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Valve Surgery

Go to the Aortic Stenosis Tool Go to the Mitral Valve Regurgitation Tool Mitral and Aortic Tools

How is valve disease treated?

Treatments for valve disease include:

  • Protecting your valve from further damage by reducing the risk for endocarditis
  • Medications to ease symptoms and reduce the risk of further valve damage
  • Valve repair or replacement surgery, if needed
  • Catheter based procedures, if needed
  • Following up with your doctor for regular visits.  Valve disease can get worse without any symptoms, so it is important to see your doctor as scheduled to checck your condition.

The best treatment options for you depends on several factors, including the type of valve disease you have, the severity of damage, your age and medical history. Your health care team will talk to you about each option.  It is important to see a cardiologist who can fully understand your condition and help you make the best choices for your treatment.

Treatment with medication

You may need medication to help your heart pump better.  The medication helps make up for the loss of pumping power due to the diseased valve. But, because heart valve disease is a mechanical problem, you may eventually need surgery. 

Heart Valve Surgery

There are two types of valve surgery - valve repair surgery and valve replacement surgery.  

You will have tests so your doctor 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 the structure of your heart, your age, other medical conditions you have, and your lifestyle.  

Valve surgery may be combined  with other heart surgeries.  Examples include surgeries that involve more than one valve procedure and combining valve surgery with bypass surgery, aortic aneurysm surgery or surgery to treat atrial fibrillation

Valve repair surgery

During valve repair surgery, the surgeon fixes the damaged or faulty valve, often without the use of artificial parts.  

The mitral valve is the most commonly repaired valve, but repair surgery can also be used to treat problems with the aortic and tricuspid valve.  

The potential advantages of heart valve repair versus valve replacement are:

  • Lower risk of infection
  • Less need for life-long anticoagulant (blood thinning) medication
  • Preserved heart muscle strength

Common valve repairs

Commissurotomy (aortic valve shown)

Fused valve leaflets are separated to widen the valve opening

Valve Disease Surgery

Before: Aortic valve leaflets are fused, causing stenosis

Valve Disease Surgery

After: Valve leaflets are separated, widening the valve opening


Quadrangle Resection of Leaflet (mitral valve shown)

If a portion of the mitral valve leaflet is flail (floppy), and bows back into the left atrium, a segment may be cut out and the leaflet sewn back together, allowing the valve to close more tightly. Learn more about mitral valve repair

Valve Disease Surgery

Before: A portion of the mitral valve leaflet is floppy (flail) and bows back into the left atrium.  A rectangular-shaped section is cut out.

Valve Disease Surgery

After: The leaflet is sewn back together, allowing the valve to close more tightly.


Annulus Support (mitral valve shown)

If the valve annulus is too wide, it may be reshaped or tightened by sewing a ring around the annulus (annuloplasty). The ring may be made of tissue, cloth or metal with a clot covering.  It acts like a belt supporting the valve and bringing the leaflets together.

Valve Disease Surgery

Before: Valve annulus is too wide; the leaflets lack support and do not close tightly. This causes the valve to leak.

Valve Disease Surgery

After: The leaflet is reshaped or tightened by sewing a ring around the annulus (annuloplasty)


Patched leaflets (mitral valve shown)

The surgeon may patch leaflets with tears or holes with tissue patches.

Valve Disease Surgery

Before: Valve leaflet has a hole or tear

Valve Disease Surgery

After: Tissue patches are used to repair the hole or tear.


Bicuspid aortic valve repair (aortic valve shown)

When you have aortic valve disease, heart surgery most often requires replacement of the valve. In some cases, the aortic valve can be repaired.

Valve Disease Surgery

Before: A bicuspid aortic valve has two leaflets instead of the normal three.  The valve may not open fully (stenosis) or may not close tightly (regurgitation)

Valve Disease Surgery

After: The aortic valve leaflets are surgically reshaped allowing the valve to open and close more easily.

AVR Bioprosthesis

Heart valve replacement surgery

Valve replacement surgery is performed when valve repair surgery is not a treatment option. valve replacement surgery is most often used to treat patients with aortic valve disease, particularly aortic stenosis.  However, the aortic valve can sometimes be repaired instead of replaced.  

Valve replacement surgery involves removing the faulty valve (native valve) and replacing it with a biological or mechanical valve that is sewn to the annulus of the native valve.  All valve replacements are "biocompatible,"which means your new valve will not be rejected by your immune system.


