Heart Valve Replacement or Repair Surgery: A Complete Guide

Heart valve replacement or repair surgery is a life-changing procedure that can restore heart function and improve overall health.

If you’re dealing with heart valve disease, understanding the surgery, recovery, and long-term outlook can help you make informed decisions about your care.

In this guide, we’ll explain everything you need to know, from the procedure to post-surgery care, to ensure you're on the path to a healthier heart.

What is Heart Valve Surgery

Heart valve surgery is a treatment for heart valve disease, where one or more of the heart’s four valves aren’t functioning properly. The valves play a crucial role in ensuring blood flows in the right direction through the heart.

These include:

1. Mitral valve – located between the left ventricle and the left atrium.
2. Tricuspid valve – located between the right ventricle and the right atrium.
3. Pulmonary valve – located between the pulmonary artery and the right ventricle.
4. Aortic valve – located between the aorta and the left ventricle.

These valves open and close with each heartbeat, acting like doors to keep blood moving smoothly.

Heart valve surgery either repairs or replaces the damaged valve(s), and the method used depends on the specific issue, overall health, and age of the patient.

In some cases, open-heart surgery is required, while others may be treated with minimally invasive techniques to repair or replace a damaged or faulty valve.

Sometimes, it can be combined with other procedures, such as:

• Bypass surgery – restoring blood flow to parts of your heart.
• Aortic aneurysm surgery – stopping the aneurysm from expanding to the point where it could rupture or tear the artery.
• Surgery to treat atrial fibrillation (Afib) – correcting irregular heart rhythms to help your heart beat more effectively.

Despite the concerns that come with surgery, the procedure can improve heart function, which in turn helps you feel better and live a healthier life.

Symptoms of Heart Valve Disease

Heart valve repair or replacement surgery is performed to fix issues caused by one or more diseased heart valves.

Conditions like valve stiffness (stenosis) or a leaky valve (regurgitation) are common causes of heart valve dysfunction. These problems prevent the valves from opening and closing properly, disrupting the normal flow of blood through the heart.

If your heart valve becomes damaged or diseased, you may experience symptoms such as:

• Chest pain
• Breathing problems
• Dizziness
• Palpitations
• Swelling in the ankles, feet, or abdomen
• Quick weight gain from fluid retention
• Fainting

Your healthcare team may also recommend heart valve repair or replacement surgery for other reasons depending on your condition.

Types of Heart Valve Surgery

Your heart valve issues like leaks, narrowing, or stiffness could have been present since birth or developed over time.

Tests will help your healthcare team assess your valve disease's location, type, and extent. The results from these tests are crucial in determining the best surgical approach for you.

There are two heart valve treatment options—replacement and repair surgery.

Heart Valve Repair Surgery

Heart doctors usually suggest valve repair because it keeps your original valve and helps the heart work better, avoiding the need for a replacement.

The surgery fixes the faulty valve and preserves most of your own tissue, helping your heart function well.

During heart valve repair, surgeons can perform various procedures such as:

• Patching holes
• Reconstructing valve flaps (also known as cusps or leaflets)
• Removing excess tissue to help the valve close properly
• Replace or remove damaged tissue
• Separate fused valve flaps
• Tighten the valve's supporting ring (the annulus)

Some heart valve repairs are done with a catheter, a long and thin tube, and specialized devices like clips or plugs.

For a narrowed valve opening, a procedure called balloon valvuloplasty can be performed. In this procedure, a balloon at the tip of the catheter is inflated to widen the valve opening, then deflated and removed.

While mitral valve repairs are common, surgeons can also repair the aortic and tricuspid valves.

Heart Valve Replacement Surgery

If your heart valve can't be repaired and other treatments aren’t suitable, replacement may be necessary.

In this procedure, a mechanical or biological valve is used to replace the damaged valve with an artificial one. All valve replacements are biocompatible, meaning your immune system won’t reject the new valve.

Biological valves, made from human tissue, pig, or cow, are often called tissue valves. However, they may need to be replaced over time due to wear.

Mechanical valves, on the other hand, are made from durable materials like metal or carbon and tend to last longer without wearing out.

If you receive a mechanical valve, you’ll need to take blood thinners (a medication) for life to prevent blood clots.

Your healthcare team will discuss the pros and cons of each valve type to help you make an informed decision.

In some cases, minimally invasive surgery like Transcatheter Aortic Valve Replacement (TAVR)/Transcatheter Aortic Valve Implantation (TAVI) can be used to replace certain valves. This method involves inserting a new valve through a catheter, offering a less invasive option for replacing a damaged valve.

How to Prepare for Heart Valve Surgery

Before your heart valve surgery, your surgeon and treatment team will discuss the procedure with you and answer any questions you have.

It’s also important to talk with your loved ones about your hospital stay and the help you may need when you return home.

