stroke.