Types of Valve Replacement Surgeries

Biological Valves

Biological valves (also called tissue or bioprosthetic valves) are made of cow tissue (bovine), pig tissue (porcine) or human tissue (allografts or homografts). Biological valves may have some artificial parts to give the valve support and to make placement easier.

Biological Valve

Homograft Valve

Homograft Valve

Homograft Valve

A homograft (also called allograft) is a human heart valve that comes from a donor after death.  It is frozen and preserved under sterile conditions.  A homograft is most often used to replace a diseased aortic valve in children or young adults, especially when the aortic root is diseased or there is infection (endocarditis). The homograft can also be used to replace the pulmonic valve during the Ross Procedure

Ross Procedure

The Ross procedure involves switching your pulmonary valve to the aortic valve position and then placing a pulmonary homograft. This is a very complex procedure; however it has many benefits, especially for young patients with aortic valve disease. Techniques, such as the Ross Procedure are examples of innovative ways surgeons are able to treat valve disease while protecting the heart's natural functioning. Learn more about aortic surgery options in the young adult.

There are advantages and drawbacks to biologic valves.

Advantages: Most patients do not need to be on lifelong blood-thinner medication, unless they have other conditions (such as atrial fibrillation) which warrant it.

Drawbacks: Traditionally, biological valves were not considered as durable as mechanical valves, especially in younger people. Previously available biologic valves usually needed to be re-replaced after about 10 years However, recent studies show these valves often last 15 - 20+ years without a decline in function.

Mechanical Valves

Mechanical valves are made of metal or carbon and are designed to work just like a patient's native valve. Mechanical valves, are well-tolerated by the body, very durable and designed to last a lifetime.

The bileaflet valve is the most common type of mechanical valve. It is made up of two carbon leaflets mounted in a ring covered with polyester knit fabric. 

Mechanical Valve

There are advantages and drawbacks to mechanical valves.

Advantages: Mechanical valves are very durable. They are designed to last a lifetime.

Disadvantages: Due to the artificial material involved, patients who receive these valves need to take a blood-thinning (anticoagulant) medication lifelong. Blood-thinners are medications (such as warfarin or Coumadin) delay the clotting action of the blood. They help prevent clots from forming on the replaced valve, which can cause a heart attack or stroke.  If you take Coumadin, you will need to have regular blood tests to see how well you are responding to the medication and if you need a change in dose. 

Some patients who have a mechanical valve replacement hear the valve make a clicking noise at times.  This is the sound of the valve leaflets opening and closing.

The choice is up to you.

The decision whether to choose a bioprosthetic or a mechanical valve is based on a number of choices - including patient choice. In younger patients, the patient may weigh issues such as the inconvenience and risk of bleeding related to taking a blood thinner (coumadin) with the risk of work or lifestyle related injury, or the possibility of reoperation during their lifetime. In patients more than 60 years of age, the bovine pericardial valve will probably last for the duration of the patient's life.

Valve Surgery Techniques

Traditional Surgical Approach

Traditional heart surgery involved an incision (6-8 inches) through the breastbone.  This allows the surgeon to open the chest and see the heart and arteries.  The surgeon will use the smallest possible incision to perform the surgery.  

Minimally Invasive Surgical Approach

Minimally invasive heart valve surgery is performed using smaller incisions than those in traditional heart valve surgery.  Other techniques include endoscopic or keyhole approaches (also called port access, thoracoscopic or video-assisted surgery) and robotic-assisted surgery.  There are many minimally invasive approaches based on the type of valve surgery you need. 

The benefits of minimally invasive surgery include a smaller incision (3-4 inches or smaller) and smaller scar.  Other possible benefits include:

  • A lower risk of infection
  • Less bleeding and trauma
  • Shorter hospital stay
  • Shorter recovery

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

Your surgeon will be able to tell you if you are a candidate for minimally invasive surgery.

Percutaneous Valve Procedures

Transcatheter Aortic Valve Replacement (TAVR)
TAVI

a) Balloon catheter with valve replacement positioned in diseased valve;

b) Balloon invlation to secure the valve;

c) Valve in place


Transcatheter aortic valve replacement is a treatment option for some patients with severe aortic stenosis who are too ill to have traditional, open-heart surgery to replace the aortic valve. 