To ensure a smooth procedure and recovery, here’s a checklist to help you prepare for heart valve surgery:

• Discuss with Your Healthcare Team – Go over your medications, heart devices, allergies, and any reactions to previous treatments. Confirm when to stop eating or drinking before surgery.
• Undergo Pre-Surgery Tests – You may have tests like blood work, chest X-rays, or an echocardiogram to ensure you're ready.
• Sign a Consent Form – You’ll need to sign a consent form to give permission for the surgery. Be sure to read it carefully and ask questions if anything is unclear.
• Bring Essential Items – Bring essential items like a list of medications, personal care items (e.g., toothbrush, comb), and loose clothing. Don't forget your advance directive and any relaxation items (books or music).
• Surgery Day Prep – Wear comfortable clothing and shoes, leaving behind eyeglasses, contact lenses, jewelry, and dentures.

These steps will help ensure that your heart valve surgery goes smoothly and you’re well-prepared for your hospital stay and recovery.

What to Expect on Heart Valve Surgery

Heart valve repair or replacement procedure aims to restore normal blood flow and improve heart function.

Here's what you can expect before, during, and after surgery.

Before Surgery

You may have body hair shaved around the surgical site and your skin will be cleaned with special soap to prevent infection.

You’ll also be asked to stop eating or drinking before surgery and may undergo tests like blood tests and imaging.

During Surgery

During heart valve surgery, the goal is to repair or replace the damaged valve while ensuring your heart continues to function properly.

Here’s what to expect during the procedure:

1. You will be given anesthesia to sleep through the procedure.
2. A heart-lung bypass machine will take over for your heart and lungs.
3. The surgeon will either use open-heart surgery (large chest incision) or minimally invasive methods (smaller incisions).
4. The damaged valve will be repaired or replaced, with blood circulating through the bypass machine while the heart is stopped.
5. Once done, the heart is restarted, and the chest is closed.

The length of the surgery depends on the procedure. The open-heart surgery will take two to five hours, while repairs or minimally invasive procedures typically take less time.

Post-Surgery

After heart valve surgery, your recovery will be closely monitored to ensure proper healing and heart function.

Here's what to expect during your recovery process:

• Stay in ICU – After surgery, you'll be closely monitored in the ICU, typically for 1-2 days, receiving fluids, medications, and possibly oxygen.
• Move to a Regular Room – After ICU, you'll stay 5-7 days in a regular hospital room, depending on your recovery. Your heart function and healing will be closely monitored. Tubes may be inserted to drain fluids and the incision will be closed with stitches or staples.
• Gradual Activity – Start with short walks and increase distance as tolerated. You’ll be encouraged to cough and do breathing exercises as part of your recovery.
• Follow-up Appointments – Attend regular check-ups to monitor progress and remove stitches or staples, if necessary.
• Avoid Overexertion – Limit lifting (no more than 15 pounds), driving, and strenuous activity for 6-8 weeks. Discuss return to work with your provider.

Recovery from heart valve surgery typically takes 4 to 8 weeks, with shorter recovery times for minimally invasive procedures.

Your recovery depends on factors like the type of valve surgery, your overall health, and the surgical method used.

Once you're home, keep the surgical area clean and dry. Your healthcare team will give you bathing instructions.

Long-Term Heart Health

Your recovery doesn’t end with surgery. Lifestyle changes are key to maintaining heart health:

• Eat a balanced diet
• Exercise regularly
• Manage stress
• Avoid smoking

Your healthcare team may also recommend a cardiac rehabilitation program to support your recovery and improve your overall health.

Risks and Complications of Heart Valve Surgery

Like any surgery, heart valve replacement or repair comes with some risks, including:

• Bleeding or blood clots that can cause stroke, lung problems, heart attack, or malfunction of the replacement valve
• Infection
• Pneumonia
• Arrhythmias (irregular heartbeats)
• Breathing problems
• Pancreatitis (inflammation of the pancreas)
• Death

These risks can vary based on age, health, and the complexity of the surgery. Your surgeon will discuss these in detail before your procedure.

When to Contact Your Healthcare Team

It’s important to reach out to your healthcare provider if you experience any of the following:

• Chest pain or discomfort near your incision
• Increased pain or swelling around the incision site
• Fever (100.4°F/38°C or as directed by your provider) or chills, which could indicate an infection
• Redness, bleeding, drainage, or swelling from the incision or catheter sites
• Difficulty breathing
• More swelling in your legs or abdomen
• Gaining more than 5 pounds, which could be a sign of fluid retention
• Easy bruising, nausea, vomiting, or irregular pulse
• Weakness in your arms or legs
• Feeling depressed, which can affect your recovery

Follow any additional instructions your healthcare provider may give based on your specific recovery needs.

Frequently Asked Questions

What is the life expectancy after heart valve replacement?

Life expectancy depends on the type of valve used. Mechanical valves generally last for life, while tissue valves last 12-15 years, depending on your health factors.

How serious is it to have a valve replaced in your heart?

Having a heart valve replaced is a major surgery and carries some risks, including a 2% chance of fatal complications of aortic valve replacement. However, this risk is much lower than the danger of leaving severe valve disease untreated.

What is the survival rate after heart valve surgery?

Survival rates after heart valve surgery vary depending on the type of surgery and your overall health. A study found that people who were more physically active during the year after surgery had a lower risk of death. The death rate typically ranges from 0.1% to 10%.