Heart valve surgery

Definition

Heart valve surgery is used to repair or replace diseased heart valves.

Blood that flows between different chambers of your heart must flow through a heart valve. Blood that flows out of your heart into large arteries must flow through a heart valve.

These valves open up enough so that blood can flow through. They then close, keeping blood from flowing backward.

There are four valves in your heart:

• Aortic valve
• Mitral valve
• Tricuspid valve
• Pulmonary valve

Alternative Names

Valve replacement; Valve repair; Heart valve prosthesis; Mechanical valves, Prosthetic valves

Description

Before your surgery you will receive general anesthesia. You will be asleep and unable to feel pain.

In open surgery, the surgeon makes a large surgical cut in your breastbone to reach the heart and aorta. Most people are connected to a heart-lung bypass machine or bypass pump. Your heart is stopped while you are connected to this machine. This machine does the work of your heart while your heart is stopped.

Minimally invasive valve surgery is done through much smaller cuts than open surgery, or through a catheter inserted through the skin. Several different techniques are used:

• Laparoscopy or endoscopy
• Percutaneous surgery (through the skin)
• Robot-assisted surgery

If your surgeon can repair your valve, you may have:

• Ring annuloplasty -- The surgeon repairs the ring-like part around the valve by sewing a ring of plastic, cloth, or tissue around the valve.
• Valve repair -- The surgeon trims, shapes, or rebuilds one or more of the leaflets of the valve. The leaflets are flaps that open and close the valve. Valve repair is best for the mitral and tricuspid valves. The aortic valve is usually not repaired.

If your valve is too damaged, you will need a new valve. This is called valve replacement surgery. Your surgeon will remove your valve and put a new one in place. The main types of new valves are:

• Mechanical -- made of man-made materials, such as metal (stainless steel or titanium) or ceramic. These valves last the longest, but you will need to take blood-thinning medicine, such as warfarin (Coumadin) or aspirin, for the rest of your life.
• Biological -- made of human or animal tissue. These valves last 12 - 15 years, but you may not need to take blood thinners for life.
• In some cases, surgeons can use your own pulmonary valve to replace the damaged aortic valve. The pulmonary valve is then replaced with an artificial valve (this is called the Ross Procedure). This procedure is ideal for people who do not want to take blood thinners for the rest of their life.

For more detailed information, see:

• Aortic valve surgery - minimally invasive
• Aortic valve surgery - open
• Mitral valve surgery - minimally invasive
• Mitral valve surgery - open

Why the Procedure Is Performed

You may need surgery if your valve does not work properly.

• A valve that does not close all the way will allow blood to leak backwards. This is called regurgitation.
• A valve that does not open fully will limit forward blood flow. This is called stenosis.

You may need heart valve surgery for these reasons:

• Defects in your heart valve are causing major heart symptoms, such as chest pain (angina), shortness of breath, fainting spells (syncope), or heart failure.
• Tests show that the changes in your heart valve are beginning to seriously affect your heart function.
• Your doctor wants to replace or repair your heart valve at the same time as you are having open heart surgery for another reason.
• Your heart valve has been damaged by infection of the heart valve (endocarditis).
• You have received a new heart valve in the past, and it is not working well, or you have other problems such as blood clots, infection, or bleeding.

Some of the heart valve problems treated with surgery are:

• Aortic insufficiency
• Aortic stenosis
• Congenital heart valve disease
• Mitral regurgitation - acute
• Mitral regurgitation - chronic
• Mitral stenosis
• Mitral valve prolapse
• Pulmonary valve stenosis
• Tricuspid regurgitation
• Tricuspid valve stenosis

Risks

The risks for any anesthesia include:

• Problems breathing
• Reactions to medications

The risks for any surgery include:

• Bleeding
• Blood clots in the legs that may travel to the lungs
• Infection, including in the lungs, kidneys, bladder, chest, or heart valves

The risks for cardiac surgery include:

• Death
• Heart attack
• Irregular heartbeat (arrhythmia)
• Kidney failure
• Post-pericardiotomy syndrome -- low fever and chest pain that can last for up to 6 months
• Stroke
• Temporary confusion after surgery due to the heart-lung machine

It is very important to take steps to prevent valve infections. You may need to take antibiotics before dental work and other invasive procedures.

Before the Procedure

For more information, see:

• Aortic valve surgery - minimally invasive
• Aortic valve surgery - open
• Mitral valve surgery - minimally invasive
• Mitral valve surgery - open

After the Procedure

For more information, see:

• Aortic valve surgery - minimally invasive
• Aortic valve surgery - open
• Mitral valve surgery - minimally invasive
• Mitral valve surgery - open

The average hospital stay is 5 - 7 days. Complete recovery will take a few weeks to several months, depending on your health before surgery.

Outlook (Prognosis)

The success rate of heart valve surgery is high. The operation can relieve your symptoms and prolong your life.

Mechanical heart valves do not often fail. Artificial valves last an average of 8 - 20 years, depending on the type of valve. However, blood clots can develop on these valves. If a blood clot forms, you may have a stroke. Bleeding can occur, but this is rare.

There is always a risk of infection. Talk to your doctor before having any type of medical procedure.

The clicking of mechanical heart valves may be heard in the chest. This is normal.

References

Fullerton DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM Jr., Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 61.

Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 66.

Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr., Faxon DP, Freed MD, et al; 2006 Writing Committee Members; American College of Cardiology/American Heart Association Task Force. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patiens with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118:e523-e661.

Bernstein D. General principles of treatment of congenital heart disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 428.

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