The doctor uses a catheter to replace the diseased valve with a biologic valve.  The catheter is inserted into an artery in the groin (transfemoral approach) or an incision in the chest (transapical, subclavian and direct aortic approaches).

Not all patients are candidates for TAVR.  If you are interested in this procedure, talk to your doctor. 

Transcatheter Mitral Valve Repair
Heart Illustration

MitraClip in Place; used with Permission Abbot Vascular

The MitraClip is a treatment option for some patients with severe symptomatic mitral regurgitation (leaky vale) who are too ill to have tradition, open heart surgery to repair the valve. 

The doctor uses a catheter to place the MitraClip on the valve leaflets.  This helps them close more tightly.  The catheter is inserted into an artery in the groin or an incision in the chest.  

Not all patients are candidates for MitraClip procedure.  If you are interested in this procedure, talk to your doctor.

The Miller Family Heart & Vascular Institute at Cleveland Clinic surgeons and cardiologists specialize in the treatment of valve disease. Cleveland Clinic heart surgeons have developed many innovations in valve repair and replacement surgery. Often times, valve surgery may be combined with other procedures (bypass surgery or procedures to treat atrial fibrillation) to fully treat the patient's heart disease. The team approach at the Cleveland Clinic Heart Center insures that patients receive the best care before, during and after their valve procedure. Learn about our surgical outcomes.

Frequently Asked Questions

How does my doctor determine the best treatment for me?

the type of valve disease treatment that is recommended will depend on several factors, including the type of valve disease you have, how badly the valve damage is, your age and medical history.  Your health care team will talk to you about your best treatment options.

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 do not need to wait until your symptoms become unbearable before you have surgery.  In some cases, it is best to have surgery before symptoms begin. the decision to have surgery is a major one that is based on your individual needs.  It involves input from you, your cardiologist and your surgeon.

How will I feel after surgery?

the way you feel after surgery depends on your overall health, how the surgery went and how well you take care of yourself after surgery. Most patients feel better after they recover.  To some extent, how you feel will depend on how you felt before surgery. Patients with more severe symptoms before surgery may have a greater sense of relief after surgery.  Call your doctor if you are concerned about your symptoms or the speed of your recovery.

How long will my valve last?

The amount of time your valve repair or replacement lasts depends on several things - your health at the time of surgery, the type of surgical treatment you have and how well you take care of yourself after the surgery.

Mechanical valves rarely wear out, but they may need to replaced if a blood clot, infection or tissue growth keeps them from working properly.  Biological valves may need to be replaced.  This is especially true for younger patients who have valve replacement surgery.

Are there any risks of major complications from the surgery?

All surgery involves risks.  these risks are related to your age, other medical conditions you have and how many procedures are done in a single operation.  Your cardiologist and surgeon will talk to you about these risks before your surgery.  Please ask questions to make sure you understand all the potential risks and why the procedure is recommended. 

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 is used to prevent blood clots from forming and causing problems with your heart valve.

If you have a mechanical heart valve,  you will 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. It is possible that you may need to take an anticoagulant for a condition not related to your heart valves.  This medication is also used as a treatment for an irregular heartbeat, an enlarged hear,t, a weakened heart and in patients with a history of blood clots.  

What if I choose not to have surgery?

Depending on the type and extent of valve disease you have, you may be able to be treated with medications.  You may also be able to have a non-surgical procedure. Valve disease does not go away and gets worse with time.  As the disease gets worse, you will have more symptoms and your overall health will suffer.  these changes often happen slowly, but they can also occur very quickly.

If you decide to not have surgery, it is recommended that you stay in close contact with your doctor.  Surgery usually remains a treatment option, even for patients with advanced valve disease, and it may be the only effective treatment. 

Doctors who treat

Cleveland Clinic has the nation's largest valve surgery program.  

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice,  please review our Miller Family Heart and Vascular Institute Outcomes

Cleveland Clinic Heart and Vascular Institute Cardiologists and Surgeons

Surgeons in the Department of Thoracic and Cardiovascular Surgery are experts in the treatment of valve disease.  For more information, please contact us.

You may also use our MyConsult second opinion consultation using the Internet

See: About Us to learn more about the Sydell and Arnold Miller Family Heart & Vascular Institute.

Contact

To obtain a surgical consultation, or if you have additional questions or need more information, click here to contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Diagnostic tests are used to diagnose your valve disease and the most effective treatment method.

Anatomy

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Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don’t hesitate to ask.

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This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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