Valve Replacement Surgery

Healthline Magazine

Medically reviewed by Steve Kim, MD
Written by Erica Roth

July2020

Valvular heart disease is a form of heart disease that occurs when one or more of the heart’s four valves don’t function properly. Valve replacement surgery may be an option if the valves of your heart are too fragile, scarred, or otherwise damaged to repair.

Reasons for Replacement

The valves of the heart are responsible for allowing nutrient-rich blood to flow through the chambers of your heart. Each valve is supposed to close completely after ushering in blood flow. Diseased heart valves aren’t always able to perform the job as well as they should.

Stenosis, or a narrowing of the blood vessels, causes a less-than-normal amount of blood to flow to the heart. This causes the muscle to work harder. Leaky valves can also pose a problem. Instead of closing tightly, a valve may remain slightly open, letting blood flow backwards. This is called regurgitation.

The signs of valvular heart disease can include:

• fatigue
• dizziness
• light-headedness
• shortness of breath
• cyanosis
• chest pain
• fluid retention, especially in the lower limbs

Heart valve repair is also a solution for valvular heart disease. In some people, the damage is too far advanced, and a total replacement of the affected valve is the only option.

Types of Replacement Valves

Mechanical and biologic valves are used to replace faulty valves. Mechanical valves are artificial components that have the same purpose as a natural heart valve. They’re created from carbon and polyester materials that the human body tolerates well. They can last between 10 and 20 years. However, one of the risks associated with mechanical valves is blood clots. If you receive a mechanical heart valve, you’ll need to take blood thinners for the rest of your life to reduce your risk of stroke. Biologic valves, also called bioprosthetic valves, are created from human or animal tissue.

There are three types of biologic heart valves:

• An Allograft or homograft is made of tissue taken from a human donor’s heart.
• A porcine valve is made from pig tissue. This valve can be implanted with or without a frame called a stent.
•  A bovine valve is made from cow tissue. It connects to your heart with silicone rubber.

Biologic valves don’t increase your risk of developing blood clots. This means you most likely won’t need to commit to a lifetime of anti-clotting medication. A bioprosthetic doesn’t last as long as a mechanical valve, It may require replacement at a future date.

Your doctor will recommend which type of heart valve you get based on:

• your age
• your overall health
• your ability to take anticoagulant medications
• the extent of the disease

Types of Valve Replacement Surgery

Aortic Valve Replacement

The aortic valve is on the left side of the heart and serves as an outflow valve. Its job is to allow blood to leave the left ventricle, which is the heart’s main pumping chamber. Its job is also to close so that blood doesn’t leak back into the left ventricle. You may need surgery on your aortic valve if you have a congenital defect or disease that causes stenosis or regurgitation.

The most common type of congenital abnormality is a bicuspid valve. Normally, the aortic valve has three sections of tissue, known as leaflets. This is called a tricuspid valve. A defective valve has only two leaflets, so it’s called a bicuspid valve. A recent study found that aortic valve replacement surgery has a 94 percent five-year survival rate.

Survival rates depend on:

• your age
• your overall health
• other medical conditions you may have
• your heart function

Mitral Valve Replacement

The mitral valve is located on the left side of the heart. It serves as an inflow valve. Its job is to allow blood from the left atrium to flow into the left ventricle. Surgery may be required if the valve doesn’t fully open or completely close.

When the valve is too narrow, it can make it difficult for blood to enter. This can cause it to back up, causing pressure in the lungs.

When the valve doesn’t close properly, blood can leak back into the lungs. This can be due to a congenital defect, infection, or a degenerative disease.

The defective valve will be replaced with either a metal artificial valve or a biological valve.

The metal valve will last a lifetime but requires you to take blood thinners. The biological valve lasts between 15 to 20 years, and you won’t be required to take medication that thins your blood. The five-year survival rate is about 91 percent .

• The following also play a role in survival rate:
  your age
• your overall health
• other medical conditions you have
• your heart function

Ask your doctor to help assess your personal risks.

Double Valve Replacement

A double valve replacement is a replacement of both the mitral and the aortic valve, or the entire left side of the heart. This type of surgery is not as common as the others and the mortality rate is slightly higher.

Pulmonary Valve Replacement

The pulmonary valve separates the pulmonary artery, which carries blood to the lungs for oxidation, and the right ventricle, which is one of the heart’s chambers. Its job is to allow blood to flow from the heart to the lungs through the pulmonary artery.

The need for pulmonary valve replacement is usually due to stenosis, which restricts blood flow. Stenosis may be caused by a congenital defect, infection, or carcinoid syndrome.

The Procedure

Heart valve replacement surgery is performed under general anaesthesia with techniques that are either conventional or minimally invasive. Conventional surgery requires a large incision from your neck to your navel. If you have less invasive surgery, the length of your incision can be shorter, and you can also reduce your risk of infection.

For a surgeon to successfully remove the diseased valve and replace it with a new one, your heart must be still.

You’ll be placed on a bypass machine that keeps blood circulating through your body and your lungs functioning during surgery. Your surgeon will make incisions into your aorta, through which the valves will be removed and replaced. There’s almost a 2 percent risk of death associated with valve replacement surgery.

Recovery

The majority of heart valve replacement recipients remain in the hospital for approximately five to seven days. If your surgery was minimally invasive, you might be able to go home earlier.

Medical staff will offer pain medication as needed and continuously monitor your blood pressure, breathing, and heart function during the first few days after a heart valve replacement.

Full recovery may take a few weeks or up to several months, depending on your rate of healing and the type of surgery that was performed. Infection is the primary risk directly after surgery, so keeping your incisions sterile is of utmost importance.

Always contact your physician right away if you have symptoms that indicate infection, such as:

• fever
• chills
• tenderness or swelling at the incision site
• increased drainage from the incision site

Follow-up appointments are important and will help your doctor determine when you’re ready to resume your everyday activities.
Make sure you have a support system in place for the time following your surgery. Ask family members and friends to help you out around the house and drive you to medical appointments as you recover.