Valve Replacement Surgery

Healthline

Medically reviewed by Steve Kim, MD

Written by Erica Roth – Updated on July 2, 2020

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 functions.

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 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.

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

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.